Vaginal Surgery for Incontinence and Prolapse - part 1 pdf

Zimmern, MD, FACSProfessor of Urology Jane and John Justin Distinguished Chair in Urology In honor of Claus Roehrborn, MD Department of Urology The University of Texas Southwestern Medic

Vaginal Surgery for Incontinence and Prolapse

Philippe E Zimmern, Peggy A Norton, François Haab and

Vaginal Surgery for Incontinence and Prolapse

With 120 Figures, including 66 Color Plates

Philippe E Zimmern, MD, FACS

Professor of Urology

Jane and John Justin Distinguished Chair in Urology

In honor of Claus Roehrborn, MD

Department of Urology

The University of Texas Southwestern Medical Center at Dallas

Dallas, TX, USA

Peggy A Norton, MD, FACOG

Professor of Obstetrics and Gynecology

Chief of Urogynecology and Reconstructive Pelvic Surgery

University of Utah School of Medicine

Salt Lake City, UT, USA

Christopher C.R Chapple, BSc, MD, FRCS (Urol), FEBU

Consultant Urological Surgeon

Department of Urology

The Royal Hallamshire Hospital

Sheffi eld, UK

British Library Cataloguing in Publication Data

A catalogue record for this book is available from the British Library

Library of Congress Control Number: 2006921442

ISBN-10: 1-85233-912-8 e-ISBN 1-84628-346-9

ISBN-13: 978-1-85233-912-8

Printed on acid-free paper

© Springer-Verlag London Limited 2006

Apart from any fair dealing for the purposes of research or private study, or criticism or review, as permitted under the Copyright, Designs and Patents Act 1988, this publication may only be reproduced, stored or transmitted, in any form or by any means, with the prior permission in writing of the publishers, or in the case of reprographic reproduction in accordance with the terms of licences issued by the Copyright Licensing Agency Enquiries concerning reproduction outside those terms should be sent to the publishers.

The use of registered names, trademarks, etc in this publication does not imply, even in the absence of a specifi c statement, that such names are exempt from the relevant laws and regulations and therefore free for general use.

Product liability: The publisher can give no guarantee for information about drug dosage and application thereof contained in this book In every individual case the respective user must check its accuracy by consulting other pharmaceutical literature.

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Springer Science +Business Media

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Imagine the plight of a young woman, some time during the thousands of years before the mid-18th century, who, soon after a diffi cult childbirth, fi nds she can no longer keep from leaking urine She is standing in the chill winter wind, her urine-soaked clothes clinging wet against her thighs as she comforts her crying baby knowing that she faces

a life of misery, shame and social ostracism Or imagine the middle-aged wife of a tenant farmer on the remote central Illinois plain, straining with her husband to lift a heavy log that has fallen on their only milk cow only to feel a deep tearing sensation and discover a large mass protruding between her legs Gripped by fear, she cannot know what has happened to her or how she will care for her family if she can no longer help with the diffi cult tasks needed to live

We must be grateful to the generations of physicians before us who have pioneered treatments and developed preventions for the pelvic fl oor disorders that have affected women throughout time Each decade during the last 150 years has brought new insights, new operations, and new medicines to help women who suffer from these debilitating conditions At fi rst, surgical treatments were so dangerous that they could only be sug-gested for the most severe of cases, but advances in anesthetic and surgical safety now make them available to the majority of women Important new medications have been developed and modern obstetrical care has eliminated the obstetrical fi stula from the developed world

Your decision to read this book joins you with other physicians who have sought to inform themselves with the latest knowledge to help women with pelvic organ prolapse, urinary incontinence, and bowel control It contains the latest insights, clearly outlined and carefully presented by the leading authorities in urology and gynecology The inclu-sion of these two perspectives broadens the usefulness of the book as these two special-ties see different aspects of the same conditions In this way they are like the blind men and the elephant One man, who is holding a leg says that the elephant is like a large tree, one man holding the ear says it is like a giant bird with wings, a third feeling the elephant’s side says it is like a wall while the last man, holding the tail, says it is like a rope Only by taking these observations together does a complete picture emerge.Together the disciplines of urology and gynecology have a more complete picture than either would provide alone of problems of pelvic fl oor dysfunction Urologists, through their extensive experience with patients who suffer from neurological injury understand the neurophysiology of urination at a level not often reached by gynecologists Obstetri-cian gynecologists understand the nature of birth-induced problems such as prolapse

in a way that urologists often do not appreciate Both fi elds have a long history of addressing urinary incontinence, together having amassed a huge literature about this common condition

The knowledge presented in this book will give you an up-to-date picture of porary treatment The authors are acknowledged authorities who are practicing clini-cians with extensive practical experience in managing these problems Each brings a synthesis of his or her knowledge of the available literature and practical experience in managing patients to the task of making recommendations for your practice Although

contem-v

many areas of medicine have become somewhat routine because the direct cause of a disease and its cure are known (for example, treatment of uncomplicated primary urinary tract infection) but the management of urinary incontinence and pelvic organ prolapse remain as much of an art as a science.

