Pathways to causation and surgical cure of chronic pelvic pain of unknown origin, bladder and bowel dysfunction - an anatomical analysis

摘要

Introduction Current thinking is that chronic pelvic pain of unknown origin (CPPU) is poorly understoodand its treatment is empirical and ineffective. According to the Integral Theory System (ITS), however,CPPU is secondary to uterosacral ligament (USL) laxity which is associated with bladder and bowel symptomsand all are potentially curable by surgical reinforcement of USLs.Material and methods We applied the ITS to anatomically explain the pathogenesis and cure of theseconditions.Results The first mention of CPPU being caused by lax USLs was in the pre- WWII German literatureby Heinrich Martius. CPPU was first described in the English literature in 1993 as one of the four pillarsof the posterior fornix syndrome (PFS) (CPPU, urgency, nocturia and abnormal bladder emptying). Surgicalcure/improvement of CPPU was achieved by shortening and reinforcing USLs initially with USL ligamentplication and later with tensioned tapes because of deteriorating cure rates. Non-invasive ‘simulatedoperations’ which support USLs in the posterior fornix help predict USL causation.Conclusions USL tapes cure/improve CPPU, bladder and bowel dysfunctions by reinforcing the USLsagainst which the 3 directional forces contract. Weak suspensory ligaments may invalidate these forcesto cause incontinence, emptying and pain symptoms, all of which can be potentially reversed by usingtapes to reinforce the damaged ligaments, as demonstrated.