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This book provides the most up-to-date and comprehensive information on vaginal anatomy and physiology. It offers practical guidelines for office evaluation of incontinence and prolapse, and a series of detailed chapters on reconstructive procedures for urinary incontinence, fecal incontinence and prolapse. There are 120 illustrations to enhance the text. This book is for urological and gynecological surgeons involved in training or currently delivering surgical care to women with pelvic floor dysfunction. It succeeds in bringing together established and new practices in this fast emerging field.
List of contents
I. Anatomy/epidemiology: Vaginal anatomy.- Epidemiology of incontinence and prolapse.- II. Evaluation: Urinary incontinence.- Prolapse.- Fecal incontinence.- Neurophysiologic testing.- Outcome measures for assessing efficacy of incontinence procedures.- III. Surgery for urinary incontinence: Transvaginal surgery for stress urinary incontinence due to urethral hypermobility.- Stress urinary incontinence secondary to intrinsic sphincteric deficiency.- The mid urethral tapes.- IV. Surgery for prolapse: Anterior compartment.- Uterine and vaginal vault prolapse.- Enterocele and rectocele/perineorrhaphy.- V. Surgery for fecal incontinence.- VI. Vaginal approach to abdominal or vaginal surgery failures: After failed previous surgery for incontinence.- Post-surgical bladder outlet obstruction.- Pelvic prolapse.- Intraoperative complications.- VII. Other reconstructive vaginal procedures: Vesicovaginal and urethrovaginal fistulae.- Urethral diverticula and other periurethral masses.- Bladder neck closure.
Summary
Imagine the plight of a young woman, some time during the thousands of years before th the mid-18 century, who, soon after a dif? cult childbirth, ? nds she can no longer keep from leaking urine. She is standing in the chill winter wind, her urine-soaked clothes clinging wet against her thighs as she comforts her crying baby knowing that she faces a life of misery, shame and social ostracism. Or imagine the middle-aged wife of a tenant farmer on the remote central Illinois plain, straining with her husband to lift a heavy log that has fallen on their only milk cow only to feel a deep tearing sensation and discover a large mass protruding between her legs. Gripped by fear, she cannot know what has happened to her or how she will care for her family if she can no longer help with the dif? cult tasks needed to live. We must be grateful to the generations of physicians before us who have pioneered treatments and developed preventions for the pelvic ? oor disorders that have affected women throughout time. Each decade during the last 150 years has brought new insights, new operations, and new medicines to help women who suffer from these debilitating conditions. At ? rst, surgical treatments were so dangerous that they could only be s- gested for the most severe of cases, but advances in anesthetic and surgical safety now make them available to the majority of women.
