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Gynae-Urology—Update
Dilip Kumar Dutta
1:
Historical Review of Gynae-Urological Surgery
TIMELINE OF MILESTONE RELATED TO PELVIC SURGERY AND FEMALE UROLOGY
2:
Diagrammatic Representation of Embryology and Developmental Abnormalities of Urogenital System
DEVELOPMENT OF UROGENITAL SYSTEM
3:
Anatomy of Female Pelvis
THE PELVIC VISCERA
ANATOMY OF UTERUS
ANATOMY OF THE BLADDER
ANATOMY OF THE URETER
ANATOMY OF SIGMOID COLON
BLOOD SUPPLY TO THE PELVIS
Abdominal Aorta and Inferior Vena Cava
Internal Pudendal
COLLATERAL ARTERIAL CIRCULATION OF THE FEMALE PELVIS
NERVE SUPPLY TO THE PELVIS
4:
Urinary Tract Infection—Prevention and Management
KNOWN RISK FACTORS FOR URINARY TRACT INFECTION
CLINICAL PRESENTATION
DIAGNOSIS
Urine Collection Methods
Urine Microscopy
Rapid Diagnostic Tests
Urine Culture
Radiologic Studies
Cystourethroscopy
Urodynamic Studies
MANAGEMENT OF LOWER URINARY TRACT INFECTION
Asymptomatic Bacteriuria
PREVENTION OF BLADDER INFECTION IN ELDERLY PATIENTS WITH LONG-TERM CATHETERISATION
5:
Management of Ureter, Bladder and Urethral Injury
INCIDENCE
PREOPERATIVE EVALUATION
Vaginal Approach
MANAGEMENT OF INJURIES
Recognition of Ureteral Injury
Ureteral Dye Injection
Cystotomy
Ureteral Catheterisation
Intravenous Urography
Management of Ureteral Injury
URETERONEOCYSTOSTOMY
URETEROURETEROSTOMY
BLADDER MOBILISATION AND EXTENSION
TRANSURETEROURETEROSTOMY
CUTANEOUS URETEROSTOMY
RECOGNITION OF BLADDER INJURY
Bladder Dye Instillations
CYSTOSCOPY
Management of Bladder Injury
Recognition of Urethral Injury
Catheter Insertion
URETHROSCOPY
Management of Urethral Injury
6:
Lower Urinary Tract Injuries following Endoscopic Gynaecological Surgery
URETERIC INJURIES
RISK FACTOR IDENTIFICATION AND PREVENTION OF INJURY
POTENTIAL SITES OF URETERIC INJURIES
MANAGEMENT
Diagnosed during Surgery
Diagnosed After Surgery (Delayed Manifestation)
CLINICAL PRESENTATIONS
ASSESSMENT
TREATMENT
URINARY BLADDER INJURY
7:
Management of Genitourinary Fistula
INTRODUCTION
A BRIEF HISTORY
TYPES
AETIOLOGY
(A) OBSTETRICAL
(I) Ischaemic
(II) Traumatic
(B) GYNAECOLOGICAL
(I) Surgical Trauma
(II) Radiation Therapy
(III) Diseases
(IV) Other Miscellaneous Causes (rare)
CLINICAL FEATURES
Patient Profile
(A) SYMPTOMS: History alone can be misleading.
