PELVIC FLOOR DISORDERS : a multidisciplinary textbook.

• Publisher: SPRINGER
• Year: 2020
• Tongue: English
• Leaves: 1164
• Edition: 2
• Category: Library

✦ Table of Contents

Foreword
Preface
Contents
Contributors
Part I: State of the Art Pelvic Floor Anatomy
1: Pelvic Floor Anatomy
1.1 Introduction
1.1.1 Support of the Pelvic Organs: Conceptual Overview
1.2 Anatomy and Prolapse
1.2.1 Overview
1.2.2 Apical Segment
1.2.3 Anterior Compartment
1.2.4 Perineal Membrane (Urogenital Diaphragm)
1.2.5 Posterior Compartment and Perineal Membrane
1.2.6 Lateral Segment Comprising of the Levator Ani Muscle Support
1.2.7 Endopelvic Fascia and Levator Ani Interactions
1.2.8 The Levator Plate
1.2.9 Interaction Between Different Compartments
1.2.10 Nerves
1.3 Summary
References
2: Biochemical Properties and Hormonal Receptors of Pelvic Floor Tissues
2.1 Introduction: How Complicated Is That?
2.1.1 The Role of Reproductive Hormones on the Pelvic Floor Function During the Life Span
2.1.2 Hormonal Changes and Pelvic Floor Symptoms
2.2 The Role of Biochemical Properties and Hormonal Receptors of Pelvic Floor Tissues in Epidemiology of Pelvic Floor Function
2.2.1 Sexual Hormone Receptors
2.2.2 Biochemical Properties of Pelvic Floor Tissues
2.2.2.1 Collagen of Pelvic Floor Tissues
Anterior Vaginal Wall
Periurethral Tissue
Cardinal Ligaments
Uterosacral Ligament
Endopelvic Fascia
The Arcus Tendineus Fasciae Pelvis (ATFP)
Elastin
2.2.3 The Role of Matrix Metalloproteinases (MMPs) on Pelvic Floor Tissue Remodeling
2.3 The Recent Investigations and Possibilities for Future Research
2.4 Hormonal Impact on Vaginal Atrophy, the Role on Pelvic Floor Dysfunction, and Treatment
2.4.1 Conclusion: Hormone Therapy
2.5 Summary and Recommendations for Practice
References
3: The Integral System of Pelvic Floor Function and Dysfunction
3.1 Introduction
3.2 The Integral Theory of Pelvic Floor Function
3.3 The Integral System
3.4 Part 1: Pubourethral Ligament: How the Midurethral Sling Was Discovered
3.4.1 Development of the Artificial Collagenous Neoligament for PUL Repair
3.4.2 Application of the Neoligament Surgical Principle to PUL and Other Ligaments
3.4.3 Clinical Relevance of Some Initial MUS Operation Findings (1988–1989)
3.4.4 Closure of the Urethra
3.4.5 Role of PUL and Subsidiary Structures in Normal Urethral Closure and Incontinence
3.4.6 Role of Lax PUL in the Causation of Urinary Stress Incontinence
3.4.7 External Urethral Ligament Laxity: A Rarely Recognized Cause of Nonstress Urine Leakage
3.4.8 Anorectal Closure
3.4.9 Serendipity: Cure of Fecal Incontinence (FI) Following PUL and USL Sling Repair
3.4.10 Surgical Repair of PUL by MUS
3.4.11 Surgical Results for PUL Repair (Midurethral Sling)
3.4.12 Zone of Critical Elasticity: Tethered Vagina Syndrome and Role of Fibrosis in Incontinence After Post-obstetric Fistula Repair
3.5 Part 2: The Uterosacral Ligament “USL”: Cure of Uterine Prolapse with Posterior Sling
3.5.1 Role of USL in Micturition
3.5.2 Role of USL in Normal Defecation
3.5.3 Lax USLs: Anatomical Pathways to Pain, Bladder, and Bowel Dysfunction
3.5.4 Lax USLs: Role in “Obstructive Micturition and Defecation” (Organ Emptying Problems)
3.5.5 Lax USL: Pathways from Ligament Laxity to Symptoms of Urge, Frequency, and Nocturia
3.5.6 Lax USL: Anatomical Pathway to Chronic Pelvic Pain
3.6 Part 3: Cardinal Ligament (CL): Its Role in Cystocele Causation
3.7 Part 4: ATFP: Role in Lateral Cystocele and Urinary Stream Diversion
3.8 Part 5: Deep Transversus Perinei (DTP): Role in Rectocele and Descending Perineal Syndrome
3.8.1 Anatomical and Surgical Significance of DTP Ligaments
3.8.2 PB Function Is Linked to USL Function
3.8.3 Surgical Principles Derived from the Integral System
3.8.4 Complications of Total Ligament Repair Surgery Using the TFS Tensioned Mini Sling
3.8.5 Role of Muscle in Continence Control
3.8.6 Muscle, Ligament, or Both?
3.8.7 The Three-Muscle, 3-Month Pelvic Floor Muscle Strengthening Study
3.8.8 Is Rectopexy or Sacrocolpopexy (SCP) an Anatomically Correct Method for Restoration of Rectal Intussusception and Rectal Prolapse?
