ABSTRACT

Background:

Learned institutions do not consider symptoms of chronic pelvic pain (CPP) to be surgically curable. The Integral Theory hypothesizes that CPP where no obvious cause is evident, is mainly caused by loose suspensory ligaments; hence it is potentially curable surgically by repairing such ligaments. This type of CPP generally co-occurs with one or more symptoms of bladder and bowel dysfunctions which may occur with even minimal apical prolapse.

Objective:

To test this hypothesis by surgical repair of loose cardinal and uterosacral ligaments in patients who have 2nd degree or greater uterine or apical prolapse.

Material and methods:

This was a multicenter prospective case control audit comprising 614 women, mean age 70 years. Inclusion criteria: symptomatic apical prolapse (POPQ stages 2- 4), plus OAB symptom(s). Exclusion criteria: Comorbid medical problems. Surgery: minimally invasive cardinal/uterosacral ligament repair was performed using the TFS (Tissue Fixation System) minisling. Primary outcome was uterine prolapse cure. Secondary outcomes were bladder, bowel, pain, symptom improvement.

Results:

Prolapse cure was noted in 90% of 614 patients. Symptom incidence and % cure at 12 months (in brackets) were as follows: chronic pelvic pain: n= 197 (79%); urge incontinence: n= 320 (86%); frequency: n= 313 (84%); nocturia: n=257 (69%); fecal incontinence: n= 93 (65%). Statistics: x²-tests of McNemar to test for significance in symptom incidence-frequency from preoperative to postoperative phase.

Conclusions:

Chronic pelvic pain, bladder & bowel incontinence occur in predictable symptom groupings which are associated with apical prolapse. Application of the Integral Theory System has the potential to improve clinical practice, QoL for women and open new research directions.