Imagine having a group of the world’s authorities available to you to assist in ing your patients This book represents that resource, ready at hand, to improve your knowledge of these common conditions now, and, in the future, to act as a ready refer-ence for new problems as you encounter them

manag-John O L DeLancey

Professor, Division of Gynecology

Department of Obstetrics and Gynecology

University of Michigan Health System

Ann Arbor, Michigan, USA

Vaginal surgery has a great tradition empowered by the tremendous contributions of outstanding surgeons and by the rewarding outcome in terms of patient satisfaction, because the vaginal approach is both effi cacious and minimally invasive

This very focused and timely book on incontinence and prolapse provides a hensive review of anatomy, epidemiology, and evaluation of the many conditions which can be effectively treated by vaginal surgery

compre-Urinary incontinence (either primary or failure cases), pelvic organ prolapse, fecal incontinence, and other vaginal reconstructive procedures (urethral diverticula, bladder neck closure, vesico- and urethro-vaginal fi stulae) are described in detail in regards to indications, technique, complications and outcome

The book is a must for all those who are or wish to be involved in the management

of female pelvic fl oor disorders

The editors and authors should be congratulated for their effort and unique contribution

But fi rst, let us ask: Why such a divide? Simply because, up to now, a line has been drawn between urologists dealing mainly with incontinence and gynecologists dealing primarily with prolapse When a combined urologist–gynecologist team can function well together, patients do not mind being cared for by two “specialists” However, in many practices, these two individuals cannot interact well or one is simply lacking, leaving for example a urologist with no or minimal expertise to deal with a patient suf-fering from concomitant prolapse and stress urinary incontinence.

This dividing line is rapidly changing, and this book is among the efforts to do so Other initiatives have already been implemented In the US, a joint effort from the ABU and ABOG has led to a fellowship training program in “Female Pelvic Floor Medicine and Reconstructive Surgery”, with emphasis on equipping trainees with combined knowledge on the surgical options to correct incontinence and prolapse Large networks involving both urologists and urogynecologists (UITN and PFDN) have recently initi-ated several multicentric randomized controlled trials to compare surgical techniques

to correct these conditions

The industry is also aware of these emerging domains and has fueled the fi eld with

a large array of new products, some with minimal preliminary investigations before being released for human application For any vaginal surgeon, this infl ux of new products and surgical techniques is quite overwhelming, although it underscores the recognition of a very large and fairly untapped market and signals the expansion of the fi eld

to provide an updated and comprehensive reference manual addressing these very focused, yet very common topics The editors have different training backgrounds and are geographically diverse Yet, this is their strength as they share not only a vast experi-ence in vaginal surgery but also a deep motivation to render this book useful not only

to the less experienced but also to the more seasoned reconstructive surgeon among us

The book is divided into sections covering vaginal anatomy and physiology, practical guidelines for offi ce evaluation of urinary incontinence, prolapse, and fecal inconti-nence, and many detailed chapters on reconstructive procedures to correct these three conditions The challenging topic of “recurrence” is also addressed from the standpoint

of vaginal surgery Other vaginal procedures involving urethral reconstruction, fi stula,

diverticulum, bladder neck closure are also expertly reviewed since these entities relate

to urinary incontinence as well

Extirpative surgery (kidney stone, cancer) is on the decline Reconstructive surgery

is on the rise because women live longer and many will suffer from the effect of aging, pregnancies, and hormonal changes This book will have an immediate appeal to all those involved in training or currently delivering care to women with aging pelvic fl oor changes because vaginal surgery offers simplicity, minimal intra-operative morbidity, prompt recovery, and very adequate overall patient satisfaction

The editors remain deeply indebted to the panel of committed experts who dedicated time and effort to bring the readership up to speed with the “established” and the “new”

never been possible without mutual respect and friendship between all of the tors, full support of this academic endeavor from our loved ones and families, and cer-tainly the invaluable help and able assistance of Eva Senior, Melissa Morton, and Robert Maged at Springer, and the highly organized skills and dedication of my secretary, Susan Brewer

contribu-Philippe E Zimmern

Forewords vPreface ixContributors xiii

I Anatomy/Epidemiology

1 Vaginal Anatomy for the Pelvic Surgeon

Courtenay Moore and Firouz Daneshgari 3

2 Epidemiology of Incontinence and Prolapse

Anne M Weber and Mark D Walters 11

Adam G Baseman and Gary E Lemack 75

III Surgery for Urinary Incontinence

8 Transvaginal Surgery for Stress Urinary Incontinence Owing

to Urethral Hypermobility

Christina Poon and Philippe E Zimmern 91

9 Stress Urinary Incontinence Secondary to Intrinsic

Sphincteric Defi ciency

Robert W Frederick and Gary E Leach 109

xii Vaginal Surgery for Incontinence and Prolapse

10 The Mid-Urethral Tapes

Bruno Deval and François Haab 133

IV Surgery for Prolapse

Donna Y Deng, Matthew P Rutman, Larissa V Rodriguez,

and Shlomo Raz 145

12 Uterine and Vaginal Vault Prolapse

Peggy A Norton 155

13 Enterocele and Rectocele/Perineorrhaphy

Larry T Sirls and Matthew P Rutman 169

V Surgery for Fecal Incontinence

14 Surgery for Fecal Incontinence

Rebecca G Rogers 185

VI Vaginal Approach to Abdominal or Vaginal Surgery

Failures: Now What?