3.9 Conclusion
References
4: The Pelvic Floor: Neurocontrol and Functional Concepts
4.1 Introduction
4.2 The Urinary and Recto-Anal Systems
4.3 Urinary and Faecal Storage and Voiding
4.3.1 Bladder Equilibrium
4.3.2 The Lumbosacral Loop
4.3.3 The Pontine Loop
4.3.4 The Cortical System
4.3.5 Central Representation of Afferent Information from Bladder and Bowel
4.3.6 Universal Organisation of CNS Control Systems
4.4 The Pelvic Floor and Its Innervation
4.5 Pelvic Floor Dysfunction in Incontinence
4.6 Investigation of the Pelvic Floor
4.7 Urinary Storage: The Default Mode
4.8 Urethral Opening: Voiding
4.9 The Bladder Trigone During Micturition
4.10 Neurological Feedback Control of Anorectal Function
4.11 When Things Go Wrong: Urge, Frequency, and Nocturia
4.12 Overactive Bladder Syndrome (OAB)
4.13 How Does Detrusor Overactivity Relate to Feedback Control?
4.14 Events Occurring in Detrusor Overactivity and Overactive Bladder Syndrome
4.15 Non-linear Flow Mechanics Enhance the Storage and Voiding Responses
4.16 Why Urodynamic Urethral Pressure Measurements Correlate Poorly with Clinical States
4.17 How Repeatable Are Urine Flow Measurements in an Individual?
4.18 Detrusor Underactivity
4.19 Low Bladder Compliance
4.20 Clinical Variations in Bladder Symptoms Are Consistent with the Chaos Theory Feedback Equation
4.21 Concluding Remarks
References
Part II: Pelvic Floor Imaging
5: Principles and Technical Aspects of Integrated Pelvic Floor Ultrasound
5.1 Introduction
5.2 Principles of Pelvic Floor Ultrasound
5.3 Two-Dimensional Transperineal Ultrasound (2D TPUS)
5.3.1 Convex Transducers
5.3.2 Linear/Microconvex Transducers
5.4 Three-Dimensional/Four-Dimensional Transperineal Ultrasound (3D/4D TPUS)
5.4.1 Volumetric Transducers
5.5 Two-Dimensional Endovaginal Ultrasound (2D EVUS)
5.6 Three-Dimensional Endovaginal Ultrasound (3D EVUS)
5.7 Two-Dimensional Endoanal Ultrasound (2D EAUS)
5.8 Three-Dimensional Endoanal Ultrasound (3D EAUS)
5.9 Conclusions
References
6: Transperineal Ultrasonography: Methodology and Normal Pelvic Floor Anatomy
6.1 Introduction
6.2 Basic Technique
6.3 The Anterior Compartment: Urethra and Bladder Base
6.3.1 The Urethra
6.3.2 Paraurethral Tissues
6.3.3 The Bladder Neck and Trigone
6.4 The Fornices
6.5 The Central Compartment: Uterus and Vault
6.6 The Posterior Compartment
6.6.1 Normal Anatomy in the Midsagittal Plane
6.6.2 The Perineal Body/Transversus Perinei
6.6.3 The Rectovaginal Septum
6.6.4 The Anal Canal on Tomographic Imaging
6.7 The Levator Ani Muscle
6.7.1 2D Imaging
6.7.2 Axial Plane
6.7.3 Multislice Imaging
6.8 Static Versus Dynamic “Normality”
6.9 Urethral Mobility and Bladder Neck Configuration
6.10 Pelvic Organ Descent
6.11 Hiatal Dimensions
6.12 Conclusions
References
7: Endovaginal Ultrasonography: Methodology and Normal Pelvic Floor Anatomy
7.1 Introduction
7.2 Technical Aspects of 3D Endovaginal Ultrasound
7.3 Ultrasonographic Anatomy of the Pelvic Floor
7.4 Assessment of the Anterior Compartment
7.5 Assessment of the Posterior Compartment
7.6 Discussion
7.7 Conclusion
References
8: Endoanal and Endorectal Ultrasonography: Methodology and Normal Anorectal Anatomy
8.1 Introduction
8.2 Ultrasonographic Technique
8.3 Endosonographic Anatomy of the Anal Canal
8.4 Endosonographic Anatomy of the Rectum
8.5 Normal Values
8.6 Conclusions
References
9: Technical Innovations in Pelvic Floor Ultrasonography
9.1 Introduction
9.2 Volume Render Mode
9.3 Maximum Intensity Projection
9.4 Brush Options: Segmentation—Sculpting
9.5 Fusion Imaging
9.6 PixelFlux
9.7 Framing
9.8 Motion Tracking and Color Vector Mapping
9.9 Elastography
9.9.1 Endovaginal Elastography
9.9.2 Endoanal Elastography
9.10 Contrast-Enhanced Ultrasound (CEUS)
9.10.1 Rectal Cancer
9.10.2 Contrast-Enhanced Voiding Urosonography (ceVUS)
9.10.3 Contrast-Enhanced Ultrasound Genitography
9.11 Automatic Ultrasound Calculation Systems
9.12 Conclusions
References
10: Magnetic Resonance Imaging: Methodology and Normal Pelvic Floor Anatomy
10.1 Introduction
10.2 The Anatomy of the Female Pelvic Floor
10.3 The Anterior Compartment
10.4 The Middle Compartment
10.5 The Posterior Compartment
10.5.1 The Posterior Compartment Contains the Rectum and Anal Sphincter
10.5.1.1 The Internal Anal Sphincter
10.5.1.2 The Intersphincteric Space and Longitudinal Layer
10.5.1.3 The Outer Striated Layer: External Anal Sphincter
10.5.1.4 The Outer Striated Layer: Puborectal Muscle
10.5.1.5 Anal Sphincter Support
10.6 The Endopelvic Fascia
10.7 The Pelvic Diaphragm
10.7.1 The Levator Ani Muscle
10.7.2 The Ischiococcygeus Muscle
10.8 The Perineal Membrane (Urogenital Diaphragm)
10.9 Conclusion
References
11: Dynamic Magnetic Resonance Imaging of the Pelvic Floor: Technique and Methodology
11.1 Introduction
11.2 Patient Positioning
11.3 Patient Preparation
11.4 Imaging Protocol
11.5 Image Analysis
11.5.1 Three-Compartment Model
11.5.2 Reference Systems
11.5.3 Anorectal Angle
11.5.4 Evacuation Ability
11.6 Normal Findings
11.7 Conclusion
References
Part III: Obstetric Pelvic Floor and Anal Sphincter Trauma
12: Mechanisms of Pelvic Floor Trauma During Vaginal Delivery
12.1 Biomechanics of the Second Stage of Labor
12.2 Injury from Vaginal Birth
12.3 Mechanisms of Levator Muscle Injury
12.4 Effect of Pregnancy on Pelvic Floor Tissue Properties
12.5 Finite Element Models of Vaginal Birth
12.6 Other Approaches to Modeling Vaginal Birth
12.7 Pudendal Nerve Stretch During Vaginal Birth
12.8 Effect of Forceps on Cephalolevator Disproportion
12.9 Effect of Maternal Pushing Styles During the Second Stage
12.10 Conclusions
References
13: Posterior Compartment Trauma and Management of Acute Obstetric Anal Sphincter Injuries
13.1 Introduction
13.2 Rectoceles
13.3 Obstetric Anal Sphincter Injuries (OASIS)
13.3.1 Applied Anatomy and Physiology
13.3.2 Diagnosis of OASIS
13.3.3 Repair of OASIS
13.3.4 Timing of Repair
13.3.5 Technique of Repair
13.3.6 Repair of Rectal Buttonhole Tear
13.3.7 Suture Material
13.3.8 Role of Antibiotics
13.3.9 Stool Softeners
13.3.10 Postoperative Catheterization
13.3.11 Postoperative Analgesia
13.3.12 Follow-Up
13.3.13 Anal Incontinence Symptoms After Primary Repair
13.3.14 Management of Subsequent Pregnancies
13.3.15 Training Issues
13.4 Conclusions
References
14: Neurogenic Trauma During Delivery
14.1 Introduction
14.2 Neural Anatomy
14.3 Pudendal Neuropathy
14.4 Mechanism of Nerve Injury
14.5 Measuring Nerve Injury
14.6 Striated Urethral Sphincter
14.7 External Anal Sphincter
14.8 Levator Ani Musculature
14.9 Conclusions
References
15: Prevention of Perineal Trauma
15.1 Introduction
15.2 Interventions in the Antenatal Period
15.2.1 Antepartum Perineal Massage
15.2.2 Pelvic Floor Muscle Training
15.3 Interventions During Labor and Birth
15.3.1 Water Birth
15.3.2 Position During Labor and Birth
15.3.3 Application of Warm Perineal Compresses in the Second Stage of Labor
15.3.4 Manual Perineal Protection (MPP)
15.3.5 Second Stage Perineal Massage
15.3.6 Episiotomy
15.3.7 Instrumental Delivery
15.3.8 Epidural Analgesia
15.3.9 Interventions to Correct or Deliver with an Occipito-Posterior Position
15.4 Conclusions
References
Part IV: Urinary Incontinence and Voiding Dysfunction
16: Overview: Epidemiology and Etiology of Urinary Incontinence and Voiding Dysfunction
16.1 General Comments and Definitions
16.2 Prevalence of Urinary Incontinence
16.3 Factors Influencing the Prevalence of Urinary Incontinence
16.4 OAB and Other LUTS
16.5 Public Health Consequences of UI and LUTS on a Global Scale
16.6 Voiding Dysfunction
16.7 Overall Conclusion
References
17: Urinary Incontinence and Voiding Dysfunction: Patient-Reported Outcome Assessment
17.1 Introduction
17.2 Development of a PRO
17.3 Linguistic and Cultural Validation
17.4 Types of PROs
17.4.1 Symptom Frequency and Bother
17.4.2 Discomfort and ADL
17.4.3 Treatment Satisfaction
17.4.4 Productivity
17.4.5 QALY
17.4.6 Types for Urinary Problems
17.4.7 Health-Related Quality of Life (HRQL) PRO
17.4.8 PROs for LUTS in Women: Symptom Bother and Urgency
17.4.9 Screening Questionnaires
17.5 International Consultation on Incontinence Modular Questionnaire (ICIQ)
17.6 Voiding Dysfunction
17.7 Limitations of PRO
17.8 Future of PRO
17.9 Conclusion
References
18: Urodynamics Techniques and Clinical Applications
18.1 Introduction
18.2 Urodynamic Techniques
18.2.1 Free Uroflowmetry and Measurement of Post-void Residual Volume
18.2.2 Evaluation of Storage Function: Filling Cystometry
18.2.3 Evaluation of Voiding Function: Pressure-Flow Studies or Voiding Cystometry
18.2.4 Video-Urodynamics
18.2.5 Ambulatory Urodynamics
18.2.6 Urethral Pressure Profilometry
18.3 Clinical Applications
18.3.1 Overactive Bladder
18.3.1.1 Free Uroflowmetry and Measurement of Post-void Residual Volume
18.3.1.2 Filling Cystometry
Detrusor Overactivity
Reduced Bladder Compliance
18.3.2 Stress Urinary Incontinence
18.3.2.1 Free Uroflowmetry and Measurement of Post-void Residual Volume
18.3.2.2 Assessment of Urethral Function
Urethral Pressure Profilometry
Abdominal Leak Point Pressure
18.3.2.3 Pelvic Organ Prolapse
18.3.3 Underactive Bladder and Detrusor Underactivity
18.3.3.1 Free Uroflowmetry and Measurement of Post-void Residual Volume
18.3.3.2 Pressure-Flow Studies
18.3.4 Bladder Outlet Obstruction
18.4 Future Perspectives
18.5 Conclusions
References
19: Ultrasonographic Techniques and Clinical Applications
19.1 Introduction
19.2 External Ultrasound
19.2.1 Examination Technique
19.3 Endoluminal Ultrasound
19.3.1 Examination Technique
19.4 Discussion
19.5 Conclusions
References
20: Biofeedback
20.1 Introduction
20.2 Purpose of Using Biofeedback
20.3 Effect of Biofeedback Training
20.4 Clinical Recommendations for the Use of Biofeedback
20.5 Conclusion
References
21: Selection of Midurethral Slings for Women with Stress Urinary Incontinence
21.1 Introduction
21.2 Other Types of Retropubic Midurethral Slings
21.2.1 Top-Down Systems
21.2.2 Intravaginal Slingplasty (IVS)
21.2.3 Self-Made Slings
21.2.4 Overview
21.3 Other Approaches for Sling Placement
21.3.1 The Transobturator Route
21.3.2 Outside-In Versus Inside-Out
21.3.3 Retropubic Versus Obturator
21.4 Predictors of Failure
21.4.1 Intrinsic Sphincter Deficiency
21.4.2 Effect of MUS on Lower Urinary Tract Function
21.4.3 The Elderly
21.4.4 The Obese
21.5 Biological Slings and Exitless Slings
21.5.1 Exitless Mini-Sling
21.6 Surgeon-Related Factors
21.7 Summary
21.8 Conclusions
References
22: Tape Positioning: Does It Matter?
