Urinary And Fecal Incontinence: An Interdisciplinary Approach

by Becker, Horst-Dieter; Stenzl, Arnulf; Wallwiener, Diethelm; Zittel, Tilman T.

• ISBN13: 9783540222255
• ISBN10: 3540222251
• Edition: 1st
• Format: Hardcover
• Copyright: 2005-07-16
• Publisher: Springer Verlag

Summary

The book surveys the prevalence, the pathophysiology, the diagnosis, the current therapy, both conservative and operative, and the long-term outcome of treatment of urinary and fecal incontinence. It is targeted at general and colorectal surgeons, urologists, gynecologists and gastroenterologists who treat incontinent patients, and also gives general practitioners and geriatric physicians an overview of the diagnostic methods and treatment options that can be offered to incontinent patients.

Table of Contents

Part I Epidemiology and Health Costs of Incontinence
1 Epidemiology of Urinary Incontinence	1	(12)
Steinar Hunskaar
1.1 Definitions	4	(1)
1.2 Epidemiology of Nocturnal Enuresis	4	(1)
1.2.1 Survey Studies	5	(1)
1.2.2 Remission and Natural History	5	(1)
1.2.3 Potential Risk Factors of Nocturnal Enuresis	5	(1)
1.3 Epidemiology of Urinary Incontinence in Women	5	(4)
1.3.1 Prevalence	5	(2)
1.3.2 Type	7	(1)
1.3.3 Severity	7	(1)
1.3.4 Incidence, Remission, and Natural History	8	(1)
1.3.5 Racial and Ethnic Differences	8	(1)
1.3.6 Potential Risk Factors	8	(1)
1.4 Epidemiology of Urinary Incontinence in Men	9	(1)
1.4.1 Prevalence	9	(1)
1.4.2 Type and Severity	10	(1)
1.4.3 Potential Risk Factors	10	(1)
References	10	(3)
2 Epidemiology of Fecal Incontinence: A Review of Population-based Studies	13	(12)
Catherine W. McGrother, Madeleine Donaldson
2.1 Introduction	14	(1)
2.2 Prevalence	15	(5)
2.3 Associated Factors	20	(1)
2.4 Conclusions	21	(1)
References	22	(3)
3 Economic Costs of Urinary Incontinence in Germany	25	(8)
Günter Neubauer, Sandra Stiefelmeyer
3.1 Prevalence and Social Importance	26	(1)
3.2 From a Medical to an Economic Approach	27	(1)
3.3 Direct Costs	27	(1)
3.4 Indirect Costs	28	(1)
3.5 Economic Impact in Germany	29	(1)
3.6 From Treating to Healing	30	(1)
References	31	(2)
4 Perception of Incontinence in and by Society	33	(8)
Paul Enck, Sibylle Klosterhalfen
4.1 Background	34	(1)
4.2 Incontinence Citations in PubMed	34	(1)
4.3 Available Therapeutic Tools	35	(1)
4.4 Incontinence Knowledge in Traditional Health Care	36	(2)
4.6 Summary	38	(1)
References	39	(2)
Part II Pelvic Anatomy, Physiology and Etiology of Incontinence
5 An Attempt at an Explanation of Stress Urinary Incontinence Through the Rodent Animal Model	41	(46)
Karl-Dietrich Sievert, Emer Bakircioglu, Lora Nunes, Tony Tsai, Tom F. Lue
5.1 Introduction	44	(1)
5.2 Part I	45	(9)
5.2.1 Experimental Set-up	45	(1)
5.2.2 Statistical Analyses	45	(1)
5.2.3 Functional Evaluation	46	(1)
5.2.4 Histological Evaluation	47	(1)
5.2.4.1 Immunohistochemical Staining	47	(1)
5.2.4.2 Electron Microscopy	48	(5)
5.2.5 RT-PCR	53	(1)
5.3 Part II	54	(21)
5.3.1 Experimental Set-up	54	(1)
5.3.2 Statistical Analysis	55	(1)
5.3.3 Functional Evaluation	56	(1)
