We reiterate that the rectocele is certainly a primary disease

We reiterate that the rectocele is certainly a primary disease further information of the rectum, the dilation is due to a thinning or disappearance of the muscular layer of the distal rectum; posterior colpocele and related anatomical and structural alterations of the posterior vaginal wall must be considered secondary alterations. Therefore applying a mesh between the rectum and vagina, while giving back a new look to the vagina, does not solve the cause and symptoms of ODS, increasing moreover the rate of dyspareunia and complications. In addition, the rectocele continuing to push on the mesh can be able to bring about recurrence colpocele and erosion of the mesh. For these reasons, the STARR, resecting rectocele and restoring muscular continuity, in addition to correcting recto-colpocele improves ODS.

Any excessive posterior vaginal redundancy can be corrected by stretching and suturing the posterior vaginal fornix to the subperitoneal mesh of the POPS. The preservation of the uterus, suspending it in a natural position, involves significant surgical, functional and psychological benefits. In fact, all the complications related to hysterectomy are avoided, the uterus will continue to divide the pelvis into two compartments and modulate straining for evacuation and urination and at the same time prevents excessive dilation of bladder. Finally, we found that hysterectomy for women is a serious psychological trauma that can affect sexual activity. In reviewing the literature, we found that even Kapandji (7), in 1967, had proposed the suspension of the vagina, by tense subperitoneal skin-strips from the anterior superior iliac spines to the vagina.

In the original description the author completed the technique with routinely Douglassectomy and plastic of round ligaments. This of course leads to excessive anteriorization of the vagina resulting in the widening of the space of Douglas. In addition, the stiff suspension of the iliac spines prevents the natural movements of the vagina. However, the advantages of the lateral suspension is commendable. Conclusions In conclusion we believe that the procedure proposed by us was excellent in patients with the vagina walls elongated and that retain a good trophism. Our proposal must be understood as a contribution from coloproctologists to gynecologists for a better comprehension of the rectum��s role in this surgery.

We emphasized that the genital apparatus represents also the anatomical support for the bladder and rectum and, therefore, inevitably the genital prolapse implies serious anatomical and functional alterations of these organs. Obviously, the gynecologist Brefeldin_A remains a specialist to refer for POP, but it is desirable to have a greater multidisciplinary collaboration.
Liver abscesses are a common disease whose diagnosis and treatment are still problematic, although considerable progress has been made since the late 80s.

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