Atlas of the Urologic Clinics of North America RSS feed: Current Issue. http://www.urologicatlas.theclinics.com/?rss=yesElsevier Inc.en © 2004 Elsevier Inc. All rights reserved. Atlas of the Urologic Clinics of North America1063-5777122October 2004 © 2004 Elsevier Inc. All rights reserved. healthpermissions@elsevier.comhttp://www.urologicatlas.theclinics.com/article/PIIS1063577704000362/abstract?rss=yesPosterior compartment prolapse can be thought of as a relaxation or separation of the tissues of the rectovaginal septum and perineal body. Common symptoms include difficulty with defecation and, less commonly, sexual dysfunction. A continued active lifestyle and improved quality of life usually can be restored; however, this result requires a thorough understanding of pelvic anatomy and pathophysiology and experience in performing the appropriate surgical procedures. This article reviews the pathophysiology, diagnosis, and surgical management of rectoceles and relaxed vaginal outlet.The treatment of posterior compartment vaginal defectsR. Duane Cespedes10.1016/j.auc.2004.06.003Atlas of the Urologic Clinics of North America 12, 2 (2004)2004-10-01Atlas of the Urologic Clinics of North America2004-10-01122S1063-5777(00)X0006-0233241http://www.urologicatlas.theclinics.com/article/PIIS1063577704000350/abstract?rss=yesSince its introduction in 1973 (American Medical Systems [AMS] model 721), the artificial urinary sphincter (AUS) has become a widely accepted therapy, particularly for male urinary incontinence. Over the years, improvements in product design, surgical techniques, and patient selection have led to increased reliability with durable success. The current American Medical Systems model 800 (AMS 800) AUS was introduced in 1983 and has a 20-year history of use. This device has become the gold-standard treatment for incontinence of many causes, including prostatectomy, radiation therapy, neuropathy, and as a part of reconstructive procedures. Outcomes with the device are excellent, and most patients are pleased with the results, an outcome that persists in the long term . The authors review their experience with more than 600 AUS devices and discuss practical points concerning surgery and revisions. They describe their routine surgical approach as a means of reporting on technical lessons learned.Artificial urinary sphincter: lessons learnedAndrew C. Peterson, George D. Webster10.1016/j.auc.2004.06.002Atlas of the Urologic Clinics of North America 12, 2 (2004)2004-10-01Atlas of the Urologic Clinics of North America2004-10-01122S1063-5777(00)X0006-0265274http://www.urologicatlas.theclinics.com/article/PIIS1063577704000349/abstract?rss=yesUse of neuromodulation to treat voiding dysfunction has been studied for decades. In 1997, InterStim (Medtronic, Minneapolis, Minnesota) was approved by the Food and Drug Administration (FDA) to treat urinary urgency, frequency, urge incontinence, and nonobstructive urinary retention. Many technologic advances have occurred since InterStim's introduction, making this procedure a minimally invasive therapy that is performed on an outpatient basis and allowing physicians to test the device's efficacy before implanting the neurogenerator.Neuromodulation, staged intervention, and new instrumentsKenneth M. Peters10.1016/j.auc.2004.06.001Atlas of the Urologic Clinics of North America 12, 2 (2004)2004-10-01Atlas of the Urologic Clinics of North America2004-10-01122S1063-5777(00)X0006-0275291http://www.urologicatlas.theclinics.com/article/PIIS1063577704000374/abstract?rss=yesThe incidence of urinary incontinence is approximately 1% to 3% after prostatectomy for benign disease , and after radical prostatectomy, the incidence has been reported to range from 2.5% to 87% . This wide discrepancy is a result of varying definitions of incontinence and inconsistent methods of data acquisition. The timing of studies is important, as urinary control may improve with time. Most patients have some degree of incontinence immediately after catheter removal, but a progressive reduction in incontinence may occur up to 1 year after prostatectomy. There is little dispute that the occurrence of incontinence after prostatectomy has a significant negative impact on a patient's quality of life. In a questionnaire-based study, Herr discovered that incontinence adversely affected the quality of life in 26% of patients, and in a separate survey, patients who underwent radical prostatectomy scored significantly worse