Pelvic Floor Disorders G.A

Pelvic Floor Disorders G.A. Santoro • A.P. Wieczorek • C.I. Bartram Editors

Pelvic Floor Disorders

Imaging and Multidisciplinary Approach to Management

Forewords by Jim Fleshman András Palkó Peter K. Sand

123 Giulio Aniello Santoro Head, Pelvic Floor Unit and Colorectal Service 1st Department of General Surgery Regional Hospital Treviso, Italy

Andrzej Paweł Wieczorek, Department of Pediatric Radiology Children’s Teaching Hospital Skubiszewski Medical University of Lublin Lublin, Poland

Clive I. Bartram Diagnostic Imaging Princess Grace Hospital London, UK

ISBN 978-88-470-1541-8 e-ISBN 978-88-470-1542-5

DOI 10.1007/978-88-470-1542-5

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Springer-Verlag Italia S.r.l., Via Decembrio 28, 20137 Milan Springer is a part of Springer Science+Business Media (www.springer.com) The glory of medicine is that it is constantly moving forward, that there is always more to learn.

William J. Mayo (1861-1939) To the most important people in my life – my wife Anna and my children Giuseppe, Paolo, and Marco for their love and support To my mother and my father, to whom I will be eternally grateful To the memory of my friend Bjorn Fortling

G.A. Santoro

To my family

C.I. Bartram

To my family

A.P. Wieczorek Foreword

Drs. Santoro, Wieczorek, and Bartram have honored me by asking me to write the foreword for this comprehensive text about pelvic floor disorders. The editors have raised the bar for the rest of us with this new publication. In the past, rectal and anal issues with pelvic disorders have been evaluated separately, away from urologic and gynecologic issues. Other books have addressed these issues in more isolated format. In this comprehensive text, the anterior and posterior pelvis are evaluated and managed as a unit, with obvious improvement in our approach to both areas. Pelvic Floor Disorders provides us with the theory behind disorders, the normal and abnormal functional issues, as well as testing and imaging methodology. Not since the classic Coloproctology and the Pelvic Floor by Henry and Swash, has there been a textbook that dealt so thoroughly with the specifics of pelvic floor diseases or disorders. The book contains everything that any starting colon and rectal surgeon will need to develop a practice in pelvic floor disorders, as well as being a reference book for those of us who have been experts in the pelvic floor for many years. The book is extremely thorough, with comprehensive coverage of all approaches, new technology, and practical guides to performance of specific procedures. The step-by-step description of operations, with excellent intraoperative photographs, make this almost an atlas of techniques. The outstanding quality of reproduced images from ultrasonography and magnetic resonance imaging allows us to compare the imaging modalities to the illustration models, which use different colors to make anatomic relationships easy to comprehend. The book is well referenced, with an extensive up-to-date bibliography for each chapter. The editors have gathered a spectacular collection of expert international authors. The table of contents is clear and well organized, and the chapters are of manageable length with the latest of techniques and references. This will be a must- have and must-read text for all of us who deal with pelvic floor abnormalities. I want to congratulate the editors on a job well done and look forward to this as a beginning of a longstanding educational effort on their behalf as we see edition after edition in the future.

Prof. Dr. Jim Fleshman MD Professor of Surgery, Chief of Colon and Rectal Surgery Washington University in St Louis, MO, USA Past-President of American Society of Colon and Rectal Surgeons Foreword

