Comments on: “Plumbing and Renovations” Preview – Uterine resuspension and other hysterectomy-free options for vaginal prolapse http://www.urogynics.org/blog/2009/08/plumbing-and-renovations-preview-uterine-resuspension-and-other-hysterectomy-free-options-for-vaginal-prolapse/ The official blog of Lauri Romanzi, MD Tue, 22 Mar 2011 19:52:36 +0000 hourly 1 http://wordpress.org/?v=3.1.1 By: Anonymous http://www.urogynics.org/blog/2009/08/plumbing-and-renovations-preview-uterine-resuspension-and-other-hysterectomy-free-options-for-vaginal-prolapse/#comment-8 Anonymous Wed, 25 Nov 2009 21:37:56 +0000 http://www.urogynics.com/blog/?p=9#comment-8 I loved going through the article, you totally knocked it out of the ballpark! I have sent a link to my dad, and shall definately be returning for more updates. I loved going through the article, you totally knocked it out of the ballpark! I have sent a link to my dad, and shall definately be returning for more updates.

]]> By: admin http://www.urogynics.org/blog/2009/08/plumbing-and-renovations-preview-uterine-resuspension-and-other-hysterectomy-free-options-for-vaginal-prolapse/#comment-7 admin Sat, 19 Sep 2009 05:57:51 +0000 http://www.urogynics.com/blog/?p=9#comment-7 Your detailed and persistent commentary continues to intrigue. Thought experiments <em>are</em> designed to question established theory, and by nature tend to question central assumptions, otherwise, what's the point? Should your theories prove true, I anticipate that the medical establishment would manage to refrain from drastic acts of retribution. All the best you you and your fellow- pelvic activists. Your detailed and persistent commentary continues to intrigue. Thought experiments are designed to question established theory, and by nature tend to question central assumptions, otherwise, what’s the point? Should your theories prove true, I anticipate that the medical establishment would manage to refrain from drastic acts of retribution. All the best you you and your fellow- pelvic activists.

]]> By: Louise http://www.urogynics.org/blog/2009/08/plumbing-and-renovations-preview-uterine-resuspension-and-other-hysterectomy-free-options-for-vaginal-prolapse/#comment-6 Louise Sun, 06 Sep 2009 13:19:59 +0000 http://www.urogynics.com/blog/?p=9#comment-6 In reality, for modern Western women, the pubic symphysis often doesn't provide much support for the bladder and uterus because we are encouraged to pull the tummy and butt under, and not lead the way with our breasts. This modern posture pushes the bladder and uterus backwards off the pubic symphysis. The result is that the bladder and uterus do end up resting on the pelvic floor. By reconfiguring our posture back to a more 'primitive' posture with our breasts and butt more prominently displayed and the lower belly relaxed, the bladder and uterus can fall forward onto the relaxed, front abdominal wall, underpinned by the pubic symphysis. For me, this posture definitely does throw both my bladder and uterus forwards. I have a prolapsed uterus, and significant cystocele and rectocele, and can feel the forward movement of my bladder and uterus, and the rising of my prolapses, with my own hands when I pull up into more primitive posture, compared with more androgenous, modern Western posture. I feel sure that this new upright scanning technology would enable clinicians and radiographers to see the difference and measure it for themselves. It would not be the first time that a new technology enabled fresh insight into current scientific thinking and changed 'anatomical concepts of the day'. Re Thought Experiments, I understand that Thought Experiments are not valid if they draw out a contradiction in a theory, or if they conflict with other beliefs that are held, or if they undermine a central assumption or premise. Galileo made the mistake of undermining the central premise (and widely held belief) that the sun rotated around the earth, and was excommunicated for his trouble. The only problem was that the widely held belief was ultimately proved to be false. In reality, for modern Western women, the pubic symphysis often doesn’t provide much support for the bladder and uterus because we are encouraged to pull the tummy and butt under, and not lead the way with our breasts. This modern posture pushes the bladder and uterus backwards off the pubic symphysis. The result is that the bladder and uterus do end up resting on the pelvic floor. By reconfiguring our posture back to a more ‘primitive’ posture with our breasts and butt more prominently displayed and the lower belly relaxed, the bladder and uterus can fall forward onto the relaxed, front abdominal wall, underpinned by the pubic symphysis. For me, this posture definitely does throw both my bladder and uterus forwards. I have a prolapsed uterus, and significant cystocele and rectocele, and can feel the forward movement of my bladder and uterus, and the rising of my prolapses, with my own hands when I pull up into more primitive posture, compared with more androgenous, modern Western posture. I feel sure that this new upright scanning technology would enable clinicians and radiographers to see the difference and measure it for themselves. It would not be the first time that a new technology enabled fresh insight into current scientific thinking and changed ‘anatomical concepts of the day’.