on a scale evaluating urinary function compared with controls. Patients should be screened after prostatectomy for these symptoms, which are likely to have a detrimental effect on quality of life.Male slings in the treatment of sphincteric incompetenceJ. Christian Winters10.1016/j.auc.2004.06.004Atlas of the Urologic Clinics of North America 12, 2 (2004)2004-10-01Atlas of the Urologic Clinics of North America2004-10-01122S1063-5777(00)X0006-0251263http://www.urologicatlas.theclinics.com/article/PIIS1063577704000386/abstract?rss=yesStress urinary incontinence (SUI) and urge incontinence (UI) are increasingly significant health concerns for millions of women. Approximately 180,000 surgical procedures are performed for genuine SUI alone. The lack of a single, reproducible, permanent, and minimal-risk procedure has led to the development of several minimally invasive options that provide the hope of reasonable efficacy and minimal morbidity. Reimbursement trends have placed an emphasis on interventions that require minimal hospitalization or that can be performed in the ambulatory office without the use of general or regional anesthesia and attendant recuperative facilities.Urethral and bladder injections for incontinence including botoxRodney A. Appell10.1016/j.auc.2004.06.005Atlas of the Urologic Clinics of North America 12, 2 (2004)2004-10-01Atlas of the Urologic Clinics of North America2004-10-01122S1063-5777(00)X0006-0159164http://www.urologicatlas.theclinics.com/article/PIIS1063577704000398/abstract?rss=yesSurgical excision is the definitive treatment of urethral diverticulum (UD) and the only reasonable surgical option for treating midurethral and proximal UD. Transvaginal excision of a urethral diverticulum previously has been described, and there has been little variance in technique. The description provided in this article does not differ significantly from previous ones, but it offers some practical guidance in adjusting technique to accommodate commonly encountered difficult clinical scenarios.Female urethral diverticulaHarriette M. Scarpero, Roger R. Dmochowski, Patrick B. Leu10.1016/j.auc.2004.07.001Atlas of the Urologic Clinics of North America 12, 2 (2004)2004-10-01Atlas of the Urologic Clinics of North America2004-10-01122S1063-5777(00)X0006-0205212http://www.urologicatlas.theclinics.com/article/PIIS1063577704000404/abstract?rss=yesUrethral obstruction after surgery to treat stress urinary incontinence (SUI) is reported to occur in 5% to 20% of patients. Studies report that the incidence of surgery for treating SUI has increased dramatically over the past decade . If only patients requiring an inpatient admission are taken into account, the rate increases by 45%. As most of these procedures are done in the outpatient setting, this figure vastly underestimates the true increase. With this increase in the number of procedures performed, there likely also has been an increase in the number of patients with iatrogenic urethral obstruction. Surgeons who perform these procedures should be adept at recognizing the signs of iatrogenic obstruction and be comfortable with performing a procedure to unobstruct the patient or with referring the patient to someone with more experience in this area. In most cases, timely recognition and treatment lead to significant symptom relief.UrethrolysisHoward B. Goldman10.1016/j.auc.2004.07.002Atlas of the Urologic Clinics of North America 12, 2 (2004)2004-10-01Atlas of the Urologic Clinics of North America2004-10-01122S1063-5777(00)X0006-0197204http://www.urologicatlas.theclinics.com/article/PIIS1063577704000416/abstract?rss=yesA plethora of surgical techniques has been devised for the treatment of stress urinary incontinence, but over the past decade, two approaches have emerged as the gold standards—the Burch colposuspension and the pubovaginal sling. Historically, use of the pubovaginal sling had been reserved for women with complicated, severe, or recurrent sphincteric incontinence, but has been advocated for almost all types of sphincteric incontinence (simple and complicated). Fueled by a stampede of commercial innovations in sling materials, allograft and synthetic slings have become the most commonly used techniques for treating sphincteric incontinence in women. There is little doubt that some kind of allograft or synthetic sling will replace the autologous fascial sling as the gold-standard treatment. This article provides an update on the surgical technique and