22.1 Introduction
22.2 The Theoretical Basis for Midurethral Sling Placement
22.3 Proposed Mechanism of Action of the Midurethral Tape
22.3.1 The Controversy Regarding Sling Location and the Evidence on the Importance of Sling Location
22.3.2 Evidence in Favor of Primacy of Location in the Continence Mechanism of Midurethral Slings
22.3.3 The Benefits of Determining the Location of a Failed Sling
22.4 Does the Position of the Sling Change After Implantation?
22.5 If Location of the Sling Is Important, Does Suture Fixation of the Sling upon Implantation Help?
22.6 What Explains Successful Outcomes Following Sling Surgery in Patients in Whom the Sling Is Not Located Midurethrally? Dynamic Functional Assessment of Slings and Its Correlation with Outcome
22.7 Tape Position and Postoperative Complications
22.8 Future Directions
22.9 Conclusion
References
23: Colposuspension and Fascial Sling
23.1 Introduction
23.2 Colposuspension
23.2.1 Historical Background
23.2.2 Mechanism Action
23.2.3 Surgical Technique of the Modern Colposuspension
23.2.4 Indications
23.2.5 Contraindications
23.2.6 Complications
23.3 Fascial Sling
23.3.1 Historical Background
23.3.2 Mechanism of Action
23.3.3 Variation in Surgical Technique of the Autologous Fascial Sling
23.3.3.1 The Original Aldridge Sling
23.3.4 Indications for a Fascial Sling
23.3.5 Contraindications
23.4 Outcomes of Colposuspension and Fascial Sling
23.5 Is Laparoscopic Colposuspension as Effective as Open?
23.6 Do the Sutures Used for a Colposuspension Affect Outcome?
23.7 Is Colposuspension as Effective as an Autologous Fascial Sling?
23.8 Is the Sling on a String as Effective as the Traditional Aldridge Sling?
23.9 Is a Shorter Sling on a String as Effective as a Full Length Detached Sling?
23.10 Is an Autologous Sling Better at the Mid-Urethra or the Bladder Neck?
23.11 Is Fascia Lata as Effective as Rectus Sheath Fascia?
23.12 Are Allografts as Effective as Autologous Slings?
23.13 Are Xenograft Slings as Effective as Autologous Slings?
23.14 Conclusion
References
24: Injectable Biomaterials
24.1 Introduction
24.2 Safety of Urethral Bulking Agents
24.3 Efficacy of Urethral Bulking Agents
24.4 Future Directions
24.5 Conclusions
References
25: Artificial Urinary Sphincter in Women
25.1 Introduction
25.2 Artificial Urinary Sphincter
25.3 Indications
25.4 Contraindications
25.5 Operation
25.5.1 Preoperative Counselling and Preparation
25.5.2 Open Procedure for Insertion of AUS
25.5.2.1 Abdominal Approach
25.5.2.2 Vaginal Approach
25.5.2.3 Laparoscopic Extra-Peritoneal Approach for Insertion of AUS in Women
Patient Preparation
25.6 Complications
25.6.1 Per-operative Complications
25.6.1.1 During Trocar Placement
25.6.2 Early Post-operative Complications
25.6.2.1 Urinary Retention
25.6.2.2 Infection and Extrusion of the Prosthesis
25.6.3 Late Post-operative Complications
25.6.3.1 Urethral Atrophy, Erosion or Extrusion
25.6.3.2 Mechanical Failure
25.6.3.3 Recurrent/Persistent Urinary Incontinence
25.7 Brief Review of the Literature About AUS Implantation in Women
25.7.1 Open Procedure
25.7.2 Laparoscopic Procedure
25.7.3 Robot-Assisted Artificial Urinary Sphincter Insertion
25.8 Conclusion
References
26: Pharmacological Treatment of Urinary Incontinence and Overactive Bladder: The Evidence
26.1 Introduction
26.2 Pathophysiology
26.2.1 Muscarinic Receptors
26.3 Detrusor Overactivity
26.3.1 Outflow Obstruction Hypothesis
26.3.2 Neurogenic Hypothesis
26.3.3 Urethral Reflex
26.3.4 Myogenic Hypothesis
26.3.5 Urothelial Afferent Hypothesis
26.4 Clinical Presentation
26.5 Investigation
26.5.1 Urodynamic Investigations
26.5.2 Cystourethroscopy
26.6 Conservative Management
26.6.1 Bladder Retraining
26.7 Medical Management
26.8 Antimuscarinics
26.8.1 Oxybutynin
26.8.2 Tolterodine
26.8.3 Trospium Chloride
26.8.4 Solifenacin
26.8.5 Darifenacin
26.8.6 Fesoterodine
26.8.7 Propiverine
26.9 Anticholinergic Burden
26.10 β-Adrenoceptors and OAB
26.10.1 Mirabegron
26.10.2 Combination Therapy: Mirabegron and Solifenacin
26.10.3 Desmopressin
26.11 Oestrogens in the Management of Overactive Bladder
26.11.1 Combination Therapy: Oestrogens and Antimuscarinics
26.12 Conclusions
References
27: Intravesical Botulinum Toxin for the Treatment of Overactive Bladder
27.1 Introduction
27.2 Recommendation for Practice
27.2.1 Injection Procedure
27.2.2 Neurogenic Detrusor Overactivity (NDO) Treatment with OnabotulinumtoxinA
27.2.3 Overactive Bladder Treatment with OnabotulinumtoxinA
27.3 Future Directions
27.4 Conclusion
References
28: Sacral Nerve Stimulation for Overactive Bladder and Voiding Dysfunction
28.1 Historical Overview
28.2 Mode of Action
28.3 Indications
28.4 Selection Criteria
28.5 Implant Technique
28.6 Results
28.7 Predictive Factors
28.8 Complications
28.9 Newer and Investigational (Experimental) Neuromodulation Techniques
28.10 Conclusions
References
Part V: Anal Incontinence
29: Overview: Epidemiology and Aetiology of Anal Incontinence
29.1 Introduction
29.2 Epidemiology of Anal Incontinence
29.2.1 Prevalence
29.2.2 How Future Estimates of Prevalence May Be Affected
29.2.3 Incidence
29.2.4 Risk Factors
29.2.5 Future Directions
29.3 Aetiology of Anal Incontinence
29.3.1 Continence
29.3.2 Incontinence
29.3.3 Risk Factors for Incontinence
29.3.3.1 Age
29.3.3.2 Nursing Home Residence
29.3.3.3 Gender
29.3.3.4 Childbirth
Mechanisms for Anal Incontinence After Childbirth
Epidemiology of Anal Incontinence After Childbirth
29.3.3.5 Urinary Incontinence
29.3.3.6 Diabetes
29.3.3.7 Gastrointestinal Disorders and Stool Consistency
Diarrhoea
Rectal Urgency
Constipation/Faecal Impaction
Irritable Bowel Syndrome
29.3.3.8 Neurological/Psychiatric Disorders
Dementia
Depression
29.3.3.9 Nutrition
Obesity
Vitamin D
29.3.3.10 Physical Mobility
29.3.3.11 Radiation
29.3.3.12 Prolapse
29.3.3.13 Surgery
Anorectal Surgery
Rectal Resection
Other Surgeries
Ureterosigmoidostomy
Hysterectomy
Cholecystectomy
29.3.3.14 Smoking
29.3.4 Future Directions
References
30: Patient-Reported Outcome Assessment in Anal Incontinence
30.1 Introduction
30.2 Development of PROMs
30.3 Evaluation of Reliability, Validity, and Responsiveness of PROMs
30.4 Anal or Fecal Incontinence Symptom Severity Scales
30.5 Anal or Fecal Incontinence-Specific Quality of Life Questionnaire
30.6 Combined Questionnaire of Anal Incontinence Severity Scale and Anal Incontinence-Specific Quality of Life Questionnaire
30.7 Recommendation for Practice in Choosing Appropriate PROMs for Anal Incontinence
30.8 Future Directions
References
31: Anorectal Manometry
31.1 Introduction
31.2 Manometric Data
31.3 Anorectal Manometry and Fecal Incontinence
31.4 Anorectal Manometry and Pelvic Floor Rehabilitation
31.5 High-Resolution Manometry and High-Definition Three-Dimensional Anorectal Manometry
References
32: Endoanal Ultrasonography in Anal Incontinence
32.1 Introduction
32.2 Internal Anal Sphincter Abnormalities
32.3 External Anal Sphincter Abnormalities
32.4 Puborectalis Muscle Abnormalities
32.5 Accuracy and Reliability
32.6 EAUS Versus EVUS and TPUS
32.7 EAUS Versus MRI
32.8 Current Recommendations for Research for EAUS
32.9 Conclusions
References
33: Transperineal Ultrasonography in the Assessment of Anal Incontinence and Obstetric Anal Sphincter Injuries
33.1 Introduction
33.2 Recommendations for Practice
33.2.1 Endovaginal Ultrasound (EVUS)
33.2.2 Transperineal Ultrasound (TPUS)
33.2.2.1 2D-TPUS
33.2.2.2 3D-TPUS
33.3 Conclusions
References
34: Magnetic Resonance Imaging
34.1 Introduction
34.2 Technique
34.2.1 MRI Coil
34.2.2 Preparation
34.2.3 Imaging Protocol
34.3 MRI Findings
34.4 Accuracy for Sphincter Defects
34.5 Accuracy for Sphincter Atrophy
