Pelvic Floor Dysfunction and Pelvic Surgery in the Elderly An Integrated Approach 1st Edition by David Gordon 1493965540 9781493965540

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ISBN-10 :  1493965540 

ISBN-13 :  9781493965540

Author:  David A. Gordon 

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.

Pelvic Floor Dysfunction and Pelvic Surgery in the Elderly An Integrated Approach 1st table of contents:

Part I: General Physiology and Pelvic Floor Disorders
1: Anatomy, Neuroanatomy, and Biomechanics of the Pelvis
Introduction
The Pelvis as a Unit
Pelvic Osteology
Developmental Considerations
Site Specific Considerations
The Ossa Coxae
The Sacrum and Coccyx
The Ligamentous Structure of the Pelvis
External Ligamentous Support of the Pelvis
Internal Ligamentous Support of the Pelvis
Female Specific Anatomy
Male Specific Anatomy
The Trigone
Pelvic Myology
Embryologic Considerations
Individual Considerations
The Psoas Major, the Psoas Minor, and the Iliacus
The Obturator Internus and Piriformis Muscles
The Pelvic Diaphragm
Pelvic Myofascial Support
Peritoneal Reflections in the Male
Peritoneal Reflections in the Female
The Perineum
The Anogenital Triangle
The Male Urogenital Triangle
The Female Urogenital Triangle
The Blood Supply of the Pelvis
Internal Iliac Vasculature
Pelvic Venous Plexuses
The Lymphatic Drainage of the Pelvis
The Innervation of the Pelvis
Somatic Innervation
Autonomic Innervation
References
2: Pelvic Floor Physiology: From Posterior Compartment to Perineal Body to Anterior Compartment
Introduction
Posterior Pelvic Floor Physiology
Pelvic Floor and Anal Sphincters
Anorectal Reflexes
Pelvic Floor Dysfunction
Constipation
Fecal Incontinence
Pelvic Pain
Physiologic Testing (Fecal Incontinence v. Constipation)
Anorectal Manometry
Balloon Expulsion Testing
Saline Continence Testing
Neurophysiologic Testing (PNTML & PFM EMG)
Pelvic Floor Imaging
Dynamic Functional Testing (Defecography)
Posterior Physiology: In Conclusion
The Perineum and Perineal Body
Anterior Pelvic Floor Physiology
Pelvic Floor and Urinary Sphincters
Lower Urinary Tract Physiology
Physiology of Voiding
Physiology of Urinary Continence
Anterior Physiology: In Conclusion
References
3: Cellular and Molecular Aging
Introduction
Life Span and Life Expectancy
Characteristics of Aging
Theories of Aging
Development/Genetic Theories
Stochastic Theories on Aging
Free Radical/Oxidative Stress
Mitochondrial Dysfunction Theory of Aging
DNA Damage Theory of Aging
Somatic Mutation, DNA Repair, Error Catastrophe
Models of Aging
Accelerated Aging Syndromes in Humans
Cellular Senescence as a Model for Aging
Nutrition and Metabolism, A Modern-Day Elixir of Life?
References
4: Principles of Geriatric Surgery
Introduction
Principle I: Clinical Presentation
Principle II: Lack of Reserve
Principle III: Preoperative Preparation
Principle IV: Emergency Surgery
Principle V: Attention to Detail
Principle VI: Age Is a Scientific Fact
Conclusion
Key Points
References
5: Nutritional Considerations in Pelvic Medicine and Surgery
General Considerations
Dietary Modifications for Calcium Oxalate Urolithiasis
Dietary Suggestions for Cystitis: Infectious, Inflammatory, & Interstitial
“To Eat or Not to Eat”, the Big Question with IC
How to Begin an IC Diet
The Elimination Technique for IC Dietary Modification
Nutritional Aspects in Surgery
Pelvic Surgery in the Nutritionally Compromised Patient
Perioperative Nutritional Optimization
Suggested Reading
6: Microbiology of Virulence: Urinary Tract Infection Versus Colonization
Introduction
Definitions
Epidemiology
Etiology
Pathogenesis
Clinical Presentation
Diagnosis
Treatment and Resistance
Complications
Prevention
Conclusion/Summary
References
7: Chronic Catheter Associated Complications and Catheter-Associated Urinary Tract Infection
Asymptomatic Bacteriuria vs Symptomatic Urinary Tract Infection
CAUTI Definitions
Risk Factors for CAUTI
Guidelines for CAUTI
Pathogenesis of CAUTI
Indications for a Chronic Indwelling Urinary Catheter
