A serendipitous cure in a 73-year-old woman of Hunner’s ulcer, urge, nocturia, apical prolapse by a tissue fixation system tensioned minisling (TFS) which reinforced the cardinal, and uterosacral ligaments (USLs) led us to analyse the relationship between Hunner’s ulcer and known pain conditions associated with USL laxity. The original intention was to cure the “posterior fornix syndrome” (PFS), uterine prolapse, and associated pain and bladder symptoms by USL repair. A speculum inserted preoperatively into the posterior fornix alleviated pain and urge symptoms, by mechanically supporting USLs. Hunner’s ulcer, along with pain and other PFS symptoms were cured by USL repair. The concept of USL laxity causing chronic pelvic pain and bladder problems is not new. It was published in the German literature by Heinrich Martius in 1938 and by Petros in the English literature in 1993. These findings raise important questions. As PFS symptoms are identical with those of interstitial cystitis (IC), are PFS and IC similar conditions? If so, then patients with IC who have a positive speculum test are at least theoretically, potentially curable by USL repair. These questions need to be explored.

1.
Hanno
P
,
Dmochowski
R
.
Status of international consensus on interstitial cystitis/bladder pain syndrome/painful bladder syndrome: 2008 snapshot
.
Neurourol Urodyn
.
2009
;
28
(
4
):
274
86
.
2.
Doggweiler
R
,
Whitmore
KE
,
Meijlink
JM
,
Drake
MJ
,
Frawley
H
,
Nordling
J
,
.
A standard for terminology in chronic pelvic pain syndromes: a report from the chronic pelvic pain working group of the international continence society
.
Neurourol Urodyn
.
2017 Apr
;
36
(
4
):
984
1008
.
3.
Meijink
J
.
2018 ESSIC meeting
.
Florence, Italy
;
2018 29 Nov–1 Dec
. Presidential Address.
4.
Wagenlehner
FM
,
Fröhlich
O
,
Bschleipfer
T
,
Weidner
W
,
Perletti
G
.
The integral theory system questionnaire: an anatomically directed questionnaire to determine pelvic floor dysfunctions in women
.
World J Urol
.
2014
;
32
(
3
):
769
81
.
5.
Wu
Q
,
Luo
L
,
Petros
P
.
Mechanical support of the posterior fornix relieved urgency and suburethral tenderness
.
Pelviperineology
.
2013
;
32
:
55
6
.
6.
Petros
PE
,
Ulmsten
UI
.
An integral theory and its method for the diagnosis and management of female urinary incontinence
.
Scand J Urol Nephrol Suppl
.
1993
;
153
(
Suppl 153
):
1
93
.
7.
Skilling
PM
,
Petros
P
.
Synergistic non-surgical management of pelvic floor dysfunction: second report
.
Int Urogynecol J Pelvic Floor Dysfunct
.
2004
;
15
(
2
):
106
10
.
8.
Goeschen
K
.
Role of uterosacral ligaments in the causation and cure of chronic pelvic pain syndrome
.
Pelviperineology
.
2015
;
34
:
2
20
.
9.
Sekiguchi
Y
,
Inoue
H
,
Liedl
B
,
Haverfield
M
,
Richardson
P
,
Yassouridis
A
,
.
Is chronic pelvic pain in the female surgically curable by uterosacral/cardinal ligament repair
.
Pelviperineology
.
2017
;
36
:
74
8
.
10.
Wagenlehner
F
,
Muller-Funogeal
I-A
,
Perletti
G
,
Abendstein
B
,
Goeschen
K
,
Inoue
H
,
.
Vaginal apical prolapse repair using two different sling techniques improves chronic pelvic pain, urgency and nocturia: a multicentre study of 1420 patients
.
Pelviperineology
.
2016
;
35
(
4
):
99
104
.
11.
Inoue
H
,
Kohata
Y
,
Fukuda
T
,
Monma
M
,
Uzawa
Y
,
Kubo
Y
,
.
Repair of damaged ligaments with tissue fixation system minisling is sufficient to cure major prolapse in all three compartments: 5-year data
.
J Obstet Gynaecol Res
.
2017
;
43
(
10
):
1570
.
12.
Petros
PP
.
Severe chronic pelvic pain in women may be caused by ligamentous laxity in the posterior fornix of the vagina
.
Aust N Z J Obstet Gynaecol
.
1996
;
36
(
3
):
351
4
.
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