Editorial Editorial: Future Directions

Cover pelviperineologyThis edition of Pelviperineology is the final edition of Volume 26 and is the last issue of our first year in English. We have seen a steady growth in interest in the journal with 4 international societies currently negotiating to collaborate with Pelviperineology and produce the journal in their region. Pelviperineology is printed in the same format around the world and in some countries is accompanied by a local language edition or a newsletter. [More]

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Original ArticleThe clinical role of the gracilis muscle: an example of multidisciplinary collaboration by Enrico Vigato et al.

gracilis muscle Gracilis muscle is widely used in reconstructive surgery, either as a pedicled flap or as a free microsurgical flap. Both pedicled and free flaps can be muscular or musculocutaneos (the so- called “composite flaps”). As a pedicled flap, gracilis muscle can be used in perineal and vaginal reconstruction, after oncological surgery, in the treatment of recurrent anovaginal and rectovaginal fistulas as well in the coverage of the neurovascular bundle after vascular surgery. [More]

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Case Report Neurilemoma (Schwannoma) of the ischiorectal fossa: a case report and a brief review of the relevant pathology by Johann Coetzee - Amanda De Beer

neurilemoma - schwannomaA case of a primary neurilemoma of the ischiorectal space is described. The ischiorectal fossa is a pelvic anatomic space, which until recently received scanty attention in medical training programmes. With the advent of new surgical techniques in reconstructive pelvic surgery, for example both the trans-obturator route for sub-urethral slings and the passage of trocars for the posterior placement of mesh supports in posterior prolapse, knowledge of the anatomy and pathology of this space has assumed more importance. [More]

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Original ArticlePreliminary retrospective case series study of the outcome of Prolift™ technique in thirty women with pelvic organ prolapse including its effect on stress urinary incontinence by Nader Gad, Maaike Moller

prolift techiniquePelvic organ prolapse (POP) and associated stress urinary incontinence (SUI) is a major health care problem. It is estimated that 50% of parous women lose pelvic support and an American woman has a 11.1% lifetime risk of undergoing an operation for pelvic floor support. An ageing population is likely to increase the prevelance of POP and DeLancey describes this anticipated increasing health burden as a “hidden epidemic”. [More]

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Review Role of enterocele in obstructed defecation syndrome: proposal of a new radiological and surgical classification by Claudio Morandi - Beatrice Breveglieri - Claudio Moratti - Luca Verganti - Pietro Torricelli

sigmoidoceleObstructed defecation syndrome (ODS) is clinically defined as a prolonged (more than 6 months) history of difficult rectal evacuation, including excessive straining, feeling of incomplete evacuation or inability to evacuate without digitation. It is usually related to a functional disorder and it occurs most exclusively in females. Many authors have reported an incidence of enterocele from 19% to 35% in patients with Obstructed defecation syndrome. However, the role of enterocele (defined as prolapse of the small bowel into the rectogenital space) in this syndrome is still controversial. [More]

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Retrospective Review The impact of birth history on pelvic floor function: a retrospective assessment of 10,125 patients by Vito Leanza, Stefano Dati, Giovanni Pisapia Cioffi, Manuela Accardi

PIVSThe pelvic floor is a network of muscles, ligaments and tissues that act like a hammock to support the organs of the pelvis: uterus, bladder, and rectum. If the muscles become weak or the ligaments or tissues are stretched or damaged, the pelvic organs may fall down and protrude into the wall of the vagina. The result is prolapse, urinary incontinence and reduced sexual response. It is well known that pelvic floor disorders usually result from a combination of factors. Pregnancy and vaginal delivery (VD) may weaken or stretch some of the supporting structures. Pelvic floor disorders are common among women who have had several vaginal deliveries, and the risk may increase with each delivery. [More]

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Original ArticleSurgical complications in coloproctology: a scoring system by Fabio Gay - Pietro Crispino

surgical complications scoreSymptomatic anorectal diseases frequently present to surgical outpatient departments and many patients with these symptoms undergo surgical treatments. Recent studies have demonstrated that a better understanding of the pathophysiology of anorectal diseases and use of some recently introduced diagnostic tools can lead to better choice of surgery for specific cases. In clinical practice the choice of a specific surgical technique is based on the pre-operative assessment. [More]