34.6 MRI in the Management of Fecal-Incontinent Patients
34.7 Conclusions
References
35: Neurophysiological Evaluation: Techniques and Clinical Evaluation
35.1 Introduction
35.2 Neural Control of Colorectal Motility
35.3 Nerve Conduction Studies
35.4 Pudendal Nerve Terminal Motor Latency (PNTML)
35.5 Electromyography (EMG)
35.6 Developments Neurophysiological Investigations
35.7 Cortical Evoked Potentials (CEP)
35.8 Motor Evoked Potentials
35.9 Mucosal Blood Flow: Laser Doppler Flowmetry (LDF)
35.10 Sacral Nerve Stimulators
35.11 Conclusion
References
36: Behavioral Therapies and Biofeedback for Anal Incontinence
36.1 Introduction
36.2 Etiological Factors
36.3 Factors Predicting Response to Pelvic Physiotherapy
36.4 Diagnostic Process
36.4.1 Measurement Instruments
36.4.2 Physical Examination
36.5 Physiotherapy Analysis/Diagnosis
36.6 Therapeutic Process
36.7 Evaluation
36.8 Updating the Evidence After Publication of the Dutch Evidence Statement
36.8.1 Prior (2013) Assessment of Electrical Stimulation of the Anal Mucosa or Perineum
36.8.2 Prior (2013) Assessment of Pelvic Floor Muscle Exercises
36.8.3 Prior (2013) Assessment of Biofeedback Therapy
36.9 Update: Review of Evidence from January 2012 to May 2016
36.10 Conclusions
36.11 Spin Off
36.12 Recommendations for Practice
36.13 Future Directions
References
37: Sphincter Repair and Postanal Repair
37.1 Introduction
37.2 Diagnostic Workup
37.3 Indications
37.4 Surgical Technique
37.5 Technical Considerations at Surgery
37.5.1 Overlapping vs. End-to-End Repair
37.5.2 Separate Suturing of External and Internal Sphincters
37.5.3 Scar Tissue
37.5.4 Suture Material
37.5.5 Diverting Stoma
37.6 Other Considerations
37.6.1 Primary Repair vs. Sphincteroplasty
37.6.2 Failed Primary Repair
37.6.3 Age
37.6.4 Pudendal Neuropathy
37.6.5 Biofeedback
37.6.6 Concomitant Perineal Operations
37.6.7 Alternative Surgical Options
37.6.8 Financial Aspects
37.7 Measurement of Outcomes After Sphincteroplasty
37.7.1 Descriptive Measures
37.7.2 Severity Measures
37.7.3 Impact Measures
37.8 Results of Sphincteroplasty
37.8.1 Short-Term Results
37.8.2 Long-Term Results
37.9 Sexual Function After Sphincteroplasty
37.10 Postanal Repair
References
38: Dynamic Graciloplasty
38.1 Introduction
38.2 Perioperative Assessment
38.2.1 Indications for Graciloplasty
38.2.2 Contraindications to Graciloplasty
38.3 Technique
38.4 Outcomes and Complications of Dynamic Graciloplasty
38.5 Adynamic Graciloplasty
38.6 Total Anorectal Reconstruction (TAR)
38.7 Conclusion
References
39: Injectable and Implantable Biomaterials for Anal Incontinence
39.1 Introduction
39.2 Types of Agents Used
39.3 Technique
39.4 Safety and Adverse Events
39.5 Efficacy
39.6 Anorectal Physiology and Endoanal Ultrasound
39.7 Discussion
39.8 Conclusions
References
40: Sacral Neuromodulation for Fecal Incontinence
40.1 Introduction
40.2 Technique and Its Evolution
40.3 Mechanism of Action
40.4 Indications
40.5 Prognostic Factors of Outcome
40.6 Outcome
40.7 Future Directions
References
41: Posterior Tibial Nerve Stimulation for Faecal Incontinence
41.1 Introduction
41.2 Percutaneous PTNS
41.3 Transcutaneous PTNS
41.4 Mechanism of Action
41.5 Percutaneous PTNS vs. Sacral Nerve Stimulation
41.6 Percutaneous PTNS vs. Transcutaneous PTNS
41.7 PTNS vs. Sham
References
42: Radiofrequency
42.1 Introduction
42.2 Recommendations for Practice
42.2.1 Technique (Fig. 42.1)
42.2.2 Complications
42.2.3 Results
42.3 Future Directions
References
43: Other Surgical Options for Anal Incontinence: From End Stoma to Stem Cell
43.1 Introduction
43.2 Sphincter Replacing Procedures
43.3 Muscle Transposition Techniques
43.4 Gluteoplasty (Gluteus Maximus Plasty)
43.5 Dynamic Gluteoplasty
43.6 Graciloplasty
43.7 Dynamic Graciloplasty
43.8 Artificial Bowel Sphincter (ABS)
43.9 Magnetic Anal Ring
43.10 Stem Cell Transposition
43.11 Anal Plugs
43.12 Colostomy
43.13 Conclusion
References
44: Treatment of Anal Incontinence: Which Outcome Should We Measure?
44.1 Introduction
44.2 Symptom Assessment
44.2.1 Symptom Severity Questionnaires
44.2.1.1 The Jorge-Wexner Score
44.2.1.2 The St Mark’s Incontinence Score
44.2.1.3 The Revised Faecal Incontinence Scale
44.2.1.4 The Faecal Incontinence Severity Index (FISI)
44.2.2 Symptom Severity Questionnaires Designed to Assess Outcomes for Rectal Cancer Treatment
44.2.2.1 The Low Anterior Resection Syndrome Score (LARS Score)
44.2.2.2 The Memorial Sloan Kettering Cancer Center (MSKCC) Bowel Function Instrument
44.2.3 Diary Monitoring
44.2.4 Quality of Life Questionnaires
44.2.4.1 The Rockwood Scale (FIQL)
44.2.5 The Combined Assessment of Symptom Severity and Quality of Life
44.2.5.1 The Rapid Assessment Faecal Incontinence Score (RAFIS)
44.2.5.2 ICIQ-BS
44.2.6 Visual Analogue Scores
44.2.7 Interview Assessment
44.3 Anorectal Structure and Function
44.3.1 Anorectal Physiology
44.3.1.1 Anorectal Manometry
44.3.1.2 Sensory Measurements
44.3.1.3 Neurophysiology
44.3.2 Saline Continence Tests or Porridge Enema
44.3.3 Imaging
44.3.3.1 Endoanal Ultrasound
44.3.3.2 MRI
44.4 Future Directions
References
Part VI: Pelvic Organ Prolapse
45: Epidemiology and Etiology of Pelvic Organ Prolapse
45.1 Definition and Classification
45.2 Prevalence and Incidence
45.3 Risk Factors and Pathophysiological Mechanisms
45.3.1 Ethnicity
45.3.2 Familiarity and Other Genetic Risk Factors
45.3.3 Obstetric Factors
45.3.4 Age and Hormonal Status
45.3.5 Socioeconomic Factors
45.3.6 General Medical Conditions
45.3.7 Previous Pelvic Surgery
References
46: Patient-Reported Outcomes and Pelvic Organ Prolapse
46.1 Introduction
46.2 Recommendations for Practice
46.2.1 POP Symptomatology
46.2.2 Patient-Reported Outcome Questionnaires
46.2.3 Selecting PRO Instruments
46.2.4 Categories of PROs
46.3 PRO Instruments for POP
46.3.1 Screeners
46.3.2 Symptom Questionnaires
46.3.3 Quality of Life Questionnaires or Health-Related Quality of Life Questionnaires
46.3.4 Sexual Function
46.3.5 Patients’ Expectations and Satisfaction
46.4 Future Directions
Further Reading
Screeners
Detection of Patients with POP Symptoms Before a Clinical Examination
Detection of Patients with LUTS
Detection of Patients with Sexual Dysfunction
Symptom Questionnaires
PROs with Wide Coverage of POP Symptoms
PROs Focusing on LUTS
PROs Focusing on Bowel Function
Quality of Life Questionnaires
Generic Questionnaires
Condition Specific
Sexual Function
Generic PROs
Condition-Specific PROs
Patients’ Expectations PROs
Patients’ Satisfaction PROs
References
47: Integrated Imaging Approach to Pelvic Organ Prolapse
47.1 Introduction
47.2 Review of Imaging Techniques
47.2.1 Evacuation Proctography (EP)
47.2.2 Ultrasonography (US)
47.2.2.1 Two-Dimensional Transperineal Ultrasound (2D TPUS)
47.2.2.2 Three-Dimensional Transperineal Ultrasound (3D TPUS)
47.2.2.3 Four-Dimensional Transperineal Ultrasound (4D TPUS)
47.2.2.4 Three-Dimensional Endoanal Ultrasound (3D EAUS)
47.2.2.5 Three-Dimensional Endovaginal Ultrasound (3D EVUS)
47.2.2.6 Dynamic Endovaginal Ultrasound
47.2.3 Magnetic Resonance Imaging (MRI)
47.3 Review of the Literature and Recommendations
47.4 Summary and Conclusions
References
48: Transperineal Ultrasound: Practical Applications
48.1 Introduction
48.2 Instrumentation and Indications
48.3 Anterior Compartment Pathology
48.3.1 Residual Urine and Bladder Wall
48.3.1.1 The Anatomy of Stress Urinary Incontinence
48.3.1.2 Anterior Compartment Prolapse
48.3.1.3 Central Compartment
48.3.1.4 Posterior Compartment
48.3.1.5 The Anal Sphincter
48.3.1.6 Synthetic Implants
48.3.2 The Levator Ani
48.4 Conclusions
References
49: Three-Dimensional and Dynamic Endovaginal Ultrasonography for Pelvic Organ Prolapse and Levator Ani Damage
