Female Pelvic Surgery

Foreword
Preface
Acknowledgments
Contents
Contributors
1: Anatomy of the Female Pelvis
	Introduction
	Abdominal Wall
	Bony Pelvis
	Pelvic Muscles
	The Urinary Tract
	Kidneys
	Ureters
	The Bladder (Fig. 1.13)
	The Urethra
	The Female Reproductive System
		Ovaries
	Fallopian Tubes
	Uterus
	Vagina
		Vulva
	Conclusion
	References
2: Instrumentation for Female Pelvic Surgery
	Introduction
	Instruments Used for Open/Vaginal Surgery
		Uterine Tenaculum (Fig. 2.1)
		Allis Forceps (Fig. 2.2)
		DeBakey Forceps (Fig. 2.3)
		Metzenbaum Scissors (Fig. 2.4)
		Mayo Scissors (Fig. 2.5)
		Deaver Retractor (Fig. 2.6)
		Vaginal Handheld Retractors (Fig. 2.7)
		Self-Retaining Retractors (Fig. 2.8)
		Weighted Vaginal Speculum (Fig. 2.9)
		Mid-Urethral Sling Trocar (Fig. 2.10)
		Raz Double-Pronged Needle (Fig. 2.11)
		Heaney Needle Holder (Fig. 2.12)
		Capio® Device (Fig. 2.13)
		Phaneuf Clamp (Fig. 2.14)
		Cystoscope (Fig. 2.15)
		Catheters (Fig. 2.16)
		Diluted Indigo Carmine Solution
		Surgical Sutures
		Stirrups (Fig. 2.17)
		Vaginal Packing
	Instruments Used for Laparoscopic Procedures
		Veress Needle and Laparoscopic Trocars (Fig. 2.18)
		LigaSure™ (Fig. 2.19)
		Harmonic® Scalpel (Fig. 2.20)
		Laparoscopic Maryland Forceps and Laparoscopic Scissors (Fig. 2.21)
	Instruments Used for Robotic Surgery: Da Vinci® Surgical System (Figs. 2.22, 2.23, 2.24, 2.25, 2.26, 2.27, 2.28a, b)
3: The Surgical Management of Stress Urinary Incontinence
	Introduction
	Evaluation
		Surgical Options
			Burch Colposuspension
		Surgical Technique
			Open
		Laparoscopic/Robotic
		Outcomes
		Complications
	Detrusor Overactivity
	Urinary Retention
	Enterocele/Rectocele Formation
	Periurethral Bulking Agent
		Surgical Technique
			Periurethral
			Transurethral
		Outcomes
		Complications
	Pubovaginal Sling
		Surgical Technique
		Outcomes
		Complications
	Midurethral Synthetic Slings
	Retropubic
		Surgical Technique
			Top-Down
			Bottom-Up
	Transobturator
		Surgical Techniques
			Out-In
			In-Out
		Outcomes
		Complications
	Single Incision
		Surgical Technique
		Outcomes
		Complications
	Conclusion
	References
4: Neuromodulation for Voiding Dysfunction
	Introduction
	Background
	Normal Physiology of Voiding
	Indications for Treatment and Patient Selection
	PTNS
	Patient Selection, Contraindications, and Treatment Side Effects
	PTNS (Fig. 4.1)
		Technique
		Success Rates and Future of PTNS
		Sacral Neuromodulation
		Patient Selection
	Risks of Therapy
		Technique
			Technique: Percutaneous Nerve Evaluation (PNE)
			Technique: First-Stage Lead Implant
			Technique: Placement of Neurostimulator
			Technique: Device Removal
	Success Rates and Future Direction of SNM
	Future Direction/Conclusion
	References
5: Transvaginal Prolapse Repair
	Introduction
	Anterior Repair
		Background
		Evaluation
		Surgical Repair
		Traditional Anterior Colporrhaphy
		Mesh-Augmented Colporrhaphy
		Paravaginal Defect Repair
		Recent Randomized Trials on Outcomes [10]
		Summary
	Posterior Repair and Perineorrhaphy
		Background
		Evaluation
		Surgical Repair
		Traditional Posterior Colporrhaphy
		Site-Specific Posterior Colporrhaphy
		Graft-Augmented Posterior Colporrhaphy
		Recent Randomized Trials on Outcomes
		Summary
	Apical Repair
		Background
		Evaluation
		Surgical Repair
	Restorative Apical Prolapse Repair
		Transvaginal Sacrospinous Ligament Fixation (SSLF)
		Transvaginal Uterosacral Ligament Suspension (USLS)
		Compensatory Apical Prolapse Repair
		Obliterative Apical Prolapse Repair
	Recent Randomized Trials on Outcomes (Table 5.1)
		Transvaginal Repair With Versus Without Mesh
		Transvaginal USLS Versus SSLF
		Transvaginal Versus Transabdominal Approach
		Summary
		Conclusion
	References
