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The Complete Pelviperineology June 2011 Issue
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New High Resolution Pelviperineology
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Editorial Editorial: Preservation of the prolapsed uterus in pelvic surgery

Preservation of the prolapsed uterus in pelvic surgeryIs uterine prolapse an (absolute) indication for vaginal hysterectomy?! • Is vaginal hysterectomy an (essential) part of pelvic floor reconstruction?! • Is the uterus an innocent victim? • Are we performing vaginal hysterectomies only because we were trained to? • Hysterectomy is a complication related operation • Hysterectomy mutilates physiologically the patient • Hysterectomy defects the endo-pelvic fascia integrity and makes the pelvic floor vulnerable • Hysterectomy impairs the pelvic floor blood supply, increasing the risk of vaginal mesh exposure • Preservation the Uterine isthmus provides the benefit of recruiting the cervical ring and the attachments to it’s ligaments for reinforcement. [More]

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Original Article TFS (Tissue Fixation System) minisling reinforcement of uterosacral ligaments cures nocturia, urgency, frequency, even with minimal prolapse. A 6 months review by Stefano Dati

Tissue Fixation SystemIn a recent review, Van Kerrebroek et al stated that “Unlike other LUTS (lower urinary tract symptoms), nocturia has a specific and detrimental effect on the sleep period, and when ≥2 voids per night are experienced, it is associated with various sequelae including reduced QoL and productivity, and increased morbidity and perhaps mortality. Many sources suggest that nocturia is associated with chronic medical illness, but little evidence demonstrates that successful treatment of these conditions results in normalization of nocturia. It is likely that more than one contributory factor is responsible for nocturia, and management ought to better reflect this multifactorial pathophysiology.  [More]

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Original Article A semi-automated programme for urodynamic diagnosis: preliminary report of a work in progress by Giancarlo Vignoli, Massimo Protopapa

semi-automated programme for urodynamic diagnosisIn recent years the role of urodynamics in the assessment of lower urinary tract dysfunctions has become contentious. Urodynamics is not an esoteric concept of limited applicability to be confined to the “ivory towers“. Urodynamics may be questioned, but its basic principles are simple and in most cases it doesn’t need complex mental efforts. However, some recent reports indicated that most of the time the personel carrying out urodynamics have little understanding of what the recordings mean. The need of developing a urodynamics curriculum for urology residents has been recently addressed by some publications. Indeed, in the Author’s experience, there are instances of recordings still being sent to the equipment manufacturer for their interpretation!  [More]

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Review Botulinum neurotoxin (BoNT) in Urology - An overview of current and emerging uses by Ayesha Karunatillake, Thomas R Jarvis, Vincent Tse, Prem Rashid

Botulinum neurotoxinBotulinum neurotoxin (BoNT) is produced by the anaerobic bacteria Clostridium Botulinum. The toxin was first discovered in 1897. Although scientists recognized the ability of BoNT to block nerve transmission in 1949, it was not until the 1980s that the toxin was used in a clinical setting. Produced within the cytosol of the bacteria, BoNT is released as a polypeptide chain. It consists of a light (50kDa) and heavy (100kDa) chain linked by a disulphide bond. The structure of BoNT is pivotal to its ability to act on the cholinergic neuromuscular junction. There are seven serotypes of BoNT, each produced by a distinct strain of the bacteria. Designated type A, B, C1, D, E, F or G, each BoNT serotype has individual characteristics. However, only types A (Botox®, Allergan, Inc., CA, USA; Dysport, Ipsen Ltd, Berkshire, UK) and types B (Myobloc®, Elan Pharmaceuticals, Inc., Princeton, NJ, USA) are commercially available. In urology, type A BoNT is most commonly used. [More]

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Book Review Pelvic floor anatomy by Giulio A. Santoro, Andrzej P. Wieczorek

Pelvic floor anatomyThe first section of the book “Pelvic floor disorders - Imaging and Multidisciplinary Approach to Management” is entitled “Pelvic Floor Anatomy” and consists of five chapters describing the detailed anatomy of female pelvic floor, its physiology and patophysiology as well as neural control. In the first chapter “State of the Art: Pelvic Floor Anatomy” J. O. L DeLancey and S. A. Shobeiri describe the functional anatomy of the pelvic floor in women especially highlighting supportive function of muscles and fasciae for pelvic organs and changes in their structures with the presence of prolapse. The female pelvis is naturally divided into anterior, posterior and lateral compartments, and its bottom is formed by levator ani muscles. [More]

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Original Article Surgical strategies for full-thickness rectal prolapse: a retrospective study and review of literature by Giovanni Milito, Federica Cadeddu, Ivana Selvaggio, Attilio M Farinon

Tissue Fixation SystemRectal prolapse is defined as a protrusion of the rectum beyond the anus. Full-thickness rectal prolapse should be distinguished from mucosal prolapse in which there is protrusion of only the rectal or anal mucosa. Aetiological factors include lax and anatomic condition of the muscles of the pelvic floor and anal canal, abnormally deep pouch of Douglas, weakness of both internal and external sphincters, lack of normal mesorectum and finally weakness of lateral ligaments. Constipation is associated with prolapse in 30% to 70% of patients, with chronic straining, sensation of anorectal blockade, need of digital evacuation. In addition 60% of patients have coexisting incontinence due to the stretching of the anal sphincters caused by the prolapse and due to the impaired rectal compliance.  [More]

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