PELVIC FLOOR DISORDERS : a multidisciplinary textbook.

Foreword
Preface
Contents
Contributors
Part I: State of the Art Pelvic Floor Anatomy
	1: Pelvic Floor Anatomy
		1.1	 Introduction
			1.1.1	 Support of the Pelvic Organs: Conceptual Overview
		1.2	 Anatomy and Prolapse
			1.2.1	 Overview
			1.2.2	 Apical Segment
			1.2.3	 Anterior Compartment
			1.2.4	 Perineal Membrane (Urogenital Diaphragm)
			1.2.5	 Posterior Compartment and Perineal Membrane
			1.2.6	 Lateral Segment Comprising of the Levator Ani Muscle Support
			1.2.7	 Endopelvic Fascia and Levator Ani Interactions
			1.2.8	 The Levator Plate
			1.2.9	 Interaction Between Different Compartments
			1.2.10	 Nerves
		1.3	 Summary
		References
	2: Biochemical Properties and Hormonal Receptors of Pelvic Floor Tissues
		2.1	 Introduction: How Complicated Is That?
			2.1.1	 The Role of Reproductive Hormones on the Pelvic Floor Function During the Life Span
			2.1.2	 Hormonal Changes and Pelvic Floor Symptoms
		2.2	 The Role of Biochemical Properties and Hormonal Receptors of Pelvic Floor Tissues in Epidemiology of Pelvic Floor Function
			2.2.1	 Sexual Hormone Receptors
			2.2.2	 Biochemical Properties of Pelvic Floor Tissues
				2.2.2.1	 Collagen of Pelvic Floor Tissues
					Anterior Vaginal Wall
					Periurethral Tissue
					Cardinal Ligaments
					Uterosacral Ligament
					Endopelvic Fascia
					The Arcus Tendineus Fasciae Pelvis (ATFP)
					Elastin
			2.2.3	 The Role of Matrix Metalloproteinases (MMPs) on Pelvic Floor Tissue Remodeling
		2.3	 The Recent Investigations and Possibilities for Future Research
		2.4	 Hormonal Impact on Vaginal Atrophy, the Role on Pelvic Floor Dysfunction, and Treatment
			2.4.1	 Conclusion: Hormone Therapy
		2.5	 Summary and Recommendations for Practice
		References
	3: The Integral System of Pelvic Floor Function and Dysfunction
		3.1	 Introduction
		3.2	 The Integral Theory of Pelvic Floor Function
		3.3	 The Integral System
		3.4	 Part 1: Pubourethral Ligament: How the Midurethral Sling Was Discovered
			3.4.1	 Development of the Artificial Collagenous Neoligament for PUL Repair
			3.4.2	 Application of the Neoligament Surgical Principle to PUL and Other Ligaments
			3.4.3	 Clinical Relevance of Some Initial MUS Operation Findings (1988–1989)
			3.4.4	 Closure of the Urethra
			3.4.5	 Role of PUL and Subsidiary Structures in Normal Urethral Closure and Incontinence
			3.4.6	 Role of Lax PUL in the Causation of Urinary Stress Incontinence
			3.4.7	 External Urethral Ligament Laxity: A Rarely Recognized Cause of Nonstress Urine Leakage
			3.4.8	 Anorectal Closure
			3.4.9	 Serendipity: Cure of Fecal Incontinence (FI) Following PUL and USL Sling Repair
			3.4.10	 Surgical Repair of PUL by MUS
			3.4.11	 Surgical Results for PUL Repair (Midurethral Sling)
			3.4.12	 Zone of Critical Elasticity: Tethered Vagina Syndrome and Role of Fibrosis in Incontinence After Post-obstetric Fistula Repair
		3.5	 Part 2: The Uterosacral Ligament “USL”: Cure of Uterine Prolapse with Posterior Sling
			3.5.1	 Role of USL in Micturition
			3.5.2	 Role of USL in Normal Defecation
			3.5.3	 Lax USLs: Anatomical Pathways to Pain, Bladder, and Bowel Dysfunction
			3.5.4	 Lax USLs: Role in “Obstructive Micturition and Defecation” (Organ Emptying Problems)
			3.5.5	 Lax USL: Pathways from Ligament Laxity to Symptoms of Urge, Frequency, and Nocturia
			3.5.6	 Lax USL: Anatomical Pathway to Chronic Pelvic Pain
		3.6	 Part 3: Cardinal Ligament (CL): Its Role in Cystocele Causation
		3.7	 Part 4: ATFP: Role in Lateral Cystocele and Urinary Stream Diversion
		3.8	 Part 5: Deep Transversus Perinei (DTP): Role in Rectocele and Descending Perineal Syndrome
			3.8.1	 Anatomical and Surgical Significance of DTP Ligaments
			3.8.2	 PB Function Is Linked to USL Function
			3.8.3	 Surgical Principles Derived from the Integral System
			3.8.4	 Complications of Total Ligament Repair Surgery Using the TFS Tensioned Mini Sling
			3.8.5	 Role of Muscle in Continence Control
			3.8.6	 Muscle, Ligament, or Both?
			3.8.7	 The Three-Muscle, 3-Month Pelvic Floor Muscle Strengthening Study
			3.8.8	 Is Rectopexy or Sacrocolpopexy (SCP) an Anatomically Correct Method for Restoration of Rectal Intussusception and Rectal Prolapse?
		3.9	 Conclusion
		References
	4: The Pelvic Floor: Neurocontrol and Functional Concepts
		4.1	 Introduction
		4.2	 The Urinary and Recto-Anal Systems
		4.3	 Urinary and Faecal Storage and Voiding
			4.3.1	 Bladder Equilibrium
			4.3.2	 The Lumbosacral Loop
			4.3.3	 The Pontine Loop
			4.3.4	 The Cortical System
			4.3.5	 Central Representation of Afferent Information from Bladder and Bowel
			4.3.6	 Universal Organisation of CNS Control Systems
		4.4	 The Pelvic Floor and Its Innervation
		4.5	 Pelvic Floor Dysfunction in Incontinence
		4.6	 Investigation of the Pelvic Floor
		4.7	 Urinary Storage: The Default Mode
		4.8	 Urethral Opening: Voiding
		4.9	 The Bladder Trigone During Micturition
		4.10	 Neurological Feedback Control of Anorectal Function
		4.11	 When Things Go Wrong: Urge, Frequency, and Nocturia
		4.12	 Overactive Bladder Syndrome (OAB)
		4.13	 How Does Detrusor Overactivity Relate to Feedback Control?
		4.14	 Events Occurring in Detrusor Overactivity and Overactive Bladder Syndrome
		4.15	 Non-linear Flow Mechanics Enhance the Storage and Voiding Responses
		4.16	 Why Urodynamic Urethral Pressure Measurements Correlate Poorly with Clinical States
		4.17	 How Repeatable Are Urine Flow Measurements in an Individual?
		4.18	 Detrusor Underactivity
		4.19	 Low Bladder Compliance
		4.20	 Clinical Variations in Bladder Symptoms Are Consistent with the Chaos Theory Feedback Equation
		4.21	 Concluding Remarks
		References
Part II: Pelvic Floor Imaging
	5: Principles and Technical Aspects of Integrated Pelvic Floor Ultrasound
		5.1	 Introduction
		5.2	 Principles of Pelvic Floor Ultrasound
		5.3	 Two-Dimensional Transperineal Ultrasound (2D TPUS)
			5.3.1	 Convex Transducers
			5.3.2	 Linear/Microconvex Transducers
		5.4	 Three-Dimensional/Four-Dimensional Transperineal Ultrasound (3D/4D TPUS)
			5.4.1	 Volumetric Transducers
		5.5	 Two-Dimensional Endovaginal Ultrasound (2D EVUS)
		5.6	 Three-Dimensional Endovaginal Ultrasound (3D EVUS)
		5.7	 Two-Dimensional Endoanal Ultrasound (2D EAUS)
		5.8	 Three-Dimensional Endoanal Ultrasound (3D EAUS)
		5.9	 Conclusions
		References
	6: Transperineal Ultrasonography: Methodology and Normal Pelvic Floor Anatomy
		6.1	 Introduction
		6.2	 Basic Technique
		6.3	 The Anterior Compartment: Urethra and Bladder Base
			6.3.1	 The Urethra
			6.3.2	 Paraurethral Tissues
			6.3.3	 The Bladder Neck and Trigone
		6.4	 The Fornices
		6.5	 The Central Compartment: Uterus and Vault
		6.6	 The Posterior Compartment
			6.6.1	 Normal Anatomy in the Midsagittal Plane
			6.6.2	 The Perineal Body/Transversus Perinei
			6.6.3	 The Rectovaginal Septum
			6.6.4	 The Anal Canal on Tomographic Imaging
		6.7	 The Levator Ani Muscle
			6.7.1	 2D Imaging
			6.7.2	 Axial Plane
			6.7.3	 Multislice Imaging
		6.8	 Static Versus Dynamic “Normality”
		6.9	 Urethral Mobility and Bladder Neck Configuration
		6.10	 Pelvic Organ Descent
		6.11	 Hiatal Dimensions
		6.12	 Conclusions
		References
	7: Endovaginal Ultrasonography: Methodology and Normal Pelvic Floor Anatomy
		7.1	 Introduction
		7.2	 Technical Aspects of 3D Endovaginal Ultrasound
		7.3	 Ultrasonographic Anatomy of the Pelvic Floor
		7.4	 Assessment of the Anterior Compartment
		7.5	 Assessment of the Posterior Compartment
		7.6	 Discussion
		7.7	 Conclusion
		References
	8: Endoanal and Endorectal Ultrasonography: Methodology and Normal Anorectal Anatomy
		8.1	 Introduction
		8.2	 Ultrasonographic Technique
		8.3	 Endosonographic Anatomy of the Anal Canal
		8.4	 Endosonographic Anatomy of the Rectum
		8.5	 Normal Values