Re Thought Experiments, I understand that Thought Experiments are not valid if they draw out a contradiction in a theory, or if they conflict with other beliefs that are held, or if they undermine a central assumption or premise. Galileo made the mistake of undermining the central premise (and widely held belief) that the sun rotated around the earth, and was excommunicated for his trouble. The only problem was that the widely held belief was ultimately proved to be false.

]]> By: admin http://www.urogynics.org/blog/2009/08/plumbing-and-renovations-preview-uterine-resuspension-and-other-hysterectomy-free-options-for-vaginal-prolapse/#comment-5 admin Wed, 26 Aug 2009 01:27:50 +0000 http://www.urogynics.com/blog/?p=9#comment-5 You may be pleased to learn that much of contemporary anatomic renderings are indeed based on vertical imaging of living women using high-def sonography and dynamic MRI - women with and without prolapse, with and without incontinence - most revealing. Your concept of the pubic symphysis as a supportive shelf for the uterus is interesting. Having examined many women in the standing and upright seated position, both with and without prolapse, I am not sure that clinicians or dynamic radiologists who benefit from such a realtime-real life perspective share the belief that the boney symphysis plays any role in direct uterine or vaginal support. That said, Einstein was famous for his "thought experiments" - perhaps your anatomic opinions will yet prove true. You may be pleased to learn that much of contemporary anatomic renderings are indeed based on vertical imaging of living women using high-def sonography and dynamic MRI – women with and without prolapse, with and without incontinence – most revealing. Your concept of the pubic symphysis as a supportive shelf for the uterus is interesting. Having examined many women in the standing and upright seated position, both with and without prolapse, I am not sure that clinicians or dynamic radiologists who benefit from such a realtime-real life perspective share the belief that the boney symphysis plays any role in direct uterine or vaginal support. That said, Einstein was famous for his “thought experiments” – perhaps your anatomic opinions will yet prove true.

]]> By: Louise http://www.urogynics.org/blog/2009/08/plumbing-and-renovations-preview-uterine-resuspension-and-other-hysterectomy-free-options-for-vaginal-prolapse/#comment-4 Louise Sun, 23 Aug 2009 06:48:31 +0000 http://www.urogynics.com/blog/?p=9#comment-4 Yes, her knees are locked, aren't they? I didn't see that at first. She doesn't look very balanced; more like the figurehead on a boat. I couldn't stand like that all day. However, by relaxing back a little onto the centre of her feet, letting her hands come forward and unlocking the knees it would be pretty good posture. It is encouraging to see that you accept that posture is a, "somewhat neglected albeit active area of interest in urogynecology". How hard would it be to look for clinical evidence of the role of posture in supporting pelvic organs? If it was proved that the pubic symphysis could (or did) carry much of the vertical load of the prolapsing uterus and bladder, would that change the anatomic concepts of the day? I am not sure that the anatomic concepts of the day are wrong, simply incomplete. The configuration of the pelvic region and its organs when a woman is vertical is quite different from when she is recumbent like the cadavers on which our anatomical drawings are based. I think only good medical images or examination of active, vertical women with living, working muscles would provide information on the role of the pubic symphysis (arch?) in supporting the uterus and bladder. Simply rotating the picture to represent vertical orientation does not account for the semi-liquid behaviour of pelvic organs and how they move over each other in the pelvic cavity. BTW, I agree. The women would be much more comfortable if Dr Pancoast kept his hands to himself! Yes, her knees are locked, aren’t they? I didn’t see that at first. She doesn’t look very balanced; more like the figurehead on a boat. I couldn’t stand like that all day. However, by relaxing back a little onto the centre of her feet, letting her hands come forward and unlocking the knees it would be pretty good posture.

