Download Imaging Pelvic Floor Disorders, 2nd Revised Edition (Medical Radiology Diagnostic Imaging) PDF

TitleImaging Pelvic Floor Disorders, 2nd Revised Edition (Medical Radiology Diagnostic Imaging)
File Size33.7 MB
Total Pages282
Table of Contents
                            Cover Page
Title page
ISBN 3540719660
Foreword
Preface
Table of contents
1 The Anatomy of the Pelvic Floor and Sphincters
	1.1 Introduction
	1.2 Embryology
		1.2.1 Cloaca and Partition of the Cloaca
		1.2.2 Bladder
		1.2.3 Urethra
		1.2.4 Vagina
		1.2.5 Anorectum
		1.2.6 Pelvic Floor Muscles
		1.2.7 Fascia and Ligaments
		1.2.8 Perineum
		1.2.9 Newborn
	1.3 Anatomy
		1.3.1 Pelvic Wall
			1.3.1.1 Tendineus Arcs
		1.3.2 Pelvic Floor
			1.3.2.1 Supportive Connective Tissue (Endopelvic Fascia)
				1.3.2.1.1 Endopelvic Fascia
			1.3.2.2 Pelvic Diaphragm
				1.3.2.2.1 Coccygeus Muscle
				1.3.2.2.2 Levator Ani Muscle
			1.3.2.3 Perineal Membrane (Urogenital Diaphragm)
			1.3.2.4 Superfi cial Layer (External Genital Muscles)
				1.3.2.4.1 Transverse Perineal Muscles
		1.3.3 Bladder
			1.3.3.1 Detrusor
			1.3.3.2 Adventitia
			1.3.3.3 Bladder Support
			1.3.3.4 Neurovascular Supply
		1.3.4 Urethra and Urethral Support
			1.3.4.1 Female Urethra
				1.3.4.1.1 Urethral Mucosa
				1.3.4.1.2 Smooth Muscle Urethral Coat
				1.3.4.1.3 External Urethral Sphincter
			1.3.4.2 Male Urethra
				1.3.4.2.1 Lining of the Male Urethra
				1.3.4.2.2 Preprostatic Urethra
				1.3.4.2.3 Prostatic Urethra
				1.3.4.2.4 Membranous Urethra and Spongiose Urethra
			1.3.4.3 Urethral Support
		1.3.5 Uterus and Vagina
			1.3.5.1 Uterus and Vaginal Support
		1.3.6 Perineum and Ischioanal Fossa
			1.3.6.1 Perineal Body
			1.3.6.2 Ischioanal Fossae
			1.3.6.3 Perianal Connective Tissue
		1.3.7 Rectum
			1.3.7.1 Rectal Wall
			1.3.7.2 Rectal Support
			1.3.7.3 Neurovascular Supply of the Rectum
		1.3.8 Anal Sphincter
			1.3.8.1 Lining of the Anal Canal
			1.3.8.2 Internal Anal Sphincter
			1.3.8.3 Intersphincteric Space
			1.3.8.4 Longitudinal Layer
			1.3.8.5 External Anal Sphincter
			1.3.8.6 Pubovisceral (Puborectal) Muscle
			1.3.8.7 Anal Sphincter Support
			1.3.8.8 Anal Sphincter Anatomy Variance and Ageing
			1.3.8.9 Neurovascular Supply of the Anal Sphincter
		1.3.9 Nerve Supply of the Pelvic Floor
			1.3.9.1 Somatic Nerve Supply
			1.3.9.2 Autonomic Nerve Supply
	References
2 Functional Anatomy of the Pelvic Floor
	2.1 Introduction
	2.2 Support of the Pelvic Organs
		2.2.1 Endopelvic Fascia
		2.2.2 Uterovaginal Support
		2.2.3 Apical Prolapse; Uterus or Vaginal Apex
		2.2.4 Anterior Wall Support and Urethra
		2.2.5 Posterior Support
		2.2.6 Levator Ani Muscles
		2.2.7 Pelvic Floor Muscles and Endopelvic Fascia Interactions
		2.2.8 Perineal Membrane and External Genital Muscles
	2.3 Functional Anatomy of the Lower Urinary Tract
		2.3.1 Bladder
			2.3.1.1 Vesical Neck
		2.3.2 Urethra
			2.3.2.1 Striated Urogenital Sphincter
			2.3.2.2 Urethral Smooth Muscle
			2.3.2.3 Submucosal Vasculature
			2.3.2.4 Glands
	References
3 Pelvic Floor Muscles-Innervation, Denervation and Ageing
	3.1 Introduction
	3.2 Innervation and Neural Control
		3.2.1 Somatic Motor System