		8.6	 Conclusions
		References
	9: Technical Innovations in Pelvic Floor Ultrasonography
		9.1	 Introduction
		9.2	 Volume Render Mode
		9.3	 Maximum Intensity Projection
		9.4	 Brush Options: Segmentation—Sculpting
		9.5	 Fusion Imaging
		9.6	 PixelFlux
		9.7	 Framing
		9.8	 Motion Tracking and Color Vector Mapping
		9.9	 Elastography
			9.9.1	 Endovaginal Elastography
			9.9.2	 Endoanal Elastography
		9.10	 Contrast-Enhanced Ultrasound (CEUS)
			9.10.1	 Rectal Cancer
			9.10.2	 Contrast-Enhanced Voiding Urosonography (ceVUS)
			9.10.3	 Contrast-Enhanced Ultrasound Genitography
		9.11	 Automatic Ultrasound Calculation Systems
		9.12	 Conclusions
		References
	10: Magnetic Resonance Imaging: Methodology and Normal Pelvic Floor Anatomy
		10.1	 Introduction
		10.2	 The Anatomy of the Female Pelvic Floor
		10.3	 The Anterior Compartment
		10.4	 The Middle Compartment
		10.5	 The Posterior Compartment
			10.5.1	 The Posterior Compartment Contains the Rectum and Anal Sphincter
				10.5.1.1	 The Internal Anal Sphincter
				10.5.1.2	 The Intersphincteric Space and Longitudinal Layer
				10.5.1.3	 The Outer Striated Layer: External Anal Sphincter
				10.5.1.4	 The Outer Striated Layer: Puborectal Muscle
				10.5.1.5	 Anal Sphincter Support
		10.6	 The Endopelvic Fascia
		10.7	 The Pelvic Diaphragm
			10.7.1	 The Levator Ani Muscle
			10.7.2	 The Ischiococcygeus Muscle
		10.8	 The Perineal Membrane (Urogenital Diaphragm)
		10.9	 Conclusion
		References
	11: Dynamic Magnetic Resonance Imaging of the Pelvic Floor: Technique and Methodology
		11.1	 Introduction
		11.2	 Patient Positioning
		11.3	 Patient Preparation
		11.4	 Imaging Protocol
		11.5	 Image Analysis
			11.5.1	 Three-Compartment Model
			11.5.2	 Reference Systems
			11.5.3	 Anorectal Angle
			11.5.4	 Evacuation Ability
		11.6	 Normal Findings
		11.7	 Conclusion
		References
Part III: Obstetric Pelvic Floor and Anal Sphincter Trauma
	12: Mechanisms of Pelvic Floor Trauma During Vaginal Delivery
		12.1	 Biomechanics of the Second Stage of Labor
		12.2	 Injury from Vaginal Birth
		12.3	 Mechanisms of Levator Muscle Injury
		12.4	 Effect of Pregnancy on Pelvic Floor Tissue Properties
		12.5	 Finite Element Models of Vaginal Birth
		12.6	 Other Approaches to Modeling Vaginal Birth
		12.7	 Pudendal Nerve Stretch During Vaginal Birth
		12.8	 Effect of Forceps on Cephalolevator Disproportion
		12.9	 Effect of Maternal Pushing Styles During the Second Stage
		12.10	 Conclusions
		References
	13: Posterior Compartment Trauma and Management of Acute Obstetric Anal Sphincter Injuries
		13.1	 Introduction
		13.2	 Rectoceles
		13.3	 Obstetric Anal Sphincter Injuries (OASIS)
			13.3.1	 Applied Anatomy and Physiology
			13.3.2	 Diagnosis of OASIS
			13.3.3	 Repair of OASIS
			13.3.4	 Timing of Repair
			13.3.5	 Technique of Repair
			13.3.6	 Repair of Rectal Buttonhole Tear
			13.3.7	 Suture Material
			13.3.8	 Role of Antibiotics
			13.3.9	 Stool Softeners
			13.3.10 Postoperative Catheterization
			13.3.11 Postoperative Analgesia
			13.3.12 Follow-Up
			13.3.13 Anal Incontinence Symptoms After Primary Repair
			13.3.14 Management of Subsequent Pregnancies
			13.3.15 Training Issues
		13.4	 Conclusions
		References
	14: Neurogenic Trauma During Delivery
		14.1	 Introduction
		14.2	 Neural Anatomy
		14.3	 Pudendal Neuropathy
		14.4	 Mechanism of Nerve Injury
		14.5	 Measuring Nerve Injury
		14.6	 Striated Urethral Sphincter
		14.7	 External Anal Sphincter
		14.8	 Levator Ani Musculature
		14.9	 Conclusions
		References
	15: Prevention of Perineal Trauma
		15.1	 Introduction
		15.2	 Interventions in the Antenatal Period
			15.2.1	 Antepartum Perineal Massage
			15.2.2	 Pelvic Floor Muscle Training
		15.3	 Interventions During Labor and Birth
			15.3.1	 Water Birth
			15.3.2	 Position During Labor and Birth
			15.3.3	 Application of Warm Perineal Compresses in the Second Stage of Labor
			15.3.4	 Manual Perineal Protection (MPP)
			15.3.5	 Second Stage Perineal Massage
			15.3.6	 Episiotomy
			15.3.7	 Instrumental Delivery
			15.3.8	 Epidural Analgesia
			15.3.9	 Interventions to Correct or Deliver with an Occipito-Posterior Position
		15.4	 Conclusions
		References
Part IV: Urinary Incontinence and Voiding Dysfunction
	16: Overview: Epidemiology and Etiology of Urinary Incontinence and Voiding Dysfunction
		16.1	 General Comments and Definitions
		16.2	 Prevalence of Urinary Incontinence
		16.3	 Factors Influencing the Prevalence of Urinary Incontinence
		16.4	 OAB and Other LUTS
		16.5	 Public Health Consequences of UI and LUTS on a Global Scale
		16.6	 Voiding Dysfunction
		16.7	 Overall Conclusion
		References
	17: Urinary Incontinence and Voiding Dysfunction: Patient-Reported Outcome Assessment
		17.1	 Introduction
		17.2	 Development of a PRO
		17.3	 Linguistic and Cultural Validation
		17.4	 Types of PROs
			17.4.1	 Symptom Frequency and Bother
			17.4.2	 Discomfort and ADL
			17.4.3	 Treatment Satisfaction
			17.4.4	 Productivity
			17.4.5	 QALY
			17.4.6	 Types for Urinary Problems
			17.4.7	 Health-Related Quality of Life (HRQL) PRO
			17.4.8	 PROs for LUTS in Women: Symptom Bother and Urgency
			17.4.9	 Screening Questionnaires
		17.5	 International Consultation on Incontinence Modular Questionnaire (ICIQ)
		17.6	 Voiding Dysfunction
		17.7	 Limitations of PRO
		17.8	 Future of PRO
		17.9	 Conclusion
		References
	18: Urodynamics Techniques and Clinical Applications
		18.1	 Introduction
		18.2	 Urodynamic Techniques
			18.2.1	 Free Uroflowmetry and Measurement of Post-void Residual Volume
			18.2.2	 Evaluation of Storage Function: Filling Cystometry
			18.2.3	 Evaluation of Voiding Function: Pressure-Flow Studies or Voiding Cystometry
			18.2.4	 Video-Urodynamics
			18.2.5	 Ambulatory Urodynamics
			18.2.6	 Urethral Pressure Profilometry
		18.3	 Clinical Applications
			18.3.1	 Overactive Bladder
				18.3.1.1	 Free Uroflowmetry and Measurement of Post-void Residual Volume
				18.3.1.2	 Filling Cystometry
					Detrusor Overactivity
					Reduced Bladder Compliance
			18.3.2	 Stress Urinary Incontinence
				18.3.2.1	 Free Uroflowmetry and Measurement of Post-void Residual Volume
				18.3.2.2	 Assessment of Urethral Function
					Urethral Pressure Profilometry
					Abdominal Leak Point Pressure
				18.3.2.3	 Pelvic Organ Prolapse
			18.3.3	 Underactive Bladder and Detrusor Underactivity
				18.3.3.1	 Free Uroflowmetry and Measurement of Post-void Residual Volume
				18.3.3.2	 Pressure-Flow Studies
			18.3.4	 Bladder Outlet Obstruction
		18.4	 Future Perspectives
		18.5	 Conclusions
		References
	19: Ultrasonographic Techniques and Clinical Applications
		19.1	 Introduction
		19.2	 External Ultrasound
			19.2.1	 Examination Technique
		19.3	 Endoluminal Ultrasound
			19.3.1	 Examination Technique
		19.4	 Discussion
		19.5	 Conclusions
		References
	20: Biofeedback
		20.1	 Introduction
		20.2	 Purpose of Using Biofeedback
		20.3	 Effect of Biofeedback Training
		20.4	 Clinical Recommendations for the Use of Biofeedback
		20.5	 Conclusion
		References
	21: Selection of Midurethral Slings for Women with Stress Urinary Incontinence
		21.1	 Introduction
		21.2	 Other Types of Retropubic Midurethral Slings
			21.2.1	 Top-Down Systems
			21.2.2	 Intravaginal Slingplasty (IVS)
			21.2.3	 Self-Made Slings
			21.2.4	 Overview
		21.3	 Other Approaches for Sling Placement
			21.3.1	 The Transobturator Route
			21.3.2	 Outside-In Versus Inside-Out
			21.3.3	 Retropubic Versus Obturator
		21.4	 Predictors of Failure
			21.4.1	 Intrinsic Sphincter Deficiency
			21.4.2	 Effect of MUS on Lower Urinary Tract Function
			21.4.3	 The Elderly
			21.4.4	 The Obese
		21.5	 Biological Slings and Exitless Slings
			21.5.1	 Exitless Mini-Sling
		21.6	 Surgeon-Related Factors
		21.7	 Summary
		21.8	 Conclusions
		References
	22: Tape Positioning: Does It Matter?