49.1 Introduction
49.1.1 Imaging Modalities for Endovaginal Imaging
49.1.2 3D EVUS Technique for Levator Ani Imaging
49.2 Clinical Applications
49.2.1 Prevalence of Pelvic Floor Injury Following Vaginal Delivery
49.2.2 Levator Ani Injury and Hematomas
49.2.3 Levator Ani Avulsion
49.2.4 LAD: Levator Ani Deficiency Score as a Measure of Levator Ani Atrophy
49.2.5 Scoring System
49.2.6 Changes of Levator Ani with Aging
49.2.6.1 Levator Plate Descent Angle and Minimal Levator Hiatus
49.3 Future Research
References
50: Magnetic Resonance Imaging, Levator Ani Damage, and Pelvic Organ Prolapse
50.1 Introduction
50.2 Functional Anatomy: Levator Ani Muscle and Connective Tissue Work Together to Provide Pelvic Organ Support
50.2.1 Levator Ani Muscle Anatomy
50.2.2 Levator Ani Muscle Lines of Action
50.2.3 What Type of Injury Occurs to Lead to These Visible Abnormalities?
50.2.4 Location and Types of Levator Injury
50.2.5 Injury Distorts the Pelvic Sidewall Supports
50.2.6 The Amount of Injured Muscle Matters
50.2.7 Levator Failure and Surgical Outcome
50.2.8 Muscle Injury Reduces Force
50.2.9 Levator Ani Injury and Fascial Failure
50.2.10 Exposed Vaginal Length, Pressure Differentials, and Symptomatic Prolapse
50.3 Concluding Message and Future Directions
References
51: Dynamic Magnetic Resonance Imaging of Pelvic Floor Pathologies
51.1 Introduction and Definitions of Pelvic Floor Dysfunction
51.2 Indications of Dynamic Pelvic Floor MRI
51.3 Anterior Compartment
51.4 Middle Compartment
51.5 Posterior Compartment
51.5.1 Anorectal Descent
51.5.2 Rectocele
51.5.3 Intussusception and Rectal Prolapse
51.5.3.1 Intussusception
51.5.3.2 External Rectal Prolapse
51.5.4 Enterocele
51.6 Pelvic Floor Relaxation
51.7 Dyssynergic Defecation
51.8 Conclusion
References
52: Pelvic Floor Muscle Training in Prevention and Treatment of Pelvic Organ Prolapse
52.1 Introduction
52.2 Methods
52.3 Results
52.3.1 In the General Population
52.3.1.1 Hypopressive Technique
52.3.2 FMT to Prevent and Treat POP in the Peripartum Period
52.3.3 Prevention
52.3.4 PFMT in Combination with Surgery
52.3.5 Long-Term Effect
52.4 Discussion
52.4.1 Conscious Contraction (Bracing or “Performing the Knack”) to Prevent and Treat POP
52.4.2 Strength Training
52.5 Conclusions
References
53: Use of Pessaries for Pelvic Organ Prolapse
53.1 Introduction
53.2 Types of Pessaries
53.2.1 Support Pessaries
53.2.2 Space-Filling Pessaries
53.2.3 Incontinence Pessaries
53.3 Pessary Selection
53.3.1 Assessment and Insertion
53.3.2 Follow-Up Pessary Care
53.4 Complications of Pessary Treatment
53.5 Evidence of Effectiveness
53.6 Training of Pessary Practitioners
53.7 Future Directions
References
54: Anterior and Posterior Colporrhaphy: Native Tissue Versus Mesh
54.1 Introduction
54.2 Vaginal Defects: What Needs to Be Fixed?
54.3 Vaginal Vault Fixation: Importance to More Effective Colporrhaphies
54.4 Anterior (Level II) Repair [11]
54.5 Posterior (Level II) Repair [11]
54.6 Posterior (Level III) Repair [11, 19]
54.7 Posterior (Level I) Repair
54.8 Efficacy of Outcomes of Native Tissue and Mesh Colporrhaphies
54.9 Conclusion
Appendix
Pelvic Organ Prolapse Quantification (POP-Q) [11, 16]
Posterior Repair Quantification (PR-Q) [11, 15, 17]
References
55: Apical Prolapse Surgery
55.1 Uterine Prolapse
55.1.1 Uterine Preservation
55.1.2 Uterine Prolapse: Hysterectomy or Uterine Preservation
55.1.3 Vault Prolapse
55.2 Route of Sacral Colpopexy
55.3 Conclusion
References
56: Laparoscopic Pelvic Floor Surgery
56.1 Introduction
56.2 Laparoscopic Colposuspension
56.2.1 Management of Stress Urinary Incontinence
56.2.2 The Rise and Fall of Laparoscopic Colposuspension
56.2.3 Technique of Laparoscopic Colposuspension
56.2.3.1 Preperitoneal or Transperitoneal Approach
56.2.3.2 Operative Technique
56.2.3.3 Outcomes
56.2.4 Conclusion
56.3 Laparoscopic Sacrocolpopexy
56.3.1 Management of Level I Defects
56.3.2 Laparoscopic Versus Open Sacrocolpopexy
56.3.3 Technique of Laparoscopic Sacrocolpopexy
56.3.4 Outcomes
56.3.5 Outcomes in the Elderly
56.3.6 Learning Curve
56.3.7 Conclusion
56.4 Associated Ventral Rectopexy
56.4.1 Concurrence with Posterior Pelvic Floor Dysfunctions (PFD)
56.4.2 Associating Anterior Rectopexy in Combined Middle and Posterior Compartment Problems
56.4.3 Technique and Outcomes of an Associated Anterior Rectopexy
56.5 Future Directions
References
57: The Robotic Approach to Urogenital Prolapse
57.1 Introduction
57.2 Robot-Assisted Surgery: The Context
57.2.1 History of Robot-Assisted Surgery
57.2.2 Components of Robotic Surgery System
57.2.3 Use of Robotic Surgery in Other Sub-specialties of Gynaecology and Surgical Specialties
57.2.4 Laparoscopic Versus Robot-Assisted Surgery
57.3 Robotic Approach to Apical Prolapse
57.3.1 Robot-Assisted Sacrocolpopexy (RASC)
57.3.2 Robot-Assisted Sacrohysteropexy (RASH)
57.3.3 Other Procedures Amenable to Urogynaecological Robot-Assisted Procedures
57.4 Considerations with Robotic Surgery
57.4.1 Preoperative Evaluation and Risk Assessment
57.4.2 Education and Learning
57.4.3 Cosmesis
57.4.4 Safety
57.4.5 Economical Cost
57.5 Summary of Pros and Cons of Robotic Surgery
57.6 Future Directions
57.7 Conclusion
References
Further Reading
58: Concurrent Prolapse and Incontinence Surgery
58.1 Introduction
58.2 Diagnostic Tests to Unmask Occult SUI
58.3 Patients with Concomitant POP and SUI (Overt Incontinence)
58.4 Patients with POP and Masked (Occult) Incontinence
58.5 Patients Who Suffer from POP Only Without Overt or Masked Incontinence
58.6 Side Effects of Additional Incontinence Surgery in Patients Who Undergo Prolapse Operations
58.7 Recommendations for Practice
58.8 Future Directions
References
59: Management of Pelvic Organ Prolapse: A Unitary or Multidisciplinary Approach?
