By Sandip P. Vasavada, Rodney Appell, Peter K. Sand, Shlomo Raz
ISBN-10: 0824754263
ISBN-13: 9780824754266
ISBN-10: 0849377897
ISBN-13: 9780849377891
Seriously illustrated for transparent navigation and figuring out of anatomical websites, surgical suggestions, and reconstructive strategies, this reference reports the surgical and nonsurgical evaluate and administration of varied problems affecting woman urinary and pelvic health-collecting important techniques, instructions, and top practices from over a hundred expert professionals for specialist tips within the remedy of urinary incontinence, pelvic organ prolapse, and different dysfunctions.
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Additional info for Female Urology, Urogynecology, and Voiding Dysfunction
Sample text
Vault prolapse or eversion requires fixation of the apex to the sacrum, sacrospinous ligament or ileococcygeus muscle, often in conjunction with repair of anterior and posterior vaginal wall defects (18). B. Enterocele An enterocele is defined as a herniation of peritoneum and its contents at the level of the vaginal apex. Enteroceles occur in the upper, posterior portion of the vagina in association with the culde-sac of Douglas. Most enteroceles are acquired following hysterectomy, caused by separation of the cardinal-sacrouterine complex and described as a “pulsion” defect at the vaginal dome (19).
A significant number of women with stress incontinence will also have a cystocele, which may require surgical correction as well. A cystocele is defined as descent of the bladder base below the inferior ramus of the symphysis pubis, either at rest or with straining (17). Several systems of classification are in use that grade cystoceles based on degree of descent. We utilize a system of cystocele grading that includes four degrees of anterior vaginal wall prolapse. Grades I and II cystourethroceles are described as a mild to moderate degree of anterior vaginal wall Anatomy of Pelvic Support 13 hypermobility during straining, usually ,2 cm.
Although it is unclear how such methods correct incontinence in this segment of the urethra, we do know that anatomy and hypermobility have not necessarily been corrected. In patients with stress incontinence and urethral hypermobility, there is rotational descent of the bladder neck and urethra under the pubic symphysis. The bladder neck funnels with Valsalva maneuvers, facilitating the loss of urine. However, the degree of rotational descent 12 Rosenblum et al. does not correlate with the degree of incontinence.
Female Urology, Urogynecology, and Voiding Dysfunction by Sandip P. Vasavada, Rodney Appell, Peter K. Sand, Shlomo Raz
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