Clinical Anatomic Study On Female Pelvic Floor Dysfunction And Minimal Invasive Reconstructive Surgery

Female pelvic floor dysfunctions mainly concern stress urinary incontinence (SUI) and pelvic floor prolapse (POP). The theories describe the pathophysiology and surgical treatment of this kind of disease include "Three Levels of Vaginal Support' and'Hammock Hypothesis'of Delancey. More important is the'Integral Theory' of Petros. The fundamental principle is symptoms of stress, urge, and abnormal emptying derive, for different reasons, from loss of form because of damaged connective tissue structures. The mechanism of surgical treatments is that 'restoration of form leads to restoration of function'.Nowadays although the structure of pelvic floor has been described, the interrelation of muscle, fascia, ligament and organ is not clear. The anatomical study of pelvic floor restricted to traditional anatomy could not explain the function. Therefore the functional anatomy and surgical anatomy are of great importance.We performed the anatomical study of pelvic floor supporting system and sphincter system in one fixed female pelvic. With the study of the detail structures of levator ani muscles (LAM) and pelvic connective tissues, we found extensive fiber connections between them which indicating pelvic floor musculature and pelvic connective tissue interacted to retain normal pelvic functions. According to our anatomical findings, there was also many muscular fibers connection between pelvic floor supporting system and sphincter system. This study identified the connective tissue surpports which had seldom been referred in Chinese cadavers, for example arcs tendineus fascia pelvis (ATFP), arcus tendineus levator ani (ATLA), pebocervical fascia (PCF), rectovaginal fascia (RVF), pubourethral ligament (PUL) and external urethral ligament (EUL). We deem it established a foundation of the utilization of related theories.The minimal invasive sling procedures include tension-free vaginal tape(TVT) through retropubic space and the TVT transobturator approach (TVT-O) for the treatment of SUI ; the posterior intravaginal sling (P-IVS) procedure deal with the vaginal vault prolapse. Being 'blind needle technique', the punctures had the...