(B) SIGNS
SPECIAL TESTS
PREVENTION
DETAILED PREOPERATIVE EVALUATION AND PREPARATION
TREATMENT OF VVF
Conservative Treatment
Surgical Management
Time of Surgery
Principles of Repair
Conservative Surgeries of VVF
Special Situations:
Palliative Surgery
Postoperative Management
Complications
Prognosis
SOME SPECIAL VARIETIES
(1) Ureterovaginal Fistula
(I) Acquired: (Iatrogenic)
(II) Congenital
Clinical Features
Diagnosis
Management of Ureteric Injury/Fistula
(2) Vesico-uterine Fistula
Aetiology
Clinical Features
Diagnosis
Management
(I) Conservative
(II) Surgery
Prognosis
(3) Urethrovaginal Fistula
Aetiology
Clinical Features
Management
CONCLUDING REMARKS
ACKNOWLEDGMENTS
8:
Management of Rectovaginal Fistula
CLASSIFICATION
CAUSES AND PATHOPHYSIOLOGY
Relevant Anatomy
Clinical Features
Lab Studies
Imaging Studies
Other Tests
Diagnostic Procedures
Histologic Findings
Management
Medical Management Options
Surgical Therapy
Local Repair Methods
Transabdominal Approaches
Postoperative Details
Complications
Complications of Local Repairs
Complications of Transabdominal Repairs
Prognosis of Recurrent RVFs
Future
Bricker Patch
Device for Occlusion of Rectovaginal Fistula
Anal Fistula Plug
9:
Management of Stress Incontinence
NORMAL MICTURITION
TYPES OF INCONTINENCE AND CLINICAL ASSESSMENT
Aetiology and Risk Factors
Age
Family History
Race
Pregnancy and Childbirth
Pelvic Surgery and Radiotherapy
Obesity
Constipation
Lung Disease and Smoking
UTI
Occupation
Medications
Pelvic Organ Prolapse
Mental impairment
PATHOPHYSIOLOGY
WORKUP
Lab Studies
Imaging Studies
Other Tests
Procedures
URODYNAMICS
MANAGEMENT
Management Options for SUI: Considerations (Table 9.2)
Behavioural
Pelvic Floor Muscle Therapy
MECHANICAL
Intravaginal Devices for Stress Incontinence
Contrelle Active guard Intravaginal Device (Fig 9.9)
Vaginal Sponge (Fig 9.10)
Use
Conveen Continence Guard (Fig 9.11)
Tampons
Pessaries
Introl Bladder Neck Support
Urethral Tubes or Sleeves
Other Procedures
PHARMACOLOGICAL
SURGERY
Mechanism of Surgery
Choice of Surgery
Continence Operations
Anterior Colporrhaphy
Colposuspension
Marshall-Marchetti-Krantz Procedure
Paravaginal Repair
Suburethral Sling Procedure (Fig 9.13)
Recent Trends and Current Treatment Options
Laparoscopic Colposuspension
Tension Free Vaginal Tape (Figs 9.14 and 9.15)
ARTIFICIAL URINARY SPHINCTER (FIG. 9.17)
10:
Management of Urge Incontinence
DEFINITION
PATHOPHYSIOLOGY
Urge Incontinence
Causes
Incidence
Urge Incontinence—Signs and Symptoms
DIAGNOSIS AND TEST
Physical Examination
Test
Urge Incontinence Prevention
Urge Incontinence Prognosis (Expectation)
Treatment
Medication
Surgery
Diet
Bladder Retraining
Kegel Exercises
Biofeedback and Electrical Stimulation
Botox
Activity
Monitoring
Complications of Urge Incontinence
11:
Stress Incontinence—Tension Free Vaginal Tape Obturator (TVT-O) System Innovative Surgery
TENSION FREE VAGINAL TAPE (TVT-O)
12:
Management of Cystocele, Rectocele, Enterocele and Urethral Diverticulum
INTRODUCTION
SITES OF VAGINAL PROLAPSE
Prolapse of the Anterior Vaginal Wall
Prolapse of the Posterior Vaginal Wall
Diverticulum of the Urethra
AETIOLOGY OF DAMAGE TO PELVIC SUPPORTS
SYMPTOMS
General1
Cystocele
Enterocele
Rectocele
Urethral Diverticulum2
EXAMINATION
Physical Examination
Local Examination
Pelvic Examination1
Cystocele
Rectocele
Cysto-urethrocele
Relaxed Perineum
Rectocele and Enterocele
Supplemental Examination in a Standing Position (Rarely required)1
INVESTIGATIONS
Routine Preoperative Investigations
Cystocele
Urethral Diverticulum2
MANAGEMENT
Non-operative Treatment of Genital Prolapse
Oestrogen Supplementation
Treatment of Medical Problems
Pelvic Muscle Exercises
Pessary Treatment
Operative Management
Operative Considerations
TYPES OF OPERATION
ANTERIOR COLPORRHAPHY AND OPERATION FOR CYSTOCELE4
Indications
Objectives
Technique
Operation
Dangers
Abdominal Colporrhaphy4
Operation
COLPOPERINEORRHAPHY
Indications
Objectives
Operation
Dangers
ENTEROCELE REPAIR1
Repair of the Pouch of Douglas by Vaginal Route
Vaginal Operation for the Treatment of Hernia of the Pouch of Douglas (Enterocele)
Obliteration of the Pouch of Douglas by Abdominal Route
REPAIR OF URETHRAL DIVERTICULUM2
CURRENT OPINION ON TECHNIQUES OF VAGINAL WALL REPAIR
Anterior Vaginal Wall Prolapse
Posterior Vaginal Wall Prolapse
Use of Synthetic Grafts in Transvaginal Repair Surgery for Anterior and Posterior Vaginal Prolapse8,9
CONCLUSION
INDEX
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Index
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