Subject Index. mechanism 112 proctographic diagnosis 222, 223 Anorectal angle

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1 A Ageing and pelvic floor muscle changes Alcock s canal 47 Anal electromyography Anal manometry 158, Anal sensation 160, 233 Anal sphincter age related changes 26, 53 55, 106 anatomy congenital anomalies 247 MRI nerve supply 26 sex differences 26, 106 support 25 ultrasound, endoanal ultrasound, translabial 123 Anal sphincter repair 251 Anismus associated features 222, 223 definition 222 mechanism 112 proctographic diagnosis 222, 223 Anorectal angle definition 63 dynamic MR imaging 79 relationship to puborectalis activity 222 Anorectal function 52 Anorectal manometry Anorectal physiology Anorectal testing , , anorectal sensation , clinical examination , 248 electromyography (EMG) of anal sphincters , 236 functional anal canal length 158 imaging (see MRI, endoanal and Ultrasound, endoanal) needle electromyography external sphincter 236 pudendal nerve terminal motor latency (PNTML) 160 rectal balloon expulsion test 233 rectal capacity 234 rectal compliance 234 resting and squeeze pressures 158, utility 239 vector manometry 159 Anorectal vector manometry 159 Anterior colporraphy 198 Anterior mucosal prolapse 215, 217 Apical prolapse 34 Arcus tendineus fascia pelvis 7, 8, 13, 16, 19, 34, 36, 166, 173 Artificial bowel sphincter Artificial urethral sphincter 199 B Biofeedback fecal incontinence 250 urinary incontinence 197 Bladder anatomy 12 14, 40 diary 194 drugs influencing bladder function 193 emptying 144 neurovascular supply support 13 Bladder augmentation 204 Bladder diverticula 41 Bladder neck anatomy 13, 15, 16, 27, 42 mobility, on clinical examination position and hypermobility, urodynamics 148, position and hypermobility, dynamic MRI position and mobility, translabial ultrasound Bladder outflow obstruction 145, pressure flow studies 148 Bladder replacement 206 Bladder residual volume 146, Botuline toxin injections 204 Bulking agents anal sphincter urethra 199 Burch colposuspension 173, 189, 198, 199 C Cardinal ligaments 16, 19, 166 Cloaca 2 Coccygeus muscle 4, 5, 8,

2 266 Conduits, urinary 207 Colonic transit with radio-opaque markers , Colposuspension 173, 189, Constipation autointoxication 211 congenital cause 213 definition etiology 144, evacuation proctography findings in, functional disorder 221 idiopathic slow transit 214 incidence 212 obstructed defecation 29, 122, outlet obstruction 214 pelvic floor descent rectal prolapse rectal sensory perception in 214 rectocele slow transit, relationship to defecation water soluble contrast in 213 Cystocele anterior colporraphy 175 dynamic cystoproctography graft placement incidence on DCP compared to clinical 71 72, MRI 79 (paravaginal) repair 174 support, loss of terminology 173 triphasic examination to diagnose 68, 69, 72, 170 ultrasound, translabial 119 Cystourethrocele 35, 119 D Detrusor muscle anatomy 13 Defecography (see evacuation proctography) Dynamic cystoproctography (fluoroscopic) comparison to physical examination 71 72, normal findings 67 prolapse, definition prolapse, grading technique 66, 77 Dynamic graciloplasty Dynamic MR imaging pelvic floor clinical relevance 239 fluoroscopy comparison 87, limitations 87 patterns of disease pelvic floor movement 84 prolapse supine versus upright position 87 technique 76, 77 E Electromyography 48 56, 154, 159, 222, 223, 236, 249, 260 Endoanal ultrasound (see Ultrasound, endoanal) Endopelvic fascia anatomy 5, 8, 16, 18 19, 32, 39 interaction with pelvic floor 39 Endosonography (see Ultrasound, endoanal) Enterocele dynamic cystoproctography dynamic MRI 84 etiology grading 68 incidence on DCP compared to clinical 71 72, radiological significance relationship to peritoneocele 71 surgery triphasic examination in diagnosis 69 71, 170 ultrasound, translabial 122 Evacuation proctography clinical relevance, discussion 71, 72, , evacuation flap valve theory 63 frontal imaging 65 leakage at rest 63 normal findings prolonged evacuation 64 puborectalis impression 64 radiation dose 63 radiological report 65 stress views 64 synonyms 61 technique External anal sphincter age related changes 26, 106 anatomy atrophy 109, 137 MRI 135, 136, 140 MRI versus endoanal ultrasound post partum changes sex differences 26, 106 sphincteroplasty 139, 140 squeeze pressure 158, tears tears, incidence post partum 110 tears, occult 110 ultrasound, endoanal 109 External genital muscles 10 11, 40 F Fecal Incontinence algorithm management 241, 261 anorectal physiology tests , ,

