ABSTRACT

Purpose:

The treatment of pelvic organ prolapse, chronic pelvic pain, bladder and bowel dysfunction is largely single-symptom specific and frequently treated by a singular discipline; urology, gynaecology or coloproctology. The presence of occult symptoms in colorectal pelvic floor patients has previously been demonstrated by the Pescatori ‘iceberg’ concept: other symptoms are latent and often ignored.

Methods:

One hundred and ninety-eight patients, mean age 69 years (48-72), presenting with chronic pelvic pain (CPP) were evaluated using the validated Integral Theory System Questionnaire (ITSQ), which diagnosed pubourethral, uterosacral and cardinal ligament laxity as the principal causes of the apical prolapse, CPP, bladder and bowel symptoms. These were reinforced with transobturator and infracoccygeal sacropexy tapes.

Results:

CPP and apical prolapse were present in 198 patients; apical prolapse Grade 1 (n=15), Grade 2 (n=39), Grade 3 (n=107) and Grade 4 (n=37). Anatomic cure rate for apical prolapse was 99% (p<0.001). Symptom prevalence (% cure at 12 months in brackets): pelvic pain 198 (74%, p<0.001); urinary frequency: 127 (80%, p<0.001); bladder emptying difficulties: 68 (54%, p<0.001); urinary stress incontinence: 66 (95%, p<0.001); nocturia: 63 (79%, p<0.001); obstructive defecation: 59 (80%, p<0.001); urge incontinence: 55 (80%, p<0.001); residual urine >50ml: 44 (55%, p<0.001). Two (1%) of 198 patients with grade 3 prolapse developed a high grade 2 cystocele, which was subsequently repaired. No tape erosions were observed at 12 months.

Conclusions:

Identification and cure of ‘latent’ symptoms affirmed the validity of Pescatori’s ‘Iceberg’ concept and the theory, on which the surgery is based.