Complications of CAUTI
Symptoms of CAUTI
Prevention of CAUTI
Recommendations
Conclusion
Key Points
References
Part II: Diagnosis of Pelvic Floor Disorders and Diagnostic Armamentarium
8: Physical Therapy Evaluation and Treatment of Pelvic Floor Dysfunction Including Hypertonic Pelv
Introduction
The Importance of Communicating Empathy
Medical History of the Client with PFD
Objective Measures
Orthopedic Assessment
Soft Tissue Assessment and Treatment
Connective, Scar and Fascial Tissue Restriction
Trigger Points and Hypertonicity in Skeletal Muscle
Strain and Counterstrain
Myofascial Release
Dry Needling
Soft Tissue Mobilization
Manual Trigger Point Release or Ischemic Compression
Assessment of Vulvar Tissues and Prolapse
The Internal Pelvic Floor Assessment and Treatment
Conclusion
References
Suggested Reading
9: Multichannel Urodynamic Testing
Introduction
Uroflowmetry
Filling Cystometrogram
Cystometric Capacity
Bladder Wall Compliance
Urethral Sphincter Competence
Sensations of Bladder Filling
Detrusor Response to Bladder Filling
Voiding Pressure Flow Study
Visual Inspection of the Voiding Pressure Flow Study
Multichannel Urodynamic Testing in the Aged Adult: Case Examples
Case 1: Multichannel Urodynamic Testing in a 75-Year-Old Female with Mixed Urinary Incontinence
Case 2: Urodynamic Testing in a 90-Year-Old Male with Urinary Retention Requiring Twice Daily In
Case 3: Detrusor Overactivity Combined with Underactive Detrusor Function (Impaired Contractility)
Key Points
References
10: Anorectal Manometry
Introduction
Methods of Performing Anorectal Manometry
Water-Perfused Catheter System
Solid State Manometry System
High Resolution Anorectal Pressure Topography (HRAPT) OR High Resolution Anorectal Manometry (HRARM
3-D High-Definition Anorectal Manometry
Performing Anorectal Manometry
Probe Placement
Anal Sphincter Length
Anal Sphincter Resting Pressure
Anal Squeeze Sphincter Pressure
Duration of Squeeze and Sustained Squeeze Krenor: The Total Period of Squeeze (Duration)
The Abdominopelvic Reflex (Party Balloon Test/Cough Test)
Attempted Defecation (Bearing down maneuver)
Rectal Sensory Testing
Rectal Compliance
Rectoanal Inhibitory Reflex
Sensorimotor Response
Rectoanal Contractile Response
Balloon Expulsion Time
Complications of Anorectal Manometry
Clinical Application of Anorectal Manometry in the Elderly
Fecal Incontinence
Constipation
Biofeedback Therapy
Conclusion
References
11: Functional Anorectal Imaging: Radiologic Considerations and Clinical Implications
Introduction
Why Functional Voiding?
Association of Pelvic Compartment Defects with Defecatory Disorders
Controversies in Pelvic Floor Imaging
Imaging Pelvic Organ Prolapse Quantification/Grading
Imaging Diagnosis, Limitations, and Clinical Relevance
Functional and Structural Disorders of Defecation
Dyssynergic Defecation
Rectocele
Rectal Intussusceptions and the SRUS
Enterocele, Sigmoidocele, and Peritoneocele
Genital Prolapse
Cystocele
Summary
Key Points
References
12: Colonoscopy in Elderly Patients
Introduction
Colonoscopy in Elderly Patients
Yield
Complications and Adverse Events
Colonoscopy Completion Rates
Bowel Preparation Issues
Decision Analyses
Equipment and Logistical Issues
Overview: Screening Colonoscopy in Elderly Patients
Overview: Diagnostic Colonoscopy in Elderly Patients
Overview: Therapeutic Colonoscopy in Elderly Patients
Summary
Key Points
References
Part III: Urologic/Urogynecoloic Aspects
13: Treatment Options for Stress Urinary Incontinence
Introduction
Epidemiology
Pathophysiology
Clinical Presentation
Clinical Signs
Investigations
Urine Culture
Post Micturition Urinary Residual
Bladder Diary
Investigation in Secondary Care
Urodynamic Investigation
Cystourethroscopy
Pad Test
Quality of Life
Conservative Management
Pelvic Floor Muscle Training
Medical Management
Surgical Management
Marshall–Marchetti–Krantz
Colposuspension
Bladder Neck Suspension Procedures
Laparoscopic Colposuspension
Pubovaginal Sling
Retropubic Mid-Urethral Tape Procedures
