Peter Petros

UNSW Sydney | UNSW · Professorial Dept of Surgery, St Vincent's Hospital Clinical School

The pelvic floor biomechanics and sphincter functioning are essential for understanding pelvic floor dysfunction and the pathophysiology of the pelvic organs. The pelvic floor consists of muscles, fascial connections and ligaments. The Integral Theory Paradigm (ITP) explains the musculoskeletal entity of the sphincter mechanism and the pathophysiol...

To critically analyse the relationship of bladder pain syndrome (BPS/IC), as defined, to the posterior fornix syndrome, "PFS" predictably co-occurring bladder urgency, frequency, nocturia, chronic pelvic pain, emptying symptoms/retention, caused by uterosacral ligament (USL) laxity and cured by USL repair. The starting and end points of this paper...

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 li...

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 D...

The remit of this review is confined to the experimental scientific works and surgeries based on the Integral Theory Paradigm (ITP). Chronic pelvic pain (CPP) is a major societal problem which is said to occur in up to 20% of women. The pathogenesis of CPP of “unknown origin” is said to be unknown and CPP is said to be incurable. According to the I...

Midurethral slings (MUS) have revolutionized the treatment of stress urinary incontinence (SUI). MUS operations work by creating a collagenous pubourethral ligament (PUL). Since 1996, more than 10 million operations have been performed worldwide. Early complications with the MUS included bowel perforations, massive retropubic hemorrhages, nerve inj...

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 m...

Introduction: Recent publications of interstitial cystitis (IC)/bladder pain syndrome cure by a gynecological prolapse protocol, run counter to traditional treatments such as bladder installations which do not offer such cure. The prolapse protocol, uterosacral ligament (USL) repair, is based on the 'Posterior Fornix Syndrome' (PFS). PFS was descr...

Aims and methods: To find a simpler cure for stress urinary incontinence (SUI) without tapes. Proposed is a paraurethral operation with incisions in both sulci to plicate pubourethral ligaments (PUL) with thick polyester sutures. Results: VIDEO and ultrasound experiments showed the main cause of SUI was weak PULs extending on effort, allowing th...

Aim To examine whether hiatal expansion and levator avulsion have a role in the causation of pelvic organ prolapse (POP). Methods Data from studies which showed a strong association of hiatal expansion and levator avulsion were analysed for causation against an alternative view, POPcausation by ligament/connective tissue damage. Results Some stud...

Thesis and aims In 45 years, the definitions and practice of the urodynamically based overactive bladder (OAB)/detrusor overactivity (DO) system have failed to adequately address pathogenesis and cure of urinary urge incontinence, frequency and nocturia. Methods We analysed the OAB syndrome with reference to the Integral Theory paradigm’s (ITS) bi...

The ongoing debate in “International Urogynecology Journal” about urethral closure mechanisms is important, because without a clear understanding of the anatomy of closure and stress urinary incontinence, the surgeon can never understand how corrective surgery works, or how to systematically address complications of such operations. The two dominan...

Background: Parallel with the demographic ageing crisis, is a disabling overactive bladder (OAB) crisis (urgency/frequency/nocturia), 30% prevalence in older women, pathogenesis stated as unknown and, according to some learned societies, incurable. Hypothesis/aims: To review International Continence Society and Integral System paradigms to test...

Subject of the Debate “Urethral failure is a critical factor in female urinary incontinence Now what?” The CASE FOR by Hokanson, DeLancey pinpointed inadequacy of bladder causation for urgency urinary incontinence (UUI) and poor urethral support for stress urinary incontinence (SUI) as responsible for long‐standing lack of progress in incontinence...

Background: The posterior fornix syndrome (PFS) was first described in 1993 as a predictably occurring group of symptoms: chronic pelvic pain (CPP), urge, frequency, nocturia, emptying difficulties/urinary retention, caused by uterosacral ligament (USL) laxity, and cured by repair thereof. Summary: Our hypothesis was that non-Hunner's interstiti...

This short opinion aimed to present the evidence to support our hypothesis that vulvodynia is a neuroinflammatory pain syndrome originating in the pelvic visceral nerve plexuses caused by the failure of weakened uterosacral ligaments (USLs) to support the pelvic visceral nerve plexuses, i.e., T11–L2 sympathetic and S2–4 parasympathetic plexuses. Th...

Aim: To present an anatomical pathogenesis parallel with the 2002 International Continence Society Lower Urinary Tract (LUTS) definitions standardization Report 2002. Methods: Each LUTS section is discussed using the same numbers as the Report. Results: Normal function Bladder control is binary, with two reflexes alternating, either closure (d...

Hypothesis: A structurally sound puboprostatic ligament (PPL), like the pubourethral ligament in the female, is the core structure for control of stress urinary incontinence (SUI) in males. Methods: The hypothesis was tested at several levels. Twelve transperineal ultrasound examinations were performed to confirm reflex directional closure vecto...