5.3.4 Histological Evaluation	57	(1)
5.3.4.1 Muscle Changes	57	(1)
5.3.4.2 Neural Changes	66	(9)
5.4 Discussion	75	(9)
References	84	(3)
6 Birth Trauma and Incontinence	87	(8)
Ralf Tunn, Ursula Peschers
6.1 Morphological Changes of the Continence Controlling System of Urethra and Anus Caused by Pregnancy and Delivery	88	(2)
6.1.1 Urethra	88	(1)
6.1.2 Levator ani Muscle	88	(1)
6.1.3 Endopelvic Fascia	89	(1)
6.1.4 Anal-Sphincter System	89	(1)
6.2 Birth Trauma and Prevalence Incontinence	90	(1)
6.2.1 Prevalence of Urinary Incontinence	90	(1)
6.2.2 Prevalence of Anal Incontinence	90	(1)
6.3 Risk Factors for the Development of Urinary and Anal Incontinence	91	(1)
6.4 Summary	91	(1)
References	92	(3)
7 Neurogenic Urinary Incontinence	95	(8)
Helmut Madersbacher
7.1 Introduction and Aims	96	(1)
7.2 Pathophysiology of Neurogenic Urinary Incontinence	96	(2)
7.3 Therapeutic Options for Neurogenic Urinary Incontinence	98	(3)
7.3.1 Urinary Incontinence Due to Suprapontine Lesions	98	(1)
7.3.2 Suprasacral Spinal Cord Lesions	99	(1)
7.3.3 Spinal Sacral and Subsacral Lesions	100	(1)
7.4 Conclusions	101	(2)
8 Fecal Incontinence after Rectal and Perianal Surgery	103	(16)
Alan G. Thorson
8.1 Introduction	104	(1)
8.2 At-risk Procedures	104	(1)
8.3 Procedure-specific Risks	105	(8)
8.3.1 Procedures for Anal Diseases	105	(1)
8.3.1.1 Hemorrhoidectomy	105	(1)
8.3.1.2 Sphincterotomy	106	(1)
8.3.1.3 Operations for Fistula-in-ano	106	(3)
8.3.2 Procedures with Secondary Impact on Continence	109	(1)
8.3.2.1 Anterior Resection	109	(1)
8.3.2.2 Ileal Pouch Anal Anastomosis	111	(1)
8.3.2.3 Transanal excision	111	(1)
8.3.3 Procedures for Prolapse	112	(1)
8.3.3.1 Abdominal Procedures	112	(1)
8.3.3.2 Perineal Procedures	112	(1)
8.3.4 Miscellaneous Procedures	113	(1)
8.3.4.1 Rectocele Repair	113	(1)
8.3.4.2 Sphincteroplasty	113	(1)
8.4 High-risk Procedures	113	(1)
8.5 Etiology of Postoperative Incontinence	113	(1)
8.6 High-risk Patient Groups	114	(1)
8.7 Decreasing the Risk of Fecal Incontinence Following Rectal and Perianal Surgery	115	(1)
8.8 Outcomes Data	115	(1)
8.9 Conclusion	116	(1)
References	116	(3)
Part III Diagnostic Methods to Detect Incontinence
9 Evaluation of Anorectal and Pelvic Floor Muscle Function	119	(18)
Fernando Azpiroz, Aniceto Puigdollers, Carlos Amselem
9.1 Anatomical Background	122	(1)
9.2 Functional Parameters and Evaluation Techniques	122	(6)
9.2.1 Rectal Reservoir Function	123	(1)
9.2.1.1 Compliance	123	(1)
9.2.1.2 Perception of Rectal Filling	124	(1)
9.2.2 Anal Sphincter Function	124	(1)
9.2.3 Neural Reflexes	125	(1)
9.2.3.1 Rectoanal Inhibitory Reflex	125	(1)
9.2.3.2 Cough Reflex	125	(1)
9.2.3.3 Anocutaneous Reflex	126	(1)
9.2.4 Defecatory Function	126	(1)
9.2.4.1 Expulsion Tests	127	(1)
9.2.5 Pelvic Floor Muscle Function	127	(1)
9.2.5.1 Perineometry	127	(1)
9.2.5.2 Levator Ani Contraction	128	(1)
9.3 Outcome Measures and Clinical Relevance	128	(6)
9.3.1 Rectal Reservoir	128	(1)
9.3.2 Anal Sphincters	129	(1)
9.3.2.1 Weak Sphincters	129	(1)
9.3.2.2 Hyperactive Sphincters	130	(1)
