Original Article

Posterior Fornix Syndrome: Comparison of original (2004) and modified (2015) post-PIVS anatomic and symptomatic resultsa personal journey


Pelviperineology 2015;34(3):85-91


Posterior Fornix Syndrome (PFS) surgery was first reported by Petros in 1993. Farnsworth 2001 and Goeschen 2004 confirmed the reliability of his strategy.


2009 we started a second prospective observational study with a modified infracoccygeal sling procedure (PIVS). The purpose of this second study was to find out, whether in comparison to the technique 1997 the cure rates for symptoms and/or prolapse recurrence improved.


198 patients with symptomatic pelvic organ prolapse (POP) in various grades underwent P-IVS operation between Jannuary 2009 and December 2012. In contrast to 2004 additionally the PIVS tape was fixed to the sacrospinous ligament on both sides. 66 patients with stress urinary incontinence obtained a concomitant suburethral transobturator sling (TOT), 96 patients an anterior transobturator 4-arm mesh (ATOM). These procedures were not performed in 2004. Furthermore, not only patients with previous hysterectomy as in 2004, but also with existing uterus are included in this study. All patients had follow-up for at least 1 year.


Compared with our data from 2004 there was no further improvement in functional or symptomatic cure rates such as frequency, nocturia, urgency with or without incontinence, pelvic pain, abnormal bladder emptying, stress incontinence, stool outlet obstruction and/or fecal incontinence. The success rate was still in the same high level. However, modified surgery lead to a statistical significant decrease of POP recurrence. At 1 year follow up 99% of patients presented a normal anatomy, whereas in 2004 only 90% were cured. Regarding the complication rate no significant difference was observed.


The results from 2015 demonstrate that total pelvic reconstruction with bilateral SSLF of P-IVS tape in combination with ATOM and TOT, if necessary, reduces the POP recurrence rate significantly, whereas the high cure rate of symptoms remains at the same level.

Keywords: Posterior fornix syndrome; POP; Pelvic pain; Urinary and faecal incontinence; LUTS; Uterosacral ligaments; Pelvic ligaments; Posterior IVS; Integral theory