		22.1	 Introduction
		22.2	 The Theoretical Basis for Midurethral Sling Placement
		22.3	 Proposed Mechanism of Action of the Midurethral Tape
			22.3.1	 The Controversy Regarding Sling Location and the Evidence on the Importance of Sling Location
			22.3.2	 Evidence in Favor of Primacy of Location in the Continence Mechanism of Midurethral Slings
			22.3.3	 The Benefits of Determining the Location of a Failed Sling
		22.4	 Does the Position of the Sling Change After Implantation?
		22.5	 If Location of the Sling Is Important, Does Suture Fixation of the Sling upon Implantation Help?
		22.6	 What Explains Successful Outcomes Following Sling Surgery in Patients in Whom the Sling Is Not Located Midurethrally? Dynamic Functional Assessment of Slings and Its Correlation with Outcome
		22.7	 Tape Position and Postoperative Complications
		22.8	 Future Directions
		22.9	 Conclusion
		References
	23: Colposuspension and Fascial Sling
		23.1	 Introduction
		23.2	 Colposuspension
			23.2.1	 Historical Background
			23.2.2	 Mechanism Action
			23.2.3	 Surgical Technique of the Modern Colposuspension
			23.2.4	 Indications
			23.2.5	 Contraindications
			23.2.6	 Complications
		23.3	 Fascial Sling
			23.3.1	 Historical Background
			23.3.2	 Mechanism of Action
			23.3.3	 Variation in Surgical Technique of the Autologous Fascial Sling
				23.3.3.1	 The Original Aldridge Sling
			23.3.4	 Indications for a Fascial Sling
			23.3.5	 Contraindications
		23.4	 Outcomes of Colposuspension and Fascial Sling
		23.5	 Is Laparoscopic Colposuspension as Effective as Open?
		23.6	 Do the Sutures Used for a Colposuspension Affect Outcome?
		23.7	 Is Colposuspension as Effective as an Autologous Fascial Sling?
		23.8	 Is the Sling on a String as Effective as the Traditional Aldridge Sling?
		23.9	 Is a Shorter Sling on a String as Effective as a Full Length Detached Sling?
		23.10	 Is an Autologous Sling Better at the Mid-Urethra or the Bladder Neck?
		23.11	 Is Fascia Lata as Effective as Rectus Sheath Fascia?
		23.12	 Are Allografts as Effective as Autologous Slings?
		23.13	 Are Xenograft Slings as Effective as Autologous Slings?
		23.14	 Conclusion
		References
	24: Injectable Biomaterials
		24.1	 Introduction
		24.2	 Safety of Urethral Bulking Agents
		24.3	 Efficacy of Urethral Bulking Agents
		24.4	 Future Directions
		24.5	 Conclusions
		References
	25: Artificial Urinary Sphincter in Women
		25.1	 Introduction
		25.2	 Artificial Urinary Sphincter
		25.3	 Indications
		25.4	 Contraindications
		25.5	 Operation
			25.5.1	 Preoperative Counselling and Preparation
			25.5.2	 Open Procedure for Insertion of AUS
				25.5.2.1	 Abdominal Approach
				25.5.2.2	 Vaginal Approach
				25.5.2.3	 Laparoscopic Extra-Peritoneal Approach for Insertion of AUS in Women
					Patient Preparation
		25.6	 Complications
			25.6.1	 Per-operative Complications
				25.6.1.1	 During Trocar Placement
			25.6.2	 Early Post-operative Complications
				25.6.2.1	 Urinary Retention
				25.6.2.2	 Infection and Extrusion of the Prosthesis
			25.6.3	 Late Post-operative Complications
				25.6.3.1	 Urethral Atrophy, Erosion or Extrusion
				25.6.3.2	 Mechanical Failure
				25.6.3.3	 Recurrent/Persistent Urinary Incontinence
		25.7	 Brief Review of the Literature About AUS Implantation in Women
			25.7.1	 Open Procedure
			25.7.2	 Laparoscopic Procedure
			25.7.3	 Robot-Assisted Artificial Urinary Sphincter Insertion
		25.8	 Conclusion
		References
	26: Pharmacological Treatment of Urinary Incontinence and Overactive Bladder: The Evidence
		26.1	 Introduction
		26.2	 Pathophysiology
			26.2.1 Muscarinic Receptors
		26.3	 Detrusor Overactivity
			26.3.1 Outflow Obstruction Hypothesis
			26.3.2 Neurogenic Hypothesis
			26.3.3 Urethral Reflex
			26.3.4 Myogenic Hypothesis
			26.3.5 Urothelial Afferent Hypothesis
		26.4	 Clinical Presentation
		26.5	 Investigation
			26.5.1 Urodynamic Investigations
			26.5.2 Cystourethroscopy
		26.6	 Conservative Management
			26.6.1 Bladder Retraining
		26.7	 Medical Management
		26.8	 Antimuscarinics
			26.8.1 Oxybutynin
			26.8.2 Tolterodine
			26.8.3 Trospium Chloride
			26.8.4 Solifenacin
			26.8.5 Darifenacin
			26.8.6 Fesoterodine
			26.8.7 Propiverine
		26.9	 Anticholinergic Burden
		26.10	 β-Adrenoceptors and OAB
			26.10.1 Mirabegron
			26.10.2 Combination Therapy: Mirabegron and Solifenacin
			26.10.3 Desmopressin
		26.11	 Oestrogens in the Management of Overactive Bladder
			26.11.1 Combination Therapy: Oestrogens and Antimuscarinics
		26.12	 Conclusions
		References
	27: Intravesical Botulinum Toxin for the Treatment of Overactive Bladder
		27.1	 Introduction
		27.2	 Recommendation for Practice
			27.2.1	 Injection Procedure
			27.2.2	 Neurogenic Detrusor Overactivity (NDO) Treatment with OnabotulinumtoxinA
			27.2.3	 Overactive Bladder Treatment with OnabotulinumtoxinA
		27.3	 Future Directions
		27.4	 Conclusion
		References
	28: Sacral Nerve Stimulation for Overactive Bladder and Voiding Dysfunction
		28.1	 Historical Overview
		28.2	 Mode of Action
		28.3	 Indications
		28.4	 Selection Criteria
		28.5	 Implant Technique
		28.6	 Results
		28.7	 Predictive Factors
		28.8	 Complications
		28.9	 Newer and Investigational (Experimental) Neuromodulation Techniques
		28.10	 Conclusions
		References
Part V: Anal Incontinence
	29: Overview: Epidemiology and Aetiology of Anal Incontinence
		29.1	 Introduction
		29.2	 Epidemiology of Anal Incontinence
			29.2.1	 Prevalence
			29.2.2	 How Future Estimates of Prevalence May Be Affected
			29.2.3	 Incidence
			29.2.4	 Risk Factors
			29.2.5	 Future Directions
		29.3	 Aetiology of Anal Incontinence
			29.3.1	 Continence
			29.3.2	 Incontinence
			29.3.3	 Risk Factors for Incontinence
				29.3.3.1	 Age
				29.3.3.2	 Nursing Home Residence
				29.3.3.3	 Gender
				29.3.3.4	 Childbirth
					Mechanisms for Anal Incontinence After Childbirth
					Epidemiology of Anal Incontinence After Childbirth
				29.3.3.5	 Urinary Incontinence
				29.3.3.6	 Diabetes
				29.3.3.7	 Gastrointestinal Disorders and Stool Consistency
					Diarrhoea
					Rectal Urgency
					Constipation/Faecal Impaction
					Irritable Bowel Syndrome
				29.3.3.8	 Neurological/Psychiatric Disorders
					Dementia
					Depression
				29.3.3.9	 Nutrition
					Obesity
					Vitamin D
				29.3.3.10	 Physical Mobility
				29.3.3.11	 Radiation
				29.3.3.12	 Prolapse
				29.3.3.13	 Surgery
					Anorectal Surgery
					Rectal Resection
					Other Surgeries
						Ureterosigmoidostomy
						Hysterectomy
						Cholecystectomy
				29.3.3.14	 Smoking
			29.3.4	 Future Directions
		References
	30: Patient-Reported Outcome Assessment in Anal Incontinence
		30.1	 Introduction
		30.2	 Development of PROMs
		30.3	 Evaluation of Reliability, Validity, and Responsiveness of PROMs
		30.4	 Anal or Fecal Incontinence Symptom Severity Scales
		30.5	 Anal or Fecal Incontinence-Specific Quality of Life Questionnaire
		30.6	 Combined Questionnaire of Anal Incontinence Severity Scale and Anal Incontinence-Specific Quality of Life Questionnaire
		30.7	 Recommendation for Practice in Choosing Appropriate PROMs for Anal Incontinence
		30.8	 Future Directions
		References
	31: Anorectal Manometry
		31.1	 Introduction
		31.2	 Manometric Data
		31.3	 Anorectal Manometry and Fecal Incontinence
		31.4	 Anorectal Manometry and Pelvic Floor Rehabilitation
		31.5	 High-Resolution Manometry and High-Definition Three-Dimensional Anorectal Manometry
		References
	32: Endoanal Ultrasonography in Anal Incontinence
		32.1	 Introduction
		32.2	 Internal Anal Sphincter Abnormalities
		32.3	 External Anal Sphincter Abnormalities
		32.4	 Puborectalis Muscle Abnormalities
		32.5	 Accuracy and Reliability
		32.6	 EAUS Versus EVUS and TPUS
		32.7	 EAUS Versus MRI
		32.8	 Current Recommendations for Research for EAUS
		32.9	 Conclusions
		References
	33: Transperineal Ultrasonography in the Assessment of Anal Incontinence and Obstetric Anal Sphincter Injuries
		33.1	 Introduction
		33.2	 Recommendations for Practice
			33.2.1	 Endovaginal Ultrasound (EVUS)
			33.2.2	 Transperineal Ultrasound (TPUS)
				33.2.2.1	 2D-TPUS
				33.2.2.2	 3D-TPUS
		33.3	 Conclusions
		References
	34: Magnetic Resonance Imaging
		34.1	 Introduction
		34.2	 Technique
			34.2.1	 MRI Coil
			34.2.2	 Preparation
			34.2.3	 Imaging Protocol
		34.3	 MRI Findings
		34.4	 Accuracy for Sphincter Defects
		34.5	 Accuracy for Sphincter Atrophy
