Perineology is the result of the fusion between urogynecology and
coloproctology. This "three-axis approach" is now becoming widely accepted.
Perineology is dealing with the functional troubles of the perineum
(including pain). All the diseases which are non functional of each of the
three levels (cancer, stones, polyps, hemorroids...) must be treated as
usualy by urologist, gynecologist or colo-proctologist.
The aim of Perineology is the restauration "ad integrum" of the anatomy in
the respect of biomechanics and physiology. Idealy, each defect must be
corrected without inducing troubles on the other levels (primum non nocere).
The benefit - risk ratio must be evaluated for each of the procedures.
This approach has to be interdisplinary and not multidisciplinary. There is
only one boss who must be the "architect of the perineum", somebody who
knows a lot about the anatomy and the physiology of the three axis. This new
specialist is called "perineologist". He could be the surgeon or somebody
who tells the surgeon what to do. The perineologist must have an holistic
view (integration of the psychology, the way of life, the abdominal wall
muscles... in the approach).
The functional state of the perineum can be summarized with a T.A.P.E.
(Three Axis Perineal Evaluation diagram):
urological axis = urinary incontinence-dysuria.
coloproctological axis = constipation-fecal incontinence.
If the T.A.P.E has an hexagonal shape, the result of surgery is very good. Using this tool it is possible to monitorised the degradation of the perineum with time after surgery or reeducation.
Invited presentation
FIGO 2000, Washington D.C.
september 7, SS 4.04