Pelvic Floor Dysfunction and Its Reconstructive Surgery Novel Concepts

Urinary continence depends on a closed and empty urethra with high urethral pressure. Two main factors are responsible for that, an intact internal urethral sphincter (IUS) which is a collagen-muscle tissue cylinder that extends from the bladder neck to the perineal membrane in men and women. The second factor is the presence of high alpha-sympathetic tone at the IUS gained by learning in early childhood. Defects in either of these two factors will lead to urinary incontinence. Childbirth trauma causes invisible lacerations of the collagen chassis of the vagina leading to vaginal prolapse; of the IUS resulting in stress urinary incontinence (SUI); of the IAS causing fecal incontinence (FI). The dysfunction can be a sporadic lesion or more common concomitant multiple lesions. Medical imaging using MRI and 3DUS can demonstrate the damage and show an open urethra with torn IUS and an open anal canal with torn IAS. In addition, we introduced a novel simple vaginal reconstructive operation in which we expose the torn collagen chassis of the IUS and IAS, mend the torn edges, and then perform overlapping of the redundant lax vaginal flaps. This is to strengthen the vagina and to add extra support to the closely related IUS and IAS. We do not remove any vaginal tissue and thus save the body's own collagen. We do not use any synthetic mesh or tapes with its complications. It corrects the anatomy of the pelvic organs in order to restore their normal physiology. Abdel Karim M. El Hemaly.