Operative guide: "Vaginal Surgery for Rookies " is in the making. Contact me if you want a free concept copy

Dear readers,
At last did I reached the stage in life which is generally classified as retirement age- although I will not be involved in active clinical practise in Terneuzen, I do plan to be available for a group of gynaecologists worldwide: in Ketering The UK, in Tilburg and Hardewijk in the Netherlands, but also in far away places like Florida and Tennessee. All free services with no financial incentive.
I also an building a youtube channel and will spend again sometime here on this forum. Please feel free to contact me at nieuwoudt@gmail.com.

Tissue Guided Regenerative Surgery

What is Prolapse?

It is quite interesting to sit back and observe the chaos what at present is raging in the minds of those who choose to keep them busy with the females who have pelvic floor damage. The simple question asked will probably have different answers. What the author is going to do is to keep it simple and a little bit stupid -and stay with only the defining of what we are dealing with.

"Prolapse" is seen as a collapse of the vaginal wall when intra abdominal pressure increase - this will present itself as a ball that comes down the cavity and in extreme circumstances protrude through the vaginal opening. This is here that the confusion starts: it is seen by most authors as a "prolapse of pelvic organs", hence the name and classifications based on the supposed organ that will be in the ball. The words POP (Pelvic Organ Prolapse), cystocoele ("sac of the bladder"), rectocoele ("sac of the rectum") -this is sometimes even sub classified as high and low- and enterocoele (" sac of the intestines") is used by most. No reference is made to the underlying reason why the vaginal wall is collapsing- the structural support of the vaginal cavity, which is in essence a tunnel that ends blindly into the abdominal cavity and is subjected to varying degrees of pressures, has weak areas on specific spots and it is through these areas that herniation of abdominal contents protrude, pushing the vaginal skin ahead of it. A comparison with abdominal wall herniations, e.g. inguinal hernias, can be made.

 It is at this simple starting point that difference of opinions arise on how to treat this " prolapsed" wall:
If seen as a "organ prolapse" the avenue to treat that will be followed is to push, or pull, this out of the cavity - the so called "colphorrhaphies" is done whereby the protruding wall is folded onto itself with removal of extra skin/tissues, or the vaginal wall is strapped to the bone skeleton (sacro colpopexy or rectopexy): no attention is given to the underlying defects that lead to the protrusion or herniation -in a sense is this a symptomatic treatment at best.
If seen as a defect in the wall that leads to the protrusion, the treatment will be focused on finding these spots of weakness and the subsequent surgery will focus on strengthening these. The surgical approach will thus aim at diagnosing , and laying bare, the defects -the better this is done, the better the chances of correcting it can be done. The definitions of these defects will thus focus on an anatomical definition which will define the area where the weakness is and not on what the supposed contents of the hernial sac is -this will thus focus on treating the cause and origin of the protruding wall, rather that attacking the sac directly with an obvious more enduring result.

In this blog the last avenue of thinking is being explored and developed.

important patient information

1. This video from the IUGA archives (www.iuga.org) shows what pressure changes happen in the post operative field during normal daily activity: it also  -hopefully- will take away all the urban legends on what a patient is allowed to do and not to do post operatively. In Regenerative Surgery the patient is advised that mobility is an important adjuvant to wound healing.

#D anatomy

https://youtu.be/P3BBAMWm2Eo

masterclass in vaginal surgery

Ik heb genoten van jouw workshop, alles was perfect : de ontvangst, het theoretisch gedeelte, de catering, het hotel cosy en comfortabel,  het diner, de organisatie in het operatiekwartier, de gemoedelijke sfeer, het contact met de andere deelnemers en last but not least jouw manier om de prolapsproblematiek te benaderen en de uitvoering ervan.  Ik ben wild enthousiast, zo wil ik het ook doen, of ik er ooit in slaag weet ik niet maar ik wil het proberen…..

I enjoyed your workshop- everything was perfect: the reception, the theoretical part, the catering, the hotel was cozy and comfortable, the dinner, the organization in the theatre, the relaxed admosphere, the contact with other colleques and las but not least the in which you approach prolapse and the way in which your surgical correction thereof is being done. I am wild enthousiastic- I want to operate also like that: if I will succeed will only be seen in the future.

C Beghin Gent Belgium

Thank you for taking the time out from your busy schedule for us and to show me (and share) your passion about regenerative tissue surgery principles as applied to pelvic floor reconstruction for the various defects. For some time now I have been questioning the 'conventional or traditional' incl. use of mesh surgeries for prolapse and considering (looking) for a viable alternative(s). Spending time next to you and watching the surgeries you have performed had shown me those 'missing' gaps in the alternative surgical techniques that I envisaged but was not sure of.

Dr Honest   Birmingham UK


This Master Class is about Regenerative Vaginal surgery: This is an alternative to conventional colphorrhaphies and Mesh kit surgery. It is bringing together the identification of the underlying pathology, the correction thereof and the utilization of regenerative native tissue protection techniques: the basic principles of tissue enginering and manipulation of wound healing is followed to enable the native tissue of the damaged vaginal wall to regenerate back to normal morphology and function. A full day of roundtable discussions and video directed theoretical presentations, is followed by live hands-on participation in theatre.
The next meeting is scheduled for7th and 8th May 2015.
contact: nieuwoudt@gmail.com