6: Female Pelvic Surgery: Obliterative Vaginal Procedures
	Background
	Colpocleisis
	Evaluation/Workup
	Management of the Uterus
	Adverse Perioperative Events
	Regret and Recurrence
	Concurrent Procedures
		Concurrent Hysterectomy
		Concurrent Midurethral Sling
	Surgical Procedures
	Summary
	References
7: Open Transabdominal Sacrocolpopexy
	Introduction
	Background
	History
	Patient Evaluation
	Technique
	Outcomes
		Definition of Success
		Genitourinary/Gastrointestinal/Sexual Function Outcomes
		Open ASC Versus Laparoscopic/Robot-Assisted ASC
	Controversial Topics in Open ASC
		Uterine Sparing
		Concomitant Hysterectomy
		Concomitant Anti-incontinence Procedure
	Summary
	References
8: Robotic/Laparoscopic Sacrocolpopexy
	Introduction
	Patient Evaluation and Preparation
	Laparoscopic/Robotic Sacrocolpopexy: Technique
	Outcomes of Laparoscopic/Robotic ASC
	Conclusion
	References
9: Transvaginal Urethrolysis for Urethral Obstruction
	Background
	Evaluation and Diagnosis
	Repair Techniques for Urethral Obstruction
		Timing of Repair
		Sling Incision/Excision
		Urethrolysis
		Retropubic Approach
		Transvaginal Approaches
		Robotic/Laparoscopic Approach
	Clinical Outcomes
		Sling Incision/Excision
		Retropubic Urethrolysis
		Transvaginal Urethrolysis
		Repeat Urethrolysis
	Complications of Repair
		Recurrence of Stress Urinary Incontinence
		Overactive Bladder
	Conclusion
	References
10: Vaginal Fistula Repairs
	Introduction
		General Principles of Fistula Repair
		Evaluation
			History and Physical Examination
			Diagnosis
			Timing
			Abdominal or Vaginal approach
			Concomitant Procedures
			Ureteral Reimplant and Bladder Augmentation
			Fecal Diversion
			Tissue Interposition: Peritoneal, Martius, Labial, Gluteal Flaps (Inner Thigh Rotational Flaps Based on the Internal Pudendal Artery)
	Vesicovaginal Fistula
		Background
			Etiology
			Diagnosis
			Timing of Repair
		Treatment
			Conservative Treatment
			Trans Vaginal Repair
			Latzko Partial Colpocleisis
			Abdominal Repair
			Laparoscopic/Robotic
			Complications
	Urethrovaginal Fistula
		Background
			Etiology
		Treatment
			Vaginal Surgical Repair
			Complications
	Ureterovaginal Fistula
		Background
			Etiology
			Surgical Repair
			Complications
	Rectovaginal Fistula
		Background
			Etiology
		Surgical Repair
			Tissue Interposition
			Vaginal Repair
			Transanal Repair
			Perineal Repair
			Complications
	References
11: Repair of Urethral Diverticula
	Introduction
	Prevalence and Risk Factors
	Pathophysiology and Etiology
	Diverticular Anatomy
	Evaluation/Workup
	Presentation
	Physical Examination
	Urine Studies
	Cystourethroscopy
	Urodynamics
	Imaging
	Surgical Repair
		Indications for Repair
		Techniques for Repair
			Alternative Techniques
			Excision and Reconstruction
		Preoperative Preparation
		Procedure
		Postoperative Care
		Complications
		Persistence of Symptoms Following Urethral Diverticulectomy
	Summary
	References
12: Augmentation Cystoplasty
	Introduction
	Background
	Presentation
	Evaluation, Initial Treatment, and Workup Prior to Augmentation Cystoplasty
	Surgical Techniques
		Catheterizable Cutaneous Stoma Techniques
		Augmentation Cystoplasty Techniques
	Postoperative Management
	Outcomes
	Complications
		Irrigation
		Calculi
		Bladder Rupture
		UTI
		Malignancy
		Upper Tract Deterioration
		Pregnancy
	Summary
	References
13: Urethroplasty for Female Urethral Stricture Disease
	Introduction
	Background
	Evaluation
	Preoperative Considerations
	Postoperative Care
	Surgical Techniques
		Ventral Incision and Anastomosis
		Vaginal Inlay Flap
		Free Labia Minora Skin Flap
	Pedicle Flap from the Labia Minora
		Ventral Buccal Graft
		Dorsal Buccal Graft [18]
		Dorsal Vestibular Flap Urethroplasty [27]
