Letter to the Editor

Impacted foetal head – functional anatomical analysis and some directions for avoidance.Running title Impacted foetal head- anatomical analysis and avoidancePE Petros  DSc DS (UWA) PhD (Uppsala) MB BS MD (Syd) FRCOG (Lond)31/93 Elizabeth Bay Rd, Elizabeth Bay NSW 2011 AUSTRALIAAffiliation NILReconstructive Pelvic Floor Surgeon and Certified Urogynaecologist (retired)Tel 61 2 9361 3853 Cellphone (AUST) 61 411 181 731  email pp@kvinno.com.

The ULP (urethral ligament plication) operation for stress urinary incontinence is based on the same anatomical etiopathogenesis as the midurethral sling (MUS): restoring collagen to weakened PULs (pubourethral ligaments), albeit, by plication with collagenopoietic wide-bore polyester sutures to prevent PUL elongation under stress. Calculated collagenopoietic sufficiency of polyester sutures came from a doctoral thesis where collagen strength from a rejected polyester graft was tested. Precise placements of the single polyester suture to PUL were based on a live anatomical study. 12-month cure rate was 83% (learning curve included), with no post-operative urinary retention, due to absence of suburethral tapes.

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TITLE Letter to the editor BJOG “Necessity the mother of invention”- wider significance of novel mid-urethral rectus fascial sling.1 Professor PEP Petros DSc DS (UWA) PhD (Uppsala) MB BS MD (Syd) FRCOG (Lond) FRANZCOG CU.31/93 Elizabeth Bay Rd Elizabeth Bay NSW 2011 AUSTRALIAPelvic Floor Surgeon (retired)1Single and corresponding author.1Affiliation None. Retired pelvic surgeonEmail pp@kvinno.comTel+61 411 181 731

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A document by Peter Petros. Click on the document to view its contents.

VIDEO ABSTRACT provides an anatomical summary of the PPP operation. A technique for the pubourethral plication procedure (PPP) with No3 polyester sutures for cure of stress urinary incontinence without tapes via parallel sulcal incisions extending from bladder neck to urethral meatus. Both branches of each pubourethral ligament were sutured with No2 or 3 polyester sutures extending to the external urethral ligaments and medial part of pubococcygeus; the vaginal incisions closed with polyglactin sutures. All women were discharged of day of surgery. Six month results Age :58.6 years;31/36 women (86%)were cured of SUI and 11/19 (58%) concomitant urge. 5 surgical failures, 4 immediately post-operatively, and one at 3 months.

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Our minimally invasive Fothergill-Manchester technique aims to decrease blood loss and surgical trauma and to preserve function by1. Vaginal conservation. 2. Cardinal (CL) and uterosacral (USL) ligaments plicated, not severed. 3. Direct suture of vagina to cervix without Sturmdorf sutures after cervical amputation. 4. Use of No2 polyester sutures to create new collagen to reinforce the plicated ligaments.

Professor PEP Petros DSc DS (UWA) PhD (Uppsala) MB BS MD (Syd) FRCOG (Lond)31/93 Elizabeth Bay Rd, Elizabeth Bay NSW 2011 AUSTRALIAReconstructive Pelvic Floor Surgeon and Certified Urogynaecologist (retired)Formerly University of NSW Professorial Dept of Surgery, St Vincent’s Hospital Sydney (retired)Adjunct Professor, University of Western Australia School of Mechanical and Chemical Engineering, Perth WA (current)Tel 61 2 9361 3853 Cellphone (AUST) 61 411 181 731Email pp@kvinno.com website www.integraltheory.org

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