The pelvic floor is a rather complex system, comprising active and passive compo- nents, bestowing mechanical support but at the same time preserving continence and managing coordinated relaxation during bladder and bowel voiding. Its mal- function may manifest in the form of pain, constipation, incontinence, and prolapse. As a result of increasing awareness of clinical conditions resulting from dysfunction and anatomical disorders of the pelvic floor, with respect to the rather high, although frequently hidden, prevalence of these changes that compromise the quality of life of many patients, together with the rapidly developing and increasingly widely available technical-technological solutions, pelvic floor imaging has become an ex- tensively required segment of imaging diagnostics. However, some of the techniques are available at relatively few centers only, and members of the community of radiologists, including even specialists of abdominal and urogenital imaging, are far less aware of the therapeutic and diagnostic implications of these conditions than their significance deserves. A group of renowned experts, as editors and authors, with the assistance of many professionals from different fields of medicine, have thus chosen the optimal time and format to present most diagnostic and therapeutic aspects of pelvic floor disorders. The decision to discuss the subject in such a comprehensive structure, compiling not only the traditional radiological but also the clinical approach, has been highly fruitful; as a result, the content of the volume covers not only the imaging but also the clinical management of this condition and, beyond this, it presents the topic in a “multicompartmental”, integrated fashion. The conventional “setting the ground” chapters (anatomy, ultrasonographic and magnetic resonance anatomy of the pelvic floor) are followed by those describing not only the multimodality imaging (with special emphasis on multiplanar visualization), but also the multidisciplinary management of pathologic conditions affecting one or more of the pelvic compartments (damage caused by childbirth, urinary incontinence and voiding dysfunctions, fecal incontinence, pelvic organ prolapse, pelvic pain, fistulae and the diagnostics and management of complications of surgery). The target group of this volume therefore includes interested radiologists, but the book reaches beyond this expert group and encourages clinicians to better understand not only the reports but also the images resulting from ultrasonographic and/or magnetic resonance imaging of the pelvic structures, which is necessary to fully understand the diagnostic capacity (and of course the limitations) of these modalities. While these examinations may today be considered as “exotic” by many radiologists and clinicians, proper training, standardized imaging and evaluation technique, and well-established diagnostic and therapeutic protocols will shift their XII Foreword

performance from the art of a few talented experts to the routine of many abdominal and urogenital imaging specialists. The need for detailed anatomical and functional imaging of the pelvic ﬂoor structures is likely to increase, on the one hand because of the growing patient and physi- cian consciousness, on the other hand because of the improvement in available therapeutic solutions. Since this book ﬁlls a void in the current literature, giving those interested in the topic the opportunity to have an up-to-date source of knowledge, it may be offered for thorough reading not only to radiologists and other experts deeply immersed in this special segment of their profession, but also to all those interested in new developments of their discipline.

Prof. Dr. András Palkó PhD Head and Chairman of the Department of Radiology, University of Szeged, Hungary Vice-president of the European Society of Radiology Foreword

This new book Pelvic Floor Disorders, is an exciting, novel contribution by Drs. Giulio Aniello Santoro, Andrzej Paweł Wieczorek, and Clive Bartram that should greatly add to our understanding of diagnosing and treating women with pelvic floor dysfunction. This is a unique contribution that has brought together experts from around the world from multiple disciplines (urogynecology, urology, colorectal surgery, radiology, physical therapy, gynecology, and oncology), to give their opinions on how to diagnose urinary and fecal incontinence, fistulae, pelvic pain, and prolapse. This multidisciplinary approach and commentary from subspecialists in different fields offers the reader a different perspective than textbooks that just present the opinion of one specialty. This is further enhanced by the integration of imaging chapters covering all aspects of pelvic floor dysfunction. This multidisciplinary approach, with authors recruited from all around the world, is particularly attractive to me. As a member of the International Urogynecological Association for the last 25 years, and the current president of this organization, I have learned the importance of soliciting opinions and knowledge from specialists throughout the world. The tendency of editors to publish work that just represents singular provincial views from one nation or continent often cheats readers of knowledge and different perspectives from different parts of the world. While subspecialists often share many common approaches to the diagnosis and treatment of pelvic floor dysfunction around the world, the subtle differences to the approach to these problems can improve the care of women being treated for pelvic floor dysfunction around the globe. However, without books like Pelvic Floor Disorders or participation in international organizations, like the International Urogynecological Association, many clinicians would never be exposed to the diversity of opinions and approaches to all of these disorders. These three editors from different countries and backgrounds are to be complimented for their foresight in preparing an excellent book and soliciting contributions from experts from around the world with diverse perspectives. It is an excellent book that sets a new standard for diversity.