Introduction and hypothesisThis study emanates from the ISPP OASIS and fecal incontinence study group at the 2018 annual meeting of the International Society for Pelviperineology (ISPP) in Bucharest, Romania. The aim was to analyze the biomechanical factors leading to the breakdown of anal sphincter repair and to suggest a more robust technique for...

Aims and Scope Pelvic floor disorders are a very important subject in public health, with a major impact on quality of life. In USA for instance, epidemiology data indicate that between 11 and 19% of women may suffer at least one such surgical procedure. This field is in continuous change and there is not a consensus yet in therapeutic approach. Th...

Introduction and hypothesis To compare anal sphincter damage in two groups of primigravid women in Sydney: one passively managed in public hospitals, the other more actively managed in adjacent private hospitals. Data from actively managed labours at the National Women’s Hospital, Dublin, served as an independent control. Methods We carried out a...

Introduction: The aim of this study was to compare the posterior fornix syndrome (PFS), (abnormal bladder emptying, urge, frequency, nocturia, chronic pelvic pain) cured/improved by uterosacral ligament (USL) ligation, with 'underactive bladder' (UAB) [2], whose cause and cure of UAB are said to be unknown [2]. Material and methods: A limited li...

Aims and Scope Pelvic floor disorders are a very important subject in public health, with a major impact on quality of life. In USA for instance, epidemiology data indicate that between 11 and 19% of women may suffer at least one such surgical procedure. This field is in continuous change and there is not a consensus yet in therapeutic approach. Th...

The banning of all mesh for prolapse by the FDA has failed to recognize that there is a major difference between mesh sheets applied behind the vagina for POP and repair of POP by shortening and reinforcing damaged suspensory ligaments, much as is used in the midurethral sling (MUS) which retains endorsement by the FDA. Mesh sheets interfere with t...

Introduction: Current thinking is that chronic pelvic pain of unknown origin (CPPU) is poorly understood and 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 symptoms and all are potentially curable b...

Aims To summarize the mechanics of urethral closure, incontinence, and midurethral sling repair, a work in 3 parts Part 1. Original scientific studies (1990). Part 2. Experimental validation of reliance of the closure mechanisms on a competent PUL (1993–2003). Part 3. Surgery (1990–2016). Methods Part1. Two unrelated observations in the mid 1980s...

In Part 1, The original 1990 science behind the MUS, the hypothesized closure mechanisms, and the prototype MUS itself were presented. The next phase of MUS development began in 1990 in collaboration with the late Ulf Ulmsten. It had two arms • Further development of the prototype MUS. • Further anatomical, imaging, urodynamic studies to validate...

Part 3 briefly summarizes further development in midurethral sling (MUS) instruments and technique following the 1990 prototype operations, then critically examines the whole MUS surgical methodology, 1990 to present day. The aim is to identify positive and negative aspects of these methodologies which can be usefully applied to improve current MUS...

Total urinary incontinence in women following successful Obstetric Fistula surgery is very common but has received very little attention with regard to its aetiology. Centres repairing obstetric vesico vaginal fistulas commonly report a 95% fistula closure but fail to mention that up to 55% remain incontinent (1). Reports of pain and incontinence f...

The mechanism for urinary continence is not obstructive. Ultrasound and video data indicate that 3 striated muscle forces contract in opposite directions around a competent pubourethral ligament (PUL) to close the distal urethra and bladder neck. If PUL is loose, both mechanisms are invalidated, because striated muscles need a firm insertion point...

Our aim was to describe a new surgical method for prophylaxis/cure of post obstetric fistula repair leakage based on restoring vaginal elasticity with Singapore skin flap. The rationale for this operation was based on the integral theory: scarring removes elasticity required for independent function of oppositely acting urethral closure forces so t...

Dieser Abschnitt bietet einen kurzgefassten Überblick über die wichtigsten Behandlungsoptionen bei Inkontinenz und Beckenbodenbeschwerden. Im Einzelnen werden Beckenbodenübungen, Hormonersatztherapie, Pessar, Rückenmarknervenstimulation, Eigengewebe-OP, Netzimplantate sowie der Einsatz sogenannter Minischlingen behandelt.

Warum leiden so viele Frauen im Klimakterium oder nach einer Hysterektomie plötzlich unter Verstopfung und Stuhlinkontinenz? Dieselben Haltebänder, die Scheide und Blase stützen, halten auch Darm und After. Die hinteren Haltebänder sind die wichtigsten Stützen des Darms, was Entleeren und Schließen angeht. Anhand anschaulicher Fallbeispiele wird er...

