ABSTRACT

Data is presented indicating that nocturia and other “posterior fornix” symptoms such as urgency, abnormal emptying and chronic pelvic pan can be cure/improved in up to 86% of patients using 4 different surgical operations, all of which suspend the vaginal apex: uterosacral ligament plication, infracoccygeal sacropexy sling, posterior TFS (Tissue Fixation System) sling and abdominal sacrocolpopexy. Besides nocturia, other symptoms such as urgency and chronic pelvic pain were also improved by all methods. An anatomical hypothesis for cure of nocturia is presented: a vaginal apex competently supported by the posterior ligaments of vagina prevents activation of the bladder base stretch receptors. A simple test for this hypothesis is to insert a large tampon into the apex overnight to support it; many patients report relief of their nocturia.