		Free Vaginal Wall Inlay Graft [28]
		Lateral-Based Anterior Vaginal Wall Flap [29]
	Summary
	References
14: Excision of Vaginal and Vulvar Cysts
	Introduction
	Embryology
	The Urinary Tract
	The Genital Tract
	The Vagina
	Anatomy
		Vaginal Structure and Histology
		Vaginal Neurovasculature
	The Urethra
	The Vulva
	History and Physical Examination
	Differential Diagnosis
	Vaginal Cysts
		Vaginal Epidermal Inclusion Cysts
	Gartner Duct Cysts
	Adenosis
	Vaginitis Emphysematosum
	Müllerian Cysts
	Vulvar Cysts
		Vulvar Epidermoid Cysts
		Bartholin Gland Cysts
		Skene’s Gland Cysts
		Cysts of the Canal of Nuck
	Surgical Intervention
		Operative Technique
		Incision and Drainage
	Marsupialization
	Excision
	Vulvar Considerations
	Vulvar Epidermal Inclusion Cysts
	Bartholin Gland Cysts
	Cysts of the Canal of Nuck
	Summary
	References
15: Transvaginal Closure of Bladder Neck
	Background
	Indications for Transvaginal Closure of the Bladder Neck
	Preoperative Evaluation
	Procedure
	Postoperative Management
	Complications
	Summary
	References
16: Surgical Therapy for Fecal Incontinence
	Introduction
	Etiology
		Obstetric Injury
		Congenital
		Iatrogenic
		Neurogenic
		Rectal Prolapse
		Assessment
	Physiologic Testing
		Anorectal Manometry
		Pudendal Nerve Terminal Motor Latency
		Endorectal Ultrasound
		Defecography
	Treatment
		Medical
		Biofeedback
		Anal Plugs
		Surgical Modalities
		Anal Encirclement Procedures
		Radiofrequency
		Bulking Agents
		Overlapping Sphincteroplasty
		Postanal Repair
		Muscle Transposition
		Artificial Bowel Sphincter
		Sacral Nerve Stimulation
		Diversion
	Conclusion
	References
17: Botulinum Toxin Therapy for Voiding Dysfunction
	Introduction
	Mechanism of Action
	Indications for Use of OnabotulinumtoxinA
	Use in Neurogenic Detrusor Overactivity (NDO)
	Use in Overactive Bladder
	Patient Selection and Workup
	Off-Label Uses for OnabotulinumtoxinA
	Adverse Effects of OnabotulinumtoxinA
	Injection Technique
	References
18: Construction of the Neovagina
	Introduction
	Indications
	Preoperative Assessment and Planning
	Goals of Therapy
	Conservative Management
	Surgical Management
	McIndoe Procedure
	Modifications of the McIndoe
	Williams Procedure
	Laparoscopic Procedures
	Vecchietti Procedure
	Davydov Procedure
	Myo- and Fasciocutaneous Flap Procedures
	Rectus Abdominis Flap
	Gracilis Flap
	Posterior Thigh Flap (Fig. 18.10)
	Pudendal Thigh Flap
	Martius Bulbocavernosus Flap
	Omentum-Pedicled Flap
	Intestinal Flaps
	Sigmoid Flap
	Ileocecal Flap
	Jejunal Flap
	Vaginoplasty for Transgender Women
	Complications of Neovaginal Construction
	Prolapse of the Neovagina
	Summary
	References
19: Surgical Management of Interstitial Cystitis/Bladder Pain Syndrome
	Introduction
	Hunner Lesions
	Hydrodistension: Is There a Role for It?
	Endoscopic Management
		Resection
		Fulguration
		Laser Ablation
		Steroid Injection
		OnabotulinumtoxinA Injection
		Bladder Wall Incision
	Surgical Management
		Sacral Neuromodulation
		Neurological Procedures
		Surgical Reconstruction
		Cutaneous Urinary Diversion
		Supratrigonal Cystectomy With Augmentation
	Conclusions
	References
20: The Use of Mesh in Pelvic Floor Reconstruction
	Introduction
	Mesh Properties and Characteristics
	Physiological Response to Polypropylene Mesh
	Current Vaginal Mesh Products
	Outcome Data
	The Food and Drug Administration (FDA) on transvaginal mesh
	The Future of Mesh
	Conclusion
	References
21: Gender Confirmation Surgery
	Introduction
	Male-to-Female Gender Confirmation Surgery
		Penile Inversion Technique
		Sigmoid Vaginoplasty
	Female-to-Male Gender Confirmation Surgery
		Metoidioplasty
		Phalloplasty
	Gender Confirming Surgery and Bioethics
	References
Index