59.1 Introduction
59.2 Epidemiological Basis for Coexistence of Pelvic Floor Disorders
59.3 Why the Multidisciplinary Approach
59.4 The Use of Quality of Life Questionnaires
59.5 Improved Treatment Rates with Pelvic Floor Rehabilitative Therapy
59.6 Models for Multidisciplinary Approach
59.7 Combined Surgical Cases
59.8 Barriers to Multidisciplinary Management of Pelvic Floor Prolapse
59.9 Future of Multidisciplinary Approach
59.10 Conclusion
References
Part VII: Constipation and Obstructed Defecation
60: Epidemiology and Etiology of Constipation and Obstructed Defecation: An Overview
60.1 Introduction
60.2 Definition
60.3 Epidemiology
60.4 Etiology and Pathophysiology
60.4.1 Secondary Constipation
60.4.2 Primary Constipation
60.4.2.1 Normal Transit Constipation and Irritable Bowel Syndrome (IBS)
60.4.2.2 Slow Transit Constipation
60.4.2.3 Outlet Obstruction
60.5 Future Directions
References
61: Patient-Reported Outcome Assessment in Constipation and Obstructed Defecation
61.1 Introduction
61.1.1 Constipation Symptom Severity Scales
61.1.2 Constipation-Specific Quality-of-Life Questionnaire
61.1.3 Recommendation for Practice in Choosing Appropriate PROMs for Constipation
61.2 Future Directions
References
62: Anorectal Manometry, Rectal Sensory Testing and Evacuation Tests
62.1 Introduction
62.2 Anal Manometry
62.3 Vector Manometry
62.4 High-Resolution Anal Manometry (HR-ARM)
62.4.1 Rectal Sensory Testing
62.4.2 Rectal Sensation to Electrical Stimulation
62.5 Balloon Expulsion Test (BET)
62.6 Recommendation for Practice
62.7 Future Direction
References
63: Ultrasonography in the Assessment of Obstructive Defecation Syndrome
63.1 Introduction
63.2 Transperineal/Translabial/Introital Ultrasound
63.2.1 Dynamic Transperineal Ultrasound
63.2.2 Dynamic Translabial Ultrasound
63.2.3 Dynamic Endovaginal Ultrasound
63.2.4 Endoanal Ultrasound and Echodefecography
63.3 Ultrasonographic Assessment of Obstructive Defecation Syndrome
63.4 Ultrasound vs. X-ray Defecography (DEF) vs. MR Defecography (MR-DEF) in the Assessment of ODS
63.5 Ultrasound Assessment After Pelvic Floor Surgery
63.6 Conclusions
References
64: Echodefecography: Technique and Clinical Application
64.1 Introduction
64.2 Echodefecography (EDF) Technique
64.3 3D Transvaginal and Transrectal Ultrasonography (TTUS)
64.3.1 Technique
64.3.2 Transvaginal Approach
64.3.3 Transrectal Approach
References
65: Evacuation Proctography
65.1 Introduction
65.2 Patient Preparation
65.3 Examination Technique
65.3.1 Small Bowel, Rectal and Vaginal Opacification, and Defecation
65.4 Image Analysis
65.4.1 Parameters
65.4.1.1 Anorectal Angle (ARA)
65.4.1.2 Anorectal Junction (ARJ)
65.4.1.3 Pubococcygeal Line (PCL)
65.4.2 Normal Findings
65.4.2.1 Rest
65.4.2.2 Squeeze/Strain (Push)
65.4.2.3 Evacuation
65.4.2.4 Recovery
65.4.3 Pathological Findings
65.4.3.1 Abnormal Pelvic Floor Descent
65.4.3.2 Anismus (Dyssynergic Defecation)
65.4.3.3 Intussusception and Rectal Prolapse
65.4.3.4 Rectocele
65.4.3.5 Enterocele and Sigmoidocele
65.5 Conclusions
References
66: The Abdominal Approach to Rectal Prolapse
66.1 Introduction
66.2 Etiology
66.3 Assessment of Patients with Rectal Prolapse and Associated Symptoms
66.4 Selection of Patients for Abdominal Procedures
66.5 Abdominal Procedures
66.5.1 Ripstein Procedure (Anterior Sling Rectopexy)
66.5.2 Posterior Mesh Rectopexy
66.5.3 Suture Rectopexy
66.5.4 Sigmoid Resection Associated with Rectopexy
66.6 Abdominal Surgical Techniques
66.7 Minimally Invasive Approach
66.7.1 Ventral Mesh Rectopexy
66.7.2 Robotic Ventral Mesh Retopexy
66.7.3 Combined Rectopexy and Pelvic Organ Prolapse Approach
66.8 Incontinence Improvements and Mechanisms
66.9 Management of Recurrent Rectal Prolapse
66.10 Conclusions
References
67: The Perineal Approach to Rectal Prolapse
67.1 Introduction
67.2 Delorme Procedure
67.3 Perineal Rectosigmoidectomy (Altemeier Procedure)
67.4 Anal Encirclement (Thiersch Wire)
67.5 Management of Recurrent Rectal Prolapse
67.6 Management of Incarcerated or Strangulated Rectal Prolapse
67.7 Conclusion
References
68: The Laparoscopic Approach to Rectal Prolapse
68.1 Introduction
68.2 Epidemiology
68.3 Etiology
68.4 Pelvic Floor Anatomy and (Patho) Physiology
68.5 Symptoms
68.6 Investigations
68.7 Indications
68.8 Surgical Techniques
68.8.1 Laparoscopic Ventral Mesh Rectopexy
68.9 What Are the Results of Rectopexy?
68.10 Role of Lateral Ligaments?
68.11 Choice of Operation?
68.12 Need for Colonic Resection?
68.13 Robotic Approach
68.14 Preoperative Considerations: Urinary Incontinence
68.15 Postoperative Considerations: Mesh-Related Complications
68.16 Conclusion
References
69: The Role of Robotic Surgery in Rectal Prolapse
69.1 Introduction
69.2 Preoperative Assessment
69.3 Surgical Approaches to Rectal Prolapse
69.4 Perineal Operations
69.4.1 Delorme’s Operation
69.4.2 Altemeier’s Operation
69.5 Abdominal Operations
69.5.1 Abdominal Suture Rectopexy
69.5.2 Abdominal Resection Rectopexy
69.5.3 Laparoscopic Ventral Mesh Rectopexy
69.6 Robotic Approach to Rectal Prolapse
69.7 Technique
69.8 Complications
69.9 Recurrence Rates and Functional Outcomes
69.10 Other Aspects
69.11 Conclusions
References
70: Sacral Neuromodulation for Constipation
70.1 Introduction
70.2 Technique and Its Evolution
70.3 Mechanism of Action
70.4 Indications
70.5 Prognostic Factors of Outcome
70.6 Outcome
References
Part VIII: Pelvic Pain and Sexual Dysfunction
71: Bladder Pain Syndrome/Interstitial Cystitis
71.1 Introduction
71.2 Definition
71.3 Epidemiology
71.4 Nonbladder Syndromes (NBS)
71.5 Etiology and Pathogenesis
71.5.1 Infection
71.5.2 Mastocytosis
71.5.3 Dysfunctional Bladder Epithelium
71.5.4 Neurogenic Inflammation
71.5.5 Reduced Vascularization
71.5.6 Pelvic Floor Dysfunction
71.5.7 Autoimmunity
71.6 Diagnosis
71.6.1 Gynecological Associated/Confusable Disease
71.7 Treatment
71.7.1 Conservative Therapy
71.7.2 Medical Therapy
71.7.2.1 Oral Therapy
Protection of the Mucosal Surface
Antihistamines
Immunosuppressant
Other Oral Medications
71.7.3 Intravesical Instillation
71.7.4 Pain Modulators
71.7.4.1 Analgesics
(Grade of Recommendation: C—Level of Evidence: 4)
