This book demonstrates knowledge on tissue-based procedures for stress urinary incontinence and other pelvic floor related topics. As the field shifts away from using synthetic material for repair, this work presents a new perspective on native tissue repair from the opinions and research of the authors. Written by a panel of expert authors in the field, this text provides high quality, focused information that is complimented by illustrations and videos. With established track records the authors illustrate how to perform the procedure vaginally or through open surgery, and inclusion of live surgeries via online video, makes this an invaluable tool for busy surgeons and specialists interested in pelvic floor reconstruction.

This book provides a comprehensive and up-to-date overview of the surgical treatment of pelvic organ prolapse, focusing especially on issues that continue to arouse controversy. In the first section, leading experts present detailed information on the surgical anatomy, pathophysiology, and epidemiology of prolapse and also the impact of concomitant functional disorders. The second section focuses on diagnostic work-up and the third is dedicated to the various treatment options aimed at resolution of the condition. The closing chapters discuss outcome measures and analyze the effects of prolapse surgery on urinary, bowel, and sexual symptoms. In 1966 Richard TeLinde stated that, “Every honest surgeon of extensive and long experience will have to admit that he is not entirely and absolutely satisfied with his long-term results of all his operations for prolapse and allied conditions.” Although many uncertainties in the field have since been resolved, some major issues still require clarification. Often it can be difficult to find the right balance between treatment effectiveness in the long term and risk reduction, including with respect to complications. This book will help trainees and less experienced surgeons to make appropriate treatment choices and achieve optimal outcomes.

Surgical Management of Pelvic Organ Prolapse is the ideal way to enhance your surgical skills in this key area of gynecology, urogynecology, and urology. In this volume in the Female Pelvic Surgery Video Atlas Series, written by series editor Mickey Karram, MD, detailed discussions and illustrations, case studies, and video footage clarify how to most effectively perform a variety of procedures and manage complications. - Consult this title on your favorite e-reader with intuitive search tools and adjustable font sizes. Elsevier eBooks provide instant portable access to your entire library, no matter what device you're using or where you're located. - Case-based presentations and videos, narrated by the authors, take you step-by-step through a variety of procedures including abdominal sacral colpohysteropexy, laparoscopic sacral colpopexy, high uterosacral suspension, and more. - Coverage of hot topics such as robotic and laparoscopic prolapse repairs, prolapse repairs and uterine preservation, the role of mesh augmentation, techniques and indications for native tissue prolapse repair, and surgical management and prevention of POP surgery complications keeps you current with the latest advancements in the field. - Highly illustrated, quick-reference chapters discuss all of the possible diagnoses for which each procedure is indicated. - Case studies describe the clinical history surrounding each case featured in the videos. - An overview of how the entire pelvis functions as a unit helps illustrate the importance of a multidisciplinary, team approach in diagnosing and treating abnormalities. - Online access at expertconsult.com places the full text, video clips, and more at your fingertips on any computer or mobile device.

Offering a comprehensive guide, the Oxford Textbook of Urological Surgery is a practical resource mapped to the curriculum for urological training as approved by the General Medical Council (GMC), making it particularly useful in preparation for the Intercollegiate Examination. Presented in a clear and accessible way, this evidence based volume covers all major areas, including functional urology, stone disease, infection, andrology, nephrology, transplantation, uroradiology, and paediatric urology. This highly illustrated full colour textbook has an innovative and user-friendly style, including over 500 photographs, clinical images, and line drawings. Bringing together the expertise of over 100 specialist contributors in the field, the Oxford Textbook of Urological Surgery is a highly valuable source of information, and will become the standard reference text for all who study urological disease and its treatment.

Dr. Iglesia has created an issue devoted to pelvic floor disorders that has a strong focus on the evidence behind current treatments and diagnostic methods. The authors are top experts in their areas and have contributed reviews on the most important topics in pelvic floor disorders, including Stress Urinary Incontinence; Urge Urinary Incontinence; Pelvic Organ Prolapse Native Tissue repairs; Pelvic Organ Prolapse Vaginal and Laparoscopic Mesh; Fecal Incontinence; PFDR Pelvic Floor Disorders Registry; Ultrasound Imaging of the Pelvic Floor; and Childbirth/Pelvic Floor Epidemiology to name a few.

