VIDEO ABSTRACT provides an anatomical summary of the PPP operation. A technique for the pubourethral plication procedure (PPP) with No3 polyester sutures for cure of stress urinary incontinence without tapes via parallel sulcal incisions extending from bladder neck to urethral meatus. Both branches of each pubourethral ligament were sutured with No2 or 3 polyester sutures extending to the external urethral ligaments and medial part of pubococcygeus; the vaginal incisions closed with polyglactin sutures. All women were discharged of day of surgery. Six month results Age :58.6 years;31/36 women (86%)were cured of SUI and 11/19 (58%) concomitant urge. 5 surgical failures, 4 immediately post-operatively, and one at 3 months.
Our minimally invasive Fothergill-Manchester technique aims to decrease blood loss and surgical trauma and to preserve function by1. Vaginal conservation. 2. Cardinal (CL) and uterosacral (USL) ligaments plicated, not severed. 3. Direct suture of vagina to cervix without Sturmdorf sutures after cervical amputation. 4. Use of No2 polyester sutures to create new collagen to reinforce the plicated ligaments.
Professor PEP Petros DSc DS (UWA) PhD (Uppsala) MB BS MD (Syd) FRCOG (Lond)31/93 Elizabeth Bay Rd, Elizabeth Bay NSW 2011 AUSTRALIAReconstructive Pelvic Floor Surgeon and Certified Urogynaecologist (retired)Formerly University of NSW Professorial Dept of Surgery, St Vincent’s Hospital Sydney (retired)Adjunct Professor, University of Western Australia School of Mechanical and Chemical Engineering, Perth WA (current)Tel 61 2 9361 3853 Cellphone (AUST) 61 411 181 731Email [email protected] website www.integraltheory.org
Objective: Provoked vulvodynia (PV) is the main cause of vulvar pain and dyspareunia. Although its cause is unknown, it is associated with musculoskeletal dysfunction. The inability of lax uterosacral ligaments (USLs) to support the adjoining T11/L2 and S2-4 nerve plexuses is considered to cause PV. We aimed to determine whether mechanically supporting the USLs would reduce PV. Design: Single-blind, randomized, sham, control, prospective, pilot trial Setting: The Department of Obstetrics and Gynecology, Galilee Medical Center, Israel Population or Sample: Seventeen women Methods: PV patients were randomly assigned to two groups. Subjects in each group were exposed to sham manipulation (inserting a wide swab in the vagina without applying pressure) and trial manipulation (supporting the posterior fornix with a wide swab sufficiently broad to mechanically support the USLs). The manipulation order was alternated. Main Outcome Measures: Using a pain intensity scale, the PV-associated pain level experienced by participants was recorded during each manipulation and the results were compared with baseline levels. Results: The pain level significantly reduced with USL support compared with the baseline value and sham manipulation pain level (P = .003). Pain during sham manipulation was not significantly different from that recorded at baseline. The average reduction in pain with USL support was 18.4% ± 2.2%. The manipulation order did not impact changes in pain level during trial manipulation (P = .512). Conclusions: PV is related to pain originating in the USL and musculoskeletal dysfunction.