Pelvic Floor Disorders Surgical Approach

During recent decades, more than 100 surgical procedures have been proposed to treat pelvic organ prolapse, and surgeons are still searching for the ideal approach. Although generally accepted guidelines and algorithms are still lacking, careful preoperative work-up and patient selection can serve as a sound basis for tailored surgery. In this comprehensive book, leading experts from around the world provide a detailed, up-to-date overview of the diagnostic and surgical approaches employed in patients with prolapse of the middle or posterior pelvic floor compartment. Each surgical technique is explained step by step with the aid of instructive figures. Guidance is also included on the management of surgical complications and of recurrent disease – aspects that are too frequently overlooked in the scientific literature. This book will prove essential reading for all who are interested in functional colorectal disorders of the pelvic floor and will represent a unique and invaluable source of knowledge for general surgeons, colorectal surgeons, and urogynecologists, whether in training or practice. ​

This excellent textbook provides up-to-date information on all aspects of pelvic floor disorders. After an opening section on anatomy and physiology, it explains the methodology, role and application of the integrated imaging approach in detail, including the most advanced 3D, 4D, and dynamic ultrasound techniques, illustrated with hundreds of images. It then discusses in depth the epidemiology, etiology, assessment, and management of the full range of pelvic floor disorders from multidisciplinary and practical perspectives. The book also provides information on the various forms of obstetric perineal trauma, urinary incontinence and voiding dysfunction, anal incontinence, pelvic organ prolapse, constipation and obstructed defecation, pelvic pain and sexual dysfunction, and fistulas, and includes treatment algorithms as well as helpful guidance on what to do when surgical treatment goes wrong. The authors are leading experts in the field from around the globe. Since the first edition from 2010 (more than 200,000 chapter downloads), the book has been extensively rewritten and features numerous additional topics. The result is a comprehensive textbook that is invaluable for gynecologists, colorectal surgeons, urologists, radiologists, and gastroenterologists, beginners and veterans alike.

Pelvic floor disorders are a very important subject in public health, with a major impact on quality of life. In USA for instance, epidemiology data indicate that between 11 and 19% of women may suffer at least one such surgical procedure. This field is in continuous change and there is not a consensus yet in therapeutic approach. This book provides a general overview on the pelvic pathology, concentrating on clinical aspects – diagnostic, physiopathology and treatment. Worldwide known authors have been gathered in order to present a high scientific reference. The most important thing in this book is that it offers a systematic approach on surgical techniques. Most of them are described by the surgeons who invented them and the aim of this book is to provide a strong basis for young doctors who want to operate in this field. Clinicians encounter obstacles in correctly diagnosing some patients. The physiopathology is sometimes not so obvious and except for a few surgical techniques that are accepted as golden-standards, the rest are still in debate. This book offers a unitary view in this field. It provides an algorithm diagnostic based on Integral Theory System by Peter Petros and also extensive therapeutic solutions. Key features: this book offers a comprehensive overview on pelvic floor disorders; it approaches some strongly debated issues; it proposes some new clinical entities such as “posterior vaginal fornix syndrome” the book is easy-to-read for young doctors who do not have a great experience in this field. surgical techniques are presented in a step-by-step manner, highly illustrated; many of those techniques are described by their inventors The book is divided in 10 chapters, trying to offer a comprehensive view in this field. 1. General considerations In the first chapter there is a short review regarding the importance of this topic. 2. Evolution of “Pelvic floor disorder” concept Pelvic floor disorders include a wide variety of perineal affections that seem to have, as a common denominator, an acquired laxity of the musculoskeletal system, which makes up the pelvic floor. This concept is new and it tries to comprise all the anatomoclinical entities in a standardized way, to facilitate, on one side, the description of the lesions and on the other, to favor scientific communication. 3. Classical anatomy of perineum Broadly, the perineum is anatomically made up of all the soft parts, which caudally define the pelvic excavation. These are represented by fascias, muscles, vessels and nerves, and are crossed by ducts of the urogenital and digestive systems, structures that offer a complex biomechanics, whose understanding is indispensable in a judicial therapeutic approach. 4. Perineal physiology and physiopathology Prof. Peter Papa Petros in collaboration with Prof. Ulf Ulmsten from the University in Uppsala have set the theoretical bases of “Integral Theory System”. As the name suggests, the “Integral Theory System” creates a dynamic and interconnected anatomical background to understand the function and dysfunction of perineum. The “Integral Theory System” defines the pelvic floor as a syncytial system, based on vector equilibrium in which muscles and connective tissue take part and which has a nervous component. The newly formed system represents the sum of all the elements involved. Among them, the connective tissue is the most vulnerable. 5. Clinical and paraclinical diagnosis of pelvic floor disorders Diagnosis of perineal affections, though easy at first sight, implies some subtleties. According to the principles of the Integral Theory System and respecting a principle stated by Mircea Eliade that “there are no illnesses, but only ill people”, each case must be evaluated according to the symptoms that bring the patient to the doctor and these should be correlated with the clinical signs observed during the examination. 6. Conservative treatment of pelvic floor disorders Conservative treatment of pelvic floor disorders practically overlaps the conservative treatment of effort urinary incontinence. Broadly, it also addresses other urinary disorders that can benefit more or less efficiently from conservative therapy. In this chapter following, we will focus on the treatment of effort urinary incontinence. 7. Surgical treatment of pelvic floor disorders The treatment of pelvic floor disorders implies a careful prior assessment. Selection of cases with surgical indication is sometimes problematic, in terms of both postoperative results and comorbidities. Young female patients with minimal anatomical defects and whose symptoms are not very noisy, who eventually want more children, can benefit from conservative treatment. Moreover, alternative treatment options must be sought for elderly patients, who have been treated and in whom surgery is contraindicated. Regardless of the outcome of the objective examination, the most important element is the patient’s perception of her own suffering and consequently the extent to which her quality of life is affected. Surgical treatment should be applied when there is a sufficient degree of morbidity. Complementary measures, such as the treatment of chronic associated diseases, weight loss, smoking cessation, and local estrogen treatment can be considered both conservative treatment and preoperative preparation. 8. Postoperatory complications It is widely accepted that no surgical technique lacks complications and therefore the same can be affirmed about the pelvic floor disorders surgical corrections. We can distinguish two major categories of complications, regardless of the approach: complications related to synthetic materials used and complications regarding the surgical technique used. There are a number of complications whose aetiology is unclear and which are presented in the form of symptoms difficult to classify. A last distinct category, called syndrome of vaginal tightness, will be treated separately, having a specific etiology and pathophysiology. 9. 20th century perspectives The direction in which perineal surgery will develop is hard to predict. In the last ten years, the surgery of uterine prolapse and effort urinary incontinence has seen an important boost. This textbook is trying to open new windows to the future. 10. Bibliography

