Pelvic floor reconstruction: state-of-the-art and beyond

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Overview of pelvic floor defects: anatomy of pelvic support

Any approach to surgical reconstruction of pelvic-floor defects requires a thorough understanding of the anatomy of pelvic support. As a matter of semantics, many experts prefer to refer to pelvic-support defects in a “compartmentalized” fashion. Urologists describe defects such as cystocele, rectocele, and enterocele. More appropriately, the vagina can be divided into anterior, apical, and posterior compartments. A defect in anterior support preferably is described as “anterior prolapse” as

Surgical repair of pelvic floor defects

The anatomy of pelvic support includes muscular and fascial contributions. Although the muscular contribution may be more important, the fascial component typically is “fixed” in prolapse repair. Because defective muscle is not amenable to surgical reconstruction to restore its strength, one must rely on fascial support reconstruction. The goals of surgical correction of pelvic floor defects are to restore anatomy and function of the vagina and pelvic organs. It is important to consider the

Summary

Reconstructive surgery for pelvic-floor dysfunction is challenging and complex. It requires an extensive familiarity with pelvic anatomy and a wide armamentarium of surgical procedures to offer patients with various structural defects. Not every patient is suited for every procedure and the surgeon must be able to individualize the approach. Each technique has indications and benefits: vaginal repairs are relatively simple and cause less morbidity than abdominal repairs, which are generally

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