71.7.5 Multimodal Medical Therapy
71.7.5.1 Procedural Intervention
71.8 Conclusions
References
72: Pelvic Pain Associated with a Gynecologic Etiology
72.1 Introduction
72.2 Evaluation of Pelvic Pain of Gynecologic Origin
72.2.1 History
72.2.2 Physical Exam
72.3 Etiologies and Treatments of Pelvic Pain by Site
72.3.1 Perineum and Vulva
72.3.2 Vagina
72.3.3 Cervix
72.3.4 Uterus
72.3.5 Adnexa
72.3.6 Musculoskeletal Considerations
72.3.7 Extragynecologic Considerations
72.4 Multidisciplinary Approach to Chronic Pelvic Pain
72.5 Summary
References
73: Chronic Idiopathic Anorectal Pain Disorders
73.1 Introduction
73.2 Definition
73.3 Topographic Sensitive Innervation of the Perineum
73.4 History and Physical Examination of the Perineum
73.4.1 History
73.4.2 Associated Signs
73.4.3 Physical Examination
73.5 Psychologic Aspects and Somatization of Pain
73.6 Proctalgia Fugax
73.6.1 Definition
73.6.2 Epidemiology
73.6.3 Pathophysiology
73.6.4 Physical Examination
73.6.5 Treatment
73.7 Levator Ani Syndromes (Chronic Proctalgia)
73.7.1 Definition
73.7.2 Epidemiology
73.7.3 Pathophysiology
73.7.4 Physical Examination
73.7.5 Treatment
73.8 Unspecified Anorectal Pain
73.8.1 Myofascial and Coccygeal Pain Syndromes
73.8.1.1 History
73.8.1.2 Physical Examination
73.8.1.3 Treatment
73.8.2 Postoperative Anorectal Neuralgias
73.8.3 Nerve Compression Anorectal Neuralgias
73.8.3.1 Pudendal Neuralgia
Symptoms of Pudendal Neuralgia
Physical Examination
Diagnostic Workup
Electrophysiological Diagnosis
Pelvic Radiography
Magnetic Resonance Imaging of the Pelvis
Magnetic Resonance Imaging of the Medullary Cone
Treatment
Pudendal Canal Injections
Decompression Surgery
73.8.3.2 Cluneal Neuralgia
Physical Examination
Treatment
73.8.4 Pain of Central Origin
73.9 Conclusions
References
74: Female Sexual Dysfunction
74.1 Female Sexual Function
74.2 Female Sexual Dysfunction
74.3 Assessment
74.4 Sexual Function Questionnaires
74.5 Treatment
74.6 Pelvic Floor Disorders and Sexual Function
References
75: A Myofascial Perspective on Chronic Urogenital Pain in Women
75.1 Introduction
75.2 Bladder Pain Syndrome and Vulvodynia
75.3 Pain Mapping
75.4 Exploring Mechanisms of Pain
75.5 Structure and Function of Fascia
75.6 Continuity of Pelvic Fascia
75.7 Role of Fascia in Chronic Urogenital Pain
75.8 Fascial Tonicity and Organ Function
75.9 Role of Non-relaxing Muscles
75.10 Surface Electromyography in Studies of Pelvic Floor Muscles
75.11 SEMG Studies of Chronic Urogenital Pain Disorders
75.12 Conclusion
References
76: Pharmacological Treatment of Chronic Pelvic Pain
76.1 Introduction
76.2 Traditional Analgesics
76.3 Hormonal Treatment
76.4 Local Anaesthetics
76.5 Antidepressants
76.6 Membrane Stabilisers
76.7 Anxiolytics
76.8 Conclusion
References
77: Idiopathic Chronic Pelvic Pain: A Different Perspective
77.1 Introduction
77.2 The Present Scope of ICPP: Presence of Other Symptoms
77.3 Anatomical Pathway to ICCP
77.4 USL Laxity as a Cause of CPP
77.5 Pretreatment Diagnosis That USL Laxity Is the Cause of ICPP
77.5.1 Confirmation of USL Origin of Pain by Vaginal Examination
77.5.2 Confirmation of USL Origin of Pain with “Simulated Operations”
77.5.3 Confirmation of USL Origin of Pain by the Bornstein Test
77.6 Improvement of CPP by Squatting-Based PFR
77.6.1 How the Skilling Squatting-Based PFR Method Evolved
77.6.2 The Simplified Skilling PFR Method
77.7 Surgical Repair Option
77.7.1 USL Native Tissue Repair Technique
77.7.2 Posterior Sling Repair of USL
77.7.3 USL Tensioned TFS Sling
77.8 Discussion
77.9 Conclusions
References
Part IX: Fistulae
78: Urogenital Fistulae
78.1 Introduction
78.2 Aetiology and Epidemiology
78.3 Associated Conditions
78.4 Diagnosis
78.5 Classification
78.6 Treatment
78.7 Post-operative Management and Results
78.8 Ongoing Incontinence
78.9 The Future
78.10 Conclusion
References
79: Rectovaginal Fistulae
79.1 Definition
79.2 Etiology
79.3 Classification
79.4 Presentation
79.5 Assessment and Investigations
79.6 Treatment
79.6.1 Surgical Techniques
79.6.1.1 Endorectal Advancement Flap
79.6.1.2 Transvaginal Flap
79.6.1.3 Excision of Fistula and Layered Closure
79.6.1.4 Rectal Sleeve Advancement Flap
79.6.1.5 Episio/Perineoproctotomy
79.6.1.6 Tissue Interposition
79.6.1.7 Use of Biomaterials
Surgisis™ Mesh Repair
Surgisis™ Fistula Plug
79.6.1.8 Abdominal Operations
Direct Closure with Interposed Omental Graft
Rectal Excision (Anterior Resection) with Colorectal/Coloanal Anastomosis
Proctectomy
Diversion Ileostomy/Colostomy
79.6.1.9 Other Techniques
79.6.2 Choice of Surgery
79.6.2.1 Peripartum Rectovaginal Fistula
79.6.2.2 Crohn’s Disease
79.6.2.3 RVF Due to Radiation
79.6.2.4 RVF Due to Malignancy
79.6.2.5 Postoperative (Iatrogenic) RVF
79.6.2.6 Recurrent RVF
79.6.3 Suggested Algorithm
79.7 Conclusions
References
80: Emerging Concepts in Classification of Anal Fistulae
80.1 Introduction
80.2 Anatomy
80.2.1 The Anogenital Muscles
80.2.2 The Anogenital Spaces (Fig. 80.2)
80.2.3 The Fasciae (Fig. 80.3)
80.3 Pathogenesis
80.3.1 Natural Anal Abscess Patterns (Table 80.1 and Fig. 80.4)
80.3.2 Natural Anal Fistula Patterns (Fig. 80.6)
80.4 A Proposed Anal Fistula Classification (Table 80.2)
80.4.1 Characteristics and Benefits of the New Classification
80.5 Anal Fistula Map
80.5.1 Abbreviations, Pathway and Recording Format Used in Anal Fistula Map
80.5.1.1 Abbreviations
80.5.1.2 Recording Pathway
80.6 Discussion
80.6.1 Limitations of Current Classifications
80.7 Conclusion
References
81: Ultrasonographic Assessment of Anorectal Fistulae
81.1 Introduction
81.2 Assessment of Anorectal Fistulae
81.2.1 Physical Examination
81.2.2 Fistulography
81.2.3 Endoanal Ultrasonography
81.2.3.1 Endoanal Ultrasonography in Crohn’s Disease
81.2.3.2 EAUS Vs. MRI
81.2.4 Transperineal Ultrasonography
81.3 Conclusion
References
82: MR Imaging of Fistula-in-Ano
82.1 Introduction
82.2 Aetiology, Classification, and Treatment of Fistula-in-Ano Relevant to Imaging
82.3 Imaging Fistula-in-Ano: Which Technique to Use?
82.3.1 MRI Technique
82.3.2 MRI Interpretation and Reporting
82.3.3 Extensions
82.3.4 The Radiological Report
82.4 Effect of Pre-Operative MRI on Surgery and Clinical Outcome
82.5 Differential Diagnosis of Perianal Sepsis
82.6 Which Patients Should be Imaged?
82.7 Conclusion
82.7.1 Future Directions
References
83: Surgical Treatment of Anorectal Sepsis
83.1 Introduction
83.1.1 Cryptoglandular Theory and the Spectrum of Anorectal Sepsis Comprising the Acute Abscess and Chronic Fistula
83.1.2 Principles of Treatment: Drainage of Sepsis, Eradication of Fistula Tracts, Preservation of Continence
83.1.3 The Ideal Operation
83.2 Pre-operative Evaluation
83.2.1 Endoanal Ultrasound
83.2.2 MRI
83.2.3 Anorectal Physiology and Continence Assessment
83.3 Management of Acute Anorectal Sepsis (Abscess)
83.3.1 Simple Drainage (Simple Recommendations for Practice)
83.3.2 Drainage and Loose Seton
83.3.3 Modified LIFT Approach
83.4 Management of Chronic Anorectal Sepsis (Fistula)
83.4.1 Fistulotomy With or Without Repair of Sphincter Complex
83.4.2 Cutting Seton
83.4.3 Endorectal and Anodermal Advancement Flaps
83.4.4 LIFT
83.4.5 VAAFT
83.4.6 Fibrin Glue
83.4.7 Anal Fistula Plugs
83.4.8 FiLaC
83.4.9 OTSC (Over-The-Scope-Clip)
83.5 Discussion
83.6 Future Directions
83.6.1 Stem Cell
83.6.2 3D Modeling
83.7 Conclusion
References
84: Management of Anorectal Fistulae in Crohn’s Disease
84.1 Introduction
84.2 Classification
84.3 Diagnosis
84.4 Treatment
84.4.1 Observation
84.4.2 Antibiotics and Immunomodulators
84.4.3 Biologic Medications
84.4.4 Fistulotomy
84.4.5 Seton Placement
84.4.6 Mucosal Advancement Flap
