gineco
ro
the forces that pull the vagina ahead
(the pubococcigeal muscle), backwards
(elevator ani muscles) and down
(longitudinal ani muscle). The movement
of the bladder neck at the same time
with the vagina is due to normal bounds
between the basis of the bladder and
of the vagina, and also between the
inferior third of the urethra and of the
G. Bumbu
1
, D. Riva
2
, A. Hofstetter
3
, C. Bumbu
4
, M. Berechet
5
vagina. Papa Petros’ has managed to
categorize vaginal defects anatomically
and to establish an operator algorithm.
Symptoms like increased frequency and
urgency may appear in all of the three
compartments, while stress urinary
incontinence is specific to the anterior
compartment (the alteration of the
pubourethral ligaments), and symptoms
like nocturia, pelvic pain, sacral pain, are
characteristic to the posterior vaginal
compartment.
The current surgical treatment of those
Figure 2. Lateral cystocel
patients with stress urinary incontinence
is based on two models: the intrapelvic
position of the bladder neck and of
the proximal urethra, and the urethral
hammock theory. According to the first
theory, the increase of intraabdominal
pressure will lead to an equal repartition
of this pressure at the bladder and
urethra level and thus, the female patient
will be continent. Lose of the intrapelvic
position of the bladder neck due to the
vaginal prolapse (vaginal laxity) will
lead to overcome of the intraurethral
pressure, clinically represented by stress
urinary incontinence. Bringing the neck
of the bladder to its original intrapelvic
position (Burch colposuspension) would
solve the stress urinary incontinence.
The urethral hammock theory
is referring to the alteration of the
intimate contact between the vagina
and urethra (the birth is considered to
be a risk factor), the urethra is losing
its sustaining during the increase of the
intraabdominal pressure. The repairing
of the urethral hammock along with
the weakened pubourethral ligaments,
often combined with prolapse, will
solve the stress urinary incontinence
by guarantying the action of the three
forces which open and close the neck.
There were and still are discussions
about when and especially who is
supposed to operate the stress urinary
incontinence associated or not with
the urogenital prolapse. If stress urinary
Figure 3. Voiding diary
incontinence is considered to be a
Vol. 4, Nr. 1/februarie 2008
pag. 49
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