54 O B .GYN. NEWS • March 1, 2005

T HE M ASTER C LASS Surgeons Respond to Pelvic Reconstruction Column ather than repudiating Dr. Grody’s opin- lthough I have the utmost respect for s editor of the Master Class columns on gynecology, Rion about laparoscopic , I will Aboth Dr. Grody and Dr. Liu and I believe AI was very proud to have C.Y. Liu, M.D., present an only respond to his point about the impor- that everyone is entitled to his or her own excellent two-part discourse on pelvic floor prolapse in the tance of the perineal membrane and PB to opinion, Dr Liu’s article is certainly not wor- October 1, 2004, and November 1, 2004, issues of OB.GYN. pelvic organ support. thy of such admonishment. NEWS. All defects should be repaired at the time of Dr. Liu not only correctly addresses nor- I subsequently received a letter to the editor from Mar- pelvic floor reconstructive surgery. Any tear or mal vaginal anatomy, clinical assessment, vin H. Terry Grody, M.D. In my mind, Dr. Grody has defect in the area of the perineal membrane and one surgeon’s approach to the anatom- raised compelling issues, especially in regard to the im- or PB should be repaired concurrently with ical correction of symptomatic prolapse, he portance of the perineal body in pelvic floor prolapse. Be- pelvic floor reconstruction. This point was does so in a concise, informative manner. cause of this, I have asked Dr. Liu and a panel of experts emphasized in the final step outlined in Part Dr. Grody’s belief that the perineal mem-

to discuss Dr. Grody’s concerns. CHARLES E. 2 of my series: “Repair the rectocele and per- brane and PB are crucial for pelvic organ sup- I trust you will find this discussion both interesting and MILLER, M.D. form perineorrhaphy vaginally if necessary.” port is indeed just that: his belief. Using the informative. Based upon my understanding of the func- PubMed search term “perineal body tional pelvic support anatomy as well as clin- surgery,” I found no scientific literature writ- CHARLES E. MILLER, M.D., a reproductive endocrinologist in private practice in Arlington ical observation, I maintain my position that ten in the past 40 years that supports the con- Heights, Ill., and Naperville, Ill., is the medical editor of this column. “the perineal membrane and perineal body cept that either the perineal membrane or are not very crucial for pelvic organ support.” the PB is crucial in the support of any organs The perineal membrane is a single layer of the . I have yet to read or find an ar- Dear Editors: The PB is a key element in the struc- of fibromuscular tissue that spans the ante- ticle that suggests that the cure rates of In the Oct. 1, 2004, issue of Ob.Gyn. tural composition of the normal vaginal rior triangle of the pelvic outlet. Laterally, it sacrospinous ligament suspension; sacral News, there appeared Part 1 of a two- axis. If significant defects in the PB are ig- attaches to the ischiopubic ramus; medially, colpopexy; paravaginal repair; uterosacral part series entitled “Laparoscopic Pelvic nored and not completely repaired to nat- it fuses with the sidewalls of the and ligament suspension; enterocele repair; or Reconstructive Surgery.” The author, C.Y. ural configuration in this commonly co- perineal body. The anterior portion of the Burch, sling, or any other prolapse corrective Liu, M.D., who is a well-reputed and existent lesion in pelvic floor anatomical perineal membrane is fused with the mus- surgery—including colpocleisis or Lefort pro- skilled laparoscopic surgeon, acceptably failure, then no matter how wonderful the cles of the distal urethra. Rather than form- cedures—are improved by repairing the PB. covered the issues of defects of the pelvic surgeon feels about his or her effort in cor- ing a supportive sheet as it does in the male, Furthermore, there is no scientific litera- supportive and suspensory mechanisms recting th