A practical ligament-based diagnostic system for cure of pelvic symptoms and prolapse

Peter Petros; Bernhard Liedl; Paolo Palma; Cassio Riccetto; Shuqing Ding

doi:10.21037/atm-23-1759

A practical ligament-based diagnostic system for cure of pelvic symptoms and prolapse

Ann Transl Med. 2024 Apr 22;12(2):27. doi: 10.21037/atm-23-1759. Epub 2024 Apr 18.

Authors

Peter Petros¹, Bernhard Liedl², Paolo Palma³, Cassio Riccetto⁴, Shuqing Ding⁵

Affiliations

¹ Pelvic Reconstructive Surgeon (Retired), Sydney, NSW, Australia.
² Centre for Reconstructive Urogenital Surgery, Urology Clinic Munich, Planegg, Germany.
³ Department of Urology at University of Campinas, UNICAMP, Sao Paulo, Brazil.
⁴ University of Campinas School of Medical Sciences, São Paulo, Brazil.
⁵ Northwestern Health Sciences University, Bloomington, Minnesota, USA.

Abstract

The Integral Theory Paradigm (ITP) has a 25-year track record of successfully treating bladder/bowel/pain symptoms caused by laxity in specific ligaments, even when the prolapse is minimal. The ITP-based treatment involves ligament support and can be nonsurgical or daycare surgical. An accurate diagnostic protocol is required. The Integral Theory Diagnostic system is performed in an outpatient setting. It a step-by-step "how to" resource for clinicians who wish to learn a practical anatomical diagnostic method which can quickly and accurately identify a ligament cause for bladder/bowel/pain symptoms, and therefore, potentially cure them. The structured ITP diagnosis flow chart uses symptoms to diagnose anatomical defects. It comprises 4 related steps. The ITP is holistic, and bladder, bowel, pain symptoms co-occur. The first step, therefore, is to establish all possible symptoms for transfer to the Diagnostic Algorithm which is the second step. Because patients complain of one main symptom, other symptoms must be located by direct questioning, using the Diagnostic Algorithm as an aide memoire, or a questionnaire to locate bladder, bowel, pain symptoms. Second step: symptoms are placed into 3 anatomical zones: anterior zone, pubourethral ligament (PUL) [stress urinary incontinence (SUI)]; middle zone, cardinal ligament (CL) (transverse defect cystocele); posterior zone, uterosacral ligament (USL) (uterine prolapse and enterocele). The third step is a vaginal examination to confirm the ligament damage (prolapses) in the three zones predicted by the algorithm. The fourth step is "simulated operations" (mechanical support of specific ligaments per vaginam) to validate the particular ligament indicated by the diagnostic algorithm, is indeed causing that symptom. For SUI, a hemostat test at midurethra supports PUL vaginally to stop urine loss on coughing; the lower blade of a bivalve speculum gently inserted into the vagina can relieve urge and pain.

Keywords: Diagnostic algorithm; pelvic organ prolapse (POP); pelvic symptoms; simulated operations; vaginal examnation.

Publication types

Review