Full Description
In this book we have expert urologists and gynaecologists on the two sides of the Atlantic working together with a common interest, the inadequate female urethra. What makes this volume so valuable is that it is not restricted to one speciality or one cult, but bravely (and systematically) presents established principles and practice. Not only is the current knowledge of the anatomy and function of the continence mech anisms defined by experts carefully selected by the two authorities in the field, but this infor mation is directly applied to clinical problems for the reader to use in the care of patients. Because the basics are presented first, and followed by the methods of diagnosis, the sec tions describing each form of treatment, whether medical or surgical, are set on rational bases. These are not cookbook directions. This background is especially valuable because the incontinent female usually has a complicated disorder, each case being different, so that the responsible gynaecologists or urologists must apply as much understanding as technique if their efforts are to achieve dryness. The clear descriptions and illustrations in this book, then, act as guides as much as directives. This second edition builds on the success of the first. All of us trying to help these unfortu nate women will do more for them from having this new edition at hand.
Contents
1 The Mechanism of Continence.- Embryology of the Lower Urinary Tract.- Anatomy of the Lower Urinary Tract.- Neurological Control of Micturition.- Physiology of the Lower Urinary Tract.- Pathophysiology of Urinary Incontinence.- The Effects of Incontinence Surgery on Urethral Function.- Conclusions.- 2 Investigation of Incontinence.- Clinical Assessment.- Investigations.- The Future.- 3 Congenital Causes of Incontinence.- Assessment of the Wet Girl.- Ureteric Ectopia.- Urogenital Sinus Abnormalities.- Exstrophic Anomalies.- Congenital Neuropathic Bladder.- 4 Anterior Repair.- Operative Technique.- Post-operative Management.- 5 The Marshall-Marchetti-Krantz Procedure.- Operative Technique.- Post-operative Management.- 6 Colposuspension.- Operative Technique.- Post-operative Management.- 7 Sling Procedures.- Operative Technique.- Post-operative Management.- Summary.- 8 Endoscopic Suspension of the Vesical Neck.- Operative Technique.- Post-operative Management.- Summary.- 9 Abdominoperineal Urethral Suspension: The Zacharin Procedure.- Operative Technique.- Post-operative Management.- Conclusions.- 10 Neourethra: Rationale, Surgical Technique and Indications.- Operative Technique.- Post-operative Management.- Summary.- 11 Artificial Sphincter.- Developmental History.- Indications.- Pre-operative Evaluation.- Selection of Model.- Operative Technique.- Post-operative Management.- Results and Discussion.- Summary.- 12 Urinary Diversion.- Ileal Loop.- Ureterocolic Anastomosis.- Continent Heal Pouch.- 13 Urethrotomy.- Methods of Investigation.- Techniques.- Bladder Drainage.- Conclusions.- 14 The Management of Vesicovaginal and Urethral Fistulae.- Aetiological Groups.- Clinical Presentation.- Pre-operative Care.- Surgical Repair.- Post-operative Management.- Management of Failure.- 15 Ureterovaginal Fistulae.- Time of Occurrence.- Recognition of Fistula.- Spontaneous Closure of Fistulae.- Timing of Operative Intervention.- Pre-operative Investigation and Preparation.- Operative Procedures.- Post-operative Complications.- Summary.- 16 Pharmacology of the Bladder and Urethra.- Pharmacology of the Lower Urinary Tract.- Principles of Pharmacological Therapy.- Specific Methods of Pharmacological Therapy.- Effect of Tricyclic Antidepressants.- Effects of Other Pharmacological Agents.- 17 Electrostimulation.- Sacral Root Stimulation.- Electrode 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.- Conclusion.- 20 Choice of Surgery.- I.- Coexistent Gynaecological Conditions.- Urodynamic Contraindications.- Urodynamic Factors.- Choice of Surgery.- II.- Differential Diagnosis.- Treatment.- Problems in Management.