Prof. Dr. Peter K. Sand, MD, FACOG Professor of Obstetrics & Gynecology Director, Evanston Continence Center Director, Fellowship in Female Pelvic Medicine, NorthShore University HealthSystem University of Chicago, Pritzker School of Medicine, Chicago, IL, USA President of the International Urogynecological Society Preface

Major developments in medicine over last few years have resulted in more reliable and accessible diagnostics and treatment of pelvic floor disorders. A unique aspect of the pelvic floor is the number of specialties involved (urology, gynecology, gastroenterology, colorectal surgery, radiology, rehabilitation medicine) and how often patients have problems that transgress the boundaries of any single specialty. Given the complex multicompartmental physiopathology of pelvic floor disorders, we felt that the approach in this volume should not be limited to the assessment of one compartment but should involve the three compartments (anterior, central, and posterior) in an integrated fashion. The subtitle of this book “Imaging and Multidisciplinary Approach to Management” encompasses this concept of cutting across boundaries to expand our knowledge base with regard to both imaging and the clinical management of incontinence, prolapse, pelvic pain, and fistula. We have endeavored, with the help of an international group of contributors, to provide an up-to-date and au- thoritative account of the imaging and clinical issues involved in the expert management of pelvic floor disorders. Our starting point (Section I) is the anatomy of the pelvic floor, and this section addresses not only what it is in anatomical terms, but also how it works throughout life, with chapters on its musculo-elastic and neurophysiological control, and the changes associated with ageing and the menopause. Imaging, particularly ultrasonography and magnetic resonography, knows no bounds and will take the specialist into regions of the pelvis that may be unfamiliar territory. Many clinicians undertake their own ultrasonography, and the whole of Section II is devoted to the various techniques (conventional two-dimensional, and three/four-dimensional endovaginal, endoanal, and transperineal ultrasonography) that may be employed to image the pelvic floor, in the hope that more clinicians will be encouraged to expand their repertoire of these more specialized examinations. Standardization of these techniques, fundamental for reliability and repeatability, the development of new software options, and increasing availability of training, will take pelvic floor ultrasonography from a niche application and lead to more general acceptance of this modality as a standard diagnostic option in pelvic floor disorders. Considerable space has been dedicated to drawings illustrating anatomy and techniques and to two-dimensional and three-dimensional echographic images, in order to help the reader to learn how to see and interpret ultrasound images, and provide more experienced examiners with an opportunity to review and reassess their techniques. Childbirth represents the single most important cause of damage to the female pelvic floor, and in recognition of this, Section III is devoted to the mechanisms XVI Preface