15 The Vaginal Approach After Failed Previous Surgery

for Incontinence

Christopher C.R Chapple 199

16 Vaginal Approach to Postsurgical Bladder Outlet Obstruction

Victor W Nitti and Nicole Fleischmann 209

17 Vaginal Approach to Recurrent Pelvic Prolapse

Jason P Gilleran, Peggy A Norton, and Philippe E Zimmern 221

18 Intraoperative Complications of Vaginal Surgery

Gina A Defreitas and Philippe E Zimmern 231

VII Other Reconstructive Vaginal Procedures

19 Vesicovaginal and Urethrovaginal Fistulas

Roger Dmochowski and Harriette Scarpero 243

20 Urethral Diverticula and Other Periurethral Masses

Eric S Rovner and William I Jaffe 259

21 Bladder Neck Closure

Aaron D Berger and Christopher E Kelly 277

Index 283

Glickman Urological Institute

Cleveland Clinic Foundation

Cleveland, OH, USA

Roger Dmochowski, MD, FACSDepartment of UrologyVanderbilt University Medical CenterNashville, TN, USA

Nicole Fleischmann, MDDepartment of UrologyMount Sinai School of MedicineNew York, NY, USA

Robert W Frederick, MDTower Urology Institute for Continence

Tower Urology Medical GroupLos Angeles, CA, USA

Jason P Gilleran, MDDepartment of UrologyUniversity of Texas Southwestern Medical Center

Dallas, TX, USASharon G Gregorcyk, MD, FACS, FASCRS

Gastrointestinal and Endocrine Surgery

University of Texas Southwestern Medical Center

Dallas, TX, USAFrançois Haab, MDUrology DepartmentTenon HospitalParis, France

xiv Vaginal Surgery for Incontinence and Prolapse

William I Jaffe, MD

Department of Urology

New York Presbyterian Hospital

New York, NY, USA

Division of Female Pelvic Medicine

and Reconstructive Surgery

Departments of Obstetrics and

Gynecology and Urology

Loyola University Medical Center

Maywood, IL, USA

Gary E Leach, MD

Tower Urology Institute for

Continence

Tower Urology Medical Group

Los Angeles, CA, USA

Glickman Urological Institute

Cleveland Clinic Foundation

Cleveland, OH, USA

Victor W Nitti, MD

Department of Urology

New York University School of

Medicine

New York, NY, USA

Peggy A Norton, MD, FACOGDepartment of Obstetrics and GynecologyUniversity of Utah School of MedicineSalt Lake City, UT, USA

Christina Poon, MD, FRSCSDivision of Urology

University of British ColumbiaLions’ Gate Hospital

North Vancouver, CanadaShlomo Raz, MD

Reconstructive and Female UrologyDavid Geffen School of MedicineUniversity of California–Los AngelesLos Angeles, CA, USA

Larissa V Rodriguez, MDReconstructive and Female UrologyDavid Geffen School of MedicineUniversity of California–Los AngelesLos Angeles, CA, USA

Rebecca G Rogers, MDDepartment of Obstetrics and Gynecology

University of New Mexico Health Sciences Center

Albuquerque, NM, USAEric S Rovner, MDDepartment of UrologyMedical University of South CarolinaCharleston, SC, USA

Matthew P Rutman, MDDepartment of UrologyColumbia UniversityCollege of Physicians and SurgeonsNew York, NY, USA

Harriette Scarpero, MDDepartment of UrologyVanderbilt University Medical CenterNashville, TN, USA

William Andre Silva, MDDivision of Urogynecology and Pelvic Reconstructive Surgery

Department of Obstetrics and Gynecology

Good Samaritan HospitalSeton Center

Cincinnati, OH, USA

Contributors xv

Larry T Sirls, MD

Urodynamics Laboratory

Department of Urology

William Beaumont Hospital

Royal Oak, MI, USA

Cleveland Clinic Foundation

Cleveland, OH, USA

Anne M Weber, MD, MSUniversity of Pittsburgh School of Medicine

Department of Obstetrics, Gynecology and Reproductive Sciences

Magee-Women’s HospitalPittsburgh, PA, USAPhilippe E Zimmern, MD, FACSDepartment of Urology

University of Texas Southwestern Medical Center at DallasDallas, TX, USA

Part I

Anatomy/Epidemiology