Retropubic TFS Minisling for Postprostatectomy Male Incontinence: First Report

Muctar, Sidi; Ende, David; Petros, Peter

doi:10.1159/000520629

Cited by 3 publications

(8 citation statements)

References 10 publications

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“…PPL has stretched considerably backward, from E6 to G5, almost double, indicating weakness; MU has moved very considerably upwards relative to the lower end of ES, indicating a forward force applied from behind, as seen in the distal urethra in the female. Reused from ( 1 ). Copyright 2022, with permission from Karger.…”

Section: Evidence For Parallel Anatomymentioning

confidence: 99%

“…When the TFS was inserted into the male cadaver using the exact technique used in the female, the anchor exited in the position of the PPL. Reused from ( 1 ). Copyright 2022, with permission from Karger.…”

Section: Evidence For Parallel Anatomymentioning

confidence: 99%

“…The thesis for parallel male/female pelvic anatomy rests on cure of post-prostatectomy stress urinary incontinence (SUI) by retropubic minisling repair of the puboprostatic ligament (PPL) ( 1 ) and the discovery of a uterosacral male analogue during laparoscopic surgery for rectal carcinoma ( 2 ).…”

Section: Introductionmentioning

confidence: 99%

“…The hypothesis which led to the male retropubic sling operation ( 1 ) was the question, “Does post-prostatectomy SUI have the same pathogenesis as SUI in the female, i.e., a weak or damaged PPL?”.…”

Section: Introductionmentioning

confidence: 99%

“…Would the same minisling methodology which the authors ( 1 ) used for cure of SUI in the female, also cure post-prostatectomy incontinence in the male?…”

Section: Introductionmentioning

confidence: 99%

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Pubourethral and uterosacral male analogues suggest parallel male/female pelvic anatomy and symptom pathogenesis

Farag,

Muctar,

Petros

2024

Ann Transl Med

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The thesis that functional/dysfunctional male/female pelvic floor anatomy are parallel, originated from two studies: a successful retropubic perineal male sling for post-prostatectomy stress urinary incontinence (SUI) and discovery of a male uterosacral ligament (USL) analogue, we named “prostatosacral ligament” (PSL). In 25 out of the studied 27 males (92.6%), it starts on both sides of the median sulcus of the prostate the ligament passes lateral to the rectum being fused with the lateral margin of the mesorectum before leaving it as it thins out to be attached posteriorly similar to the USL. The ultrasound data during straining in men and women showed the same three oppositely acting muscle vectors contracting around analogous ligaments, puboprostatic ligament (PPL) (male), and pubourethral ligament (PUL) (female). Further parallels were pubovesical ligaments (PVLs) and arc of Gilvernet as part of the continence and micturition mechanisms. Impressive evidence for parallel anatomy came from the successful cure of 22 males with post-prostatectomy SUI using a perineal retropubic tissue fixation system (TFS) minisling applied to the PPL using a similar methodology to that used in the female for PUL midurethral sling repair for cure of SUI. Laparoscopic evidence confirmed the prostate as a male analogue of the cervix, and PSLs as analogues of USLs: PSL origin from the prostate attached laterally to the mesorectum and inserted into the sacrum. Histologically, PSLs had identical features with USLs: collagen, elastin, smooth muscle, blood vessels and nerves. Virtually identical symptoms for “chronic prostatitis” (CP) and “posterior fornix syndrome” (PFS), such as chronic pelvic pain, overactive bladder (OAB), abnormal emptying, gave birth to the hypothesis, of a common pathogenesis for “CP” and “PFS”, USL (or PSL) laxity. If this could be proven by “simulated operations”, “CP”, at least in theory, may be potentially correctible by PSL repair.

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Section: Evidence For Parallel Anatomymentioning

confidence: 99%

Section: Evidence For Parallel Anatomymentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…Would the same minisling methodology which the authors ( 1 ) used for cure of SUI in the female, also cure post-prostatectomy incontinence in the male?…”

Section: Introductionmentioning

confidence: 99%

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Pubourethral and uterosacral male analogues suggest parallel male/female pelvic anatomy and symptom pathogenesis

Farag,

Muctar,

Petros

2024

Ann Transl Med

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A Hypothesis for Anatomical Pathways of Chronic Pelvic Pain of “Unknown Origin”

Petros,

Papadimitriou,

Bornstein

2024

Urol Int

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Background Interstitial cystitis/bladder pain syndrome (IC/BPS) is a disabling bladder condition. ESSIC, the IC/BPS society defines two types of IC/BPS: with Hunner’s lesion (HL) and without. Pathogenesis is stated as unknown, with no cure possible. Scheffler in 2021 reported cystoscopically validated cure of HL IC/BPS by repair of uterosacral ligaments (USL) and in 2022, Goeschen reported non-HL IC/BPS cure in 198 women following USL repair. Both Scheffler and Goeschen hypothesized IC/BPS may be a phenotype of the Integral Theory’s Posterior Fornix Syndrome “PFS” (chronic pelvic pain, OAB and emptying dysfunctions) and therefore potentially curable. Summary The hypothesis explores whether visceral plexuses (VP), due to weakened uterosacral ligaments support, serve as a primary source of pelvic pain impulses, leading to development of an inflammatory condition - for example, Interstitial Cystitis/Bladder Pain Syndrome, a chronic inflammatory condition, which shares similarities with vulvodynia and Complex Regional Pain Syndrome (CRPS). According to our hypothesis, such conditions involve axon reflexes. Stimuli such as gravity applied to unsupported nerve branches within the visceral pelvic plexus, trigger centrally propagating impulses, which then progress antidromally to influence innervated tissues through cytokine release and nociceptor stimulation, perpetuating inflammatory processes at the end organs, and pain perception. Key messages The hypothesis raises the question, “are IC/BPS, vulvodynia, other pain sites, even non-bacterial “chronic prostatitis” in the male, different phenotypes of the chronic pelvic pain syndrome which includes PFS. If so, the hypothesis opens several new research directions, and would predict inflammatory findings in tender endorgan pain sites.

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