involved and preventative measures. The next three sections (Sections IV, V, and VI) focus on urinary incontinence and voiding dysfunction, fecal incontinence, and pelvic organ prolapse, considered as a global entity. Surgical principles of reconstructive surgery are aimed at either restoring anatomy with a presumed restoration of function, or creating compensatory anatomical mechanisms. Thus far, decision making in relation to operative treatment has been based mainly on clinical assessment. The purpose of these sections is to describe how pelvic floor imaging, providing an extensive understanding of the pathomorphologic changes leading to these disorders, influences the selection of different forms of treatment. An important feature throughout is that every section, or group of chapters, is accompanied by an invited commentary. We hope that these expert overviews may highlight and balance the individual contributions, to add to the reader’s depth of understanding. Two issues that often cause undue concern in management and tend to be over- looked in the literature are pelvic pain and what to do when it all goes wrong surgi- cally. These are dealt with in detail in Sections VII and Section IX, to complete what the editors trust is an interesting and very practical work to further our knowledge and care of these disorders. We wish to express our deep appreciation to Springer-Verlag for supporting the idea of publishing a book in such an innovative form. Special thanks are due to Dr. Alessandra Born, a representative of the publisher, for her constant assistance throughout the development of the project, organizing every stage of the editorial work. Special acknowledgements must be given to the authors, who are among the foremost experts with outstanding qualifications in this complex field, and who have contributed to the many diverse chapters and provided critical commentaries of the individual sections of this volume. Without their experience and cooperation, this book would not have been possible. Further, thanks must go to our hospitals, whose advanced technological support made it possible to accomplish this new project, to the medical illustrators Mrs. Nadia Simeoni, Lisa Belhange, and Primal Pictures, who have created the numerous artistic drawings, and to Mr. Steffen Jorgensen, Mr. Gert Karlsson, and Mrs. Anne Mitchell of B-K Medical, for gathering much of the data and photographic material showing the technological equipment as well as for their contribution to organizing meetings of the editors’ team. We are confident that this textbook will be met with great interest from all clinicians involved in the care of patients suffering from pelvic floor disorders.

London, May 2010 Giulio Aniello Santoro Andrzej Paweł Wieczorek Clive I. Bartram Contents

Section I Pelvic Floor Anatomy

1 State of the Art Pelvic Floor Anatomy...... 3 John O.L. DeLancey and S. Abbas Shobeiri 2 The Integral Theory: A Musculo-elastic Theory of Pelvic Floor Function and Dysfunction...... 17 Peter Papa Petros and Michael Swash 3 Pathophysiology of the Pelvic Floor: Basic Physiology, Effects of Ageing, and Menopausal Changes ...... 25 Dee E. Fenner and Yvonne Hsu 4 The Pelvic Floor: Functional Concepts and Neurocontrol ...... 33 Michael Swash

5 Clinical Neurophysiology of the Pelvic Floor ...... 43 W. Thomas Gregory and Kimberly Kenton

Section II Pelvic Floor Imaging

Introduction ...... 59 Giovanni Morana and Luca Cancian 6 Endovaginal Ultrasonography: Methodology and Normal Pelvic Floor Anatomy...... 61 Giulio Aniello Santoro, Andrzej Paweł Wieczorek, S. Abbas Shobeiri and Aleksandra Stankiewicz 7 Translabial Ultrasonography: Methodology and Normal Pelvic Floor Anatomy...... 79 Hans Peter Dietz 8 Endoanal and Endorectal Ultrasonography: Methodology and Normal Pelvic Floor Anatomy...... 91 Giulio Aniello Santoro and Giuseppe Di Falco XVIII Contents

9 Technical Innovations in Pelvic Floor Ultrasonography ...... 103 Giulio Aniello Santoro, Aleksandra Stankiewicz, Jakob Scholbach, Michał Chlebiej and Andrzej Paweł Wieczorek

Invited Commentary ...... 115 Clive I. Bartram 10 Magnetic Resonance Imaging: Methodology and Normal Pelvic Floor Anatomy...... 117 Jaap Stoker 11 Technical Innovations in Magnetic Resonance Imaging of the Pelvic Floor ...... 125 Dominik Weishaupt and Caecilia S. Reiner

Invited Commentary ...... 131 Stuart Taylor and Steve Halligan

Section III Pelvic Floor Damage Due to Childbirth

Introduction ...... 135 G. Willy Davila 12 Mechanisms of Pelvic Floor Trauma During Vaginal Delivery...... 137 Gianfranco Minini, Silvia Zanelli, Patrizia Inselvini, Marcello Caria, Sara Grosso and Davide Quaresmini 13 Posterior Compartment Disorders and Management of Acute Anal Sphincter Trauma ...... 143 Abdul H. Sultan and Ranee Thakar