3 autonomic neuropathy 214 artificial bowel sphincter 252 bulking agents conservative management 250 etiology incidence 245 internal sphincter thinning , management, algorithm 241, 261 muscle transposition-graciloplasty physical examination 248 pseudo incontinence 248 overlapping anterior sphincter repair 251 radiofrequency sacral nerve stimulation scoring, Parks & Wexner systems 246 surgical management , 261 types, passive and urge 157, 161 G Graciloplasty H Hirschsprung s disease 213 I Idiopathic megacolon 213 Idiopathic megarectum 213 Iliococcygeus 9, 93 Internal anal sphincter abnormal thickness , age related changes 26, 106 anatomy 23 atrophy , idiopathic degeneration 137 lateral internal anal sphincterotomy 108 MRI 133 MRI versus endoanal ultrasound passive fecal incontinence 157, 161 sex differences 26, 106 stretch procedures 108 tears , 135 ultrasound, endoanal 103 Internal obturator muscle 5 International Continence Society definition incontinence 187 grading prolapse 168 Intersphincteric space 23 Intra-anal intussusception digitation 115, 218 progression to rectal prolapse 218 relationship to constipation 217 Irritable bowel syndrome Rome criteria 215 Ischioanal fossa 19, 20 K Kegel s exercises Pelvic floor muscle training, and 196 L Levator ani (muscle) anatomy 8 9, 38, 39, 90 94, defects 95 96, 168 effects contraction 16, 166, 167 MRI nerve supply 27 pelvic floor dysfunction pregnancy and birth related changes 97 prolapse ultrasound, translabial Levator hiatus widening of 166 ultrasound, translabial 123 Longitudinal layer anus 23 MRI 133 bladder detrusor 13 rectum 21 urethra 15 Lower urinary tract functions 143 Lower urinary tract symptoms 144 M Marshall-Marchetti-Krantz test 194 Marshall-Marchetti-Krantz procedure 198 Megacolon, idiopathic 213 Megarectum, idiopathic 213 Midurethral sling 198 MRI, endoanal abnormal thickness sphincter muscles 136, 137 atrophy 136, 137 coil comparison with endoanal ultrasound comparison with external coils 140 external anal sphincter, normal 133 fibrous scar, signal intensity 135 indications internal anal sphincter, normal 132 longitudinal muscle 123 normal findings patient preparation 132 pitfalls post surgical