long-term outcome of the full-length autologous rectus fascial sling in the treatment of women with sphincteric incontinence.Pubovaginal fascial sling for the treatment of all types of stress urinary incontinence: surgical technique and long-term outcomeJerry G. Blaivas, David C. Chaikin10.1016/j.auc.2004.07.003Atlas of the Urologic Clinics of North America 12, 2 (2004)2004-10-01Atlas of the Urologic Clinics of North America2004-10-01122S1063-5777(00)X0006-0165175http://www.urologicatlas.theclinics.com/article/PIIS1063577704000428/abstract?rss=yesThe evolution of urinary diversion after radical cystectomy has been impressive over the past century. The ideal form of diversion has yet to be determined, but orthotopic reconstruction offers the most natural voiding pattern, allowing voluntary micturition through the intact native urethra. It has been estimated that more than 50% of patients with invasive bladder cancer are suitable candidates for orthotopic urinary diversion . Before 1990, orthotopic reconstruction was contraindicated in female patients undergoing cystectomy based on two assumptions: (1) Complete removal of the urethra is necessary to provide an adequate surgical margin, and (2) female patients are unable to maintain continence after diversion with an orthotopic neobladder.Orthotopic urinary diversion in the female patientEmily E. Cole, Joseph A. Smith10.1016/j.auc.2004.07.004Atlas of the Urologic Clinics of North America 12, 2 (2004)2004-10-01Atlas of the Urologic Clinics of North America2004-10-01122S1063-5777(00)X0006-0293300http://www.urologicatlas.theclinics.com/article/PIIS106357770400043X/abstract?rss=yesThe female urethra is relatively short compared with its male counterpart and is generally between 2 and 4 cm in length. It is made up of an inner layer of mucosal epithelium with numerous infoldings that create an effective seal against the passive loss of urine. Beneath the mucosa lies a rich, vascular network of elastic tissue that is much like the corpus spongiosum. Surrounding the spongy vascular tube is a collagen-rich fibromuscular envelope comprising the periurethral fascia. These three components of a normal urethra are crucial in maintaining continence and enabling dynamic function during increases in abdominal pressure and during normal micturition.Female urethral reconstructionNirit Rosenblum, Victor W. Nitti10.1016/j.auc.2004.07.005Atlas of the Urologic Clinics of North America 12, 2 (2004)2004-10-01Atlas of the Urologic Clinics of North America2004-10-01122S1063-5777(00)X0006-0213223http://www.urologicatlas.theclinics.com/article/PIIS1063577704000441/abstract?rss=yesThe first sling operation was reported by Von Giordano in 1907. Von Giordano used a gracilis muscle flap in a patient with epispadias . In 1970, the Goebell-Frankenheim-Stoekel procedure was described during which the perimedalis muscle and rectus fascia was plicated beneath the urethra. In 1942, Aldridge incorporated the use of rectus fascia and used a separate vaginal incision to incorporate the rectus fascia sling. In addition to muscle and rectus fascia, inorganic materials also have been used for sling grafts. Suburethral slings have been modified by changing the sling material and the anchoring point of the sling. Even with modifications, however, slings basically adhere to the principle of supporting the proximal urethra or bladder neck in a hammock-like fashion, providing a backboard against increases in abdominal pressure.The tension-free vaginal tape procedureSteven D. Kleeman, Mickey M. Karram10.1016/j.auc.2004.07.006Atlas of the Urologic Clinics of North America 12, 2 (2004)2004-10-01Atlas of the Urologic Clinics of North America2004-10-01122S1063-5777(00)X0006-0177184http://www.urologicatlas.theclinics.com/article/PIIS1063577704000453/abstract?rss=yesAnterior compartment vaginal prolapse, also known as cystocele, is one of numerous types of pelvic floor relaxation that arise from weakening of the endopelvic fascia and herniation of pelvic viscera through the potential space of the vagina. Weakness of the levator fascia results in loss of pelvic floor support and subsequent formation of anterior compartment defects (the preferable term, according to International Continence Society terminology) or cystoceles.Cystocele repair with interpositional graftingPatrick B. Leu, Harriette S. Scarpero, Roger R. Dmochowski10.1016/j.auc.2004.07.007Atlas of the Urologic Clinics of North America 12, 2 (2004)2004-10-01Atlas of the