JCOGP
Journal of Controversies in Obstetrics & Gynecology and Pediatrics

As of January 2023, our "Journal of Controversies Obstetrics & Gynecology and Pediatrics" has been published under the Medihealth Academy to publish all articles, reviews and case reports on Pediatrics, especially in the field of Obstetrics and Gynecology. In order to facilitate the citation of the articles, to take our place in internationally respected indexes and to reach a wider readership, we will pay attention to the fact that our article language is only English in terms of acceptance.

eISSN: 2980-0579
Creative Commons CC BY-NC-ND 4.0 International License.
EndNote Style

Online Manuscript System

Index
Review
Urogynecological examination and simulated operations within the Integral Theory framework; a narrative review
Abstract
Pelvic floor dysfunction is commonly assessed using symptom-based classification and static anatomical examination; however, the relationship between pelvic floor anatomy and symptom generation is often complex. Within this context, the Integral Theory offers a functional and compartment-based framework that relates pelvic floor symptoms to defects in specific ligamentous and fascial supports. A central component of this approach is the concept of the simulated operation, in which temporary mechanical support is applied to a suspected anatomical defect to determine whether symptoms improve. This review summarizes the principles of urogynecological examination within the Integral Theory framework, with emphasis on the three vaginal zones, their associated symptom patterns, and the clinical role of simulated operations in the anterior, middle, and posterior compartments. Particular attention is given to the practical value of these maneuvers as dynamic bedside tests that help link symptoms to compartment-specific support failure. The review also discusses their relevance in contemporary urogynecological practice, especially in women with complex, overlapping, or disproportionate symptoms, as well as their limitations, including examiner dependence and subjective symptom interpretation. Simulated operations should not be viewed as stand-alone diagnostic tools, but as clinically useful adjuncts that complement history, examination, imaging, and other investigations. Within a structured diagnostic pathway, they may refine clinical reasoning, support compartment-specific management, and strengthen the functional correlation between anatomy and symptom expression.

Keywords : Integral Theory, urogynecological examination, simulated operation, stress urinary incontinence, posterior fornix syndrome

Download Article


1. Gold DM. The Integral Theory-paradigm, not hypothesis. Ann Transl Med. 2024;12(2):21. doi:10.21037/atm-23-1819
2. Petros PE, Ulmsten UI. An Integral Theory of female urinary incontinence. Experimental and clinical considerations. Acta Obstet Gynecol Scand Suppl. 1990;153:7-31. doi:10.1111/j.1600-0412.1990.tb08027.x
3. Petros PE. The female pelvic floor: function, dysfunction and management according to the integral theory. Springer; 2010.
4. Petros P, Liedl B, Palma P, Riccetto C, Ding S. A practical ligament-based diagnostic system for cure of pelvic symptoms and prolapse. Ann Transl Med. 2024;12(2):27. doi:10.21037/atm-23-1759
5. Petros P, Sivaslioglu AA, Papadimitriou J, Sekiguchi Y, Hodgson R, Palma P. Further developments of pubourethral ligament surgery for stress urinary incontinence. Ann Transl Med. 2024;12(2):31. doi:10. 21037/atm-23-1764
6. Petros PEP, Ulmsten UI. Pinch test for diagnosis of stress urinary incontinence. Acta Obstet Gynecol Scandinavica. 2002;69(153):33-35. doi: 10.1080/00016349.2002.12029240
7. Riccetto C, Palma P, Tarazona A. Clinical applications of the comprehensive theory of urinary incontinence. Actas Urol Esp. 2005; 29(1):31-40. doi:10.1016/s0210-4806(05)73195-8
8. Li JR, Lei L, Luo N, et al. Architecture of female urethral supporting structures based on undeformed high-resolution sectional anatomical images. Anat Sci Int. 2021;96(1):30-41. doi:10.1007/s12565-020-00554-y
9. Scheffler K, Hakenberg OW, Petros P. Cure of interstitial cystitis and non-ulcerating Hunner’s ulcer by cardinal/uterosacral ligament repair. Urol Int. 2021;105(9-10):920-923. doi:10.1159/000515647
10. Petros PE, Wenk MJ, Liedl B, Goeschen K, Bornstein J. The posterior fornix syndrome is an important differential diagnosis for interstitial cystitis/bladder pain syndrome. Urol Int. 2025:1-10. doi:10.1159/ 000547785
Article available in :
Volume 4, Issue 2, 2026
Page : 43-47
https://doi.org/10.51271/JCOGP-0072
Article Information
Received : 13 Mar 2026
Accepted : 26 Nis 2026
Published : 30 Nis 2026
Corresponding Author :

Alev Esercan: Department of Obstetrics and Gynecology, Trabzon University Kanuni Training and Research Hospital, Turkiye

[email protected]
Citation : Esercan A. Urogynecological examination and simulated operations within the Integral Theory framework; a narrative review. J Controv Obstetr Gynecol Ped. 2026;4(2):43-47. doi:10.51271/JCOGP-0072

Read: 56
Download : 33
Cited: 0
_Footer