4 268 MRI (Continued) pre surgical 139 role of sequences 132 sex differences in anal sphincter 26 tears, external anal sphincter tears, internal anal sphincter 135 technique Muscle transposition graciloplasty Muscularis submucosae ani anatomy 22 MRI 132, 133 ultrasound, endoanal 103 N Needle electromyography external anal sphincter 236 Needle urethropexy 198 Neural control pelvic floor muscles 49 sacral functions 51 Neuropathy, pudendal 219, 261 electromyography 236 nerve traction in pelvic floor descent 219 pudendal nerve terminal latency 236 O Obstetric trauma external anal sphincter tears, incidence 110 occult tears 110 Overlapping anterior sphincter repair P Paraurethral ligaments 16 Pelvic floor (muscles) ageing anatomy 1 29 anorectal function and attachments embryology 2 5 endopelvic fascia 8, 32, 33, 39 functional anatomy functional support innervation, autonomic 27, layers 5 lower urinary tract and 52 levator ani, attachments 5 8 movement 84 nerve supply 27 neural control neuromuscular injury sensory-motor integration sexual behavior and 53 tendineus arcs 7 vaginal delivery Pelvic floor defects Pelvic floor prolapse clinico-radiological comparisons defects descent 84, 218 etiology 167, 168 grading system, International continence Society 168 levator ani dysfunction and 167 MRI cost in 171 MRI, dynamic MRI, 3D in 91, 167 movement in 32, 33 muscle training repair, surgical approach surgery and clinical imaging ultrasound, translabial Pelvic organ support Perianal connective tissue 20 Perineal body anatomy 19, 25, 38 detachment 169 MRI, endoanal 134 surgical support 166, 176, 180, 252 ultrasound, endoanal 106, 111 ultrasound, translabial 91 Perineal membrane 9, 32, 40, 93, 167 Perineum anatomy 19, 25, 38 Peritoneocele MRI detection 84 peritoneography 71 Peritoneography 71 Periurethral ligament 16 Prolapse mechanisms of, 32 42, endosonography 70, 71 Puboanalis anatomy 9, 23 tears 111 ultrasound, endoanal Pubovisceralis anatomy 5, 8, 9 Pubocervical fascia 34 Pubococcygeal line definition 63 reference point, prolapse 67, 68, 71, 77, 79, 84, 169, 219, 238 Puborectalis age related changes 106 anatomy 9, 25, 26, 39, 166 anismus 84, 112, 222, 232, 233, 238 anorectal angle 53, 63, 79 atrophy 239 electromyography 236 MRI 76, 77, 79, 133 sex differences 106

5 syndromes, non-relaxing & Paradoxical contraction 84, 112, 222, 232, 233, 238 tears 111 ultrasound, endoanal 102, 104, 106, 112 ultrasound, translabial 116, 123 Pudendal nerve terminal motor latency (PNTML) 160, artificial atrophy, endocoil MRI in 139 bulking agents muscle transposition (graciloplasty) radiofrequency residual defect 140 sacral nerve stimulation Stress urinary incontinence (see Urinary incontinence) Suburethral sling 198 R Radiofrequency treatment anal sphincter Rectal balloon expulsion test 233 Rectal capacity 234 Rectal compliance 234 Rectal prolapse complete 215 grading on evacuation proctography 216 internal intussusception 215 MRI 77, 87 types 216 ultrasound, translabial 122, 125 Rectal sensation 161, 233 Rectal support 21 Rectocele definition 80 direct repair 180 etiology 33, 35, 38 graft placement 180 MRI 81 posterior 221 rectal wall imbrication 181 repair, posterior colporraphy 179 repair, trans-anal 181 ultrasound, translabial 122 Rectovaginal fascia anatomy 19, 21, 34 Rectovaginal septum anatomy 20, 166 defect 122 length 166 Rectum anatomy 20, 21 S Sacral nerve stimulation/neuromodulation fecal incontinence urinary incontinence 204 Sacrouterine ligaments 4, 19 Sensory control Sensory-motor integration Sigmoidocele 69 71, 170 association with constipation 71 Somatic motor system Solitary rectal ulcer syndrome 218, 223 internal anal sphincter, thickened in 107, 137 Sphincter, repair anterior sphincteroplasty T Translabial ultrasound (see Ultrasound, translabial) Transverse perineal muscles anatomy 11 12, 40, 134 MRI, endoanal 134 obstetric tears 101 ultrasound, endoanal 104 Tendineus arcs 7 8 Tension-free vaginal tape (TVT) 198 U Ultrasound, endoanal comparison to MRI external anal sphincter 109 interface reflections 102 internal anal sphincter longitudinal layer normal anatomy obstetric trauma puboanalis 104 subepithelium 103 technique D 101, 106, 109, 112 Ultrasound, translabial bladder neck position bladder neck mobility bladder neck descent 118 clinical applications color Doppler 119 display modes 124 enterocele 122 funneling internal urethral meatus 119 implants 119 technique 116 real time 124 rectocele 122 intussusception 122 suburethral slings uterine prolapse 122 3D 116, D 124 Uterosacral ligaments 4, 19 Uterovaginal support

