The studies described here are based on histological serial sections of the entire bladder neck region of 50 male and 15 female deceased of all age groups. For the first time, a musculus vesicoprostaticus et vesicovaginalis, a musculus dilator urethrae and a musculus ejaculatorius are defined. The bipartite musculus sphincter urethrae (glaber et transversostriatus) is the morphological basis for the maintenance of the rest and stress continence. New findings necessitate new interpretations of the basic functions of the lower urinary tract. The results presented here prove that the corresponding morphological substrate differs in many respects from descriptions in the literature.
In this book we attempt a synthesis of knowledge from two investigative extremes. On the one hand, neurophysiology and neuropharmacology are progressing via the single neuron to a subcellular level; on the other, clinicians are studying the function ofthe human urinary system in vivo as a whole. A special effort must be made over the next decade to bridge this gap. We hope that the information summarized here will catalyse the process. In 1968, de Groat and Ryall published a group of papers in the Journal of Physiology in which modern quantitative electrophysiological techniques were applied to the study ofthe reflexes that regulate bladder Junction. These papers represent alandmark in the history of bladder neurophysiology, forming a dividing li ne between old and new. The earlier techniques of lesioning and stimulation of nervous structures yielded mainly qualitative information which was open to criticism because of lack of precise control over what was actually being destroyed or stimulated. Much of this earlier work was reviewed in an authoritative volume by Bors and Comarr in 1971, entitled Neurolqgical Urology. The 16 years have seen great advances in our understanding ofthe control oflower subsequent urinary tract function.
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.
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.
Upper Tract Urothelial Carcinoma represents the first book of its kind to be dedicated solely to UTUC. It's aim is to improve understanding and eventually care of a disease that is greatly understudied and underappreciated, yet commonly dealt with by many medical and urologic oncologists. The volume features new data regarding genetic susceptibility, gene expression studies and causative factors; contemporary concepts and controversies regarding diagnosis and staging of UTUC; prediction tools and their value in treatment decisions within each disease stage and patient selection and treatment options such as endoscopic management, distal ureterectomy, radical nephroureterectomy and chemotherapy. Up-to-date information regarding boundaries of surgical resection, indication and extent of lymphadenectomy is covered as well as the role of perioperative/neoadjuvant chemotherapy in patients with high-risk UTUC. Upper Tract Urothelial Carcinoma will be of great value to all Urologists, Medical Oncologists and fellows in Urologic Oncology as well as upper level residents in training in Urology and Medical Oncology.
This book contains the most up-to-date scientific information on the anatomy, physiology, and pathophysiology of the bladder muscle, nerves, and collagen in the patient with bladder exstrophy. In addition, this book covers the most modern surgical treatment of the infant born with bladder exstrophy and those who fail initial reconstruction. Chapters are contributed by major children's centers throughout the world. The aims of this book are to familiarize both the resident and the experienced practitioner with the most modern methods for the treatment for bladder exstrophy and epispadias. This book deals with the function, innervation, and pathophysiology of the bladder muscle in the patient born with bladder exstrophy. New concepts from leading laboratories around the world regarding the function of the bladder are discussed. In addition, experts offer their advice, expertise, and thoughts concerning the management of the patient born with bladder exstrophy. This book is intended for researchers who are interested in both the innervation, structure and function of bladder muscle and for pediatricians, pediatric surgeons, pediatric orthopedic surgeons, and both adult and pediatric urologists who deal with patients from birth until adult life who are born with bladder exstrophy. This is the first book to deal specifically with the basic science of bladder exstrophy and the clinical management of the bladder exstrophy-epispadias complex.
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.
This book addresses knowledge gaps in RARP in 3 key sections: 1) Step-by-step approach including multiple technique options and innovations, 2) Patient selection, safety, outcomes, and 3) Preparing the patient for surgery. The order is more based upon knowledge priority rather than a chronologic sequence in which part 3 would go first. Part two allows more summary and commentary on evidence and part three allows some creative content that is otherwise hard to find in one place—medical evaluations, imaging, clinical trials, patient education, etc. This textbook emphasizes content for the advanced skills surgeon in that multiple techniques are presented as well as state of the art evidence. The learning curve is addressed and the authors clarify how this text is useful for learners. The caveat is that they should be careful in patient selection and stick with what their mentors are showing them. With experience, they can then branch out into the many techniques presented here. Robot-Assisted Radical Prostatectomy: Beyond the Learning Curve will also have cross-over appeal for surgical assistants, physician assistants, nurses, and anyone else involved in the surgical care of prostate cancer.