Transobturator Mid-Urethral Tape Procedures
Single Incision Mid-Urethral Slings
Urethral Bulking Agents
Conclusions
References
*Recent Systematic Review of Continence Surgery
14: Overactive Bladder (OAB) in the Elderly with Contemporary Notions on Treatment Including Sac
Introduction
Epidemiology
Prevalence
Quality of Life
Economic Impact
Workup/Evaluation of Overactive Bladder
Clinical Diagnosis
Physical Examination
Other Diagnostic Modalities
Treatment
First-Line Treatments
Second-Line Treatments
Third-Line Treatments (Available Through Specialists)
Sacral Nerve Stimulation (SNS)
Introduction
History
Putative Mechanism of Action of Sacral Neuromodulation
Putative MOA of Sacral Neuromodulation in Overactive Bladder
Putative MOA of Sacral Neuromodulation in Urinary Retention
Electrical Stimulation for Storage Disorders
Patient Selection
Predictors of Success
Special Populations
Multiple Sclerosis (MS)
Spinal Cord Injury (SCI)
Contraindications
Surgical Protocol and Technique
Bilateral Sacral Nerve Root Testing
Outcomes
Complications
Selective Nerve Stimulation/The Pudendal Nerve
Dorsal Genital Nerve
Posterior Tibial Nerve
Sacral Neuromodulation for Emptying Disorders
Summary
References
15: Interstitial Cystitis: The Painful Bladder Syndrome
Introduction
Evolution of Interstitial Cystitis (IC) Theory
Epidemiology of IC with Historical Timeline
Etiology and Pathogenesis
The Final Common Pathway
Genetics
Diagnosis
NIH/NIDDK Research Criteria (Circa 1987)
The AUA Consensus-Based Guideline Statement for the Treatment of IC
Introductory Statement About the AUA Guidelines
Treatments Range from More Conservative to More Invasive
First-Line Therapies
Patient Education
Diet
Dietary Supplements, Calcium Glycerol Phosphate (Prelief)
Dietary Supplements, Calcium Glycerol Phosphate (Prelief)
Second Line Therapies
Pelvic Floor Physical Therapy
Oral Medications: Elmiron, Amitriptyline, Hydroxyzine
Oral Medication: Elmiron
Oral Medications: Amitriptyline
Oral Medications: Hydroxazine
Intravesical Medications
Intravesical Therapy: Heparin (GAG Enhancement)
Intravesical Therapy: Dimethyl Sulfoxide
Intravesical Therapy: Combination Agents
Third Line Therapies
Fourth Line Therapies
Fifth Line Therapies
Sixth Line Therapies
Conclusion
References
16: Sacral Neuromodulation in Interstitial Cystitis
Introduction
History
Interstitial Cystitis/Bladder Pain Syndrome
Neuroanatomy
Diagnosis and Treatment Algorithm of IC/ BPS
Patient Education
Sacral Neuromodulation
Percutaneous Nerve Evaluation (PNE)
First State Lead Placement (FSLP) [16]Stage II/Permanent Implantation Involves the Following [16]Sacral Neuromodulation for IC/BPS
Pudendal Neuromodulation
Posterior Tibial Nerve Stimulation (PTNS)
Conclusion
References
17: The Neurogenic Bladder and Hypertonic Pelvic Floor Muscle Dysfunction
Introduction, Anatomy, and Physiology
Uro-Philosophy 101, Structure and Function
Neuroanatomy and Neurophysiology of the Lower Urinary Tract
The Physiology of Continence
The Physiology of Continence (Peripheral NeuroControl)
Peripheral Control of Continence (The Urothelium)
Peripheral Control of Continence (The Functional Syncytium)
The Physiology of Voiding
Site Specific Neurogenecity
Spinal Cord Injury (SCI)
Brain Lesions
Systemic Diseases
Parkinson’s Disease
Multiple Sclerosis (MS)
Multiple System Atrophy (MSA) and Detrusor Dysfunction
Detrusor Dysfunction in Diabetes
Spina Bifida Affect on Bladder Dysfunction
Treatment Options in Neurogenic Bladder
Physical-Psychological Therapy/Timed Voiding
Sacral Nerve Root Stimulation
Drug Therapy
Anticholinergic Agents
Antimuscarinic Agents
Centrally Acting Agents, Tricyclic Antidepressant Drugs
Sympathomimetic Agents (Beta III Agonists)
CIC
Surgery
Biologic Neuromodulation Using BoTox
Historical Timeline for BoTox
Preparations
Mechanism of Action (Fig. 17.7)
Botox as Therapy for Neurogenic Detrusor Overactivity
Suggested Reading
18: Biology of Pain and Pathophysiology of Pelvic Pain Syndrome
Why Study Pain? What Is the Impact and Need to Understand the Pathology?