Urologic Clinics of North America2004-10-01122S1063-5777(00)X0006-0225231http://www.urologicatlas.theclinics.com/article/PIIS1063577704000489/abstract?rss=yesIt is becoming increasingly recognized that the associated morbidity and costs associated with urinary incontinence is placing a greater and greater burden on patients, their caregivers, and third-party payers. These patients often become social outcasts and withdraw from society, which only adds to their personal burden. Newer and more effective treatment modalities are evolving that are of value in managing this common disorder, and these successes have been associated with improved outcomes, often at reduced costs.Advances in Surgery for IncontinenceMartin I. Resnick10.1016/j.auc.2004.08.003Atlas of the Urologic Clinics of North America 12, 2 (2004)2004-10-01Atlas of the Urologic Clinics of North America2004-10-01122S1063-5777(00)X0006-0Forewordviiviihttp://www.urologicatlas.theclinics.com/article/PIIS1063577704000490/abstract?rss=yesI am excited to present a new issue of the Atlas of Urologic Clinics that deals with advancements in incontinence surgery. We have taken a global approach in viewing the various procedures, and I have asked the authors to give their personal approach to procedures as well as their lessons learned. They are a distinguished group, and they have contributed their techniques to this issue and have shared procedural nuances and tips that will be helpful to those surgeons embarking upon these procedures.Advances in Surgery for IncontinenceRoger R. Dmochowski10.1016/j.auc.2004.08.004Atlas of the Urologic Clinics of North America 12, 2 (2004)2004-10-01Atlas of the Urologic Clinics of North America2004-10-01122S1063-5777(00)X0006-0Prefaceixixhttp://www.urologicatlas.theclinics.com/article/PIIS1063577704000465/abstract?rss=yesThe SPARC Sling System (American Medical Systems, Minnetonka, Minnesota) is a minimally invasive sling procedure that implants a loosely knitted, self-fixating, 1-cm-wide, 4-0 polypropylene mesh at the level of the midurethra by passing the suspension needle by way of a suprapubic-to-vaginal approach. The device design and surgical technique are unique to this system. The authors present the device design, highlight the differences in surgical implantation technique between this system and the tension-free vaginal tape (TVT) procedure, present a step-by-step implantation technique, and discuss the alternative methods for the treatment of postoperative retention and extrusion.The SPARC Sling SystemDavid R. Staskin, Renuka Tyagi10.1016/j.auc.2004.08.001Atlas of the Urologic Clinics of North America 12, 2 (2004)2004-10-01Atlas of the Urologic Clinics of North America2004-10-01122S1063-5777(00)X0006-0185195http://www.urologicatlas.theclinics.com/article/PIIS1063577704000477/abstract?rss=yesRecent advances in minimally invasive surgery include the increased use of laparoscopic techniques for the performance of a variety of complex genitourinary reconstructive surgeries. Advances in suturing and technologies for hemostasis, tissue reapproximation, and implants have allowed conversion of many open procedures to minimally invasive procedures. Urologic surgeries, such as upper tract reconstruction in the form of laparoscopic pyeloplasty, and complex extirpative procedures with reconstruction, such as laparoscopic prostatectomy and cystectomy, have been developed and have increasing widespread clinical use. Challenging aspects of laparoscopic surgery include the learning curve and necessary complex skill set. Over the past several years, advancements in computer-assisted (robotic) technology have allowed the development of current systems.Robotic pelvic prolapse surgeryS. Duke Herrell, Roger R. Dmochowski10.1016/j.auc.2004.08.002Atlas of the Urologic Clinics of North America 12, 2 (2004)2004-10-01Atlas of the Urologic Clinics of North America2004-10-01122S1063-5777(00)X0006-0243250http://www.urologicatlas.theclinics.com/article/PIIS1063577704000556/abstract?rss=yesTOC10.1016/S1063-5777(04)00055-6Atlas of the Urologic Clinics of North America 12, 2 (2004)2004-10-01Atlas of the Urologic Clinics of North America2004-10-01122S1063-5777(00)X0006-0vvihttp://www.urologicatlas.theclinics.com/article/PIIS1063577704000568/abstract?rss=yesForthcoming Issues10.1016/S1063-5777(04)00056-8Atlas of the Urologic Clinics of North America 12, 2 (2004)2004-10-01Atlas of the Urologic Clinics of North America2004-10-01122S1063-5777(00)X0006-0viiiviii