		3.2.2 Sensory Control
		3.2.3 Sensory-Motor Integration in PFM Control
		3.2.4 Neural Control Manifesting as PFM Activity Patterns
	3.3 Neural Control of Sacral Functions
		3.3.1 Lower Urinary Tract Function and PFM
		3.3.2 Anorectal Function and PFM
		3.3.3 Sexual Behaviour and PFM
	3.4 Ageing and PFM Changes
	3.5 Vaginal Delivery and Neuromuscular Injury
	3.6 Conclusion
	References
4 Imaging Techniques
	4.1 Evacuation Proctography and Dynamic Cystoproctography
		4.1.1 Evacuation Proctography
			4.1.1.1 Introduction
			4.1.1.2 Technique
			4.1.1.3 Normal Findings
				4.1.1.3.1 Pre-Evacuation
				4.1.1.3.2 Evacuation
				4.1.1.3.3 Post-Evacuation
				4.1.1.3.4 Additional Manoeuvres
				4.1.1.3.5 Radiological Report
			4.1.1.4 Alternative Approaches
		4.1.2 Dynamic Cystoproctography
			4.1.2.1 Introduction
			4.1.2.2 Technique
			4.1.2.3 Normal Findings and Defi nition of Prolapse
				4.1.2.3.1 Rectocoele
				4.1.2.3.2 Cystocoele
				4.1.2.3.3 Enterocoele and Sigmoidocoele
				4.1.2.3.4 Peritoneocoele
				4.1.2.3.5 Vaginal Vault Prolapse
			4.1.2.4 Comparison with Physical Examination
		4.1.3 Summary
		References
	4.2 Dynamic MR Imaging of the Pelvic Floor
		4.2.1 Abstract–Role of MR in Evaluating Pelvic Floor Disorders
		4.2.2 Spectrum of MR Imaging for Pelvic Floor Disorders
		4.2.3 Dynamic MR Proctography Technique
			4.2.3.1 Patient Instruction
			4.2.3.2 Patient Preparation and Positioning
			4.2.3.3 MR Technique
		4.2.4 Exam Interpretation
			4.2.4.1 Bladder and Urethra
			4.2.4.2 Vaginal, Uterus and Defects in Recto-Vaginal Fascia
			4.2.4.3 Puborectalis Function
			4.2.4.4 Rectal Abnormalities
			4.2.4.5 Enteroceles and Peritoneoceles
			4.2.4.6 Pelvic Floor Movement and Hernias
			4.2.4.7 Incidental Findings
		4.2.5 Patterns of Disease
		4.2.6 erformance and Limitations of MR
		4.2.7 Conclusion
		References
	4.3 MRI of the Levator Ani Muscle
		4.3.1 Introduction
		4.3.2 MRI Appearance of theNormal Levator Ani Muscles
			4.3.2.1 Pubovisceral Muscle
			4.3.2.2 Puborectal Muscle
			4.3.2.3 Iliococcygeus Muscle
		4.3.3 Levator Ani Muscle and Pelvic Floor Dysfunction
		4.3.4 Pregnancy and Birth-Related Changes
		4.3.5 Conclusion
		References
	4.4 Endoanal Ultrasound
		4.4.1 Introduction
		4.4.2 Technique for Endoanal Ultrasonography
		4.4.3 Normal Anatomy
		4.4.4 Anatomical Diff erences between Sexes
		4.4.5 Eff ects of Ageing
		4.4.6 Internal Anal Sphincter Abnormalities
		4.4.7 External Anal Sphincter Abnormalities
		4.4.8 Obstetric Trauma
		4.4.9 Anismus, Rectocoele and Prolapse
		4.4.10 Endoanal Ultrasound in Relation to Other Techniques
		References
	4.5 Pelvic Floor Ultrasound
		4.5.1 Introduction
		4.5.2 Equipment and Examination Technique
		4.5.3 Anterior Compartment
			4.5.3.1 Bladder Neck Position and Mobility
			4.5.3.2 Funneling
			4.5.3.3 Colour Doppler
			4.5.3.4 Cystocele
			4.5.3.5 Implants
			4.5.3.6 Other Findings
		4.5.4 Central Compartment
		4.5.5 Posterior Compartment
		4.5.6 The Axial Plane
			4.5.6.1 Display Modes
			4.5.6.2 Four-Dimensional Imaging
			4.5.6.3 Clinical Applications
		4.5.7 Conclusion
		References
	4.6 Endoanal Magnetic Resonance Imaging
		4.6.1 Introduction
		4.6.2 Imaging Technique