14 Prevention of Perineal Trauma ...... 155 Ranee Thakar and Abdul H. Sultan

Invited Commentary ...... 163 John O.L. DeLancey

Invited Commentary ...... 165 Rebecca G. Rogers Contents XIX

Section IV Urinary Incontinence and Voiding Dysfunction

Introduction ...... 169 Dmitry Pushkar Investigation

15 Ultrasonography ...... 175 Andrzej Paweł Wieczorek, Magdalena Maria Woźniak and Aleksandra Stankiewicz

Invited Commentary ...... 189 Wiesław Jakubowski

16 Urodynamics ...... 191 Edoardo Ostardo, Giuseppe Tuccitto, Francesco Beniamin and Luigi Maccatrozzo

Invited Commentary ...... 207 Paul Abrams

Management

17 Tape Positioning ...... 211 Michał Bogusiewicz and Tomasz Rechberger 18 Selection of Midurethral Slings for Women with Stress Urinary Incontinence ...... 219 Joseph K.-S. Lee and Peter L. Dwyer

19 Injectable Biomaterials ...... 235 Pierpaolo Curti

20 Artificial Urinary Sphincter in Women ...... 241 Amrith Raj Rao and Philippe Grange

21 Sacral Nerve Stimulation ...... 249 Giuseppe Tuccitto, Francesco Beniamin, Edoardo Ostardo and Luigi Maccatrozzo

Invited Commentary ...... 253 Dmitry Pushkar

22 Biofeedback...... 255 Kari Bø and Paolo Di Benedetto XX Contents

23 Medical Treatment of Urinary Incontinence, Urinary Retention, and Overactive Bladder...... 271 Francesco Pesce and Maria Angela Cerruto

Invited commentary ...... 277 G. Willy Davila

Section V Fecal Incontinence

Introduction ...... 281 Giuseppe Di Falco and Giulio Aniello Santoro Investigation 24 Three-dimensional Endoluminal Ultrasonography ...... 285 Giulio Aniello Santoro and Giuseppe Di Falco

25 Transperineal Ultrasonography ...... 297 Bruno Roche, Guillaume Zufferey and Joan Robert-Yap

26 Magnetic Resonance Imaging ...... 305 Jaap Stoker

Invited Commentary ...... 313 Clive I. Bartram

27 Anorectal Manometry...... 315 Filippo Pucciani

Invited Commentary ...... 319 Anton Emmanuel Management

28 Sphincter Repair and Postanal Repair ...... 321 Johann Pfeifer

29 Dynamic Graciloplasty ...... 331 Carlo Ratto 30 Radiofrequency Energy and Injectable Biomaterials...... 337 Mario Trompetto and Maurizio Roveroni

31 Artificial Bowel Sphincter ...... 341 Giovanni Romano, Francesco Bianco and Luisa Caggiano Contents XXI

32 Sacral Neuromodulation ...... 349 Donato F. Altomare, Marcella Rinaldi and Filippa Cuccia

33 Future Treatment ...... 355 Bruno Roche, Guillaume Zufferey and Joan Robert-Yap

Invited Commentary ...... 361 Steven D. Wexner

34 Biofeedback...... 365 Beatrice Salvioli and Luciano Pellegrini

35 Medical Treatment ...... 371 Pier Francesco Almerigi, Valentina Ciaroni and Gabriele Bazzocchi

Invited Commentary ...... 375 Paolo Di Benedetto

Section VI Pelvic Organ Prolapse

Introduction ...... 379 Tomasz Rechberger Investigation 36 Imaging as a Key to Understanding the Causes of Pelvic Organ Prolapse ...... 385 Clive I. Bartram

37 Endoluminal Ultrasonography ...... 389 Giulio Aniello Santoro, Andrzej Paweł Wieczorek, Magdalena Maria Woźniak and Aleksandra Stankiewicz