It is encouraging to see that you accept that posture is a, “somewhat neglected albeit active area of interest in urogynecology”. How hard would it be to look for clinical evidence of the role of posture in supporting pelvic organs? If it was proved that the pubic symphysis could (or did) carry much of the vertical load of the prolapsing uterus and bladder, would that change the anatomic concepts of the day? I am not sure that the anatomic concepts of the day are wrong, simply incomplete. The configuration of the pelvic region and its organs when a woman is vertical is quite different from when she is recumbent like the cadavers on which our anatomical drawings are based. I think only good medical images or examination of active, vertical women with living, working muscles would provide information on the role of the pubic symphysis (arch?) in supporting the uterus and bladder. Simply rotating the picture to represent vertical orientation does not account for the semi-liquid behaviour of pelvic organs and how they move over each other in the pelvic cavity.

BTW, I agree. The women would be much more comfortable if Dr Pancoast kept his hands to himself!

]]> By: admin http://www.urogynics.org/blog/2009/08/plumbing-and-renovations-preview-uterine-resuspension-and-other-hysterectomy-free-options-for-vaginal-prolapse/#comment-3 admin Fri, 21 Aug 2009 06:48:13 +0000 http://www.urogynics.com/blog/?p=9#comment-3 "Superb Womanhood" is also the closing image in my book on pelvic organ prolapse entitled <em><em>Plumbing and Renovations</em>. Ms. Superb's hyper-extended posture most certainly places her locked knees at risk,if not her pelvic organs. Our anatomic concepts of the day do not support your theory that the pubic bone would "catch" a potentially prolapsing uterus. notorious for stubbornly abiding the laws of gravity and, like running water, prone to taking the path of least resistance. Your theory about posture, however, is somewhat neglected albeit active area of interest in urogynecology with, thus far, little clinical data one way or the other. My personal favorite image detail in <em>Plumbing and Renovations </em>is the 'hand on the back' of the pair of women, one without and one with pelvic organ prolapse, on pages 42 and 43. If only the good Dr. Pancoast would remove said hand, I suspect both women would fare better. I think my grandmother, who always told me to stand up straight, relax my shoulders, pull in my stomach and tuck in my bum, had the right idea. Many thanks Louise, and best health! “Superb Womanhood” is also the closing image in my book on pelvic organ prolapse entitled Plumbing and Renovations. Ms. Superb’s hyper-extended posture most certainly places her locked knees at risk,if not her pelvic organs. Our anatomic concepts of the day do not support your theory that the pubic bone would “catch” a potentially prolapsing uterus. notorious for stubbornly abiding the laws of gravity and, like running water, prone to taking the path of least resistance. Your theory about posture, however, is somewhat neglected albeit active area of interest in urogynecology with, thus far, little clinical data one way or the other. My personal favorite image detail in Plumbing and Renovations is the ‘hand on the back’ of the pair of women, one without and one with pelvic organ prolapse, on pages 42 and 43. If only the good Dr. Pancoast would remove said hand, I suspect both women would fare better. I think my grandmother, who always told me to stand up straight, relax my shoulders, pull in my stomach and tuck in my bum, had the right idea. Many thanks Louise, and best health!

]]> By: Louise http://www.urogynics.org/blog/2009/08/plumbing-and-renovations-preview-uterine-resuspension-and-other-hysterectomy-free-options-for-vaginal-prolapse/#comment-2 Louise Wed, 19 Aug 2009 04:26:35 +0000 http://www.urogynics.com/blog/?p=9#comment-2 I couldn't help comparing the anatomical diagrams (based on cadaver orientation) that appear through the paper with the last illustration, Superb Womanhood. If Ms S Womanhood had POP I doubt that she would notice it much, because her bladder and uterus would flop forward and be supported by her pubic bone, right out of the way of her vagina. However, if she spent much of her evenings slumped in a lounge chair in front of a TV and her days driving around in a semi-recumbent car seat designed for a man, then she certainly would feel her symptoms, just like your diagrams. Perhaps posture has a crucial role in preventing symptoms from affecting a woman's life? I couldn’t help comparing the anatomical diagrams (based on cadaver orientation) that appear through the paper with the last illustration, Superb Womanhood. If Ms S Womanhood had POP I doubt that she would notice it much, because her bladder and uterus would flop forward and be supported by her pubic bone, right out of the way of her vagina. However, if she spent much of her evenings slumped in a lounge chair in front of a TV and her days driving around in a semi-recumbent car seat designed for a man, then she certainly would feel her symptoms, just like your diagrams. Perhaps posture has a crucial role in preventing symptoms from affecting a woman’s life?

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