A new look at pelvic relaxation.

The concept is presented that most cystoceles and/or urethroceles result from insolated defects in the connective tissue supports of the anterior quadrant of the pelvis. Four areas in which defects have been found to occur are identified. Sixty patients are presented who were found to have isolated defects in the endopelvic fascia at the lateral sidewall of the pelvis with significant cystourethroceles and stress urinary incontinence. The surgical treatment consisted only of a direct approach to and closure of the isolated defect. The operative results at 3 to 48 months were excellent in 91.7 per cent, improved in 5 per cent, and failed in 3.3 per cent. Discussion is offered of the possibility of the study of the pelvic floor from the viewpoint of a mechanical engineer.