Fax +41 61 306 12 34 E-Mail karger@karger.ch www.karger.com Review Review Urol Int 2010;84:1–9 DOI: 10.1159/000273458 Surgical Reconstruction of Pelvic Floor Descent: Anatomic and Functional Aspects vic floor ligaments. Exact preoperative identification of the anatomical lesions is necessary to allow for exact anatomical reconstruction with respect to the muscular forces of the pelvic floor. Copyright © 2010 S. Karger AG, Basel Introduction Pelvic floor disorders are frequently seen in women. A variety of symptoms can be attributed to pelvic floor le- sions, such as stress urinary incontinence, urge urinary incontinence, pollakisuria, nocturia, abnormal bladder emptying, fecal incontinence, obstructive bowel disease syndrome and pelvic pain. The prevalence of such pelvic floor disorders range between 10 and 25% depending on the patient population, type of study and definition used. Combinations of symptoms are frequent. In one study investigating 4,103 women, 67% exhibited more than 1 symptom. Risk factors in that study were obesity, more than 1 vaginal delivery, hysterectomy and the need for hormonal treatment [1]. One of the most important findings in the last years was that disorders of the pelvic floor muscular functions can negatively influence the physiological functions of the pelvic organs, namely the urinary bladder and the Key Words Pelvic floor  Functional anatomy  Urinary incontinence  Prolapse  Surgical reconstruction Abstract Introduction: The human pelvic floor is a complex structure and pelvic floor dysfunction is seen frequently in females. Materials and Methods: This review focuses on the surgical reconstruction of the pelvic floor employing recent findings on functional anatomy. A selective literature research was performed by the authors. Results: Pelvic floor activity is regulated by 3 main muscular forces that are responsible for vaginal tension and suspension of the pelvic floor organs, bladder and rectum. A variety of symptoms can derive from pelvic floor dysfunctions, such as urinary urge and stress in- continence, abnormal bladder emptying, fecal incontinence, obstructive bowel disease syndrome and pelvic pain. These symptoms mainly derive, for different reasons, from laxity in the vagina or its supporting ligaments as a result of altered connective tissue. Pelvic floor reconstruction is nowadays driven by the concept that in case of pelvic floor symptoms, restoration of the anatomy will translate into restoration of the physiology and ultimately improve patients’ symptoms. Conclusion: The surgical reconstruction of the anatomy is almost exclusively focused on the restoration of the lax pel- F.M.E. Wagenlehner Clinic of Urology, Pediatric Urology and Andrology, Justus Liebig University Rudolf-Buchheim-Strasse 7 DE–35385 Giessen (Germany) Tel. +49 641 994 4518, Fax +49 641 994 4509, E-Mail wagenlehner@aol.com © 2010 S. Karger AG, Basel 0042–1138/10/0841–0001$26.00/0 Accessible online at: www.karger.com/uin F.M.E. Wagenlehner a T. Bschleipfer a B. Liedl b A. Gunnemann c P. Petros d W. Weidner a a Clinic of Urology, Pediatric Urology and Andrology, Justus Liebig University, Giessen, b Beckenbodenzentrum München, Munich, and c Department of Urology, Klinikum Lippe, Detmold, Germany; d Department of Gynaecology, Royal Perth Hospital, Perth, W.A., Australia