38 Translabial Ultrasonography ...... 405 Hans Peter Dietz

39 Cystography and Defecography...... 429 Vittorio L. Piloni

40 Magnetic Resonance Imaging ...... 435 Dominik Weishaupt and Caecilia S. Reiner

Invited Commentary ...... 443 Julia R. Fielding

Invited Commentary ...... 445 Andrea Maier XXII Contents

41 Anorectal Manometry...... 447 Filippo Pucciani

Invited commentary ...... 451 Anton Emmanuel Management 42 Management of Pelvic Organ Prolapse: a Unitary or Multidisciplinary Approach? ...... 453 Giuseppe Dodi, Luca Amadio and Erica Stocco 43 The Abdominal Approach to Urogenital Prolapse ...... 457 Dennis H. Kim and Gamal M. Ghoniem

44 The Perineal Approach to Urogenital Prolapse...... 467 Tomasz Rechberger 45 The Laparoscopic Approach to Pelvic Floor Surgery ...... 473 Erika Werbrouck, Filip Claerhout, Jasper Verguts, Joan Veldman, Frank Van der Aa, Dirk De Ridder and Jan Deprest

46 Total Pelvic Floor Reconstruction ...... 485 Peter Papa Petros

Invited Commentary ...... 493 Paul Riss

47 The Abdominal Approach to Rectal Prolapse...... 497 Sthela M. Murad-Regadas, Rodrigo A. Pinto and Steven D. Wexner

48 The Perineal Approach to Rectal Prolapse ...... 509 Mario Trompetto and Silvia Cornaglia

Invited Commentary ...... 515 Andrew P. Zbar

49 The Laparoscopic Approach to Rectal Prolapse ...... 521 Joshua R. Karas and Roberto Bergamaschi

Invited Commentary ...... 529 Conor P. Delaney 50 Pelvic Floor Muscle Training in Prevention and Treatment of Pelvic Organ Prolapse ...... 531 Kari Bø and Ingeborg Hoff Brækken Contents XXIII

51 Medical Treatment of Irritable Bowel Syndrome, Constipation, and Obstructed Defecation ...... 539 Pier Francesco Almerigi, Mauro Menarini and Gabriele Bazzocchi

Invited Commentary ...... 545 Anton Emmanuel

Section VII Pelvic Pain

Introduction ...... 549 Ewa Kuligowska

52 Painful Bladder Syndrome ...... 551 Mauro Cervigni, Franca Natale, Albert Mako and Loredana Nasta 53 Pelvic Pain Associated with a Gynecologic Etiology ...... 563 Sondra L. Summers and Elizabeth R. Mueller 54 Pelvic Pain Associated with a Coloproctologic Etiology ...... 579 Aldo Infantino and Andrea Lauretta 55 Surface Electromyography and Myofascial Therapy in the Management of Pelvic Pain ...... 593 Marek Jantos

56 Chronic Pelvic Pain: A Different Perspective ...... 609 Peter Papa Petros

Invited Commentary ...... 615 G. Willy Davila

Invited Commentary ...... 617 Gian Gaetano Delaini

Section VIII Fistula

Introduction ...... 621 Tomasz Rechberger

57 Urogenital Fistulae ...... 627 Dmitry Pushkar, Gevorg Kasyan and Natalia Sumerova XXIV Contents

58 Rectovaginal Fistulae ...... 635 A. Muti Abulafi and Abdul H. Sultan

59 Anorectal Fistulae...... 655 Giulio Aniello Santoro, Giuseppe Gizzi, Andrea Rusconi, Claudio Pastore and Luciano Pellegrini

Invited Commentary ...... 677 Mauro Cervigni

Invited Commentary ...... 679 Thang Nguyen and Frank A. Frizelle

Section IX Failure or Recurrence after Surgical Treatment: What to Do When it All Goes Wrong

Introduction ...... 687 Tomasz Rechberger and Andrzej Paweł Wieczorek 60 Imaging and Management of Complications of Urogynecologic Surgery...... 695 S. Abbas Shobeiri