			4.6.2.1 Coil and Patient Preparation
			4.6.2.2 Sequences and Protocol
		4.6.3 Normal Anatomy, Variances, and Pitfalls
		4.6.4 Lesions of the Anal Sphincter
			4.6.4.1 Scar Tissue and Defects
				4.6.4.1.1 Internal Anal Sphincter
				4.6.4.1.2 External Anal Sphincter
			4.6.4.2 Atrophy
				4.6.4.2.1 Internal Anal Sphincter
				4.6.4.2.2 External Anal Sphincter
		4.6.5 The Role of Endoanal MRI in theDiagnostic Workup
			4.6.5.1 Comparison of Endoanal MRI versusEndoanal US
			4.6.5.2 The Role of Endoanal MRI in Pre-Surgical Evaluation
			4.6.5.3 The Role of Endoanal MRI in Post-Surgical Evaluation
			4.6.5.4 The Role of External Phased-Array MRI in Fecal Incontinence
			4.6.5.5 Comparison of Endoanal MRI versus Three-Dimensional Endoanal US in the Depiction of Atrophy
		4.6.6 Summary
		References
	4.7 Urodynamics
		Abstract
		4.7.1 Functions of the Lower Urinary Tract
		4.7.2 Lower Urinary Tract Symptoms
		4.7.3 Urodynamic Investigations
			4.7.3.1 Frequency-Volume Charts
			4.7.3.2 Pad Testing
			4.7.3.3 Urofl owmetry with Ultrasound Estimation of Post-Void Residual
			4.7.3.4 Basic Urodynamics
			4.7.3.5 Videourodynamics
			4.7.3.6 Ambulatory Urodynamics
			4.7.3.7 Urethral Function Tests
			4.7.3.8 Neuro-Physiological Investigations
			4.7.3.9 Urodynamics of the Upper Tracts (Whitaker Test)
		Summary
		References
	4.8 Anorectal Physiology
		4.8.1 Introduction
		4.8.2 Clinical Features
		4.8.3 Anorectal Manometry
			4.8.3.1 Vector Manometry
			4.8.3.2 Anal Electromyography
			4.8.3.3 Pudendal Nerve Latency Measurement
		4.8.4 Anal Sensation
		4.8.5 Rectal Sensation
		4.8.6 Colonic Transit
		4.8.7 Conclusion
		References
5 Urogenetical Dysfunction
	5.1 Surgery and Clinical Imaging for Pelvic Organ Prolapse
		5.1.1 Introduction
		5.1.2 Anatomy of Support
		5.1.3 Etiology of Prolapse
		5.1.4 The Radiologist and the Clinician
		5.1.5 Surgical Approach
		5.1.6 The Anterior Vaginal Wall
			5.1.6.1 Paravaginal Cystocele Repair
			5.1.6.2 Graft Placement
			5.1.6.3 Anterior Colporrhaphy
		5.1.7 Surgery of the Vaginal Apex
			5.1.7.1 Abdominal Sacral Colpopexy or Colpoperineopexy
			5.1.7.2 Sacrospinous Vault Suspension
			5.1.7.3 Uterosacral Ligament Vault Suspension
			5.1.7.4 Obliterative Surgery
			5.1.7.5 Uterine Preservation Procedures
		5.1.8 The Posterior Vaginal Wall
			5.1.8.1 Rectocele
				5.1.8.1.1 Posterior Colporrhaphy
				5.1.8.1.2 Defect Directed Repair of Rectocele
				5.1.8.1.3 Graft Replacement
				5.1.8.1.4 Imbrication
				5.1.8.1.5 Transanal Repair
			5.1.8.2 Enterocele
			5.1.8.3 Prolapse Repair “Kits”
		5.1.9 Conclusion
		References
	5.2 Urinary Incontinence: Clinical and Surgical Considerations
		5.2.1 Introduction
			5.2.1.1 Defi nition
			5.2.1.2 Epidemiology
				5.2.1.2.1 Prevalence of Urinary Incontinence
				5.2.1.2.2 Risk Factors for Urinary Incontinence
		5.2.2 Continence Mechanisms
		5.2.3 Types of Urinary Incontinence
			5.2.3.1 Stress Urinary Incontinence
			5.2.3.2 Urge Urinary Incontinence
			5.2.3.3 Overfl ow Incontinence
			5.2.3.4 Neurogenic Urinary Incontinence
			5.2.3.5 Extra-Urethral Incontinence
		5.2.4 Clinical Evaluation
			5.2.4.1 Patient History
			5.2.4.2 Validated Questionnaires