		34.6	 MRI in the Management of Fecal-Incontinent Patients
		34.7	 Conclusions
		References
	35: Neurophysiological Evaluation: Techniques and Clinical Evaluation
		35.1	 Introduction
		35.2	 Neural Control of Colorectal Motility
		35.3	 Nerve Conduction Studies
		35.4	 Pudendal Nerve Terminal Motor Latency (PNTML)
		35.5	 Electromyography (EMG)
		35.6	 Developments Neurophysiological Investigations
		35.7	 Cortical Evoked Potentials (CEP)
		35.8	 Motor Evoked Potentials
		35.9	 Mucosal Blood Flow: Laser Doppler Flowmetry (LDF)
		35.10	 Sacral Nerve Stimulators
		35.11	 Conclusion
		References
	36: Behavioral Therapies and Biofeedback for Anal Incontinence
		36.1	 Introduction
		36.2	 Etiological Factors
		36.3	 Factors Predicting Response to Pelvic Physiotherapy
		36.4	 Diagnostic Process
			36.4.1	 Measurement Instruments
			36.4.2	 Physical Examination
		36.5	 Physiotherapy Analysis/Diagnosis
		36.6	 Therapeutic Process
		36.7	 Evaluation
		36.8	 Updating the Evidence After Publication of the Dutch Evidence Statement
			36.8.1	 Prior (2013) Assessment of Electrical Stimulation of the Anal Mucosa or Perineum
			36.8.2	 Prior (2013) Assessment of Pelvic Floor Muscle Exercises
			36.8.3	 Prior (2013) Assessment of Biofeedback Therapy
		36.9	 Update: Review of Evidence from January 2012 to May 2016
		36.10	 Conclusions
		36.11	 Spin Off
		36.12	 Recommendations for Practice
		36.13	 Future Directions
		References
	37: Sphincter Repair and Postanal Repair
		37.1	 Introduction
		37.2	 Diagnostic Workup
		37.3	 Indications
		37.4	 Surgical Technique
		37.5	 Technical Considerations at Surgery
			37.5.1	 Overlapping vs. End-to-End Repair
			37.5.2	 Separate Suturing of External and Internal Sphincters
			37.5.3	 Scar Tissue
			37.5.4	 Suture Material
			37.5.5	 Diverting Stoma
		37.6	 Other Considerations
			37.6.1	 Primary Repair vs. Sphincteroplasty
			37.6.2	 Failed Primary Repair
			37.6.3	 Age
			37.6.4	 Pudendal Neuropathy
			37.6.5	 Biofeedback
			37.6.6	 Concomitant Perineal Operations
			37.6.7	 Alternative Surgical Options
			37.6.8	 Financial Aspects
		37.7	 Measurement of Outcomes After Sphincteroplasty
			37.7.1	 Descriptive Measures
			37.7.2	 Severity Measures
			37.7.3	 Impact Measures
		37.8	 Results of Sphincteroplasty
			37.8.1	 Short-Term Results
			37.8.2	 Long-Term Results
		37.9	 Sexual Function After Sphincteroplasty
		37.10	 Postanal Repair
		References
	38: Dynamic Graciloplasty
		38.1	 Introduction
		38.2	 Perioperative Assessment
			38.2.1	 Indications for Graciloplasty
			38.2.2	 Contraindications to Graciloplasty
		38.3	 Technique
		38.4	 Outcomes and Complications of Dynamic Graciloplasty
		38.5	 Adynamic Graciloplasty
		38.6	 Total Anorectal Reconstruction (TAR)
		38.7	 Conclusion
		References
	39: Injectable and Implantable Biomaterials for Anal Incontinence
		39.1	 Introduction
		39.2	 Types of Agents Used
		39.3	 Technique
		39.4	 Safety and Adverse Events
		39.5	 Efficacy
		39.6	 Anorectal Physiology and Endoanal Ultrasound
		39.7	 Discussion
		39.8	 Conclusions
		References
	40: Sacral Neuromodulation for Fecal Incontinence
		40.1	 Introduction
		40.2	 Technique and Its Evolution
		40.3	 Mechanism of Action
		40.4	 Indications
		40.5	 Prognostic Factors of Outcome
		40.6	 Outcome
		40.7	 Future Directions
		References
	41: Posterior Tibial Nerve Stimulation for Faecal Incontinence
		41.1	 Introduction
		41.2	 Percutaneous PTNS
		41.3	 Transcutaneous PTNS
		41.4	 Mechanism of Action
		41.5	 Percutaneous PTNS vs. Sacral Nerve Stimulation
		41.6	 Percutaneous PTNS vs. Transcutaneous PTNS
		41.7	 PTNS vs. Sham
		References
	42: Radiofrequency
		42.1	 Introduction
		42.2	 Recommendations for Practice
			42.2.1	 Technique (Fig. 42.1)
			42.2.2	 Complications
			42.2.3	 Results
		42.3	 Future Directions
		References
	43: Other Surgical Options for Anal Incontinence: From End Stoma to Stem Cell
		43.1	 Introduction
		43.2	 Sphincter Replacing Procedures
		43.3	 Muscle Transposition Techniques
		43.4	 Gluteoplasty (Gluteus Maximus Plasty)
		43.5	 Dynamic Gluteoplasty
		43.6	 Graciloplasty
		43.7	 Dynamic Graciloplasty
		43.8	 Artificial Bowel Sphincter (ABS)
		43.9	 Magnetic Anal Ring
		43.10	 Stem Cell Transposition
		43.11	 Anal Plugs
		43.12	 Colostomy
		43.13	 Conclusion
		References
	44: Treatment of Anal Incontinence: Which Outcome Should We Measure?
		44.1	 Introduction
		44.2	 Symptom Assessment
			44.2.1	 Symptom Severity Questionnaires
				44.2.1.1 The Jorge-Wexner Score
				44.2.1.2 The St Mark’s Incontinence Score
				44.2.1.3 The Revised Faecal Incontinence Scale
				44.2.1.4 The Faecal Incontinence Severity Index (FISI)
			44.2.2	 Symptom Severity Questionnaires Designed to Assess Outcomes for Rectal Cancer Treatment
				44.2.2.1 The Low Anterior Resection Syndrome Score (LARS Score)
				44.2.2.2 The Memorial Sloan Kettering Cancer Center (MSKCC) Bowel Function Instrument
			44.2.3	 Diary Monitoring
			44.2.4	 Quality of Life Questionnaires
				44.2.4.1 The Rockwood Scale (FIQL)
			44.2.5	 The Combined Assessment of Symptom Severity and Quality of Life
				44.2.5.1 The Rapid Assessment Faecal Incontinence Score (RAFIS)
				44.2.5.2 ICIQ-BS
			44.2.6	 Visual Analogue Scores
			44.2.7	 Interview Assessment
		44.3	 Anorectal Structure and Function
			44.3.1	 Anorectal Physiology
				44.3.1.1 Anorectal Manometry
				44.3.1.2 Sensory Measurements
				44.3.1.3 Neurophysiology
			44.3.2	 Saline Continence Tests or Porridge Enema
			44.3.3	 Imaging
				44.3.3.1 Endoanal Ultrasound
				44.3.3.2 MRI
		44.4	 Future Directions
		References
Part VI: Pelvic Organ Prolapse
	45: Epidemiology and Etiology of Pelvic Organ Prolapse
		45.1	 Definition and Classification
		45.2	 Prevalence and Incidence
		45.3	 Risk Factors and Pathophysiological Mechanisms
			45.3.1	 Ethnicity
			45.3.2	 Familiarity and Other Genetic Risk Factors
			45.3.3	 Obstetric Factors
			45.3.4	 Age and Hormonal Status
			45.3.5	 Socioeconomic Factors
			45.3.6	 General Medical Conditions
			45.3.7	 Previous Pelvic Surgery
		References
	46: Patient-Reported Outcomes and Pelvic Organ Prolapse
		46.1	 Introduction
		46.2	 Recommendations for Practice
			46.2.1	 POP Symptomatology
			46.2.2	 Patient-Reported Outcome Questionnaires
			46.2.3	 Selecting PRO Instruments
			46.2.4	 Categories of PROs
		46.3	 PRO Instruments for POP
			46.3.1	 Screeners
			46.3.2	 Symptom Questionnaires
			46.3.3	 Quality of Life Questionnaires or Health-Related Quality of Life Questionnaires
			46.3.4	 Sexual Function
			46.3.5	 Patients’ Expectations and Satisfaction
		46.4	 Future Directions
		Further Reading
		Screeners
			Detection of Patients with POP Symptoms Before a Clinical Examination
			Detection of Patients with LUTS
			Detection of Patients with Sexual Dysfunction
		Symptom Questionnaires
			PROs with Wide Coverage of POP Symptoms
			PROs Focusing on LUTS
			PROs Focusing on Bowel Function
		Quality of Life Questionnaires
			Generic Questionnaires
			Condition Specific
		Sexual Function
			Generic PROs
			Condition-Specific PROs
			Patients’ Expectations PROs
			Patients’ Satisfaction PROs
		References
	47: Integrated Imaging Approach to Pelvic Organ Prolapse
		47.1	 Introduction
		47.2	 Review of Imaging Techniques
			47.2.1	 Evacuation Proctography (EP)
			47.2.2	 Ultrasonography (US)
				47.2.2.1	 Two-Dimensional Transperineal Ultrasound (2D TPUS)
				47.2.2.2	 Three-Dimensional Transperineal Ultrasound (3D TPUS)
				47.2.2.3	 Four-Dimensional Transperineal Ultrasound (4D TPUS)
				47.2.2.4	 Three-Dimensional Endoanal Ultrasound (3D EAUS)
				47.2.2.5	 Three-Dimensional Endovaginal Ultrasound (3D EVUS)
				47.2.2.6	 Dynamic Endovaginal Ultrasound
			47.2.3	 Magnetic Resonance Imaging (MRI)
		47.3	 Review of the Literature and Recommendations
		47.4	 Summary and Conclusions
		References
	48: Transperineal Ultrasound: Practical Applications
		48.1	 Introduction
		48.2	 Instrumentation and Indications
		48.3	 Anterior Compartment Pathology
			48.3.1	 Residual Urine and Bladder Wall
				48.3.1.1	 The Anatomy of Stress Urinary Incontinence
				48.3.1.2	 Anterior Compartment Prolapse
				48.3.1.3	 Central Compartment
				48.3.1.4	 Posterior Compartment
				48.3.1.5	 The Anal Sphincter
				48.3.1.6	 Synthetic Implants
			48.3.2	 The Levator Ani
		48.4	 Conclusions
		References
	49: Three-Dimensional and Dynamic Endovaginal Ultrasonography for Pelvic Organ Prolapse and Levator Ani Damage
