New Directions in Restoration of Pelvic Structure and Function

The fundamental theme of this chapter is that structure and function are intimately related. Abnormal symptoms and prolapse are caused by connective tissue laxity in the vagina or its suspensory ligaments – Integral Theory (Fig. 2.1). Other than pelvic pain, in some way, all the symptoms concern closure (continence) or opening (emptying) by the muscle forces (arrows). Tissue tension is critical for each of these functions. It follows that, in order to restore function, the surgical technique used must also restore tissue tension. A new tensioned sling technique which fulfills these criteria is presented later in this chapter. The tensioned sling works like the tensioned wires of a suspension bridge. It addresses both prolapse and abnormal symptoms, and has been successfully applied in >2,000 cases since November 2003 for patients with both stress incontinence and major prolapse. There are three zones and nine potential sites of connective tissue damage in the female pelvis (Fig. 2.1). Correct diagnosis of which ligament(s) is damaged is critical, so as to guide accurate repair of such ligament(s). Restore the structure, and you will correct the function.