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Case ReportPrepubic sling in curing non-stress leakage following complete cure of stress incontinence by a midurethral sling by Peter Petros - Peter Richardson

prepubic slingA 46 year old woman with Von Willebrand’s disease gave a history of urodynamically diagnosed severe stress incontinence (SI) cured initially with a tension-free (monofilament) retropubic midurethral sling in August 2002. The patient was completely cured for almost 2 years. She presented in late 2005 with a history of gradually worsening SI, continuous leaking, no urgency, and no evidence of overactive bladder (OAB) on urodynamic testing. On transperineal ultrasound, it was evident that the mesh tape was pulling open the posterior urethral wall on straining. [More]

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Original ArticleThe effect of suture material on outcomes of surgery for pelvic organ prolapse by Howard B. Goldstein - Babak Vakili - Nicholas Franco - Karolynn T. Echols - Ralph R. Chesson

suture materialsSurgery for pelvic organ prolapse (POP) is very common with 11% of women requiring surgery at least once in their life. With dozens of different procedures being performed and more being developed all the time, attempts are being made to find the most durable procedure. Unfortunately fail- ure rates can be as high as 63% after surgery for prolapse. While most studies investigating surgical outcomes have focused on studying the actual procedures, there is very little information assessing technique. [More]

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Original ArticlePruritus ani: etiologic and causative factors in 94 adult patients by Cleto Veller Fornasa - Alessandra Trento - Gianni Bezze

pruritus aniA chronic itch around the anal area is called pruritus ani. It can be due to a localised dermatitis (caused by faeces, sweat, or moisture), viral, bacterial and fungal infection, metabolic or systemic diseases (lymphoma, iron deficiency anaemia, hyperthyroidism, diabetes, etc.), skin conditions (psoriasis, contact dermatitis, atopic dermatitis, or lichen planus), anal fissure, haemorrhoids, threadworms, irritants (soaps, perfumes, or creams), some foods (grapes, or tomatoes), some drugs (laxatives, anaesthetic agents, antibiotics), or a carcinoma of the anus.  [More]

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Letter to EditorSTARR Procedure for the treatment of outlet obstruction syndrome by Mario Pescatori

starr procedureDear Editor, I read with interest the paper by Reboa et al. reporting good results after STARR procedure in a group of constipated patients. Less satisfactory results were achieved using the stapled transanal mucosectomy, first described by Pescatori, Favetta, Dedola and Orsini in Techniques in Coloproctology in 1997 for the treatment of rectal internal mucosal prolapse (and not, as stated by the authors, by Longo, who instead reported it for the cure of hemorrhoids one year later).  [More]

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Letter to EditorAhmed Shafik (1933-2007) by Luca Amadio

ShafikDear Sir, I was never able to meet Prof. Ahmed Shafik in person. In comparison to others expressing their feelings following his death I cannot say that I have worked with him, nor was I one of his students. My link with Professor Shafik is through his scientific papers. My first contact took place as a resident in Surgery when I studied his paper on the pathogenesis of anal abscess and fistula. The original and more complex Shafik theory of anorectal sinus was in contrast to the cryptic glandular and the perineal infection theories of Eisenhammer and Goligher. The originality of his theory was the distinguishing mark of a sharp, unique and sometimes unconventional mind. The contribution of Professor Shafik to pelvic floor medicine was immense. Over 500 peer reviewed articles are listed in Pub Med..  [More]

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EditorialPERINEOLOGY… THE STORY BEHIND THE CONCEPT by Jacques Beco - Jack Mouchel

perineologyThe development during the early eighties of the procedure we later called the Mini-Vaginal-Tape (MVT) was the frst step on the road to the concept of Perineology. Development of vaginal surgery for hysterectomy and genital prolapse during the late seventies and the early eighties led inevitably to the need for an efficient vaginal procedure for the cure of the stress urinary incontinence which proved to be frequent in this kind of patients .Apart from the Marion-Kelly technique, no vaginal procedure was at that time regarded as effcacious enough and the “Gold Standard” for the cure of this urinary dysfunction was then (and remained until the late nineties) the Goebbel-Stoeckel and Burch procedures. [More]

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Pelvic Floor Digest December Issue Pelvic Floor Digest read_pdf [362 kb]

pelvic floor digestThis section presents a small sample of the Pelvic Floor Digest (December 2007), 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]

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