9.3.3 Reflex Activity	131	(1)
9.3.3.1 Anorectal Inhibitory Reflex	131	(1)
9.3.3.2 Cough Reflex	132	(1)
9.3.4 Impaired Defecation	132	(1)
9.3.5 Weak Levator Ani	133	(1)
9.4 Indications	134	(1)
9.4.1 Patients with Incontinence and/or Pelvic Floor Dysfunction	134	(1)
9.4.2 Other Indications Not Primarily Related to Pelvic Floor Damage	134	(1)
9.5 Conclusion	135	(1)
References	135	(2)
10 Imaging of the Pelvic Floor - Videoproctography and Dynamic MRI of the Pelvic Floor	137	(1)
Alois Fürst, Lilli Hutzel, Klaus Guenther, Andreas Schreyer, Christian Paetzel
10.1 Introduction	138	(1)
10.2 Technical Necessities to Perform Defecography	138	(1)
10.3 Radiation Dose of Defecography	139	(1)
10.4 Standards of Evaluation	139	(1)
10.5 Information from a Correctly Performed Defecography	140	(2)
10.6 Technical Necessities to Perform a Dynamic MRI of the Pelvic Floor	142	(1)
10.7 How to Perform Dynamic MRI	142	(1)
10.8 Indication for Dynamic MRI	143	(1)
10.9 Costs of Conventional Defecography and Dynamic MRI	143	(2)
10.10 Discussion	145	(7)
10.11 Conclusion	152	(1)
References	152	(3)
11 Diagnostic Methods to Detect Female Urinary Incontinence	155	(2)
Heinz Koelbl, Gert Naumann
11.1 Assessment of Genuine Stress Incontinence	157	(1)
11.2 Basic Investigations	157	(1)
11.3 Urodynamics	158	(4)
11.3.1 Uroflowmetry	158	(1)
11.3.2 Cystometry	159	(1)
11.3.3 Urethral Pressure Measurements	159	(2)
11.3.4 Valsalva Leak Point Pressure	161	(1)
11.3.5 Videourodynamics	161	(1)
11.3.6 Ambulatory Urodynamic Monitoring	161	(1)
11.4 Electromyography	162	(1)
11.5 Ultrasound	162	(2)
11.5.1 Sonographic Urethrocystography	162	(1)
11.5.2 Perineal Ultrasound	163	(1)
11.5.3 Introital Ultrasound	163	(1)
11.5.4 Intraurethral Ultrasound	164	(1)
11.5.5 Three-Dimensional Ultrasound	164	(1)
11.6 Conclusion	164	(1)
References	165	(2)
Part IV Conservative Therapy of Incontinence
12 Pharmacological Treatment of Urinary Incontinence	167	(46)
Gert Naumann, Heinz Koelbl
12.1 Medical Treatment of Bladder Overactivity	171	(1)
12.2 Anticholinergic Drugs	171	(1)
12.3 Drugs with Mixed Anticholinergic Action	171	(3)
12.3.1 Oxybutynin	171	(2)
12.3.2 Propiverine	173	(1)
12.4 Drugs with Antimuscarinic Action	174	(1)
12.4.1 Propantheline	174	(1)
12.4.2 Tolterodine	174	(1)
12.4.3 Trospium	174	(1)
12.4.4 Darifenacin	175	(1)
12.4.5 Solifenacin	175	(1)
12.5 Drugs Acting on Membrane Channels	175	(1)
12.5.1 Calcium Antagonists	175	(1)
12.5.2 Potassium Channel Openers	176	(1)
12.6 &alpah;-Adrenoceptor Antagonists and β-Adrenoceptor Agonists	176	(1)
12.7 Antidepressants	176	(1)
12.8 Afferent Nerve Inhibitors	176	(1)
12.8.1 Capsaicin and Resiniferatoxin	176	(1)
12.8.2 Botulinum toxin A	176	(1)
12.9 Drugs Used for Treatment of Stress Incontinence	177	(1)
12.9.1 α-Adrenoceptor Antagonists	177	(1)
12.9.2 β-Adrenoceptor Antagonists	177	(1)
12.9.3 Imipramine	178	(1)
12.9.4 Duloxetine	178	(1)
12.10 Hormonal Treatment of Urinary Incontinence	178	(1)
12.10.1 Estrogens for Stress Incontinence	178	(1)
12.10.2 Estrogens for Urge Incontinence	179	(1)
12.11 Conclusion	179	(1)
