Atlas of Urogynecological Endoscopy PDF

Preface

The lower urinary tract has for a long time been of special importance to both gynecologists and urologists in the treatment of urogynecological conditions. Howard Kelly, Professor of Obstetrics and Gynecology at Johns Hopkins Hospital in Baltimore, pioneered the use of cystoscopy and ureteric catheterization, particularly in the United States, and described operations for stress incontinence and vaginal prolapse. His successor at Johns Hopkins, Guy Hunner, continued his interest and was the first to clearly describe the condition of interstitial cystitis. However, these skills and interest were lost to most gynecologists until Jack Robertson pioneered the air cystourethroscope and its use in the evaluation of urinary incontinence and urethral pathology. Jack has been appropriately described as the father of American urogynecology and I am honored to have him as co-author for the first chapter of this book: ‘History of endoscopy of the female urinary tract'. My mentors, Stuart Stanton and Robert Zacharin, were international leaders in the discipline of urogynecology and pelvic floor disorders. Both men believe that endoscopy of the lower urinary tract is integral to the management of female urinary incontinence and pelvic floor disorders. However, they are the exceptions, and expertise in endoscopy of the lower urinary tract has been lost to most gynecologists and neglected in the curriculum of gynecological training programs. The introduction of stress incontinence procedures, including the minimally invasive sling procedures (such as TVT) and long needle urethral suspension operations (Pereira or Stamey), has increased the numbers of gynecologists performing cystourethroscopy in their surgical practices. Cystourethroscopy is integral to the safe performance of these procedures and is also being increasingly used to recognize urinary tract complications intraoperatively and lessen the risk of medicolegal consequences. However, because gynecologists have little exposure to cystourethroscopy or lower urinary tract disorders during gynecological training, this has caused new problems. Gynecologists are frequently faced with cystoscopic findings with which they are unfamiliar. These might be benign conditions such as squamous metaplasia or cystitis cystica, where they have had to call a urologist or unnecessarily refer the patient for a second cystoscopy; more importantly, serious conditions such as malignancy may be misdiagnosed or missed through ignorance or incomplete examination.

The purpose of this book is primarily to educate gynecologists and urologists in the instrumentation of the lower urinary tract and pelvic endoscopy, and how it is used in the diagnosis and treatment of lower urinary tract and pelvic floor disorders. Endoscopy is very much a visual endeavor with ‘a picture worth a thousand words.' This book is liberally illustrated with case reports and cystoscopic photographs to enhance learning and condition recognition. The majority of photographs used in this book I have collected over the last 15 years since the introduction of modern imaging technology and three-chip cameras. Photographs with case reports are used liberally to encourage learning. I would also like to thank James Scurry for his histopathological photographs and Richard Millard for his photographs of bladder cancer.

Finally, I would like to thank all my co-authors, especially Jack Robertson and Stuart Stanton, who are the present-day equivalents of Kelly and have, in their own ways, pioneered modern urogynecology. The other coauthors have all worked with me at the Mercy Hospital for Women, Melbourne and have made excellent contributions. Peter Glenning, another one of my mentors in urogynecology and life, proofread all chapters, and made helpful suggestions. My thanks also go to the publishers, Informa Healthcare, and especially Commissioning Editor Oliver Walter, for valuable advice and keeping me on track, and Kathryn Dunn, Senior Production Editor. Finally, special thanks go to Geraldine Rhoderick, my hardworking and patient secretary; my wife Pam for the many interruptions to family life, and to my son Patrick, my IT expert, who always answered my many calls for help with good nature.