Editorial Editorial

Cover pelviperineologyThe editors and staff of Pelviperineology would like to wish all our readers around the world a happy New Year and holiday season. Our readers are located in every part of the globe and include all ethnic and religious groups. Please accept our best wishes for whatever festival or celebration is appropriate. We are hoping that 2009 will be another successful year for our journal and associated societies. [More]

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Retrospective Review The TVT-O Procedure with the cough test in theatre: Preliminary retrospective case series study in the first 25 women by N. Gad - S. Thomas - A. Nagy

TVT-O Procedure with the cough test Stress urinary incontinence (SUI) is a common problem in women. An epidemiological study has showed that 30% of women aged 50 years old have urinary incontinence and that of these up to 70% have complaints of SUI. The tension-free vaginal tape procedure (TVT) has revolutionized the treatment of female stress urinary incontinence (SUI). Five years later Delmore described an outside-in transobturator approach for the surgical placement of suburethral tapes. This new approach aims to avoid the potential complications associated with the retropubic approach such as injury to bowel, or major blood vessels and reduce the risk of injury to bladder or urethra. [More]

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Review Modern surgical management of hemorrhoids by Charles F.M. Evans - Syed A. Hyder - Simon B. Middleton

Modern surgical management of haemorrhoidsHemorrhoidal tissue is a normal component of the anal canal and is composed predominantly of vascular tissue, supported by smooth muscle and connective tissue. It's function is to provide complete closure to the anus at rest and protection of the underlying muscle during defaecation. Hemorrhoidal disease is one of the most common anorectal conditions although the exact incidence is difficult to determine because many people are reluctant to seek medical advice due to various personal, cultural and socioeconomic reasons. Estimates of the proportion of the UK population affected range from 4.4% to 24.5% whilst more than 15 million people are believed to be affected annually within the United States. [More]

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Original Article Neurophysiological modification of pelvic floor parameters during sacral nerve neuromodulation by E. Andretta et al.

Neurophysiological modification of pelvic floor parameters during sacral nerve neuromodulationSacral neuromodulation (SNM) works on the neural reflexes that influence the bladder, rectum and pelvic floor. Since the initial experience of the nineteen eighties SNM has been widely used to treat both bladder and rectal dysfunction but the exact mechanism of action is still unknown. The aim of this study was to investigate the functional modifications of peripheral perineal innervation using SNM. The study involved 27 patients (3 males, 24 females) affected by urinary incontinence (44%), urinary retention (30%), obstructed defecation (18%), fecal incontinence (4%), and chronic pelvic pain (4%). [More]

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Original Article Comparison of accuracy of functional measurements of the urethra in transperineal vs. endovaginal ultrasound in incontinent women by A. Stankiewicz Et Al.

Comparison of accuracy of functional measurements of the urethraFemale urinary incontinence (UI) and pelvic organ prolapse (POP) are conditions with severe economic and psychosocial impact affecting millions of women. It is estimated that almost 30% of women older than 35 years suffer from POP and/or UI. The etiology of PFD is multifactorial and includes surgical interventions, number and type of deliveries, hormones' profile, aging, obesity. The diagnosis of these conditions is based on physical examination and imaging, mostly on ultrasound examination. Transperineal ultrasound (TPUS) and endovaginal ultrasound (EVUS), which are widely used, give only general information on anatomy, anatomical relationships and mobility of pelvic floor structures, but are insufficient to give a highly detailed assessment. Recently introduced high resolution three-dimensional (3D) EVUS seems to be a very promising modality to improve the imaging of female pelvic floor dysfunctions. [More]

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Commentary Invited comment: A new theory of anorectal function by D. Chatoor and A. Emmanuel

Invited comment: A new theory of anorectal functionThanks for asking us to comment on this manuscript by Petros and Swash, on various studies and case reports focusing on the central hypothesis that augmenting ligamentous support improves muscular loading which leads to improved muscular contractility. The studies on the continence mechanism also hypothesize that directional forces of muscular and ligamentous opposition are important.Many studies have an running theme of a mid urethral sling procedure for urinary incontinence producing “cure” of concomitant “idiopathic” faecal incontinence. While we don’t dispute the observational findings, these studies provide little objective evidence to support the hypotheses of the aetiological role of ligament and muscle loading abnormalities. [More]

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Original ArticleTransanal doppler-guided hemorrhoidal artery ligation / recto anal repair (HAL-RARŪ) for treatment of Grade 3-4 hemorrhoids: a new mini-invasive technology by E. A. Zagryadskiy - S. I. Gorelov

Transanal doppler-guided hemorrhoidal artery ligationThere are several well-established procedures such as Milligan-Morgan, Parks, and Ferguson, which are considered the gold standard in treating Grade III-IV hemorrhoidal disease. Surgical hemorrhoidectomy is a notoriously painful procedure, and much research over the last two decades has concentrated on reducing posthemorrhoidectomy pain resulting from these surgical incisions. This effort has resulted in outpatient treatments such as sclero-therapy, rubber band ligation, Ultroid and Bipolar diathermy coagulation, and infrared photocoagulation. This process accelerated the need for "minimally invasive" treatment methods also for the higher Grade III-IV patients.  [More]

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PelviperineologyBasic anatomic features in perineologyby T. Mouchel - F. Mouchel

Abdominal pressure increase during anorectal closure is secondary to striated pelvic muscle contractionPerineology is based on the diagnosis and treatment of "specific defects" so it is important to define these "defects" and for this purpose a good knowledge of anatomy is necessary. Although the anatomy of this area may seem well described in textbooks, some key features are usually underestimated or even forgotten. In order to improve the understanding of this complicated anatomy, we present a simplified three-dimensional model that describes the most important features of the functional anatomy together with some demonstrative figures. [More]

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Pelvic Floor Digest December 2008 Issue Pelvic Floor Digest read_pdf [243 kb]

pelvic floor digestThis section presents a small sample of the Pelvic Floor Digest (December 2008), an online publication (www.pelvicfloordigest.org) that reproduces titles and abstracts from over 200 journals. The goal is to increase interest in all the compartments of the pelvic floor and to develop an interdisciplinary culture in the reader. [PDF]