Surgery Of Female Incontinence

1 The Mechanism of Continence.- Embryology of the Lower Urinary Tract.- Development of the Embryonic Plate.- Formation of the Cloaca.- Partitioning of the Cloaca.- Development of Nephrogenic Mesoderm.- Formation of the Bladder, Urethra and Trigone.- Epithelium of the Bladder Base and Urethra.- Anatomy of the Lower Urinary Tract.- The Bladder.- The Urethra.- Pubourethral Ligaments.- Neurological Control of Micturition.- Innervation of the Detrusor.- Innervation of Urethral Smooth Muscle.- Innervation of Striated Muscle.- Central Nervous Connections of the Lower Urinary Tract.- Physiology of the Lower Urinary Tract.- The Behaviour of the Bladder.- The Urethra.- The Normal Micturition Cycle.- Pathophysiology of Urinary Incontinence.- General Considerations.- Genuine Stress Incontinence.- The Effects of Incontinence Surgery on Urethral Function.- Conclusions.- 2 Investigation of Incontinence.- Classification of Incontinence.- Adverse Factors.- Indications for Urodynamic Studies.- Clinical Assessment.- History.- Examination.- Investigations.- Urethrocystoscopy.- Uroflowmetry.- Urethral Function Tests.- Cystometry.- Radiology.- Electromyography.- Ultrasound.- Perineal Pad Test.- The Future.- 3 Congenital Causes of Incontinence.- Assessment of the Wet Girl.- General.- History Taking.- Physical Examination.- Investigations.- Ureteric Ectopia.- Embryology.- Duplex System Ureteric Ectopia.- Single System Ureteric Ectopia.- Urogenital Sinus Abnormalities.- Vaginal Atresia and Wide Urethra.- Vaginal Confluence with Wide Bladder Neck.- Cloaca.- Exstrophic Anomalies.- Embryology.- Bladder Exstrophy.- Epispadias.- Cloacal Exstrophy.- Congenital Neuropathic Bladder.- Presentations.- Classification and Pathophysiology.- Investigation.- Management.- 4 Anterior Repair.- Pre-operative Evaluation.- Patient Selection.- Contraindications.- Pre-operative Preparation.- Operative Technique.- Post-operative Management.- Care.- Complications.- Follow-up Assessment.- Results.- Mechanism of Failure.- 5 The Marshall-Marchetti-Krantz Procedure.- Indications and Contraindications.- Pre-operative Evaluation.- Operative Technique.- Post-operative Management.- Complications.- Follow-up Assessment.- Results.- Summary.- 6 Colposuspension.- Terminology.- Indications and Contraindications.- Pre-operative Evaluation.- Pre-operative Preparation.- Operative Technique.- Post-operative Management.- Complications.- Follow-up Assessment.- Results.- Causes of Failure.- 7 Sling Procedures.- Indications.- Classification.- Pre-operative Evaluation.- Operative Technique.- Inguinovaginal Fasciai Sling.- Dural and Alloplastic Sling.- Post-operative Management.- Complications.- Follow-up Assessment.- Results.- Summary.- 8 Endoscopic Suspension of the Vesical Neck.- Indications and Contraindications.- Pre-operative Evaluation.- Operative Technique.- Abdominal Incision.- Vaginal Incision.- Stamey Needles.- Use of Endoscopy.- The New Pereyra-Lebherz Suspension.- Post-operative Management.- Care.- Complications.- Follow-up Assessment.- Results.- Summary.- 9 Abdominoperineal Urethral Suspension: The Zacharin Procedure.- Indications and Contraindications.- Pre-operative Investigations and Preparation.- Operative Technique.- Post-operative Management.- Complications.- Follow-up Assessment.- Results.- Mechanism of Failure.- Conclusions.- 10 Neourethra: Rationale, Surgical Technique and Indications.- Anatomical Considerations and Rationale for Operation.- Indications.- Pre-operative Evaluation.- Operative Technique.- Tanagho Technique (Anterior Bladder Flap).