References	179	(2)
13 Medical, Behavioural and Minimally Invasive Therapy A Urologist's View	181	(1)
Christopher R. Chapple, Sawrabh Bhargava, Karl-Erik Andersson
13.1 Introduction	182	(1)
13.2 Nervous Control of Micturition	182	(1)
13.3 Treatment of Incontinence	183	(11)
13.3.1 Life Style Changes	183	(1)
13.3.1.1 Body Weight	183	(1)
13.3.1.2 Caffeine	184	(1)
13.3.1.3 Fluid Intake	184	(1)
13.3.1.4 Constipation	184	(1)
13.3.2 Behavioural Therapy	184	(1)
13.3.2.1 Pelvic Floor Muscle Training	184	(1)
13.3.2.2 Bladder Retraining	186	(1)
13.3.2.2 Timed Voiding	187	(1)
13.3.2.4 Prompted Voiding	188	(1)
13.3.3 Medical Treatment	188	(1)
13.3.3.1 Drugs used for Treatment of Bladder Overactivity	188	(6)
13.3.4 Minimally Invasive Therapy in Urinary Incontinence	194	(1)
13.4 Economics of Conservative Therapy	194	(2)
References	196	(3)
14 Medical and Behavioral Treatment of Fecal Incontinence	199	(1)
William E. Whitehead
14.1 Introduction	200	(1)
14.2 Education and Medical Management	200	(3)
14.2.1 Antidiarrheal Medications	201	(1)
14.2.2 Laxatives for Constipation-Related Fecal Incontinence	202	(1)
14.2.3 Antegrade Colonic Lavage	203	(1)
14.3 Biofeedback	203	(5)
14.3.1 Theory of Biofeedback	203	(2)
14.3.2 Patient Selection	205	(1)
14.3.3 Diagnostic Evaluation	205	(1)
14.3.3 Efficacy of Biofeedback	205	(1)
14.3.4 How Does Biofeedback Work?	206	(2)
14.3.5 Combining Biofeedback with Surgery or Medical Management	208	(1)
14.4 Summary and Conclusions	208	(1)
References	209	(4)
Part V Operative Therapy of Urinary Incontinence
15 Innovative and Minimally Invasive Treatment of Stress Urinary Incontinence	213	(66)
Christi Reisenauer, Konstantinos Gardanis, Diethelm Wallwiener
15.1 Introduction	214	(1)
15.2 Tension-free Vaginal Tape (TVT) - Operation	214	(4)
15.2.1 Surgical Technique	214	(2)
15.2.2 Indications, Results and Complications	216	(2)
15.3 Other Tension-free Suburethral Slings for Treatment of Stress Urinary Incontinence	218	(9)
15.3.1 Materials of Suburethral Slings	218	(3)
15.3.2 Approaches of Suburethral Slings	221	(1)
15.3.2.1 Antegrade Suprapubic Approach	221	(1)
15.3.2.2 Prepublic Approach	222	(1)
15.3.2.3 Transobturator Approach	224	(3)
15.4 Conclusion	227	(1)
References	227	(4)
16 Abdominal, Vaginal or Laparoscopic Approach for Urinary Incontinence?	231	(1)
Wolfgang Zubke, Ines Gruber, Diethelm Wallwiener
16.1 Kelly Plication	232	(1)
16.2 Anterior Colporrhaphy With and Without Kelly Plication	233	(4)
16.3 Needle Suspension	237	(1)
16.4 Different Colposuspension Techniques	238	(1)
16.5 Comparison Between Anterior Colporrhaphy and Colposuspension	239	(2)
16.6 Tension-Free Tape	241	(2)
16.7 Comparison of Colposuspension and TVT	243	(1)
16.8 Endoscopic Colposuspension	244	(1)
16.9 Comparison of Endoscopic Burch and TVT	245	(2)
References	247	(4)
17 Diagnostic and Surgical Management of Stress Urinary Incontinence	251	(1)
Karl-Dietrich Sievert, Arnulf Stenzl
17.1 Introduction	252	(1)
17.2 Types of Urinary Incontinence	252	(1)
17.3 Female Stress Urinary Incontinence	252	(1)
