Full Issue June 2010 Complete Issue read_pdf [2.8 Mb]

June 2010 Complete Issue
The Complete Pelviperineology June 2010 Issue in PDF format
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Editorialby Bernhard Liedl

Cover pelviperineologyAlmost all modern urogynecological surgery has been inspired by 2 major scientific discoveries. In the 1990s, an entirely new theory, the “Integral Theory”, by Petros (Australia) and Ulmsten (Sweden), proposed that bowel and bladder problems originate mainly from damaged vaginal ligaments, not from the bladder or bowel itself. The second discovery by Petros and Papadimitriou, was a method for repairing these ligaments by creation of artificial ligaments. This had the effect of converting major operations with large incisions to relatively minor procedures performed through “keyhole incisions”. Application of these twin discoveries has revolutionized the treatment of stress incontinence, with more than 1,500,000 operations performed world-wide to date. [More]

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Integral Theory The integral theory system. A simplified clinical approach with illustrative case historiesby Peter E. Papa Petros

Birth related laxityThe Integral Theory states that prolapse and most pelvic floor symptoms such as urinary stress, urge, abnormal bowel and bladder emptying, and some forms of pelvic pain, mainly arise, for different reasons, from laxity in the vagina or its supporting ligaments, a result of altered connective tissue. Birth related laxity compounded by ageing, are the principal causes of ligament laxity. The Integral Theory has evolved into the Integral Theory System. [More]

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Original Article TFS posterior sling improves overactive bladder, pelvic pain and abnormal emptying, even with minor prolapse. A prospective urodynamic studyby Peter Petros, Peter A. Richardson

Pelvic Floor In the 1993 publication of the Integral Theory of Female Urinary Incontinence, the “posterior fornix syndrome” was described. It comprised symptoms of frequency, urgency, nocturia, pelvic pain, and abnormal bladder emptying. Causation of this grouping of symptoms was attributed to laxity in the uterosacral ligaments (USL). According to this Theory, the anatomical rationale for symptom causation was that lax posterior ligaments prevented the posterior muscle forces from stretching the vaginal membrane to support the bladder base stretch receptors, “trampoline analogy”. [More]

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Original Article A prospective randomized controlled trial of the transobturator tape and tissue fixation system minisling in 80 patient with stress urinary incontinence - 3 year resultsby A. Akin Sivaslioglu, Eylem Unlubilgin, Serpil Aydogmus, E mine Celen, Ismail Dolen

polypropylene anchorIn 1990 Petros & Ulmsten described a prototype intravaginal slingplasty operation, later known as the “TVT”, which was based on their “Integral Theory”. A Mersilene tape was inserted below the midurethra, exiting unattached through the lower abdominal muscles. Post-operative xrays demonstrated no change in the position of bladder neck in patients cured of their SI, thereby invalidating the pressure transmission theory. This method was revolutionary in that it was a minimally invasive day-care operation, with minimal pain and no significant post- operative urinary retention. [More]

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Original ArticleInterstitial cystis (painful bladder syndrome) may, in some cases, be a referred pain from the uterosacral ligamentsby Peter Petros

Posterior Fornix SyndromeIn 1993, as part of the second exposition of the Integral Theory, the “Posterior Fornix Syndrome” was described, an apparently unrelated group of symptoms, comprising urgency, nocturia, abnormal emptying, frequency, low abdominal pain and deep dyspareunia, arising from laxity in the uterosacral ligaments. A high cure rate was obtained in a group of patients with these symptoms by surgically tightening the uterosacral ligaments. These data were subsequently confirmed by use of a posterior polypropylene sling to reinforce the uterosacral ligaments. [More]

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Case ReportCure of haemorroids following a TFS posterior sling and TFS perineal body repair - a case reportby Giancarlo Paradisi, Peter Petros

Mrs FA, aged 43 years, para3, BMI 22, presented with a feeling of heaviness, a uterus extruding from the vagina, and a history of haemorrhoids and bleeding for several years. She had regular periods with slight menstrual loss, normal ovaries, uterus and endometrium on ultrasound examination. There was no history or symptom of urinary dysfunction. Urodynamic testing indicated normal cystometry, normal urine flow, normal cough stress test at 400 ml, and a maximal urethral closure pressure of 156cm H2O. On clinical examination, prolapse according to the Baden Walker Score was Cystocele II°, Urethrocele II-III° with urethral hypermobility, Hysterocele III°, Rectocele I° with a thin bulging. POPQ Score (ICS) was : 3Aa, 3C, 1Bp. [More]

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