Benign Postreproductive Gynaecological Surgery

This text examines surgical technique in the area of reconstructive and urogynecological vaginal surgery. The full range of procedures is presented from the surgeons's perspective. Highlights include vaginal hysterectomy, reconstructive surgery of the lower urinary tract, posterior pelvis procedures, premalignant lesions of the vulva, vagina and cervix, and the pelvic mass. The book concentrates on the surgical solution to common problems of pelvic deterioration in the fastest growing population segment, women over 50 years of age. A major thrust is the introduction and advancement of creative, anatomically-orientated techniques that offer long-term alleviation of disabling symptoms that destroy any semblance of normal living. Although all aspects of correction of destruction due to atrophy, attenuation and disintegration of the delicate interdependent female pelvic support network are thoroughly covered, principle attention is directed to the most frequently occuring specific abnormalities, such as prolapse of pelvic organs and pelvic floor and urinary incontinence. The primary goal is the elimination of symptoms while simultaneously restoring the normal anatomy and re-establishing and maintaining normal functions, both excretory and sexual, including age groups in the 9th and 10th decades. Emphasis is placed on innovative, yet easily comprehensible, concepts and techniques via the vaginal approach - so much better tolerated by post-menopausal women than abdominal entry. New ideas, coupled with logic and practicality, on the roles of oestrogen replacement and suture selection in long-term operative success are singular features. State-of-the-art precepts of pre-operative and post-operative care, which are crucial for the best outcomes in older women, are accentuated.

Table of Contents:
Oestrogen: major factor in pelvic reconstruction and urogynecologic surgery; the anatomy of pelvic relaxation and stress-urinary incontinence; pre-operative evaluation and preparation; vaginal hysterectomy; investigating the older incontinent women; the treatment of genuine stress incontinence; anterior pelvic compartment reconstruction - the total vaginal approach; transabdominal sacralcolpopexy for massive vaginal vault eversion in the posthysterectomy patient; posterior pelvis I - analysis and findings in enterocoele and massive vaginal eversion; posterior pelvis II - deep pelvic reconstruction - enterocoele repair and sacrosopinous fixation; posterior pelvis III - correction of rectocoele and perineal defects; management of premalignant lesions of the vulva, vagina and cervix in the older patient; management of premalignant lesions of the menopausal endometrium; the pelvic mass; endoscopy in postmenopausal diagnosis and treatment; wound healing and suture selection in reconstructive surgery; surgical complications; postoperative management. anatomical-surgical synopsis.