Edited and authored by some of the most respected figures in the field, this newly revised book is your comprehensive guide to all areas of urogynecology, including urinary and fecal incontinence, urodynamic testing, management of genuine stress incontinence, pelvic organ prolapse, overactive bladder, and much more. Uniquely organized to reflect a physician's decision-making process, this practical, clinically oriented text moves from basic concepts through to clinical and urodynamic evaluation, management, and treatment. Inside, you'll find evidence-based assessments of appropriate therapies, along with algorithmic approaches to common complaints, and clear surgical illustrations. Exclusive to the third edition is a section addressing painful and irritative voiding disorders, including overactive bladder, as well as 20 new case presentations that offer opinions from the leading experts in urogynecology and urology. Features step-by-step instructions for urodynamic testing. Addresses all urogynecologic disorders, including genuine stress incontinence · pelvic organ prolapse · defecation disorders · painful and irritative voiding disorders · and specific conditions such as urinary tract infection. Presents vital information on urethral injections, covering the newest treatment options available. Examines the use of autologous materials and mesh in reconstructive pelvic surgery. Uses over 300 crisp illustrations to illuminate every detail. Contains a new section on painful and irritative voiding disorders, including a discussion of overactive bladder and the latest treatment options available. Discusses urodynamics and the most up-to-date testing available for urethral sphincteric function. Features 20 all new case presentations with expert commentary.

Biomechanics of the Female Pelvic Floor, Second Edition, is the first book to specifically focus on this key part of women’s health, combining engineering and clinical expertise. This edited collection will help readers understand the risk factors for pelvic floor dysfunction, the mechanisms of childbirth related injury, and how to design intrapartum preventative strategies, optimal repair techniques, and prostheses. The authors have combined their expertise to create a thorough, comprehensive view of female pelvic floor biomechanics in order to help different disciplines discuss, research, and drive solutions to pressing problems. The book includes a common language for the design, conduct, and reporting of research studies in female PFD, and will be of interest to biomechanical and prosthetic tissue engineers and clinicians interested in female pelvic floor dysfunction, including urologists, urogynecologists, maternal fetal medicine specialists, and physical therapists. Contains contributions from leading bioengineers and clinicians, and provides a cohesive multidisciplinary view of the field Covers causes, risk factors, and optimal treatment for pelvic floor biomechanics Combines anatomy, imaging, tissue characteristics, and computational modeling development in relation to pelvic floor biomechanics

The initial objective of this work was to reduce stress incontinence surgery from a major surgical procedure (requiring up to ten days in hospital) to a minor day-care operation. From the beginning it was clear that the two major impediments to achieving this goal were post operative pain and urinary retention. Addressing these problems became a long and winding road and culminated in the Integral Theory. The IVS 'tension-free' tape operation was inspired by Dr Robert Zacharin's anatomical studies. Though Zacharin suggested that the ligaments and muscles around the urethra were important for urinary continence control, he did not say how. The observation that implanted foreign materials created scar tissue led to the hypothesis that a plastic tape inserted in the position of the pubourethrallig ament, would leave behind sufficient scar tissue to reinforce that ligament, which would then anchor the muscles for urethral closure. In September 1986, two prototype Intravaginal Sling operations were per formed. A Mersilene tape was inserted with neither tension nor elevation, in the position of the pubourethral ligament. Restoration of continence was immediate and both patients were discharged on the day following surgery without require ment for catheterization. There was minimal pain, and immediate restoration of continence. After six weeks the tapes were removed. Both patients were still conti nent at last review 10 years later. The results appeared to confirm the importance of a midurethral anchoring point.