		49.1	 Introduction
			49.1.1	 Imaging Modalities for Endovaginal Imaging
			49.1.2	 3D EVUS Technique for Levator Ani Imaging
		49.2	 Clinical Applications
			49.2.1	 Prevalence of Pelvic Floor Injury Following Vaginal Delivery
			49.2.2	 Levator Ani Injury and Hematomas
			49.2.3	 Levator Ani Avulsion
			49.2.4	 LAD: Levator Ani Deficiency Score as a Measure of Levator Ani Atrophy
			49.2.5	 Scoring System
			49.2.6	 Changes of Levator Ani with Aging
				49.2.6.1	 Levator Plate Descent Angle and Minimal Levator Hiatus
		49.3	 Future Research
		References
	50: Magnetic Resonance Imaging, Levator Ani Damage, and Pelvic Organ Prolapse
		50.1	 Introduction
		50.2	 Functional Anatomy: Levator Ani Muscle and Connective Tissue Work Together to Provide Pelvic Organ Support
			50.2.1	 Levator Ani Muscle Anatomy
			50.2.2	 Levator Ani Muscle Lines of Action
			50.2.3	 What Type of Injury Occurs to Lead to These Visible Abnormalities?
			50.2.4	 Location and Types of Levator Injury
			50.2.5	 Injury Distorts the Pelvic Sidewall Supports
			50.2.6	 The Amount of Injured Muscle Matters
			50.2.7	 Levator Failure and Surgical Outcome
			50.2.8	 Muscle Injury Reduces Force
			50.2.9	 Levator Ani Injury and Fascial Failure
			50.2.10	 Exposed Vaginal Length, Pressure Differentials, and Symptomatic Prolapse
		50.3	 Concluding Message and Future Directions
		References
	51: Dynamic Magnetic Resonance Imaging of Pelvic Floor Pathologies
		51.1	 Introduction and Definitions of Pelvic Floor Dysfunction
		51.2	 Indications of Dynamic Pelvic Floor MRI
		51.3	 Anterior Compartment
		51.4	 Middle Compartment
		51.5	 Posterior Compartment
			51.5.1	 Anorectal Descent
			51.5.2	 Rectocele
			51.5.3	 Intussusception and Rectal Prolapse
				51.5.3.1	 Intussusception
				51.5.3.2	 External Rectal Prolapse
			51.5.4	 Enterocele
		51.6	 Pelvic Floor Relaxation
		51.7	 Dyssynergic Defecation
		51.8	 Conclusion
		References
	52: Pelvic Floor Muscle Training in Prevention and Treatment of Pelvic Organ Prolapse
		52.1	 Introduction
		52.2	 Methods
		52.3	 Results
			52.3.1	 In the General Population
				52.3.1.1	 Hypopressive Technique
			52.3.2	 FMT to Prevent and Treat POP in the Peripartum Period
			52.3.3	 Prevention
			52.3.4	 PFMT in Combination with Surgery
			52.3.5	 Long-Term Effect
		52.4	 Discussion
			52.4.1	 Conscious Contraction (Bracing or “Performing the Knack”) to Prevent and Treat POP
			52.4.2	 Strength Training
		52.5	 Conclusions
		References
	53: Use of Pessaries for Pelvic Organ Prolapse
		53.1	 Introduction
		53.2	 Types of Pessaries
			53.2.1	 Support Pessaries
			53.2.2	 Space-Filling Pessaries
			53.2.3	 Incontinence Pessaries
		53.3	 Pessary Selection
			53.3.1	 Assessment and Insertion
			53.3.2	 Follow-Up Pessary Care
		53.4	 Complications of Pessary Treatment
		53.5	 Evidence of Effectiveness
		53.6	 Training of Pessary Practitioners
		53.7	 Future Directions
		References
	54: Anterior and Posterior Colporrhaphy: Native Tissue Versus Mesh
		54.1	 Introduction
		54.2	 Vaginal Defects: What Needs to Be Fixed?
		54.3	 Vaginal Vault Fixation: Importance to More Effective Colporrhaphies
		54.4	 Anterior (Level II) Repair [11]
		54.5	 Posterior (Level II) Repair [11]
		54.6	 Posterior (Level III) Repair [11, 19]
		54.7	 Posterior (Level I) Repair
		54.8	 Efficacy of Outcomes of Native Tissue and Mesh Colporrhaphies
		54.9	 Conclusion
		Appendix
			Pelvic Organ Prolapse Quantification (POP-Q) [11, 16]
				Posterior Repair Quantification (PR-Q) [11, 15, 17]
		References
	55: Apical Prolapse Surgery
		55.1	 Uterine Prolapse
			55.1.1	 Uterine Preservation
			55.1.2	 Uterine Prolapse: Hysterectomy or Uterine Preservation
			55.1.3	 Vault Prolapse
		55.2	 Route of Sacral Colpopexy
		55.3	 Conclusion
		References
	56: Laparoscopic Pelvic Floor Surgery
		56.1	 Introduction
		56.2	 Laparoscopic Colposuspension
			56.2.1	 Management of Stress Urinary Incontinence
			56.2.2	 The Rise and Fall of Laparoscopic Colposuspension
			56.2.3	 Technique of Laparoscopic Colposuspension
				56.2.3.1	 Preperitoneal or Transperitoneal Approach
				56.2.3.2	 Operative Technique
				56.2.3.3	 Outcomes
			56.2.4	 Conclusion
		56.3	 Laparoscopic Sacrocolpopexy
			56.3.1	 Management of Level I Defects
			56.3.2	 Laparoscopic Versus Open Sacrocolpopexy
			56.3.3	 Technique of Laparoscopic Sacrocolpopexy
			56.3.4	 Outcomes
			56.3.5	 Outcomes in the Elderly
			56.3.6	 Learning Curve
			56.3.7	 Conclusion
		56.4	 Associated Ventral Rectopexy
			56.4.1	 Concurrence with Posterior Pelvic Floor Dysfunctions (PFD)
			56.4.2	 Associating Anterior Rectopexy in Combined Middle and Posterior Compartment Problems
			56.4.3	 Technique and Outcomes of an Associated Anterior Rectopexy
		56.5	 Future Directions
		References
	57: The Robotic Approach to Urogenital Prolapse
		57.1	 Introduction
		57.2	 Robot-Assisted Surgery: The Context
			57.2.1	 History of Robot-Assisted Surgery
			57.2.2	 Components of Robotic Surgery System
			57.2.3	 Use of Robotic Surgery in Other Sub-specialties of Gynaecology and Surgical Specialties
			57.2.4	 Laparoscopic Versus Robot-Assisted Surgery
		57.3	 Robotic Approach to Apical Prolapse
			57.3.1	 Robot-Assisted Sacrocolpopexy (RASC)
			57.3.2	 Robot-Assisted Sacrohysteropexy (RASH)
			57.3.3	 Other Procedures Amenable to Urogynaecological Robot-Assisted Procedures
		57.4	 Considerations with Robotic Surgery
			57.4.1	 Preoperative Evaluation and Risk Assessment
			57.4.2	 Education and Learning
			57.4.3	 Cosmesis
			57.4.4	 Safety
			57.4.5	 Economical Cost
		57.5	 Summary of Pros and Cons of Robotic Surgery
		57.6	 Future Directions
		57.7	 Conclusion
		References
			Further Reading
	58: Concurrent Prolapse and Incontinence Surgery
		58.1	 Introduction
		58.2	 Diagnostic Tests to Unmask Occult SUI
		58.3	 Patients with Concomitant POP and SUI (Overt Incontinence)
		58.4	 Patients with POP and Masked (Occult) Incontinence
		58.5	 Patients Who Suffer from POP Only Without Overt or Masked Incontinence
		58.6	 Side Effects of Additional Incontinence Surgery in Patients Who Undergo Prolapse Operations
		58.7	 Recommendations for Practice
		58.8	 Future Directions
		References
	59: Management of Pelvic Organ Prolapse: A Unitary or Multidisciplinary Approach?