84.4.7 Ligation of the Intersphincteric Fistula Tract (LIFT)
84.4.8 Fibrin Glue Injection and Fistula Plug
84.4.9 Mesenchymal Stem Cell Injection
84.4.10 Rectovaginal Fistula
84.4.11 Stoma Diversion
84.5 Future Directions
References
Part X: Failure or Recurrence After Surgical Treatment: What to Do When It All Goes Wrong
85: Imaging and Management of Complications of Urogynecologic Surgery
85.1 Introduction
85.2 Intra-Operative Complications Involving Anti-Incontinence Procedures
85.2.1 Overview
85.2.2 Slings and Urethral Bulking Agents
85.2.3 Retropubic Procedures
85.3 Complications of Pelvic Organ Prolapse Surgery
85.3.1 Overview
85.3.2 Apical Segment Complications
85.3.3 Lateral Vaginal Complications
85.3.4 Anterior Compartment Complications
85.3.5 Posterior Compartment Complications
85.3.6 Introital Vaginal Complications
85.4 Conclusions
References
86: Surgical Management of Complications After Urogynaecological Surgery
86.1 Introduction
86.1.1 Classification
86.2 Complications Following Incontinence Surgery
86.2.1 Introduction
86.2.2 Mid-urethral Tape Operations
86.2.2.1 Intraoperative Injuries
Urinary Tract Injury
Bowel Injury
Vascular Injury
86.2.2.2 Post-operative Complications
Immediate
Voiding Dysfunction, Retention
Infections
Urinary Tract Infections (UTIs)
Surgical Site Infections
Remote Complications
Mesh-Related Complications
Chronic Pain
Management of Chronic Pain with Surgery
86.2.3 Para-urethral Bulking
86.2.3.1 Introduction
86.2.4 Burch Colposuspension: Open and Laparoscopic
86.2.4.1 Introduction
86.2.4.2 Intraoperative Injury at the Time of Surgery
Urinary Tract Injury
Bowel Injury (Laparoscopic Route)
Vascular Injury
86.2.4.3 Post-operative Complications
Immediate
Wound Complications
Haematoma
Infection
Voiding Dysfunction
Remote Complications
Posterior Compartment Prolapse
Chronic Pain
Bladder Dysfunction
86.2.5 Autologous Fascial Sling (AFS)
86.2.5.1 Introduction
86.2.5.2 Intraoperative Complications
Visceral and Vascular Injuries
86.2.5.3 Postoperative Complications
Voiding Dysfunction
Bladder Dysfunction
86.3 Complications Following Prolapse Surgery
86.3.1 Introduction
86.3.2 Anterior Colporrhaphy
86.3.2.1 Introduction
86.3.2.2 Intraoperative Complications
86.3.2.3 Post-operative Complications
86.3.3 Posterior Colporrhaphy
86.3.3.1 Introduction
86.3.3.2 Intraoperative Complications
86.3.3.3 Post-operative Complications
86.3.4 Sacrospinous Colopopexy/Hysteropexy
86.3.4.1 Introduction
86.3.4.2 Intraoperative Complications
Nerve Damage
Vascular Damage
Visceral Damage
86.3.4.3 Post-operative Complications
Dyspareunia
Prolapse Recurrence
Voiding Dysfunction
Bladder Dysfunction
86.3.5 Vaginal Mesh Surgery
86.3.5.1 Introduction
86.3.5.2 Post-operative Complications
86.3.5.3 Management of Complications
86.3.6 Abdominal Prolapse Surgery
86.3.6.1 Mesh Complications
86.3.6.2 Vascular Injuries
86.3.6.3 Spondylodiscitis
86.3.6.4 Ureteric Injury
86.3.6.5 De Novo Stress Urinary Incontinence
86.4 Conclusion
References
87: Endosonographic Investigation of Anorectal Surgery Complications
87.1 Introduction
87.2 Early Complications
87.2.1 Postoperative Anorectal Pain
87.2.2 Postoperative Hemorrhage/Hematoma
87.2.3 Infection/Sepsis
87.3 Late Complications
87.3.1 Chronic Anal Pain
87.3.2 Anal Stenosis/Stricture
87.3.3 Anorectal/Rectovaginal Fistula
87.3.4 Fecal Incontinence
87.4 Conclusions
References
88: Investigation and Management of Complications After Coloproctological Surgery
88.1 Introduction
88.2 Infection-Related Complications
88.2.1 Anastomotic Leak
88.2.2 Abscesses
88.2.2.1 Small Perianastomotic Abscess (<3 cm)
88.2.2.2 Larger Perianastomotic Abscess (>3 cm)
88.2.2.3 Abscess in Continuity with Leak
88.2.3 Low Rectal Anastomotic Sinus
88.2.4 Anastomotic Stricture
88.2.4.1 Colonic
88.2.4.2 Rectal
88.2.5 Fistula
88.2.6 Wound Infection
88.3 Intraoperative Organ Injury
88.3.1 Ureteric Injury
88.3.2 Splenic Injury
88.4 Stomal Complications
88.4.1 Stoma Retraction and Stenosis
88.4.2 Peristomal Skin Complications
88.5 Thromboembolic Complications
88.6 Sexual Dysfunction
88.6.1 Sympathetic Damage
88.6.2 Parasympathetic Damage
88.6.3 Treatment of Postoperative Sexual Dysfunction
88.7 Defecatory Dysfunction
88.8 Complications After Surgery for Functional Disorders
88.8.1 Fecal Incontinence
88.8.2 Rectal Prolapse
88.8.3 Obstructed Defecation
88.9 Conclusions
References
Part XI: Miscellaneous
89: Congenital Abnormalities of the Pelvic Floor: Assessment and Management
89.1 Introduction
89.2 Incidence
89.3 Classification
89.4 Embryology
89.5 Associated Malformation
89.6 Anorectal Anatomy
89.7 Clinical Investigation and Surgery of ARM
89.7.1 Assessment of Male Neonate with ARM
89.7.2 Surgery of ARM
89.7.3 Definitive Treatment
89.7.4 Assessment of the Female Neonate
89.7.5 Surgery of ARM
89.7.6 Definitive Treatment
89.8 Rectal Atresia
89.9 Results of Treatment
89.9.1 Operative Complications
89.9.2 Long-Term Results
89.10 Rare and Casuistic Malformations
89.11 Diagnostic Imaging of Anorectal Malformations and Other Pelvic Floor Abnormalities in Pediatric Patients
89.11.1 Invertogram (Lateral Horizontal-Beam-Prone Radiograph)
89.11.2 Transperineal Ultrasound (TPUS)
89.11.3 Colostogram
89.11.4 Magnetic Resonance Imaging (MRI)
89.11.5 Computed Tomography Imaging (CT)
89.12 Conclusions
References
90: Male Urinary Incontinence: Assessment and Management
90.1 Introduction
90.2 Assessment
90.2.1 History
90.2.2 Examination
90.2.3 Urinalysis
90.2.4 Uroflometry and Bladder Ultrasound
90.2.5 Bladder Diary
90.2.6 Pad Testing
90.2.7 Urodynamics
90.2.8 Cystoscopy
90.3 Management
90.3.1 Conservative
90.3.2 Pelvic Floor Muscle Training
90.3.3 Pharmacotherapy
90.3.4 Bulking Agents
90.3.5 Surgical Treatment
90.3.5.1 Artificial Urinary Sphincter
90.3.5.2 Male Slings
Bone Anchored Slings (BAS)
Trans-obturator Slings (TS)
Quadratic Sling
Adjustable Slings
90.3.5.3 Decision Making
90.4 Conclusions
90.5 Future Directions
References
Appendix: Management Consensus Statement
A.1 Management of Urinary Incontinence in Women From “Incontinence, 6th Edition 2017”. Abrams P, Cardozo L, Wagg A, Wein A, Editors. ICUD-ICS 2016 (with permission)
A.2 Assessment and Conservative Management of Faecal Incontinence From “Incontinence, 6th Edition 2017”. Abrams P, Cardozo L, Wagg A, Wein A, Editors. ICUD-ICS 2016 (with permission)
A.3 Surgical Management of Faecal Incontinence From “Incontinence, 6th Edition 2017”. Abrams P, Cardozo L, Wagg A, Wein A, Editors. ICUD-ICS 2016 (with permission)
A.4 Management of Pelvic Organ Prolapse From “Incontinence, 6th Edition 2017”. Abrams P, Cardozo L, Wagg A, Wein A, Editors. ICUD-ICS 2016 (with permission)
A.5 Surgical Management of Pelvic Organ Prolapse (POP) From “Incontinence, 6th Edition 2017”. Abrams P, Cardozo L, Wagg A, Wein A, Editors. ICUD-ICS 2016 (with permission)
A.6 Management of Constipation From “An International Urogynecological Association (IUGA)/International Continence Society (ICS) Joint Report on the Terminology for Female Anorectal Dysfunction” in Neurourology and Urodynamics 2017;36:10–34
A.7 Bladder Pain Syndrome (BPS) From “Incontinence, 6th Edition 2017”. Abrams P, Cardozo L, Wagg A, Wein A, Editors. ICUD-ICS 2016 (with permission)
A.8 Management of Vesicovaginal Fistula (VVF) From “Incontinence, 6th Edition 2017”. Abrams P, Cardozo L, Wagg A, Wein A, Editors. ICUD-ICS 2016 (with permission)
A.9 Management of Anorectal Fistulae From “The ASCRS Textbook of Colon and Rectal Surgery, 3rd Edition 2015”. Steele SR, Hull TL, Read TE, Saclarides TJ, Senagore AJ, Whitlow CB, Editors. Springer International Publishing 2016 (modified with permis
Index