Effects of pelvic relaxation on gynecologic urologic problems.

It is evident that the maintenance and reestablishment of urinary continence is in large part dependent, during times of intraabdominal stress, upon maintenance of an intraurethral pressure higher than that within the bladder. It is important that the presence of cystocele be carefully and accurately assessed preoperatively and intraoperatively so that correction appropriate to its etiologic circumstance can be achieved. Continence is under the influence of urethral tone, as well as the response of the distal urethra to changes in intraabdominal pressure. Cranial elevation of the vesicourethral junction, as may be required, may be provided by any one of several different or combined surgical techniques. When vaginal inversion causes displacement of the vesicourethral junction, a restoration of vaginal depth and axis by transvaginal sacrospinous fixation with appropriate colporrhaphy will relocate a defective urethrovesical site to a higher level within the pelvis where it may once again be responsive to changes in intraabdominal pressure.