6 270 Urethra anatomy, female 14 15, 42 anatomy, male artificial urethral sphincter 199 bulking agents 199 diverticula 42, 84, 119, 124 embryology 3 funneling MRI 78, 79 ultrasound, translabial 119 hypermobility MRI 78 Urethral support anatomy compressor urethrae 18 periurethral ligament 16 paraurethral ligament 16 urethrovaginal sphincter 18 Urethrovaginal sphincter 18 Urinary continence 189 Urinary diversion Urinary incontinence abdominal retropubic urethropexy 198 additional tests anterior colporraphy 198 artificial urethral sphincter 199 behavior therapy 201 biofeedback training stress 197 bladder augmentation bladder diary 194 bladder replacement bladder training 201 bladder ultrasound 195 botulinum toxin injection 204 clinical evaluation colposuspension 198 conduits 207 conservative treatment stress conservative treatment urge cystoscopy 195 definition 187, 188 drug therapy stress 197 drug therapy urge 203 epidemiology 188 extra urethral incontinence habit training 196 mechanical devices 196 needle urethropexy 198 neobladder heterotopic 207 orthotopic 207 neurogenic neurostimulation 202 overflow incontinence 190 pelvic floor training stress 196 pelvic floor training urge 202 peripheral nerve stimulation prevalence 188 Q-tip test 194 questionnaires 193 risk factors for 188, 189 sacral neuromodulation 204 suburethral sling 198 stress incontinence, definition 189, 190 surgical therapy stress surgical therapy urge stress provocation test 194 treatment of urge or neurogenic urinary incontinence 201 tension free vaginal tape (TVT) urethral bulking agents 199 urethral hypermobility MRI 78 urethral funneling MRI 78, 79 translabial ultrasound 119 urge incontinence, definition 190 urinary diversion urine analysis 194 Urinary tract functions 143 Urinary tract symptoms 144 Urodynamics abdominal leak point pressure 148 ambulant basic 147 cystometrography 147 detrusor activity 147 detrusor leak point pressure 148 electromyography frequency volume chart 145 neurophysiological investigations pad testing 145 pressure-flow studies 148 ultrasound estimation post void volume 145 upper tract (Whitaker test) 154 uroflowmetry 145 urethral function tests 153 videourodynamics Urogenital diaphragm (see Perineal membrane) Urogenital hiatus anatomy 9, 18, 25, 39, 94 birth related changes Uterovaginal apical prolapse 34 fistulas 191 levels of support paracolpium 34 prolapse, MRI 61 surgery support 33 uterosacral and cardinal ligaments in 16, 19, 33 Uterus anatomy 18

7 prolapse 79, 122 support structures V Vagina(l) abdominal sacral colpopexy 176 anatomy 18 anterior wall support delivery dynamic cystoproctography 71 dynamic MRI 79 embryology 3 4 mechanisms and levels of support 33 35, opacification 67, 77 posterior wall support sacrospinous vault suspension 177 uterosacral ligament vault suspension 178 vault defect 179 vault descent 79 vault suspension vault prolapse 34, 71, 122 Vault defect 179 Vault descent 79 Vault suspension Vault prolapse 34, 71, 122 W Whitaker test