			5.2.4.3 Physical Examination
			5.2.4.4 Additional Tests
			5.2.4.5 Imaging
		5.2.5 Treatment of Stress Incontinence
			5.2.5.1 Conservative Treatment
				5.2.5.1.1 Habit Training
				5.2.5.1.2 Mechanical Devices
				5.2.5.1.3 Specialized Pelvic Physiotherapy
				5.2.5.1.4 Drug Treatment
			5.2.5.2 Surgical Therapy
				5.2.5.2.1 Anterior Colporraphy
				5.2.5.2.2 Needle Urethropexy
				5.2.5.2.3 Abdominal Retropubic Urethropexy(Colposuspension)
				5.2.5.2.4 Suburethral Sling
				5.2.5.2.5 Minimally Invasive Midurethral Sling
				5.2.5.2.6 Urethral Bulking Agents
				5.2.5.2.7 Artifi cial Urethral Sphincter
		5.2.6 Treatment of Urge orNeurogenic Urinary Incontinence
			5.2.6.1 Conservative Treatment
				5.2.6.1.1 Behavior Therapy
				5.2.6.1.2 Bladder Training
				5.2.6.1.3 Pelvic Floor Muscle Training
				5.2.6.1.4 Neurostimulation
				5.2.6.1.5 Peripheral Neuromodulation
				5.2.6.1.6 Medical Treatment
			5.2.6.2 Surgical Treatment
				5.2.6.2.1 Botulinum Toxin Injections
				5.2.6.2.2 Sacral Neuromodulation
				5.2.6.2.3 Bladder Augmentation
				5.2.6.2.4 Bladder Replacement–Urinary Diversion
		References
6 Coloproctological Dysfunction
	6.1 Constipation and Prolapse
		6.1.1 Introduction
		6.1.2 Constipation
		6.1.3 Investigation
		6.1.4 Evacuation Proctography and Constipation
			6.1.4.1 Rectal Prolapse
			6.1.4.2 Pelvic Floor Descent
			6.1.4.3 Rectocele
			6.1.4.4 Functional Disorder
		6.1.5 Summary
		References
	6.2 Investigation of Fecal Incontinence
		6.2.1 Introduction
		6.2.2 Tests of Function
			6.2.2.1 Anal Manometry
			6.2.2.2 Rectal Balloon Expulsion
			6.2.2.3 Rectal and Anal Sensation
			6.2.2.4 Rectal Compliance and Capacity
			6.2.2.5 Pudendal Nerve Terminal Motor Latency(PNTML)
			6.2.2.6 Needle Electromyography (EMG) of the External Sphincter
		6.2.3 Tests of Structure
			6.2.3.1 Endoanal Ultrasound (EUS)
		6.2.4 Tests of Structure and Function
			6.2.4.1 Dynamic Proctography (Defecography)
			6.2.4.2 Pelvic MRI
		6.2.5 Anorectal Testing: Utility and Caveats
		6.2.6 Summary
		References
	6.3 Surgical Management of Fecal Incontinence
		6.3.1 Introduction
		6.3.2 Etiology
		6.3.3 Clinical Approach
			6.3.3.1 History
			6.3.3.2 Physical Examination
		6.3.4 Investigation
			6.3.4.1 Physiologic Studies
				6.3.4.1.1 Imaging
		6.3.5 Management of Fecal Incontinence
			6.3.5.1 Conservative Management
			6.3.5.2 Surgical Management of Fecal Incontinence
			6.3.5.3 Sphincter Repair
			6.3.5.4 Overlapping Anterior Sphincteroplasty
				6.3.5.4.1 Technique
			6.3.5.5 Artifi cial Bowel Sphincter
				6.3.5.5.1 Technique
			6.3.5.6 Muscle Transposition – Graciloplasty
				6.3.5.6.1 Technique
			6.3.5.7 Harvesting the Gracilis Muscle
			6.3.5.8 Preparing the New Position
			6.3.5.9 Attaching the Electrical Source
			6.3.5.10 Sacral Nerve Stimulation
			6.3.5.11 Mechanism of Action
				6.3.5.11.1 Technique
			6.3.5.12 Injectable Bulking Agents for the Anal Sphincter
				6.3.5.12.1 Technique
				6.3.5.13 Radiofrequency
		6.3.6 Conclusion
		References
Subject Index
	A
	B
	C
	D
	E
	F
	G
	H
	I
	K
	L
	M
	N
	O
	P
	R
	S
	T
	U
	V
	W
List of Contributors
                        

Similer Documents