		59.1	 Introduction
		59.2	 Epidemiological Basis for Coexistence of Pelvic Floor Disorders
		59.3	 Why the Multidisciplinary Approach
		59.4	 The Use of Quality of Life Questionnaires
		59.5	 Improved Treatment Rates with Pelvic Floor Rehabilitative Therapy
		59.6	 Models for Multidisciplinary Approach
		59.7	 Combined Surgical Cases
		59.8	 Barriers to Multidisciplinary Management of Pelvic Floor Prolapse
		59.9	 Future of Multidisciplinary Approach
		59.10	 Conclusion
		References
Part VII: Constipation and Obstructed Defecation
	60: Epidemiology and Etiology of Constipation and Obstructed Defecation: An Overview
		60.1	 Introduction
		60.2	 Definition
		60.3	 Epidemiology
		60.4	 Etiology and Pathophysiology
			60.4.1	 Secondary Constipation
			60.4.2	 Primary Constipation
				60.4.2.1	 Normal Transit Constipation and Irritable Bowel Syndrome (IBS)
				60.4.2.2	 Slow Transit Constipation
				60.4.2.3	 Outlet Obstruction
		60.5	 Future Directions
		References
	61: Patient-Reported Outcome Assessment in Constipation and Obstructed Defecation
		61.1	 Introduction
			61.1.1	 Constipation Symptom Severity Scales
			61.1.2	 Constipation-Specific Quality-of-Life Questionnaire
			61.1.3	 Recommendation for Practice in Choosing Appropriate PROMs for Constipation
		61.2	 Future Directions
		References
	62: Anorectal Manometry, Rectal Sensory Testing and Evacuation Tests
		62.1	 Introduction
		62.2	 Anal Manometry
		62.3	 Vector Manometry
		62.4	 High-Resolution Anal Manometry (HR-ARM)
			62.4.1	 Rectal Sensory Testing
			62.4.2	 Rectal Sensation to Electrical Stimulation
		62.5	 Balloon Expulsion Test (BET)
		62.6	 Recommendation for Practice
		62.7	 Future Direction
		References
	63: Ultrasonography in the Assessment of Obstructive Defecation Syndrome
		63.1	 Introduction
		63.2	 Transperineal/Translabial/Introital Ultrasound
			63.2.1	 Dynamic Transperineal Ultrasound
			63.2.2	 Dynamic Translabial Ultrasound
			63.2.3	 Dynamic Endovaginal Ultrasound
			63.2.4	 Endoanal Ultrasound and Echodefecography
		63.3	 Ultrasonographic Assessment of Obstructive Defecation Syndrome
		63.4	 Ultrasound vs. X-ray Defecography (DEF) vs. MR Defecography (MR-DEF) in the Assessment of ODS
		63.5	 Ultrasound Assessment After Pelvic Floor Surgery
		63.6	 Conclusions
		References
	64: Echodefecography: Technique and Clinical Application
		64.1	 Introduction
		64.2	 Echodefecography (EDF) Technique
		64.3	 3D Transvaginal and Transrectal Ultrasonography (TTUS)
			64.3.1	 Technique
			64.3.2	 Transvaginal Approach
			64.3.3	 Transrectal Approach
		References
	65: Evacuation Proctography
		65.1	 Introduction
		65.2	 Patient Preparation
		65.3	 Examination Technique
			65.3.1	 Small Bowel, Rectal and Vaginal Opacification, and Defecation
		65.4	 Image Analysis
			65.4.1	 Parameters
				65.4.1.1	 Anorectal Angle (ARA)
				65.4.1.2	 Anorectal Junction (ARJ)
				65.4.1.3	 Pubococcygeal Line (PCL)
			65.4.2	 Normal Findings
				65.4.2.1	 Rest
				65.4.2.2	 Squeeze/Strain (Push)
				65.4.2.3	 Evacuation
				65.4.2.4	 Recovery
			65.4.3	 Pathological Findings
				65.4.3.1	 Abnormal Pelvic Floor Descent
				65.4.3.2	 Anismus (Dyssynergic Defecation)
				65.4.3.3	 Intussusception and Rectal Prolapse
				65.4.3.4	 Rectocele
				65.4.3.5	 Enterocele and Sigmoidocele
		65.5	 Conclusions
		References
	66: The Abdominal Approach to Rectal Prolapse
		66.1	 Introduction
		66.2	 Etiology
		66.3	 Assessment of Patients with Rectal Prolapse and Associated Symptoms
		66.4	 Selection of Patients for Abdominal Procedures
		66.5	 Abdominal Procedures
			66.5.1	 Ripstein Procedure (Anterior Sling Rectopexy)
			66.5.2	 Posterior Mesh Rectopexy
			66.5.3	 Suture Rectopexy
			66.5.4	 Sigmoid Resection Associated with Rectopexy
		66.6	 Abdominal Surgical Techniques
		66.7	 Minimally Invasive Approach
			66.7.1	 Ventral Mesh Rectopexy
			66.7.2	 Robotic Ventral Mesh Retopexy
			66.7.3	 Combined Rectopexy and Pelvic Organ Prolapse Approach
		66.8	 Incontinence Improvements and Mechanisms
		66.9	 Management of Recurrent Rectal Prolapse
		66.10	 Conclusions
		References
	67: The Perineal Approach to Rectal Prolapse
		67.1	 Introduction
		67.2	 Delorme Procedure
		67.3	 Perineal Rectosigmoidectomy (Altemeier Procedure)
		67.4	 Anal Encirclement (Thiersch Wire)
		67.5	 Management of Recurrent Rectal Prolapse
		67.6	 Management of Incarcerated or Strangulated Rectal Prolapse
		67.7	 Conclusion
		References
	68: The Laparoscopic Approach to Rectal Prolapse
		68.1	 Introduction
		68.2	 Epidemiology
		68.3	 Etiology
		68.4	 Pelvic Floor Anatomy and (Patho) Physiology
		68.5	 Symptoms
		68.6	 Investigations
		68.7	 Indications
		68.8	 Surgical Techniques
			68.8.1	 Laparoscopic Ventral Mesh Rectopexy
		68.9	 What Are the Results of Rectopexy?
		68.10	 Role of Lateral Ligaments?
		68.11	 Choice of Operation?
		68.12	 Need for Colonic Resection?
		68.13	 Robotic Approach
		68.14	 Preoperative Considerations: Urinary Incontinence
		68.15	 Postoperative Considerations: Mesh-Related Complications
		68.16	 Conclusion
		References
	69: The Role of Robotic Surgery in Rectal Prolapse
		69.1	 Introduction
		69.2	 Preoperative Assessment
		69.3	 Surgical Approaches to Rectal Prolapse
		69.4	 Perineal Operations
			69.4.1	 Delorme’s Operation
			69.4.2	 Altemeier’s Operation
		69.5	 Abdominal Operations
			69.5.1	 Abdominal Suture Rectopexy
			69.5.2	 Abdominal Resection Rectopexy
			69.5.3	 Laparoscopic Ventral Mesh Rectopexy
		69.6	 Robotic Approach to Rectal Prolapse
		69.7	 Technique
		69.8	 Complications
		69.9	 Recurrence Rates and Functional Outcomes
		69.10	 Other Aspects
		69.11	 Conclusions
		References
	70: Sacral Neuromodulation for Constipation
		70.1	 Introduction
		70.2	 Technique and Its Evolution
		70.3	 Mechanism of Action
		70.4	 Indications
		70.5	 Prognostic Factors of Outcome
		70.6	 Outcome
		References
Part VIII: Pelvic Pain and Sexual Dysfunction
	71: Bladder Pain Syndrome/Interstitial Cystitis
		71.1	 Introduction
		71.2	 Definition
		71.3	 Epidemiology
		71.4	 Nonbladder Syndromes (NBS)
		71.5	 Etiology and Pathogenesis
			71.5.1	 Infection
			71.5.2	 Mastocytosis
			71.5.3	 Dysfunctional Bladder Epithelium
			71.5.4	 Neurogenic Inflammation
			71.5.5	 Reduced Vascularization
			71.5.6	 Pelvic Floor Dysfunction
			71.5.7	 Autoimmunity
		71.6	 Diagnosis
			71.6.1	 Gynecological Associated/Confusable Disease
		71.7	 Treatment
			71.7.1	 Conservative Therapy
			71.7.2	 Medical Therapy
				71.7.2.1	 Oral Therapy
					Protection of the Mucosal Surface
					Antihistamines
					Immunosuppressant
					Other Oral Medications
			71.7.3	 Intravesical Instillation
			71.7.4	 Pain Modulators
				71.7.4.1	 Analgesics
					(Grade of Recommendation: C—Level of Evidence: 4)