In diesem Abschnitt geht es um die Schädigung der vorderen Haltebänder. Belastungharninkontinenz ist die wichtigste Beschwerde bei Erschlaffung der vorderen Haltebänder. Andere Beschwerden können Harndrang kombiniert mit Belastungsharninkontinenz, Stuhlinkontinenz kombiniert mit Belastungsharninkontinenz und Harnaustritt beim Geschlechtsverkehr sei...

Im Zentrum des Schlusskapitels steht die Frage „Was können Sie selbst tun?“ Zwar ist von einer Selbstdiagnose unbedingt abzuraten, doch mithilfe des hier vorgestellten Diagnosediagramms sowie des sogenannten Tampontests lässt sich häufig eine erste orientierende Einschätzung hinsichtlich der Ursache der Beschwerden gewinnen. Das Kapitel schließt mi...

Blase, Gebärmutter und Mastdarm sowie deren Funktionen werden in diesem Kapitel vorgestellt. Es zeigt sich, dass eine Erschlaffung der vaginalen Haltebänder die entscheidende Ursache für Scheidenvorfall, Blasen- und Darmbeschwerden sowie einige Arten des Beckenschmerzes ist.

In diesem Abschnitt wird ein typischer Besuch in der Klinik aus Patientensicht beschrieben. Im Einzelnen werden die üblichen Untersuchungen, die Patienteneinwilligung, die Operation selbst sowie die erste Zeit nach dem Eingriff behandelt.

In diesem Abschnitt geht es um die Schädigung der mittleren Haltebänder. Das Hauptsymptom ist eine Vorwölbung der Scheide unter der Blase, bekannt als Blasenvorfall oder Zystozele. Häufig sind Beschwerden bei der Entleerung der Blase und manchmal Harndrangbeschwerden. In einer Reihe von Fallberichten wird das Problem eindrücklich geschildert.

Im Einzelfall können durch das Vermeiden bestimmter Nahrungsmittel vorhandene Blasenbeschwerden gelindert werden. Auf welche Nahrungsmittel und Getränke man besser verzichtet, da sie eine Blasenreizung verursachen können, wird auf den folgenden Seiten kurz erläutert. Außerdem finden sich in diesem Abschnitt auch Hinweise zu Hautpflege und der richt...

Im Fokus stehen Beschwerden infolge einer Erschlaffung der hinteren Haltebänder. Im Einzelnen handelt es sich um Dranginkontinenz, Nykturie, ziehende Schmerzen im Unterleib, Penetrationsschmerzen, Überempfindlichkeit oder brennendes Gefühl am Scheideneingang, Entleerungsstörung der Blase, des Mastdarms und manchmal auch Stuhlinkontinenz. In einer R...

Inkontinenz, Entleerungsstörungen von Darm und Blase, häufiges und nächtliches Wasserlassen, Harndrangbeschwerden oder Beckenschmerz können von Schädigungen an der Scheide oder ihren Haltebändern herrühren. Sobald die Haltebänder beschädigt sind, wird die Scheide schlaff, darum senken sich Blase, Darm oder Gebärmutter. Welche Ursachen im Einzelnen...

In diesem einleitenden Abschnitt werden Aufbau und Ziel des Buches erläutert sowie das Kvinno Centre im australischen Perth vorgestellt, das sich zwischen 1991 und 2009 zu einem bedeutenden Zentrum in der chirurgischen und nichtchirurgischen Behandlung von Beschwerden wie Darm- und Blaseninkontinenz, Harndrang, nächtliches Wasserlassen und Beckensc...

Un chirurg trebuie să fie deopotrivă arhitect și inginer. Arhitect-să poată proiecta o operație. Inginer-pentru a fi capabil să o realizeze. "

Context: The 1990 integral theory (IT) stated that urinary stress and urge symptoms mainly arise (for different reasons) from lax suspensory ligaments, a consequence of altered collagen/elastin. The first surgical application of IT was repair of the pubourethral ligament (PUL), now known as tension-free vaginal tape repair. Objective: To update the...

Background More than 130 000 new cases of vesicovaginal fistula (VVF) develop each year in Africa alone, and though the cure rate for the VVF itself is more than 90%, up to 55% of patients continue to leak heavily. Aim To present an interim report of testing a hypothesis which states that the major cause of post fistula repair incontinence is tissu...

Dieser Patientenratgeber richtet sich an Frauen mit Beschwerden und Schmerzen im Bereich von Blase, Darm und Becken, wie Urin- und Stuhlinkontinenz, Entleerungsstörungen von Blase und Darm. Er informiert über die neuen Behandlungsmethoden nach der Integraltheorie, die davon ausgeht, dass die meisten Inkontinenzprobleme ihren Ursprung im Bereich ges...

Pelvic Organ Prolapse (POP) can be defined as a downward descent of female pelvic organs, including the bladder, uterus, post-hysterectomy vaginal cuff and the small or large bowel, resulting in protrusion of the vaginal walls, uterus, or both. The International Continence Society includes also rectal prolapses. POP development is multifactorial.