Petros Peter, Abendstein Burghard
University of Western Australia, Perth, Australia.
FA für Gynäkologie, Geburtshilfe und Chirurgie, Akademisches Lehrkrankenhaus, Feldkirch, Austria.
Cent European J Urol. 2018;71(4):448-452. doi: 10.5173/ceju.2018.1807. Epub 2018 Dec 27.
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 by surgical reinforcement of USLs.
We applied the ITS to anatomically explain the pathogenesis and cure of these conditions.
The first mention of CPPU being caused by lax USLs was in the pre- WWII German literature by Heinrich Martius. CPPU was first described in the English literature in 1993 as one of the four pillars of the posterior fornix syndrome (PFS) (CPPU, urgency, nocturia and abnormal bladder emptying). Surgical cure/improvement of CPPU was achieved by shortening and reinforcing USLs initially with USL ligament plication and later with tensioned tapes because of deteriorating cure rates. Non-invasive 'simulated operations' which support USLs in the posterior fornix help predict USL causation.
USL tapes cure/improve CPPU, bladder and bowel dysfunctions by reinforcing the USLs against which the 3 directional forces contract. Weak suspensory ligaments may invalidate these forces to cause incontinence, emptying and pain symptoms, all of which can be potentially reversed by using tapes to reinforce the damaged ligaments, as demonstrated.
目前的观点认为，不明原因的慢性盆腔疼痛（CPPU）尚未得到充分理解，其治疗是经验性的且效果不佳。然而，根据整体理论体系（ITS），CPPU继发于子宫骶韧带（USL）松弛，这与膀胱和肠道症状相关，并且通过手术加强子宫骶韧带，所有这些都有可能治愈。
我们应用ITS从解剖学角度解释这些病症的发病机制和治疗方法。
首次提及CPPU由松弛的子宫骶韧带引起是在二战前德国文献中，作者是海因里希·马蒂乌斯。1993年，CPPU在英文文献中首次被描述为后穹窿综合征（PFS）的四大支柱之一（CPPU、尿急、夜尿症和膀胱排空异常）。由于治愈率下降，最初通过子宫骶韧带折叠术，后来使用张紧带缩短并加强子宫骶韧带，从而实现了CPPU的手术治愈/改善。在后穹窿支撑子宫骶韧带的非侵入性“模拟手术”有助于预测子宫骶韧带的病因。
子宫骶韧带带通过加强子宫骶韧带，抵抗三个方向的力量收缩，从而治愈/改善CPPU、膀胱和肠道功能障碍。薄弱的悬韧带可能会使这些力量失效，导致失禁、排空和疼痛症状，如所示，所有这些都可以通过使用带子加强受损韧带而潜在地逆转。
