Foreword 5
Introduction 7
Contents 9
Contributors 14
Section I Concept of the Pelvic Floor as a Unit 17
1-1 Concept of the Pelvic Floor as a Unit 18
Section II Epidemiology and Prevalence 22
2-1 Epidemiology of Non-Neurogenic Urinary Dysfunction 23
2-2 Bowel Dysfunction 28
2-3 Genital Prolapse, Urogenital Atrophy, and Sexual Dysfunction 32
Section III Evaluation 37
Evaluation 38
3-1 Primary Evaluation of the Pelvic Floor 39
3-2 Urodynamics 47
3-3 Imaging of the Genitourinary Tract in Females 58
3-4 Anorectal Physiology 62
3-5 Anorectal Ultrasound 67
3-6 Neurologic Evaluation of the Pelvic Floor 73
3-7 Upper Gastrointestinal Evaluation Related to the Pelvic Floor 77
Section IV Anatomic Correlates 79
Anatomic Correlates 80
4-1 Urologic Anatomic Correlates 81
4-2 Genital Anatomic Correlates 89
4-3 Colorectal Anatomic Correlates 98
Section V Sexual Function 103
5-1 Female Sexual Dysfunction 104
Section VI Incontinence Therapy 113
Incontinence Therapy 114
6-1 Device Therapy for Stress Incontinence 115
6-2 Medications for Stress Urinary Incontinence 118
6-3 Sling/Tension-Free Vaginal Tape 120
6-4 Bulking Agents 126
6-5 Retropubic Therapy for Stress Incontinence 132
6-6 Laparoscopic Surgery for Urodynamic Stress Incontinence 138
6-7 Other Therapies for Stress Urinary Incontinence 142
6-8 Anal Sphincter Repair 147
6-9 Fecal Diversion 154
6-10 ACYST, Secca, Sacral Nerve Stimulation, Artificial Bowel Sphincter, and Stimulated Graciloplasty 157
6-11 Case Presentation: Stress Urinary Incontinence/Fecal Incontinence 165
Section VII Urgency/Frequency Syndromes Therapy 169
Urgency/Frequency Syndromes Therapy 170
7-1 Overactive Bladder: Pharmacologic Therapy 171
7-2 Sacral Nerve Stimulation 177
7-3 Surgical Management of the Overactive Bladder: Evacuation Disorders 182
7-4 Irritable Bowel Syndrome 187
7-5 Irritable Bowel-Anismus 189
Section VIII Prolapse Syndromes Therapy 191
Prolapse Syndromes Therapy 192
8-1 Vaginal Pessaries 193
8-2 Vaginal Vault Prolapse Surgery 199
8-3 Anterior Vaginal Prolapse 206
8-4 Vaginal Enterocele Repair 215
8-5 Vaginal Rectocele Repairs 220
8-6 Rectal Prolapse Therapy 226
8-7 Rectoanal Intussusception, Solitary Rectal Ulcer, and Sigmoidoceles 230
8-8 Case Presentation: Prolapse 234
Section IX Pain and Irritative Syndromes Therapy 237
Pain and Irritative Syndromes Therapy 238
9-1 Interstitial Cystitis-Painful Bladder Syndrome 239
9-2 Painful Conditions of the Urogenital Sinus 246
9-3 Anal Pain 252
9-4 Pain Localization and Control 254
9-5 Acupuncture for Pelvic Floor Dysfunction 258
Section X Evacuation Disorders 261
Evacuation Disorders 262
10-1 Conservative Management of Urinary Retention in Women 263
10-2 Surgical Management of Urinary Retention 268
10-3 Bladder Outlet Obstruction after Anti-Incontinence Surgery/Urethrolysis 274
10-4 Conservative Management of Constipation 278
10-5 Surgical Management of Constipation 281
Section XI Hormonal Influences on the Pelvic Floor 284
11-1 Hormonal Influences on the Pelvic Floor 285
Section XII Physiotherapeutic Approaches 290
Physiotherapeutic Approaches 291
12-1 Kegel Exercises and Biofeedback 292
12-2 Timed Voiding and Fluid Management 300
12-3 Bowel Retraining for Functional Disorders of the Colon, Rectum, and Anus 304
Section XIII Surgical Therapy: Mutual and Combined Aspects 308
Surgical Therapy: Mutual and Combined Aspects 309
13-1 Vesico-Vaginal Fistula 310
13-2 Rectovaginal Fistula 314
13-3 Enterourinary Fistula 323
13-4 Management of Urinary Tract Injuries 325
13-5 Combined Versus Sequential Reconstructive Surgeries 329
Section XIV Severity Assessment 332
Severity Assessment 333
14-1 Voiding Diary 334
14-2 Scoring Systems 339
14-3 Quality-of-Life Assessment Tools 344
Index 354