			71.7.5	 Multimodal Medical Therapy
				71.7.5.1	 Procedural Intervention
		71.8	 Conclusions
		References
	72: Pelvic Pain Associated with a Gynecologic Etiology
		72.1	 Introduction
		72.2	 Evaluation of Pelvic Pain of Gynecologic Origin
			72.2.1	 History
			72.2.2	 Physical Exam
		72.3	 Etiologies and Treatments of Pelvic Pain by Site
			72.3.1	 Perineum and Vulva
			72.3.2	 Vagina
			72.3.3	 Cervix
			72.3.4	 Uterus
			72.3.5	 Adnexa
			72.3.6	 Musculoskeletal Considerations
			72.3.7	 Extragynecologic Considerations
		72.4	 Multidisciplinary Approach to Chronic Pelvic Pain
		72.5	 Summary
		References
	73: Chronic Idiopathic Anorectal Pain Disorders
		73.1	 Introduction
		73.2	 Definition
		73.3	 Topographic Sensitive Innervation of the Perineum
		73.4	 History and Physical Examination of the Perineum
			73.4.1	 History
			73.4.2	 Associated Signs
			73.4.3	 Physical Examination
		73.5	 Psychologic Aspects and Somatization of Pain
		73.6	 Proctalgia Fugax
			73.6.1	 Definition
			73.6.2	 Epidemiology
			73.6.3	 Pathophysiology
			73.6.4	 Physical Examination
			73.6.5	 Treatment
		73.7	 Levator Ani Syndromes (Chronic Proctalgia)
			73.7.1	 Definition
			73.7.2	 Epidemiology
			73.7.3	 Pathophysiology
			73.7.4	 Physical Examination
			73.7.5	 Treatment
		73.8	 Unspecified Anorectal Pain
			73.8.1	 Myofascial and Coccygeal Pain Syndromes
				73.8.1.1	 History
				73.8.1.2	 Physical Examination
				73.8.1.3	 Treatment
			73.8.2	 Postoperative Anorectal Neuralgias
			73.8.3	 Nerve Compression Anorectal Neuralgias
				73.8.3.1	 Pudendal Neuralgia
					Symptoms of Pudendal Neuralgia
					Physical Examination
					Diagnostic Workup
						Electrophysiological Diagnosis
						Pelvic Radiography
						Magnetic Resonance Imaging of the Pelvis
						Magnetic Resonance Imaging of the Medullary Cone
					Treatment
						Pudendal Canal Injections
						Decompression Surgery
				73.8.3.2	 Cluneal Neuralgia
					Physical Examination
					Treatment
			73.8.4	 Pain of Central Origin
		73.9	 Conclusions
		References
	74: Female Sexual Dysfunction
		74.1	 Female Sexual Function
		74.2	 Female Sexual Dysfunction
		74.3	 Assessment
		74.4	 Sexual Function Questionnaires
		74.5	 Treatment
		74.6	 Pelvic Floor Disorders and Sexual Function
		References
	75: A Myofascial Perspective on Chronic Urogenital Pain in Women
		75.1	 Introduction
		75.2	 Bladder Pain Syndrome and Vulvodynia
		75.3	 Pain Mapping
		75.4	 Exploring Mechanisms of Pain
		75.5	 Structure and Function of Fascia
		75.6	 Continuity of Pelvic Fascia
		75.7	 Role of Fascia in Chronic Urogenital Pain
		75.8	 Fascial Tonicity and Organ Function
		75.9	 Role of Non-relaxing Muscles
		75.10	 Surface Electromyography in Studies of Pelvic Floor Muscles
		75.11	 SEMG Studies of Chronic Urogenital Pain Disorders
		75.12	 Conclusion
		References
	76: Pharmacological Treatment of Chronic Pelvic Pain
		76.1	 Introduction
		76.2	 Traditional Analgesics
		76.3	 Hormonal Treatment
		76.4	 Local Anaesthetics
		76.5	 Antidepressants
		76.6	 Membrane Stabilisers
		76.7	 Anxiolytics
		76.8	 Conclusion
		References
	77: Idiopathic Chronic Pelvic Pain: A Different Perspective
		77.1	 Introduction
		77.2	 The Present Scope of ICPP: Presence of Other Symptoms
		77.3	 Anatomical Pathway to ICCP
		77.4	 USL Laxity as a Cause of CPP
		77.5	 Pretreatment Diagnosis That USL Laxity Is the Cause of ICPP
			77.5.1	 Confirmation of USL Origin of Pain by Vaginal Examination
			77.5.2	 Confirmation of USL Origin of Pain with “Simulated Operations”
			77.5.3	 Confirmation of USL Origin of Pain by the Bornstein Test
		77.6	 Improvement of CPP by Squatting-Based PFR
			77.6.1	 How the Skilling Squatting-Based PFR Method Evolved
			77.6.2	 The Simplified Skilling PFR Method
		77.7	 Surgical Repair Option
			77.7.1	 USL Native Tissue Repair Technique
			77.7.2	 Posterior Sling Repair of USL
			77.7.3	 USL Tensioned TFS Sling
		77.8	 Discussion
		77.9	 Conclusions
		References
Part IX: Fistulae
	78: Urogenital Fistulae
		78.1	 Introduction
		78.2	 Aetiology and Epidemiology
		78.3	 Associated Conditions
		78.4	 Diagnosis
		78.5	 Classification
		78.6	 Treatment
		78.7	 Post-operative Management and Results
		78.8	 Ongoing Incontinence
		78.9	 The Future
		78.10	 Conclusion
		References
	79: Rectovaginal Fistulae
		79.1	 Definition
		79.2	 Etiology
		79.3	 Classification
		79.4	 Presentation
		79.5	 Assessment and Investigations
		79.6	 Treatment
			79.6.1	 Surgical Techniques
				79.6.1.1	 Endorectal Advancement Flap
				79.6.1.2	 Transvaginal Flap
				79.6.1.3	 Excision of Fistula and Layered Closure
				79.6.1.4	 Rectal Sleeve Advancement Flap
				79.6.1.5	 Episio/Perineoproctotomy
				79.6.1.6	 Tissue Interposition
				79.6.1.7	 Use of Biomaterials
					Surgisis™ Mesh Repair
					Surgisis™ Fistula Plug
				79.6.1.8	 Abdominal Operations
					Direct Closure with Interposed Omental Graft
					Rectal Excision (Anterior Resection) with Colorectal/Coloanal Anastomosis
					Proctectomy
					Diversion Ileostomy/Colostomy
				79.6.1.9	 Other Techniques
			79.6.2	 Choice of Surgery
				79.6.2.1	 Peripartum Rectovaginal Fistula
				79.6.2.2	 Crohn’s Disease
				79.6.2.3	 RVF Due to Radiation
				79.6.2.4	 RVF Due to Malignancy
				79.6.2.5	 Postoperative (Iatrogenic) RVF
				79.6.2.6	 Recurrent RVF
			79.6.3	 Suggested Algorithm
		79.7	 Conclusions
		References
	80: Emerging Concepts in Classification of Anal Fistulae
		80.1	 Introduction
		80.2	 Anatomy
			80.2.1	 The Anogenital Muscles
			80.2.2	 The Anogenital Spaces (Fig. 80.2)
			80.2.3	 The Fasciae (Fig. 80.3)
		80.3	 Pathogenesis
			80.3.1	 Natural Anal Abscess Patterns (Table 80.1 and Fig. 80.4)
			80.3.2	 Natural Anal Fistula Patterns (Fig. 80.6)
		80.4	 A Proposed Anal Fistula Classification (Table 80.2)
			80.4.1	 Characteristics and Benefits of the New Classification
		80.5	 Anal Fistula Map
			80.5.1	 Abbreviations, Pathway and Recording Format Used in Anal Fistula Map
				80.5.1.1	 Abbreviations
				80.5.1.2	 Recording Pathway
		80.6	 Discussion
			80.6.1	 Limitations of Current Classifications
		80.7	 Conclusion
		References
	81: Ultrasonographic Assessment of Anorectal Fistulae
		81.1	 Introduction
		81.2	 Assessment of Anorectal Fistulae
			81.2.1	 Physical Examination
			81.2.2	 Fistulography
			81.2.3	 Endoanal Ultrasonography
				81.2.3.1	 Endoanal Ultrasonography in Crohn’s Disease
				81.2.3.2	 EAUS Vs. MRI
			81.2.4	 Transperineal Ultrasonography
		81.3	 Conclusion
		References
	82: MR Imaging of Fistula-in-Ano
		82.1	 Introduction
		82.2	 Aetiology, Classification, and Treatment of Fistula-in-Ano Relevant to Imaging
		82.3	 Imaging Fistula-in-Ano: Which Technique to Use?
			82.3.1	 MRI Technique
			82.3.2	 MRI Interpretation and Reporting
			82.3.3	 Extensions
			82.3.4	 The Radiological Report
		82.4	 Effect of Pre-Operative MRI on Surgery and Clinical Outcome
		82.5	 Differential Diagnosis of Perianal Sepsis
		82.6	 Which Patients Should be Imaged?
		82.7	 Conclusion
			82.7.1	 Future Directions
		References
	83: Surgical Treatment of Anorectal Sepsis
		83.1	 Introduction
			83.1.1	 Cryptoglandular Theory and the Spectrum of Anorectal Sepsis Comprising the Acute Abscess and Chronic Fistula
			83.1.2	 Principles of Treatment: Drainage of Sepsis, Eradication of Fistula Tracts, Preservation of Continence
			83.1.3	 The Ideal Operation
		83.2	 Pre-operative Evaluation
			83.2.1	 Endoanal Ultrasound
			83.2.2	 MRI
			83.2.3	 Anorectal Physiology and Continence Assessment
		83.3	 Management of Acute Anorectal Sepsis (Abscess)
			83.3.1	 Simple Drainage (Simple Recommendations for Practice)
			83.3.2	 Drainage and Loose Seton
			83.3.3	 Modified LIFT Approach
		83.4	 Management of Chronic Anorectal Sepsis (Fistula)
			83.4.1	 Fistulotomy With or Without Repair of Sphincter Complex
			83.4.2	 Cutting Seton
			83.4.3	 Endorectal and Anodermal Advancement Flaps
			83.4.4	 LIFT
			83.4.5	 VAAFT
			83.4.6	 Fibrin Glue
			83.4.7	 Anal Fistula Plugs
			83.4.8	 FiLaC
			83.4.9	 OTSC (Over-The-Scope-Clip)
		83.5	 Discussion
		83.6	 Future Directions
			83.6.1	 Stem Cell
			83.6.2	 3D Modeling
		83.7	 Conclusion
		References
	84: Management of Anorectal Fistulae in Crohn’s Disease
		84.1	 Introduction
		84.2	 Classification
		84.3	 Diagnosis
		84.4	 Treatment
			84.4.1	 Observation
			84.4.2	 Antibiotics and Immunomodulators
			84.4.3	 Biologic Medications
			84.4.4	 Fistulotomy
			84.4.5	 Seton Placement
