A NEW THEORY OF ANO-RECTAL FUNCTION
This issue of Pelviperineology has been dedicated entirely to a substantive work by Petros, Swash and their collaborators, which explains anorectal function based on a musculo-elastic theory. The concepts are developed from the Integral Theory of Petros and Ulmsten which provides an anatomic explanation for a number of functional disorders of the lower urinary tract in women. Petros has been a colourful and controversial figure since he challenged the basis of our knowledge regarding the bladder and launched the “Tension Free Sling” when he and Ulmsten presented the “intravaginal slingplasty” in 1990.
The suburethral sling in various forms has become the so called “gold standard” for treatment of urinary stress incontinence. Many surgeons are unaware of the scientific basis of the procedure that they perform and others are aware but do not subscribe to the theory. One of the consequences of the publication of the Integral Theory has been the resurgence of interest in the anatomy and physiology of pelvic function with new societies and journals appearing.
This has led to increasing awareness by doctors of the shared nature of the anatomy and physiology between the three compartments of the pelvis and renewed interest on the part of urologists, gynaecologists and colorectal surgeons in developing better interventions to address these problems. Whilst colorectal surgeons have long used their own techniques in the treatment of ano-rectal prolapse and faecal incontinence, the emergence of new vaginal surgery procedures has led to new opportunities for collaboration.
We anticipate that this work will create a new controversy and we are pleased to present it in this journal. We know that it will generate an interesting discussion but only time will tell whether these papers will become as influential and groundbreaking as the Integral Theory of urinary incontinence. A number of experts have been asked to comment on this work and the first of their responses is published in this issue. Readers are also invited to submit correspondence concerning this matter for publication in future editions of the journal.
This issue of the journal has been published in time to distribute to attendees at the Pelvic Surgery Congress held in Padua and Venice between September 30th and October 4th. In the next few months we hope to announce increased collaboration with other pelvic societies and an expansion of the Editorial Advisory Board. Pelviperineology will continue to strive to develop a multidisciplinary culture in pelvic floor medicine. We can all learn from each other and we have to try to replace opinion with science as we go forward together.