Surgical Reconstruction of Pelvic Floor Descent: Anatomic and Functional Aspects

Abstract

Introduction: The human pelvic floor is a complex structure and pelvic floor dysfunction is seen frequently in females. Materials and Methods: This review focuses on the surgical reconstruction of the pelvic floor employing recent findings on functional anatomy. A selective literature research was performed by the authors. Results: Pelvic floor activity is regulated by 3 main muscular forces that are responsible for vaginal tension and suspension of the pelvic floor organs, bladder and rectum. A variety of symptoms can derive from pelvic floor dysfunctions, such as urinary urge and stress incontinence, abnormal bladder emptying, fecal incontinence, obstructive bowel disease syndrome and pelvic pain. These symptoms mainly derive, for different reasons, from laxity in the vagina or its supporting ligaments as a result of altered connective tissue. Pelvic floor reconstruction is nowadays driven by the concept that in case of pelvic floor symptoms, restoration of the anatomy will translate into restoration of the physiology and ultimately improve patients’ symptoms. Conclusion: The surgical reconstruction of the anatomy is almost exclusively focused on the restoration of the lax pelvic floor ligaments. Exact preoperative identification of the anatomical lesions is necessary to allow for exact anatomical reconstruction with respect to the muscular forces of the pelvic floor.

Sexual Impairment in Women Undergoing Laparoscopic Surgery for Genital Prolapse: A Hospital-Based Cohort Study

“…Sixty-seven percent of patients suffer from concomitant cystocele, rectocele or both [9]. Most patients report vaginal pressure, pain or even an external bulge caused by prolapsed vaginal and uterine regions [10]. Individuals with genital prolapse commonly report that their sexual life is impaired, but do not define it as a primary symptom of their disease.…”

Predictive factors for postoperative constipation and continence after stapled transanal rectal resection

“…Univariable analysis of predictive factors for postoperative continence revealed significant correlations between postoperative incontinence score and various preoperative parameters, including sphincter pressures, pelvic floor descent, rectal diameter and organ prolapse. Some of these are known to be associated with faecal incontinence in general15, 16.…”

The Role of Altered Connective Tissue in the Causation of Pelvic Floor Symptoms

“…The use of alloplastic materials has to be reduced to the necessary amount and their application sites carefully considered. The conventional techniques have to be evaluated following these fundamental principles (Liedl 2010, Wagenlehner et al 2010 In order to minimize pain, surgery to the perineal skin and tension when suturing the vagina should be avoided. Vaginal excision should be avoided even in patients with large bulging prolapse.…”