17.4 Male Urinary Stress Incontinence	252	(1)
17.5 Evaluation of Urinary Incontinence	252	(1)
17.6 Possible Approaches	253	(1)
17.7 Patient History: Analysis and Examination	254	(1)
17.8 Data Gathering Prior to the Office Examination	254	(1)
17.9 Office Examination	254	(1)
17.10 Urethral Bulking Agents (Injectables)	255	(1)
17.10.1 Historic Bulking Agents	255	(1)
17.11 Successfully Introduced Bulking with the CE Mark	255	(2)
17.12 FDA-approved Bulking Agents	257	(1)
17.13 Tissue-engineered Stem Cells for Bulking: Dream or Reality?	258	(1)
17.13.1 Mid-Urethral Synthetic Slings	258	(1)
17.13.1.1 Transvaginal Needle Procedures	258	(1)
17.13.1.2 Vaginal Slings	258	(1)
17.14 Tension-Free Vaginal Tapes	259	(2)
17.15 Comparison of Two Major Tapes	261	(1)
17.16 New Materials: The Resorbable Sling	261	(1)
17.17 Transobturatoric Tension-Free Tapes	262	(1)
17.18 Retropubic Suspensions	262	(1)
17.19 Artificial Urethral Sphincter	263	(1)
17.20 What to Do When All the Efforts Did Not Result in a Continent Patient?	263	(1)
17.21 After a Tension-Free Sling Did Not Bring the Desired Success	264	(1)
17.22 The Sling with Tension	264	(1)
17.23 Urinary Stress Incontinence in Men	264	(2)
17.24 Conclusion	266	(1)
References	267	(4)
18 The Artificial Urinary Sphincter	271	(1)
Roberto Olianas, M. Fisch
18.1 Introduction	272	(1)
18.2 History of the Artificial Sphincter	272	(1)
18.3 Indications and Patient Selection	273	(1)
18.4 Pre- and Postoperative Patient Preparation	273	(1)
18.5 Surgical Technique	274	(2)
18.5.1 Placement of the Cuff	274	(1)
18.5.1.1 Bladder Neck Sphincter	274	(1)
18.5.2 Membranous Cuff	275	(1)
18.5.3 Distal Double Cuff	275	(1)
18.5.4 Transcorporal Cuff	275	(1)
18.5.5 Placement of the Balloon, Pump and Connection	275	(1)
18.6 Activation/Deactivation and Function	276	(1)
18.7 Results	276	(1)
18.8 Conclusion	277	(1)
References	278	(1)
Part VI Operative Therapy of Fecal Incontinence
19 Sphincteroplasty	279	(54)
Tilman T. Zittel
19.1 Introduction	282	(1)
19.2 Diagnostic Evaluation	282	(2)
19.3 Operative Technique	284	(1)
19.4 Functional Results	285	(1)
References	286	(3)
20 Dynamic Graciloplasty	289	(1)
Cor G.M.I. Baeten, Jarno Melenhorst
20.1 Introduction	290	(1)
20.2 Indications	290	(1)
20.3 Technique	290	(2)
20.4 Stimulation of the Gracilis Muscle	292	(1)
20.5 Results	293	(1)
20.6 Complications	294	(1)
20.7 Discussion	294	(1)
20.8 Conclusion	295	(1)
References	295	(2)
21 The Artificial Bowel Sphincter in the Treatment of Severe Fecal Incontinence in Adults	297	(1)
Nicolas Regenet, Guillaume Meurette, Paul-Antoine Lehur
21.1 Background	298	(1)
21.2 Description of the Acticon ABS Artificial Bowel Sphincter	298	(2)
21.3 Functioning of the Acticon ABS Artificial Bowel Sphincter	300	(1)
21.4 Implantation Technique - Perioperative Care	300	(2)
21.5 Recommendations for Follow-up of Patients with Implants	302	(2)
21.6 Recently Published Results	304	(3)
21.6.1 Recently Published Results with the Acticon ABS and Personal Series	305	(1)
21.6.2 Acticon ABS Reimplantation after Failure	306	(1)
