Tethered vagina syndrome

Abstract

The key to understanding the pathogenesis leading to the “Tethered vagina syndrome” and its cure by a skin graft applied to the anterior vaginal wall is to understand the importance of the three oppositely-acting directional forces which close the urethral tube and on relaxation of the forward force, open it for micturition. Any scarring from vaginal excision during “native tissue repair”, application of large mesh sheets, or overstretching by a Burch colposuspension effectively “tethers” the more powerful posterior forces to the weaker anterior force; the posterior urethral wall is pulled open exactly as happens during micturition; the patient loses urine uncontrollably typically on getting out of bed in the morning, which is the classical diagnostic symptom.