			84.4.6	 Mucosal Advancement Flap
			84.4.7	 Ligation of the Intersphincteric Fistula Tract (LIFT)
			84.4.8	 Fibrin Glue Injection and Fistula Plug
			84.4.9	 Mesenchymal Stem Cell Injection
			84.4.10	 Rectovaginal Fistula
			84.4.11	 Stoma Diversion
		84.5	 Future Directions
		References
Part X: Failure or Recurrence After Surgical Treatment: What to Do When It All Goes Wrong
	85: Imaging and Management of Complications of Urogynecologic Surgery
		85.1	 Introduction
		85.2	 Intra-Operative Complications Involving Anti-Incontinence Procedures
			85.2.1	 Overview
			85.2.2	 Slings and Urethral Bulking Agents
			85.2.3	 Retropubic Procedures
		85.3	 Complications of Pelvic Organ Prolapse Surgery
			85.3.1	 Overview
			85.3.2	 Apical Segment Complications
			85.3.3	 Lateral Vaginal Complications
			85.3.4	 Anterior Compartment Complications
			85.3.5	 Posterior Compartment Complications
			85.3.6	 Introital Vaginal Complications
		85.4	 Conclusions
		References
	86: Surgical Management of Complications After Urogynaecological Surgery
		86.1	 Introduction
			86.1.1	 Classification
		86.2	 Complications Following Incontinence Surgery
			86.2.1	 Introduction
			86.2.2	 Mid-urethral Tape Operations
				86.2.2.1	 Intraoperative Injuries
					Urinary Tract Injury
					Bowel Injury
					Vascular Injury
				86.2.2.2	 Post-operative Complications
					Immediate
						Voiding Dysfunction, Retention
					Infections
						Urinary Tract Infections (UTIs)
						Surgical Site Infections
					Remote Complications
						Mesh-Related Complications
						Chronic Pain
						Management of Chronic Pain with Surgery
			86.2.3	 Para-urethral Bulking
				86.2.3.1	 Introduction
			86.2.4	 Burch Colposuspension: Open and Laparoscopic
				86.2.4.1	 Introduction
				86.2.4.2	 Intraoperative Injury at the Time of Surgery
					Urinary Tract Injury
					Bowel Injury (Laparoscopic Route)
					Vascular Injury
				86.2.4.3	 Post-operative Complications
					Immediate
						Wound Complications
							Haematoma
							Infection
						Voiding Dysfunction
					Remote Complications
						Posterior Compartment Prolapse
						Chronic Pain
						Bladder Dysfunction
			86.2.5	 Autologous Fascial Sling (AFS)
				86.2.5.1	 Introduction
				86.2.5.2	 Intraoperative Complications
					Visceral and Vascular Injuries
				86.2.5.3	 Postoperative Complications
					Voiding Dysfunction
					Bladder Dysfunction
		86.3	 Complications Following Prolapse Surgery
			86.3.1	 Introduction
			86.3.2	 Anterior Colporrhaphy
				86.3.2.1	 Introduction
				86.3.2.2	 Intraoperative Complications
				86.3.2.3	 Post-operative Complications
			86.3.3	 Posterior Colporrhaphy
				86.3.3.1	 Introduction
				86.3.3.2	 Intraoperative Complications
				86.3.3.3	 Post-operative Complications
			86.3.4	 Sacrospinous Colopopexy/Hysteropexy
				86.3.4.1	 Introduction
				86.3.4.2	 Intraoperative Complications
					Nerve Damage
					Vascular Damage
					Visceral Damage
				86.3.4.3	 Post-operative Complications
					Dyspareunia
					Prolapse Recurrence
					Voiding Dysfunction
					Bladder Dysfunction
			86.3.5	 Vaginal Mesh Surgery
				86.3.5.1	 Introduction
				86.3.5.2	 Post-operative Complications
				86.3.5.3	 Management of Complications
			86.3.6	 Abdominal Prolapse Surgery
				86.3.6.1	 Mesh Complications
				86.3.6.2	 Vascular Injuries
				86.3.6.3	 Spondylodiscitis
				86.3.6.4	 Ureteric Injury
				86.3.6.5	 De Novo Stress Urinary Incontinence
		86.4	 Conclusion
		References
	87: Endosonographic Investigation of Anorectal Surgery Complications
		87.1	 Introduction
		87.2	 Early Complications
			87.2.1	 Postoperative Anorectal Pain
			87.2.2	 Postoperative Hemorrhage/Hematoma
			87.2.3	 Infection/Sepsis
		87.3	 Late Complications
			87.3.1	 Chronic Anal Pain
			87.3.2	 Anal Stenosis/Stricture
			87.3.3	 Anorectal/Rectovaginal Fistula
			87.3.4	 Fecal Incontinence
		87.4	 Conclusions
		References
	88: Investigation and Management of Complications After Coloproctological Surgery
		88.1	 Introduction
		88.2	 Infection-Related Complications
			88.2.1	 Anastomotic Leak
			88.2.2	 Abscesses
				88.2.2.1	 Small Perianastomotic Abscess (<3 cm)
				88.2.2.2	 Larger Perianastomotic Abscess (>3 cm)
				88.2.2.3	 Abscess in Continuity with Leak
			88.2.3	 Low Rectal Anastomotic Sinus
			88.2.4	 Anastomotic Stricture
				88.2.4.1	 Colonic
				88.2.4.2	 Rectal
			88.2.5	 Fistula
			88.2.6	 Wound Infection
		88.3	 Intraoperative Organ Injury
			88.3.1	 Ureteric Injury
			88.3.2	 Splenic Injury
		88.4	 Stomal Complications
			88.4.1	 Stoma Retraction and Stenosis
			88.4.2	 Peristomal Skin Complications
		88.5	 Thromboembolic Complications
		88.6	 Sexual Dysfunction
			88.6.1	 Sympathetic Damage
			88.6.2	 Parasympathetic Damage
			88.6.3	 Treatment of Postoperative Sexual Dysfunction
		88.7	 Defecatory Dysfunction
		88.8	 Complications After Surgery for Functional Disorders
			88.8.1	 Fecal Incontinence
			88.8.2	 Rectal Prolapse
			88.8.3	 Obstructed Defecation
		88.9	 Conclusions
		References
Part XI: Miscellaneous
	89: Congenital Abnormalities of the Pelvic Floor: Assessment and Management
		89.1	 Introduction
		89.2	 Incidence
		89.3	 Classification
		89.4	 Embryology
		89.5	 Associated Malformation
		89.6	 Anorectal Anatomy
		89.7	 Clinical Investigation and Surgery of ARM
			89.7.1	 Assessment of Male Neonate with ARM
			89.7.2	 Surgery of ARM
			89.7.3	 Definitive Treatment
			89.7.4	 Assessment of the Female Neonate
			89.7.5	 Surgery of ARM
			89.7.6	 Definitive Treatment
		89.8	 Rectal Atresia
		89.9	 Results of Treatment
			89.9.1	 Operative Complications
			89.9.2	 Long-Term Results
		89.10	 Rare and Casuistic Malformations
		89.11	 Diagnostic Imaging of Anorectal Malformations and Other Pelvic Floor Abnormalities in Pediatric Patients
			89.11.1 Invertogram (Lateral Horizontal-Beam-Prone Radiograph)
			89.11.2 Transperineal Ultrasound (TPUS)
			89.11.3 Colostogram
			89.11.4 Magnetic Resonance Imaging (MRI)
			89.11.5 Computed Tomography Imaging (CT)
		89.12	 Conclusions
		References
	90: Male Urinary Incontinence: Assessment and Management
		90.1	 Introduction
		90.2	 Assessment
			90.2.1	 History
			90.2.2	 Examination
			90.2.3	 Urinalysis
			90.2.4	 Uroflometry and Bladder Ultrasound
			90.2.5	 Bladder Diary
			90.2.6	 Pad Testing
			90.2.7	 Urodynamics
			90.2.8	 Cystoscopy
		90.3	 Management
			90.3.1	 Conservative
			90.3.2	 Pelvic Floor Muscle Training
			90.3.3	 Pharmacotherapy
			90.3.4	 Bulking Agents
			90.3.5	 Surgical Treatment
				90.3.5.1	 Artificial Urinary Sphincter
				90.3.5.2	 Male Slings
					Bone Anchored Slings (BAS)
					Trans-obturator Slings (TS)
					Quadratic Sling
					Adjustable Slings
				90.3.5.3	 Decision Making
		90.4	 Conclusions
		90.5	 Future Directions
		References
Appendix: Management Consensus Statement
	A.1 Management of Urinary Incontinence in Women From “Incontinence, 6th Edition 2017”. Abrams P, Cardozo L, Wagg A, Wein A, Editors. ICUD-ICS 2016 (with permission)
	A.2 Assessment and Conservative Management of Faecal Incontinence From “Incontinence, 6th Edition 2017”. Abrams P, Cardozo L, Wagg A, Wein A, Editors. ICUD-ICS 2016 (with permission)
	A.3 Surgical Management of Faecal Incontinence From “Incontinence, 6th Edition 2017”. Abrams P, Cardozo L, Wagg A, Wein A, Editors. ICUD-ICS 2016 (with permission)
	A.4 Management of Pelvic Organ Prolapse From “Incontinence, 6th Edition 2017”. Abrams P, Cardozo L, Wagg A, Wein A, Editors. ICUD-ICS 2016 (with permission)
	A.5 Surgical Management of Pelvic Organ Prolapse (POP) From “Incontinence, 6th Edition 2017”. Abrams P, Cardozo L, Wagg A, Wein A, Editors. ICUD-ICS 2016 (with permission)
	A.6 Management of Constipation From “An International Urogynecological Association (IUGA)/International Continence Society (ICS) Joint Report on the Terminology for Female Anorectal Dysfunction” in Neurourology and Urodynamics 2017;36:10–34
	A.7 Bladder Pain Syndrome (BPS) From “Incontinence, 6th Edition 2017”. Abrams P, Cardozo L, Wagg A, Wein A, Editors. ICUD-ICS 2016 (with permission)
	A.8 Management of Vesicovaginal Fistula (VVF) From “Incontinence, 6th Edition 2017”. Abrams P, Cardozo L, Wagg A, Wein A, Editors. ICUD-ICS 2016 (with permission)
	A.9 Management of Anorectal Fistulae From “The ASCRS Textbook of Colon and Rectal Surgery, 3rd Edition 2015”. Steele SR, Hull TL, Read TE, Saclarides TJ, Senagore AJ, Whitlow CB, Editors. Springer International Publishing 2016 (modified with permis
Index