- Leadbetter Technique (Trigonal Tube).- Post-operative Management.- Complications.- Case Examples.- Results.- Mechanism of Failure.- Summary.- 11 Artificial Sphincter.- Developmental History.- The First Model, AS 721.- Sphincter with Pressure-Regulation Balloon, AS 761.- Automatic Reflation Sphincter AS 742.- Automatic Reflation Sphincter AS 791/792.- Model AS 800 Controlled Activation and Deactivation.- Indications.- Pre-operative Evaluation.- Selection of Model.- Operative Technique.- Aseptic Technique.- Patient Position.- Instrumentation.- Surgical Procedure.- Selection of Cuff Size.- Cuff Implantation.- Selection of Balloon Pressure Reservoir.- Post-operative Management.- Results and Discussion.- Summary.- 12 Urinary Diversion.- Classification of Patients.- Choice of Diversion.- Ileal Loop.- Pre-operative Management.- Technique.- Post-operative.- Ureterocolic Anastomosis.- Pre-operative Management.- Technique.- Post-operative.- Continent Heal Pouch.- 13 Urethrotomy.- Methods of Investigation.- Techniques.- Urethral Dilatation.- Internal Urethrotomy.- Bladder Neck Procedures.- Alternative Techniques.- Bladder Drainage.- Conclusions.- 14 The Management of Vesicovaginal and Urethral Fistulae.- Aetiological Groups.- Obstetric.- Surgical Trauma.- Pelvic Malignancy.- Clinical Presentation.- Pre-operative Care.- Early Management.- Associated Conditions.- Concurrent Rectovaginal Fistulae.- Local Assessment.- Surgical Repair.- General.- Vaginal Route.- Abdominal Route.- Post-operative Management.- Complications.- Results.- Management of Failure.- 15 Ureterovaginal Fistulae.- Operative Injuries.- Obstetric Laceration.- Invasion by Growth.- Time of Occurrence.- Early.- Intermediate.- Late.- Recognition of Fistula.- Confirmation of Urinary Leakage.- Confirmation of Ureteric Fistula.- Spontaneous Closure of Fistulae.- Timing of Operative Intervention.- Pre-operative Investigation and Preparation.- Identification of the Side of the Fistula.- Recognition of Level.- Operative Procedures.- Objectives.- Exploratory Laparotomy.- Selection of Procedure.- Direct Reimplantation.- Indirect Reimplantation.- Bilateral Ureteric Injuries.- Primary Nephrectomy.- Urinary Diversion.- Post-operative Complications.- Leakage.- Stenosis.- Urinary Infection.- Reflux.- Late Recurrence of Ureterovaginal Fistula.- Summary.- 16 Pharmacology of the Bladder and Urethra.- Pharmacology of the Lower Urinary Tract.- Principles of Pharmacological Therapy.- Specific Methods of Pharmacological Therapy.- Therapy to Facilitate Bladder Emptying.- Therapy to Facilitate Urine Storage.- Effect of Tricyclic Antidepressants.- Effects of Other Pharmacological Agents.- 17 Electrostimulation.- Sacral Root Stimulation.- Background.- Animal Studies.- Human Studies.- Electrode Implantation.- Pre-operative Evaluation.- Method.- Accomplishments from Human Implantations.- Other Applications of Percutaneous Sacral Root Implantation.- Summary.- 18 Post-operative Voiding Dysfunction.- Pathophysiology.- Problems of Inhibition-the Large Bladder.- Problems of Facilitation-the Unstable Bladder.- Surgical Causes.- Prevention.- Treatment.- Long-term Management.- 19 Post-operative Catheter Drainage.- Indications.- Suprapubic Versus Urethral Drainage.- Technique.- Urethral.- Suprapubic.- Conclusion.- 20 Choice of Surgery.- I.- Coexistent Gynaecological Conditions.- Urodynamic Contraindications.- Urodynamic Factors.- Bladder Neck Elevation.- Urethral Alignment.- Urethral Resistance.- Choice of Surgery.- II.- Differential Diagnosis.- Treatment.- Problems in Management.