This text provides a comprehensive, state of the art review of this field and will serve as a resource for urologists, colorectal surgeons, geriatricians, and gynecologists as well as researchers interested in neuromuscular phenomena in the pelvis. The book also reviews new data regarding risk factors for pelvic floor muscle dysfunction and profiles new minimally invasive surgical strategies for well known pelvic disease processes. Each chapter is chock full of data from landmark trials which have been published over the past few years and placed in context with respect to current management techniques for pelvic floor disorders. Written by experts in their field, Pelvic Floor Dysfunction and Pelvic Surgery in the Elderly: An Integrated Approach provides a concise yet comprehensive summary to help guide patient management.​

Written by emerging young leaders in the field, Pelvic Floor Disorders for the Colorectal Surgeon provides a current, thought-provoking, and practical study of the approach to and treatment of pelvic floor disorders.

All the characteristics and driving force of The Cleveland Clinic are to be found in this book on pelvic ?oor function. The Cleveland Clinic is a group practice founded in 1921 on the principles of cooperation,collaboration,and collegiality.Its founders believed that many physicians working together will discover better solutions to medical problems than physicians working in isolation. They believed that the combination of disciplines, with their inherent differences in philosophy and skills, will produce a better outcome than might have evolved singularly. The power of the collaborative approach is on full display in this book. The pelvic ?oor unites three separate organ systems. Before this time, each has been approached individually. Urologists, gynecologists, and colorectal surgeons are each trained in their own disciplines, and the pelvic ?oor is subsumed in these larger ?elds of study. When they combine their focus on the pelvic ?oor, they bring their unique perspectives and different approaches to a common goal: the relief of pelvic ?oor syndromes such as incontinence and pelvic organ prolapse.

The fully updated edition of this text provides a state-of-the-art surgical review of female pelvic surgery, and will serve as a valuable resource for clinicians and surgeons dealing with, and interested in the treatment of pelvic floor disorders. The book reviews the basic indications for treatment and details the many surgical approaches to the management of all pelvic floor disorders, including stress urinary incontinence, transvaginal prolapse, transabdominal sacrocolpopexy, robotic/laparoscopic sacrocolpopexy, vaginal and vulvar cysts, and interstitial cystitis/bladder pain syndrome. In addition to step-by-step descriptions, the text is augmented with illustrations and photographs of surgical techniques demonstrating the major repairs described in each section. Written by experts in their fields, the second edition of Female Pelvic Surgery provides a concise and comprehensive review of all surgical approaches to female pelvic surgery.

Dramatic improvement in imaging techniques (3D ultrasonography, dynamic magnetic resonance) allows greater insight into the complex anatomy of the pelvic floor and its pathological modifications.Obstetrical events leading to fecal and urinary incontinence in women, the development of pelvic organ prolapse, and mechanism of voiding dysfunction and obstructed defecation can now be accurately assessed, which is fundamental for appropriate treatment decision making. This book is written for gynecologists, colorectal surgeons, urologists, radiologists, and gastroenterologists with a special interest in this field of medicine. It is also relevant to everyone who aspires to improve their understanding of the fundamental principles of pelvic floor disorders.