Invited Commentary ...... 711 G. Willy Davila 61 Investigation and Management of Complications after Coloproctological Surgery ...... 713 Tim W. Eglington and Frank A. Frizelle

Invited Commentary ...... 725 Filippo La Torre

Invited Commentary ...... 727 Iwona Sudoł-Szopińska and Małgorzata Kołodziejczak

Subject Index ...... 731 Contributors

Paul Abrams, MD Bristol Urological Institute, Southmead Hospital, Bristol, UK

A. Muti Abulaﬁ, MD Department of Colorectal Surgery, Mayday University Hospital, Croydon, Surrey, UK

Pier Francesco Almerigi, MD Unit of General Surgery, Department of General Surgery and Organ Transplantation, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy

Donato F. Altomare, MD Colorectal Unit, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy

Luca Amadio MD Department of Oncological and Surgical Science, 2nd Surgical Clinic, University of Padova, Padova, Italy

Clive I. Bartram, MD Diagnostic Imaging, Princess Grace Hospital, London, UK

Gabriele Bazzocchi, MD Unit of Visceral Disorders and Autonomic Dysfunction, Montecatone Rehabilitation Institute, University of Bologna, Imola, Italy

Francesco Beniamin, MD Division of Urology, Regional Hospital, Treviso, Italy

Roberto Bergamaschi, MD Division of Colon and Rectal Surgery, State University of New York, Stony Brook, NY, USA

Francesco Bianco, MD Division of Colon and Rectal Surgery, Department of On- cologic Surgery, National Cancer Institute “G. Pascale”, Napoli, Italy

Kari Bø, PhD Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway

Michał Bogusiewicz, MD 2nd Department of Gynecology, Medical University of Lublin, Lublin, Poland

Ingeborg Hoff Brækken, PhD Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway

Luisa Caggiano, MD Division of General Surgery, Military Policlinic “Celio”, Roma, Italy

Luca Cancian, MD Department of Radiology, Regional Hospital, Treviso, Italy

Marcello Caria, MD Urogynecology Unit, Department of Obstetrics and Gynecol- ogy, University of Brescia, Brescia, Italy XXVI Contributors

Maria Angela Cerruto, MD Urology Clinic, Department of Biomedical and Surgical Sciences, University of Verona, Verona, Italy

Mauro Cervigni, MD Division of Urogynecology, San Carlo-IDI Hospital, Roma, Italy

Michał Chlebiej, MSc Department of Parallel and Distributed Computing, Faculty of Mathematics and Computer Science, Nicolaus Copernicus University, Torun, Poland

Valentina Ciaroni, MD Unit of General Surgery, Department of General Surgery and Organ Transplantation, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy

Filip Claerhout, MD Pelvic Floor Unit, UZ Gasthuisberg, Leuven, Belgium

Silvia Cornaglia, MD Department of General Surgery, U. Parini Hospital, Aosta, Italy

Filippa Cuccia, MD Colorectal Unit, Department of Emergency and Organ Trans- plantation, University of Bari, Bari, Italy

Pierpaolo Curti, MD Urology Clinic, Department of Surgery, A.O.U.I., Policlinic Hospital, Verona, Italy

G. Willy Davila, MD Department of Gynecology, Urogynecology and Reconstructive Pelvic Surgery, Cleveland Clinic Florida, Weston, FL, USA

Gian Gaetano Delaini, MD Department of Surgery and Gastroenterology, University of Verona, Verona, Italy

John O.L. DeLancey, MD Department of Obstetrics and Gynecology, University of Michigan Medical School, Pelvic Floor Research Group, Ann Arbor, MI, USA

Conor P. Delaney, MD Division of Colorectal Surgery, Case Medical Center, Cleve- land, OH, USA

Jan Deprest, MD Pelvic Floor Unit, UZ Gasthuisberg, Leuven, Belgium

Dirk De Ridder, MD Pelvic Floor Unit, UZ Gasthuisberg, Leuven, Belgium

Paolo Di Benedetto, MD Department of Rehabilitation Medicine, Institute of Phys- ical Medicine and Rehabilitation, University of Udine, Udine, Italy

