Dr. Liu does not mention the important action of the levator plate or the action of the PB in this vaginal support mechanism. In fact, with a poorly supportive levator plate, as is frequently seen in vaginal prolapse patients, a well-reconstructed PB will substitute as a backstop against which the resuspended vagina can be compressed for support.
The reconstructed PB will help close off the genital hiatus at times of mechanical pelvic stress. The PB must be reconstructed in shape and bulk to support and orient the anal canal and lower third of the vagina, but also to position itself and the anal canal at or above the level of the ischial tuberosities.
As Dr. Liu implies, we cannot repair or completely rehabilitate damaged and weakened pelvic floor muscles and their innervations. We should surgically reconstruct a disrupted PB. I do feel that Dr. Liu does indeed perform perineoplasty on many of his prolapse patients. He simply emphasized the reconstruction and proper placement of the pericervical ring in his excellent article.
MARVIN H. TERRY GRODY, M.D., is a professor of obstetrics and gynecology and senior attending gynecology consultant, Robert Wood Johnson Medical School at Camden (N.J.).
C.Y. LIU, M.D., is the director of the Manhattan Women's Laser Center, New York.
JOHN R. MIKLOS, M.D., is the director of the Atlanta Center for Laparoscopic Urogynecology.
VINCENT R. LUCENTE, M.D., is chief of urogynecology at Abington (Pa.) Memorial Hospital and associate professor of ob.gyn. at Pennsylvania State Medical Center, Hershey.
ROBERT M. ROGERS JR., M.D., is an attending gynecologist at the Reading Hospital and Medical Center in West Reading, Pa.