Female Genital Prolapse and Urinary Incontinence PDF

Preface

Genital prolapse and urinary incontinence are common conditions that afflict women, especially in their postmenopausal years, and adversely affect their quality of life. Increasing life expectancy has augmented the proportion of the graying population. This, together with improved living conditions and much easier access to information, has increased the demand on the part of women for treatment of such anatomical and functional conditions that afflict them, along with their expectations of the outcomes.

In a parallel fashion, in the last 20 years we have witnessed the introduction of new surgical techniques for the treatment of both genital prolapse and urinary stress incontinence. Many of the traditional techniques have been modified and used by laparoscopic access. New and simpler techniques have been introduced to treat urinary stress incontinence. Most of these are designed to support the urethra by the placement of a strip of mesh using specially designed needles and various routes of introduction.

Dysfunction of the pelvic organs in the female is closely related to disruption of anatomy. Knowledge of anatomic changes in function of the disease is essential for successful reconstructive surgery. This prompted us to open the book with a chapter on anatomy that addresses functional changes. In the same spirit we included chapters on clinical investigation and urodynamic and radiological investigations, to define their roles in the elucidation of genital organ prolapse and urinary incontinence.

Cysto-colpo-defecography has become the keystone in the preoperative investigation of many patients, because this technique is able to pinpoint the defects in a dynamic fashion, not infrequently contradicting the clinical findings. Definitions of different abnormalities and a scoring system that allows the clarification of the extent of the problem have also been included.

In crafting the book we attempted to follow a logical sequence by dividing it into sections. Following the Introduction are three sections: the anterior, mid, and posterior segments, which represent the anatomical segments of the pelvis.

The section on the anterior segment, composed of six chapters, brings together the surgical techniques primarily used in the treatment of urinary incontinence. Data from large series are presented to compare outcomes achieved by the various available mesh techniques. Also included in this section are chapters on paraurethral treatments, which are less invasive interventions and may be further developed in the future, and computerbased artificial sphincters that provide a treatment option when all others have failed.

The section on the mid segment begins with hysterectomy, which remains the most frequently performed major gynecologic operation. This section details specific measures to prevent subsequent vault prolapse. Each of the subsequent four chapters presents a different method for the treatment of vault prolapse and lateral sidewall prolapse, aimed at obtaining a functional result. The total mesh approach is compared with the traditional suspension methods, now adapted to laparoscopic surgical access.

The section on the posterior segment has two chapters in which the classical approaches are reviewed and compared to a new laparoscopic rectal suspension technique.

In view of the many developments mentioned here, we believe that the publication of this book is timely. The 16 chapters, written by internationally recognized experts, review the pertinent aspects of the field of female genital prolapse and urinary stress incontinence, describe in detail both the more traditional and newer surgical procedures, and discuss their place and outcomes.