Pelvic Organ Prolapse (POP) is defined as the descent of one or more of the pelvicstructures and includes uterine prolapse, vaginal vault prolapse, and anterior or posterior vaginal wall prolapse. The resultant symptoms are urinary and bowel dysfunction, incontinence, and sexual dysfunction. POP is primarily caused by childbirth injury, but ageing, obesity and other factors also contribute. Common treatment of POP is surgery and includes native tissue surgical reconstruction alone or with implantation of either synthetic or biological mesh with the former having a higher success rate. However, thelong-term outcome of synthetic mesh augmented surgery is unsatisfactory due to postsurgical complications. The most common problems are mesh exposure and pain possiblydue to scarring, folding and/or contraction of synthetic meshes. Polypropylene (PP) wasrapidly adopted for POP surgery and was not carefully reassessed to determine whether PPmet the criteria for treating the damaged pelvic floor tissues.Mesenchymal Stem Cells (MSC) have been discovered in almost every adult tissue andare highly proliferative, self-renew and differentiate into mesodermal lineages in vitro.MSC also have immunomodulatory and angiogenic properties making them idealcandidates for cell-based therapies. Recently MSC have been discovered in theregenerative endometrial lining of the uterus and specific markers (W5C5/SUSD2) havebeen identified for their prospective isolation. These endometrial MSC (eMSC) fulfil the classical criteria of adult MSC and can be obtained under minimally invasive procedures without anaesthesia or scarring from premenopausal women.Tissue engineering is defined as a combination of cells and materials and is widely used in the field of regenerative medicine. Many cell types from the same or a different individual can be used in combination with a synthetic, biological or composite material. Of the urogenital organs, to date, researchers have only been able to reconstruct the human bladder and urethra using tissue engineering approaches.In this thesis, new meshes designed specifically for POP repair surgery were evaluated in an abdominal wall fascial defect model to evaluate the extent of host tissue response, tissue integration and subsequent mechanical properties. Polyamide (PA), Polyamide plus Gelatin (PA+G) and Polyether-etherketone (PEEK) showed temporal inflammatory responses that were different to that seen with PP meshes with enhancedneovascularisation, collagen production, and decreased inflammation. PA and PA+Gcould be a future treatment option for POP repair surgery.Most women who suffer from POP are postmenopausal and we therefore characterisedeMSC from postmenopausal women treated with or without exogenous estrogen. Similarto premenopausal women, eMSC can be obtained by a curettage procedure followingshort-term estrogen treatment. Postmenopausal eMSC are similar to premenopausal eMSC in terms of cloning efficiency and phenotype but are available in lower numbers and differentiate to a lesser degree.The next step was to test the PA+G meshes and eMSC in a nude rat fascial wound modelas a small preclinical proof of principle animal model. Meshes seeded with eMSCimproved the tissue integration compared to meshes alone by increasing theneovascularisation, altering macrophages from an inflammatory to wound healingphenotype, decreasing the foreign body reaction, and improving the biomechanicalproperties in the long term, without engraftment.This thesis also provides a comprehensive analysis of sheep vaginal tissue to generatebaseline data in this large animal preclinical model, including biochemical, biomechanical and histological analyses. Sheep that have not delivered lambs have similar biomechanical and biochemical properties to parous sheep whereas pregnancy significantly changes both the tissue composition and mechanical properties. We also determined regional differencesin postmenopausal sheep vagina and correlated the biochemical and histological results with postmenopausal women. The ovine vagina showed differences between the upper and lower region whereas human vagina did to a lesser degree but with similar tissuecomposition. These results can help to understand the biochemical tissue composition and passive biomechanical properties of ovine vagina and relate this to the histo-architecture at different reproductive stages as part of the establishment of a large animal preclinicalmodel for evaluating regenerative medicine approaches for surgical treatment of pelvicorgan prolapse. The next step would be to test the above mentioned TE construct in a large animal model; however this was not feasible within the time frame of this thesis.In conclusion eMSC are a promising source of MSC independent of a women's stage oflife and could be used for TE purposes. A Tissue Engineering construct might be thefuture treatment for POP but has yet to be evaluated in a large animal preclinical model.

The ASCRS Textbook of Surgery of the Colon and Rectum offers a comprehensive textbook designed to provide state of the art information to residents in training and fully trained surgeons seeking recertification. The textbook also supports the mission of the ASCRS to be the world’s authority on colon and rectal disease. The combination of junior and senior authors selected from the membership of the ASCRS for each chapter will provide a comprehensive summary of each topic and allow the touch of experience to focus and temper the material. This approach should provide the reader with a very open minded, evidence based approach to all aspects of colorectal disease. Derived from the textbook, The ASCRS Manual of Surgery of the Colon and Rectum offers a “hands on” version of the textbook, written with the same comprehensive, evidence-based approach but distilled to the clinical essentials. In a handy pocket format, readers will find the bread and butter information for the broad spectrum of practice. In a consistent style, each chapter outlines the condition or procedure being discussed in a concise outline format – easy to read, appropriately illustrated and referenced.