21.6.3 New Indications for Acticon ABS	307	(1)
21.7 Indications and Contraindications	307	(1)
21.8 Conclusion	308	(1)
References	308	(3)
22 Innovations in Fecal Incontinence: Sacral Nerve Stimulation	311	(1)
Klaus E. Matzel, Uwe Stadelmaier, Werner Hohenberger
22.1 Methods and Patient Selection	312	(2)
22.1.1 Technique	312	(1)
22.1.1.1 Acute Percutaneous Nerve Evaluation	312	(1)
22.1.1.2 Subchronic Percutaneous Nerve Evaluation	312	(1)
22.1.1.3 Chronic Stimulation with a Permanent Implant	313	(1)
22.2 Patients	314	(3)
22.2.1 Indications	314	(1)
22.2.2 Contraindications	314	(1)
22.2.3 Selection Process	315	(2)
22.3 Results	317	(2)
22.3.1 Clinical Results	317	(2)
22.3.2 Quality of Life	319	(1)
22.3.3 Anorectal Physiologic Findings	319	(1)
22.4 Discussion	319	(3)
References	322	(3)
23 Stoma Surgery	325	(1)
Martin E. Kreis, Ekkehard C. Jehle
23.1 Introduction	326	(1)
23.2 Preparation	327	(1)
23.3 Technical Aspects of Stoma Surgery	328	(3)
23.3.1 Operative Access	328	(1)
23.3.2 Loop Ostomies	329	(1)
23.3.3 Hartmann Procedure, End Colostomy of the Descending Colon	330	(1)
23.4 Postoperative Complications	331	(1)
23.5 Summary	331	(1)
References	331	(2)
Part VII Postoperative Care of Patients After Pelvic Operations
24 Postoperative Management After Surgery for Incontinence and Prolapse	333	(36)
Ursula M. Peschers, Ralf Tunn
24.1 Introduction	336	(1)
24.2 Immediate Postoperative Phase	336	(1)
24.2.1 Medium Term	336	(1)
24.3 Immediate Postoperative Care	336	(4)
24.3.1 Medium Term:	337	(2)
25 Postoperative Management of Urinary Incontinence After Urologic Surgery	339	(1)
Daniela Schultz-Lampel
25.1 Introduction	340	(1)
25.2 Incontinence After Radical Prostatectomy	340	(10)
25.2.1 Incidence and Pathophysiology	340	(2)
25.2.2 Information and Education Before Discharge from the Hospital	342	(1)
25.2.3 Diagnostic Work-up	342	(3)
25.2.4 Treatment in the Early Postoperative Period	345	(1)
25.2.4.1 Incontinence Products and Appliances	345	(1)
25.2.4.2 Pharmacotherapy	346	(1)
25.2.4.3 Physiotherapy: Pelvic Floor Muscle Exercise, Biofeedback, Electrical Stimulation	346	(1)
25.2.4.4 Treatment in the Advanced Postoperative Period	348	(2)
25.3 Incontinence After Female Incontinence Surgery	350	(2)
25.3.1 Incidence and Pathophysiology	350	(1)
25.3.2 Diagnostic Work-up	351	(1)
25.3.3 Treatment in the Early Postoperative Period	351	(1)
25.3.4 Treatment in the Advanced Postoperative Period	352	(1)
25.4 Conclusion	352	(1)
References	353	(4)
26 Incontinence Treatment After Rectal or Perianal Surgery	357	(1)
Christoph A. Ausch, Harald R. Rosen
26.1 Introduction	358	(1)
26.2 Etiology	358	(1)
26.3 Perianal or Rectal Surgical Procedures Associated with Fecal Incontinence	359	(1)
26.4 Conservative Treatment	360	(1)
26.4.1 Medical Therapy	360	(1)
26.4.2 Biofeedback	360	(1)
26.5 Surgical Treatment of Fecal Incontinence	361	(3)
26.5.1 Traditional Surgical Techniques	361	(1)
26.5.2 New Approaches	361	(1)
26.5.3 Muscle Replacement Procedures	362	(1)
26.5.3.1 Dynamic Graciloplasty	362	(1)
26.5.3.2 Artificial Sphincter	363	(1)