8 List of Contributors List of Contributors Paul Abrams, MD, FRCS Professor of Urology Bristol Urological Institute Southmead Hospital Bristol BS10 5NB Clive I. Bartram, FRCS, FRCP, FRCR Professor Consultant Radiologist (Retired) St Mark s Hospital Princess Grace Hospital Nottingham Place London W1U 5NY cibartram@gmail.com Adil E. Bharucha, MBBS, MD Professor of Medicine Clinical Enteric Neuroscience Translational and Epidemiological Research Program Mayo Clinic, College of Medicine 200 First Street SW Rochester, MN bharucha.adil@mayo.edu Annette C. de Bruijne-Dobben, PhD Department of Radiology Academic Medical Center University of Amsterdam Meibergdreef AZ Amsterdam and presently: Senior advisor Knowledge Center Health Care Inspectorate St. Jacobsstraat BS Utrecht ac.bruijne@igz.nl John O. L. DeLancey, MD Norman F. Miller Professor of Gynecology Director, Pelvic Floor Research Group Director, Fellowship in Female Pelvic Medicine and Reconstructive Surgery L4000 Women s Hospital University of Michigan 1500 E. Medical Center Drive Ann Arbor, MI delancey@umich.edu Hans Peter Dietz, MD, PhD, FRANZCOG, DDU, CU Associate Professor in Obstetrics and Gynaecology Nepean Clinical School, University of Sydney Nepean Hospital Penrith NSW 2750 Australia hpdietz@bigpond.com Anton V. Emmanuel, MD, BSc, FRCP Director of GI Physiology Unit University College Hospital 235 Euston Road London NW1 2BU a.emmanuel@ucl.ac.uk Joel G. Fletcher, MD Associate Professor of Radiology Department of Radiology Mayo Clinic 200 First Street SW Rochester, MN fletcher.joel@mayo.edu Douglass S. Hale, MD, FACOG, FACS Director Female Pelvic Medicine & Reconstructive Surgery Fellowship Associate Clinical Professor Indiana University/Methodist Hospital 1633 N Capitol Avenue, Suite 436 Indianapolis, IN dough22@aol.com 273

9 274 List of Contributors Steve Halligan, MD, MRCP, FRCR Professor of Gastrointestinal Radiology Department of Specialist X-Ray University College Hospital 235 Euston Road London NW1 2BU Jaap Stoker, MD, PhD Professor of Radiology Department of Radiology Academic Medical Center University of Amsterdam Meibergdreef AZ Amsterdam j.stoker@amc.uva.nl Fadi Housami, MD, MRCS Clinical Research Registrar Bristol Urological Institute Southmead Hospital Bristol BS10 5NB fhousami@bui.ac.uk Stuart A. Taylor, MD, MRCP, FRCR Senior Lecturer in Radiology Department of Specialist X-Ray University College Hospital 2F Podium, 235 Euston Road London NW1 2BU stuart.taylor@uclh.nhs.uk Matthias Oelke, MD, FEBU Department of Urology Medical School Hanover University of Hanover Carl-Neuberg-Strasse Hanover Germany Wolfgang H. Umek, MD Associate Professor Department of Obstetrics and Gynecology Medical University of Vienna Waehringer Guertel Vienna Austria oelke.matthias@mh-hannover.de wolfgang.umek@gmail.com Jan-Paul Roovers, MD, PhD Department of Obstetrics and Gynecology Academic Medical Center University of Amsterdam Meibergdreef AZ Amsterdam David B. Vodušek, PhD Professor of Neurology Medical Faculty, University of Ljubljana and Medical Director Division of Neurology, University Medical Centre 1525 Ljubljana Slovenia j.p.roovers@amc.uva.nl david.vodusek@kclj.si Sherief Shawki, MD Research Fellow Department of Colorectal Surgery Cleveland Clinic Florida 2950 Cleveland Clinic Boulevard Weston, FL shawkis@ccf.org Christian Wallner, MSc Department of Anatomy and Embryology Academic Medical Center University of Amsterdam Meibergdreef BK Amsterdam c.wallner@amc.uva.nl Hassan Siddiki, MD Department of Radiology Mayo Clinic 200 First Street SW Rochester, MN Steven D. Wexner, MD, FACS, FRCS, FRCS(Ed) Chairman, Department of Colorectal Surgery Chief of Staff Cleveland Clinic Florida 2950 Cleveland Clinic Boulevard Weston, FL siddiki.hassan@mayo.edu wexners@ccf.org