“When you build it, keep it simple” Comment on “if you build it, they will come” (1998): Neurourol urodynam 17:1–2
✍ Scribed by Raymond R. Rackley; Rodney A. Appell
- Publisher
- John Wiley and Sons
- Year
- 1998
- Tongue
- English
- Weight
- 19 KB
- Volume
- 17
- Category
- Article
- ISSN
- 0733-2467
No coin nor oath required. For personal study only.
✦ Synopsis
And so it has been with the advent of change in pelvic floor reconstruction. For years, urology and urogynecology have struggled with various tricks and paradigms of surgical treatments for stress urinary incontinence. So confusing were the options that a great flood of catharsis (outcome studies) was needed to clarify that the proposed paradigms offered by the experts had been misleading their supporters who were experiencing poorer clinical results. After the pouring down of outcome studies, the light still shines favorable on the choice of surgical options when compared to pelvic floor rehabilitation and other nonsurgical therapy for the best longterm and cost-effective cure or improvement of stress urinary incontinence. In the period of enlightenment that follows, surgeons with realistic expectations choose to rethink and rebuild with sound fundamentals based on observation and anatomical principles of reconstructive techniques. The current renaissance period we are experiencing in pelvic floor reconstruction has resulted in the development and attraction of ideas and people who seek to advance this field. Although the opponents of change to tertiary referrals for incontinence and complex surgical procedures use their editorial positions to speak of ''kits that do practically everything for the surgeon'' with ''idiot-proof techniques,'' are these not developments that promote the simplicity and reproducibility of pelvic floor reconstructive procedures that all surgeons in this field deserve to be able to incorporate into their practice for better patient outcome measures?
One of best examples of new developments is the introduction and evolution of bone anchors in pelvic floor reconstruction. For years, bone anchors have provided reconstructive surgeons an efficacious means of securely attaching soft tissue to bone instead of periosteum. Periosteum is not only too weak to provide this attachment, but also contains nerve endings that can be adversely affected by periosteal lifting and inflammation due to suture attachment or periosteal manipulation. To avoid this well-known complication of osteitis pubis in patients after pelvic floor reconstructive procedures, bone anchors have been promoted as a means to safely secure sutures in a simplistic fashion in laparoscopic, retropubic, transperitoneal, and transvaginal surgeries. The incidence of osteomyelitis involving bone anchor use in pelvic floor *God's advice to Noah on the construction of the Ark (Genesis 6)