26.6 Sacral Nerve Stimulation	364	(2)
References	366	(3)
Part VIII Quality of Life and Long-term Results After Incontinence Treatment
27 Quality of Life with Urinary and Fecal Incontinence	369	(70)
Todd H. Rockwood
27.1 Introduction	372	(1)
27.2 Incontinence and Health-related Quality of Life	372	(2)
27.3 Instruments	374	(8)
27.3.1 Type 1: Generic Health-related Quality-of-Life Instruments	376	(1)
27.3.2 Type 2: Specialized Instruments	377	(1)
27.3.2.1 Depression	377	(1)
27.3.2.2 Social Interaction/Isolation	378	(1)
27.3.2.3 Life: Well-being, Mastery and Locus of Control	378	(1)
27.3.3 Type 3: Condition-specific Scales: Urinary	379	(1)
27.3.4 Type 3: Condition-specific Scales: Fecal	380	(1)
27.3.5 Quality of Life and Children	381	(1)
27.3.6 Translation	381	(1)
27.4 Summary	382	(1)
References	382	(3)
28 Long-Term Results After Surgery for Urinary Incontinence	385	(1)
Wolfgang Zubke, Ella Retzlaw, Diethelm Wallwiener
28.1 Anterior Colporrhaphy	386	(2)
28.3 Needle Suspension	388	(2)
28.4 Colposuspension Techniques	390	(2)
28.5 Tension-free Vaginal Tape	392	(2)
28.6 Discussion	394	(1)
References	394	(3)
29 Long-term Results of Surgery for Stress Urinary Incontinence - A Urologist's View	397	(1)
Prasad Patki, Rizwan Hamid, Julian R. Shah
29.1 Background	398	(1)
29.2 Mechanism of Urinary Continence	398	(1)
29.3 Treatment for Stress Urinary Incontinence	398	(3)
29.3.1 Surgery for Stress Incontinence	398	(1)
29.3.1.1 Outcome of Surgery for Stress Incontinence	399	(1)
29.3.2 Open Colposuspension	399	(1)
29.3.3 Laparoscopic Colposuspension	400	(1)
29.3.4 Endoscopic Bladder Neck Suspensions	400	(1)
29.3.5 Suburethral Slings	400	(1)
29.3.6 Periurethral Injections	400	(1)
29.3.7 Artificial Urinary Sphincter	401	(1)
29.4 Summary	401	(1)
References	401	(2)
30 Long-term Results After Fecal Incontinence Surgery	403	(1)
Tilman T. Zittel
30.1 Introduction	404	(1)
30.2 Study Inclusion Criteria	404	(1)
30.3 General Study Weaknesses	405	(1)
30.4 Presentation of the Study Results	406	(1)
30.5 Overlapping Sphincteroplasty	407	(1)
30.6 Postanal Repair	407	(5)
30.7 Preanal Repair (Anterior Levatorplasty and Sphincteroplasty)	412	(1)
30.8 Total Pelvic Floor Repair	412	(3)
30.9 Dynamic Graciloplasty	415	(1)
30.10 Artificial Bowel Sphincter	415	(5)
30.11 Sacral Nerve Stimulation	420	(1)
30.12 Quality of Life	420	(3)
30.13 Conclusion	423	(1)
References	424	(5)
31 Quality of Life with a Permanent Colostomy	429	(1)
Brigitte Holzer, Harald R. Rosen
31.1 Introduction	430	(1)
31.1.1 Social Well-Being	430	(1)
31.1.2 Psychological Well-Being	430	(1)
31.2 Preoperative Expectations	431	(1)
31.2.1 Influence of Age	432	(1)
31.2.2 Influence of Education	432	(1)
31.3 QoL Instruments	432	(1)
31.4 Individual Factors Influencing QoL in Patients with a Stoma	433	(4)
31.4.1 Age and Gender	433	(1)
31.4.2 Counseling	434	(1)
31.4.3 Time of QoL Evaluation	434	(1)
31.4.4 Social Factors (Education, Religion)	435	(2)
31.5 Conclusion	437	(1)
References	437	(2)
Part IX How Can We Improve the Treatment of Incontinence?