What Is Pelvic Pain? How Do We Separate the Objective and Experiential?
Pathophysiology of Pelvic Pain in Women
Sexual Pain Disorder
The Role of Mental Health and Pain: Depression, Trauma, and Anxiety
Pelvic Pain in Men: A Brief Overview
What Is the Biology of Pain?
The Ascending Pain Pathway
The Descending Pain Pathway
Are There Sex-Related Differences in Perception of Pain?
Pelvic Pain in Sociocultural Context
What About Pleasure? Is It All About Avoiding Pain?
Key Points
References
19: Chronic Pelvic Pain: Pudendal Neuralgia and Therapeutic Neural Blockade
Introduction
Neuroanatomy of the Pudendal Nerve
Neurophysiology of the Pudendal Nerve
Pathophysiology of Pudendal Neuralgia
Pathophysiology of Pudendal Neuralgia in Tarlov’s Cysts
Persistent Genital Arousal Disorder (PGAD)
Neurodiagnostic Evaluation in Pudendal Neuralgia
Treatment of Pudendal Neuralgia
General Concepts of Neural Blockade
Anesthetic Properties in Neural Blockade
Somatic Nerve Blocks
Trigger Point Therapy
Treatment of MTrPs
Summary
Suggested Reading
Part IV: Gynecologic/Urogynecologic Aspects
20: Pelvic Organ Prolapse in the Older Woman
Pelvic Organ Prolapse in the Older Woman
Conclusion
Key Points
References
21: Robotic Pelvic Surgery: Historical Perspective, Single-Site Robotic Surgery and Robotic Sacral
Introduction
Historical Evolution
Single-Site Robotic Surgery
Robotic-Assisted Abdominal Sacrocolpopexy
Robotic-Assisted Abdominal Sacrocolpopexy
Technique Considerations
Conclusions
References
22: Genito-Urinary Fistulae: Vesicovaginal, Ureterovaginal, and Other Urinary Fistula
Historical Perspective
Introduction
Gynecologic Fistulae
Etiology
Presentation
Management
Treatment
Non-surgical
Surgical
Techniques
Latzko Partial Colpocleisis
Transvaginal Repair of VVF (Excisional Type)
Transabdominal Repair
Transvesical Approach
Other Techniques
Complications
Obstetric Fistula
Epidemiology
Classification of Fistulae
Perioperative Considerations
Evaluation for other Lesions
Nutritional Status
HIV
Timing of Surgery
Surgical Route
Tissue Flap Interposition
Ureteral Stent Placement
Stress Urinary Incontinence
Urodynamics
Antibiotics
Anesthesia
Treatment
Non-surgical
Surgical
Surgical Techniques
Simple Closure of Obstetrical VVF
Complex Repairs
Post-operative Care
The Incurable Patient and Urinary Diversion
Other Fistulas
Ureterovaginal Fistulas (UVFs)
Vesicouterine and Vesicocervical Fistulae
Urethrovaginal Fistulae
Rectovaginal Fistulae (RVF) with VVF
Enterovesical and Colovesical Fistulae
Conclusion
References
Part V: Colorectal Interventions
23: Rectal Prolapse in the Elderly
Introduction
Presentation and Associated Findings
Evaluation
Management Options
Non-operative Management
Operative Management
Operative Indications
Rectal Prolapse and Constipation
Rectal Prolapse with Fecal Incontinence
Mucosal Prolapse
Operative Techniques
Abdominal Approach
Perineal Approach
Surgical Outcomes for the Elderly
Conclusion
References
24: Fecal Incontinence
Introduction
Medical Therapy
Patients with Fecal Incontinence and Disordered Defecation with Incomplete Evacuation
Patients with Fecal Seepage
Biofeedback and Cognitive Behavioral Therapy
Types of Biofeedback Therapy
Elements of Biofeedback Therapy
Invasive Therapy
Perianal Injectable Bulking Agents
Sacral Nerve Stimulation
Radiofrequency Energy
Artificial Bowel Sphincter
Magnetic Bowel Sphincter
Overlapping Sphincteroplasty
Dynamic Graciloplasty
Malone Antegrade Continence Enema
Colostomy
Key Points
References
25: Chronic Constipation
