Editorial Editorial: Pelvic Floor Imaging by G.A. Santoro and P. Wieczoreck

Cover pelviperineologyRecent milestones in surgical techniques and the development of new operative materials and implants for use in coloproctology and urogynaecology, together with advances in molecular diagnostics and laboratory testing have revolutionized the management of patients with pelvic floor disorders. The assessment of urogynaecological and coloproctological operations, the surgical techniques themselves and the outcomes of these treatments are areas of great interest in the literature. [More]

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Original ArticleHistotopographic study of the pubovaginalis muscle by Veronica Macchi et al.

pubovaginalis muscle The levator ani muscle is considered the most important supportive system of the pelvic floor and has been divided into many portions, according to their attachments or physiological functions. Standring et alsubdivide the levator ani muscle into the ischiococcygeus, iliococcygeus and pubococcygeus portions. The pubococcygeus muscle is often subdivided into separate parts according to the pelvic viscera to which they relate, i.e. pubourethralis and puborectalis in the male, pubovaginalis (PVM) and puborectalis in the female. At the level of the vagina and the rectum, the muscle bundles of the pubococcygeus muscle are continuous with those controlateral, forming a sling (pubovaginalis and puborectalis). [More]

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Original Article Posterior intravaginal slingplasty Feasibility and preliminary results by Peter Von Theobald - Emmanuel Labbé

Erosion Rate TableAdequate treatment of genital prolapse requires a defect specific approach. Repair of upper compartment prolapse (vaginal vault, hysterocoele, enterocoele) can involve abdominal or laparoscopic techniques such as sacrocolpopexy the Kapandji type operation, combined abdominal/vaginal techniques or techniques using the vaginal route, such as spinofixation or MacCall type culdoplasty. Peter Petros described a new technique using a sling of polypropylene mesh for suspension of upper compartment organs which have prolapsed, called “Posterior Intra Vaginal Slingplasty” (PIVS), and for which a more detailed name would be “infracoccygeal translevatorial colpopexy”. [More]

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Original ArticleMaterial and type of suturing of perineal muscles used in episiotomy repair in Europe by Vladimir Kalis et al.

sutures sizes tableEpisiotomy, the incision of the perineum during the last part of the second stage of labour or delivery is still considered a controversial procedure. Long-term complications after episiotomy repair are common. A large proportion of women suffer short-term perineal pain and up to 20% have longer-term problems (e.g. dyspareunia). Other complications involve the removal of suture material, extensive dehiscence and the need for resuturing. According to an Italian study, episiotomy is associated with significantly lower values in pelvic floor functional tests, both in digital tests and in vaginal manometry, in comparison with women with intact perineum and first- and second-degree spontaneous perineal lacerations.3 In another prospective trial of 87 patients, the pelvic floor muscle strength, assessed with the aid of vaginal cones, was significantly weaker in the episiotomy subgroup compared to a subgroup with spontaneous laceration. [More]

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Original Article A preliminary report on the use of a partially absorbable mesh in pelvic reconstructive surgery by Achim Niesel et al.

sigmoidoceleConventional procedures for reconstructive vaginal surgery are burdened with recurrence rates of up to 30%. Many of these operations can result in a poor anatomical result and loss of the physiological vaginal axis. This may lead to secondary pelvic defects and functional pelvic problems. Since the introduction of mesh in pelvic organ prolapse (POP) surgery good anatomical restoration appears to be associated with lower recurrence rates and good functional outcome. Polypropylene tapes have proven to have good biocompatibility in vaginal tissues, but there are complications such as mesh erosion and extrusion. [More]

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Case Report A simple technique for intravesical tape removal by Stavros Charalambous et al.

PIVS63-year-old woman presented with recurrent urinary tract infections and dysuria, six months following a TVT procedure performed elsewhere. A physical examination revealed no abnormalities. A cystoscopy was performed and an intravesical mesh was identified entering just behind the right ureteral orifice and exiting from the right side of the bladder dome. The patient was then prepared for mesh removal. A 26 Fr resectoscope was introduced into the bladder and subsequently reached the tape. The mesh was resected in the same way as a deep resection of a bladder tumor, with the loop in constant contact with the bladder wall. [More]

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Case Report Unusual vulvar cystic mass - suspected metastasis by Charlotte Ngo - Richard Villet

vulvar cystic massThis 73 year old caucasian woman with a previous history of breast and colon adenocarcinomas was complaining about a growing vulvar mass, with hypoaesthesia of the glans clitoridis. Examination found a tender vulvar mass located deeply in the anterior part of the left labium majora, above the urethral meatus, close to the clitoris and pubic symphysis.There was no local inflammation. MRI showed a 3cm independent cystic mass with a thick wall between the pubic symphysis and the urethra. Surgical excision was done with a longitudinal incision between the hymen and the labium minor. [More]

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Original ArticleThe T.A.P.E. (Three Axes Perineal Evaluation) freeware: a good tool to introduce you to Perineology by Jacques Beco

TAPE freewareIn the past each specialist of the perineum, the gynecologist, the urologist and the colo-proctologist, has to deal with two main symptoms: one which reflects a failure to maintain the door closed (incontinence) and one which is linked to a difficulty to open the way (obstruction). In this old approach the only problem of the specialist is to treat “his incontinence” without creating “his obstruction” and reverse. For example, the urologist working only on “his axis” has to treat urinary incontinence without creating dysuria or to treat dysuria without inducing urinary incontinence.  [More]

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Pelvic Floor Digest March Issue Pelvic Floor Digest read_pdf [535 kb]

pelvic floor digestThis section presents a small sample of the Pelvic Floor Digest (March 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]

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