32 Is Urinary or Fecal Incontinence a Preventable Event?	439	(28)
Daniele Perucchini, Daniel Faltin
32.1 General Consideration	442	(1)
32.2 Incidence of Urinary and Fecal Incontinence	442	(2)
32.2.1 Incidence of Urinary Incontinence	443	(1)
32.2.1.1 Incidence of Urinary Incontinence Before First Pregnancy	443	(1)
32.2.1.2 Incidence of Urinary Incontinence During Pregnancy	443	(1)
32.2.1.3 Incidence of Urinary Incontinence After Childbirth	443	(1)
32.2.2 Incidence of Fecal Incontinence	444	(1)
32.3 Factors That Might Influence Continence During Pregnancy and Delivery	444	(1)
32.4 Primary Prevention of Urinary and Fecal Incontinence	445	(2)
32.4.1 Before Pregnancy	445	(1)
32.4.2 During Pregnancy	446	(1)
32.4.3 At Delivery	446	(1)
32.4.3.1 Episiotomy	446	(1)
32.4.3.2 Instrumental Delivery	447	(1)
32.5 Secondary Prevention of Urinary and Fecal Incontinence	447	(4)
32.5.1 Urinary Incontinence	447	(1)
32.5.1.1 Pelvic Floor Muscle Exercise During Pregnancy	447	(1)
32.5.1.2 Pelvic Floor Muscle Exercise After Pregnancy and Delivery	448	(1)
32.5.2 Fecal Incontinence: Diagnosing and Treating Anal Sphincter Tears After Childbirth	449	(1)
32.5.2.1 Improving the Recognition of Anal Sphincter Tears	449	(1)
32.5.2.2 Repair of Anal Sphincter Tears	450	(1)
32.5.2.3 Pelvic Floor Training	450	(1)
32.5.2.4 The Role of Subsequent Deliveries	450	(1)
32.6 Tertiary Prevention of Urinary Fecal Incontinence	451	(1)
32.7 The Role of Cesarean Section	451	(2)
32.7.1 Should Women with or Without Risk Factors for Incontinence Be Allowed to Choose a Planned Cesarean Section?	452	(1)
32.7.2 Will the Urinary or Fecal Incontinence Rate Decrease as the Cesarean Section Rate Increases?	452	(1)
References	453	(4)
33 Concept of the Pelvic Floor as a Unit: The Case for Multi-disciplinary Pelvic Floor Centers	457	(1)
G. Willy Davila
33.1 Introduction	458	(1)
33.2 Background	458	(1)
33.3 Anatomic and Functional Correlates	459	(1)
33.4 Anatomic Defects	460	(1)
33.5 Obstetrical Correlates	460	(1)
33.6 The Pelvic Floor Team	461	(1)
33.7 Patient Flow	461	(2)
33.8 Educational Programs	463	(1)
33.9 Summary	464	(1)
References	464	(3)
Part X On Asymmetry in Sphincters
34 Functional Asymmetry of Pelvic Floor Innervation and Its Potential Role in the Pathogenesis of Fecal and Urinary Incontinence - Report from the EU-Sponsored Research Project OASIS (On Asymmetry In Sphincters)	467	(24)
Paul Enck, Fernando Azpiroz, Roberto Merletti
34.1 Assessment of Pelvic Floor Innervation by Conventional Neurophysiological Techniques	470	(4)
34.1.1 Neurophysiology of the Pelvic Floor	470	(1)
34.1.2 Unilateral Pudendal Neuropathy - Fact or Fiction?	470	(1)
34.1.3 Evidence for Functional Asymmetry of Pelvic Floor Innervation	471	(1)
34.1.3.1 Intraoperative Monitoring of Pudendal Sensory and Motor Pathways	471	(1)
34.1.3.2 Central (Cortical) Representation of Motor and Sensory Functions of the Pelvic Floor	472	(1)
34.1.3.3 Peripheral Nerve Stimulation and Recording	472	(1)
34.1.4 Clinical Relevance of Asymmetry in Patients with Incontinence	473	(1)
34.2 The Project OASIS	474	(14)
34.2.1 Multiple-Electrode Array Surface EMG to Study Sphincter Innervation	474	(1)
34.2.2 Background of Surface EMG Technology	474	(1)
34.2.3 Muscle Anatomy and Concepts Behind the Array Detection	475	(1)
34.2.4 An Anal Probe with Multiple Electrode Arrays	476	(2)
34.2.5 Signal Interpretation and Development of Sphincter Models	478	(1)
34.2.5.1 Models	478	(2)
34.3 First Results of the OASIS Technique to Study Healthy, Continent Subjects	480	(1)
34.3.1 EMG Signal Amplitude	480	(1)
34.3.2 Noninvasive Assessment of Muscle Anatomical Properties	480	(1)
34.3.3 Detection of Single Motor Unit Activities	480	(1)
34.3.4 Estimation of Muscle Fiber Conduction Velocity	482	(1)
34.3.5 Differences in Sphincter Innervation Between Men and Women	484	(4)
References	488	(3)
Subject Index	491