Introduction
Definition and Classification
Epidemiology
Burden of Disease
Physiology of Colonic Transit and Defecation
Pathophysiology of Constipation
Clinical Aspects
History and Physical Exam
Diagnostic Testing
Special Considerations in the Elderly
Treatment
Medical Treatment of Functional Constipation
Bulking Agents
Stool Softeners and Probiotics
Stimulant Laxatives
Osmotic Laxatives
Intestinal Secretagogues
Treatment of Defecation Disorders
Treatment of Slow Transit Constipation
Key Points
References
26: Fecal Diversion and Ostomies
Introduction
Preoperative Preparation
Indications for Ostomies
Temporary vs. Permanent
Fecal Diversion: Loop Colostomy vs. Loop Ileostomy
Ostomy Site Selection
Operative Approach
Creation of Stoma Aperture
Maturation of the Stoma
Ostomy Management
Stoma Appearance
Appliance Products
Ostomy Output
Postoperative Complications
Vascular Compromise
Retraction
Prolapse
Parastomal Herniation
Stricture/Stenosis
Peristomal Skin Irritation
Small Bowel Obstruction
Peristomal Abscess, Infection, and Fistula
Quality of Life
Key Points
References
27: Pelvic Hernias
Introduction
Obturator Hernia
Anatomy
Development
Clinical Features
Symptoms and Signs
Investigations and Diagnosis
Surgical Repair
Sciatic Hernia
Anatomy
Clinical Features
Symptoms and Diagnosis
Surgical Repair
Perineal Hernia
Anatomy
Clinical Features
Symptoms and Diagnosis
Surgical Repair
Key Points
References
28: Colorectal Interventions: Rectovaginal Fistulas
Definition and Classification
Epidemiology and Etiology
Clinical Presentation and Evaluation
Initial Presentation
Advanced Examination
Radiographic Imaging
Medical Management
Surgical Management
Timing of Surgery
Pre-Operative Management
Local Repairs
Simple Fistulotomy
Transsphincteric and Transperineal Repairs
Transvaginal Approaches
Setons, Fibrin Glue, and Fistula Plugs
Endorectal Advancement Flap
Muscle Interposition
Gracilis Interposition
Martius Graft
Bioprosthetic Repairs
Transabdominal Approaches
Diversion
Special Considerations
Crohn’s Disease
Radiation Injury
Malignancy
Recurrence
Summary and Recommendations
Key Points
References
29: Colorectal Interventions: Benign Anorectal Disease
Pruritis Ani
Epidemiology and Classification
Etiology and Management
Infectious
Dermatologic
Systemic Disease and Psychological Factors
Anorectal Causes
Neoplasm
Diagnosis
History and Physical Examination
Laboratory Examination
Treatment
Hemorrhoids
Anatomy
Etiology
Epidemiology
Classification
Diagnosis and Examination
Treatment
Nonoperative Treatment
Minor Office Procedures
Rubber Band Ligation
Sclerotherapy
Infrared Coagulation, Bipolar Diathermy, Direct-�Current Electrotherapy
Operative Treatment
Hemorrhoidectomy
Stapled Hemorrhoidectomy
Special Cases
Thrombosed External Hemorrhoids
Strangulated Hemorrhoids
Anorectal Abscess and Fistula-in-Ano
Anatomy and Classification of Anorectal Abscess
Diagnosis
Treatment
Fistula-in-Ano
Classification
Diagnosis
Treatment
Operative Techniques
Postoperative Care
Anal Fissure
Etiology and Pathophysiology
Epidemiology
Diagnosis
Treatment
Conservative Management
Medical Management
Operative Treatment
Sexually Transmitted Diseases
Epidemiology
Diagnosis
Etiology and Management
Bacterial Pathogens
Neisseria Gonorrhea
Chlamydia Trachomatis
Syphilis
Viral Pathogens
Herpes Simplex Virus
Human Immunodeficiency Virus
Human Papillomavirus
Conclusions
Key Points

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Tags: Pelvic Floor, Dysfunction, Pelvic Surgery, the Elderly, David Gordon