gineco
ro
tehnici chirurgicale
functional disorder, and pelvic floor
disorder is an anatomical alteration,
any experienced surgeon in the vaginal
surgery (urologist, gynecologist, general
surgeon) or a team of surgeons may
proceed to the intervention.
Current surgical techniques are based
on profound knowledge of the local
anatomy [5], strength elements used
in repairing the pelvic floor and some
anatomical markers that are not always
easy to localize during the intervention.
The tendeinous arch of endopelvic fascia
should be palpable on all its length from
pubis to ischiadic spine. The ischiadic
spine must be found and palpated in
order to prevent the interception of the
pudental nerve and of the sacrospinal
ligament. There must not be forgotten
the ischiorectal fossa: limitated medial
by the elevator ani muscle, lateral by
the internal obturator muscle, inferior
by the urogenital diaphragm and
ventral by the gluteus muscle, a space
filled with fat without any important
anatomical elements, crossed by devices
during interventions with meshes and
interventions that fix the vagina to the
sacrospinos ligament.
Symptomatology
These patients present increased
frequency, stress urinary incontinence,
Figure 4. The profile urinary cistography
pressure sensations, the feeling of a lump
(“something coming down”), the feeling
of a foreign body, urgency, dispareuny,
sacral pain, pelvic pain, symptoms that
have a major impact on the quality of
life and on their lifestyle. A responsible
objective exam is essential, being well-
known the fact that the patients do not
acknowledge the existence of a prolapse
until it overcomes the hymeneal
membrane. Thus, we find cystocel
from a central defect ( figure 1), lateral
defect ( figure 2), mixed cystocel, uterine
prolapse, rectocel, enterocel and most
often different combinations of those.
Diagnosis
Many times we must demonstrate
that what the patient loses represents
indeed urine and the loose is through the
urethra. There are being used different
intravaginal tampon tests and different
colorants administrated intravenous or
through the bladder. The questionnaire
is important, but most important is the
Figure 5. Valves vaginal examination voiding diary ( figura 3) – where patients
pag. 50 Vol. 4, Nr. 1 /februarie 2008
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