Hans Peter Dietz, MD Department of Obstetrics, Gynecology and Neonatology, Sydney Medical School-Nepean, University of Sydney, Sydney, Australia

Giuseppe Di Falco, MD 1st Department of Surgery, Regional Hospital, Treviso, Italy

Giuseppe Dodi, MD Department of Oncological and Surgical Science, 2nd Surgical Clinic, University of Padova, Padova, Italy

Peter L. Dwyer, MD Department of Urogynaecology, Mercy Hospital for Women, Merlbourne, VIC, Australia

Tim W. Eglington, MD Division of Colorectal Surgery, Department of Academic Surgery, University of Otago, Christchurch, New Zealand Contributors XXVII

Anton Emmanuel, MD GI Physiology Unit, University College Hospital, London, UK Dee E. Fenner, MD Department of Obstetrics and Gynecology, University of Michi- gan Medical School, Pelvic Floor Research Group, Ann Arbor, MI, USA Julia R. Fielding, MD Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA Frank A. Frizelle, MD Division of Colorectal Surgery, Department of Academic Surgery, University of Otago, Christchurch, New Zealand Gamal M. Ghoniem, MD Department of Urology, Cleveland Clinic Florida, Weston, FL, USA Giuseppe Gizzi, MD Department of Medicine and Gastroenterology, S. Orsola- Malpighi Hospital, University of Bologna, Bologna, Italy Philippe Grange, MD Laparoscopic Urology, Department of Urology, Kings College Hospital, London, UK W. Thomas Gregory, MD Female Pelvic Medicine and Reconstructive Surgery, Departments of Obstetrics and Gynecology and Urology, Oregon Health and Science University, Portland, OR, USA Sara Grosso, MD Urogynecology Unit, Department of Obstetrics and Gynecology, University of Brescia, Brescia, Italy Steve Halligan, MB Department of Gastrointestinal Radiology, University College, London, UK Yvonne Hsu, MD Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT, USA Aldo Infantino, MD Department of Surgery, “Santa Maria dei Battuti” Hospital, San Vito al Tagliamento, Italy Patrizia Inselvini, MD Urogynecology Unit, Department of Obstetrics and Gyne- cology, University of Brescia, Brescia, Italy Wiesław Jakubowski, MD Department of Diagnostics Imaging, General Brodnowski Hospital, Medical University of Warsaw, Warsaw, Poland Marek Jantos, PhD Behavioural Medicine Institute of Australia, Adelaide, Aus- tralia

Joshua R. Karas, MD Division of Colon and Rectal Surgery, State University of New York, Stony Brook, NY, USA

Gevorg Kasyan, MD Department of Urology, Moscow State Medical Stomatological University (MSMSU), Moscow, Russia

Kimberly Kenton, MD Female Pelvic Medicine & Reconstructive Surgery, De- partments of Obstetrics and Gynecology and Urology, Loyola University Stritch School of Medicine, Chicago, IL, USA

Dennis H. Kim, MD Department of Urology, Cleveland Clinic Florida, Weston, FL, USA XXVIII Contributors

Małgorzata Kołodziejczak, MD Department of Surgery with Subdepartment of Proctology, Hospital at Solec, Warsaw, Poland

Ewa Kuligowska, MD Department of Radiology, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA Filippo La Torre, MD Department of Surgical Sciences, University “La Sapienza”, Roma, Italy

Andrea Lauretta, MD Department of Surgery, “Santa Maria dei Battuti” Hospital, San Vito al Tagliamento, Pordenone, Italy Joseph K.-S. Lee, MD Department of Urogynaecology, Mercy Hospital for Women, Victoria, Australia Luigi Maccatrozzo, MD Division of Urology, Regional Hospital, Treviso, Italy Andrea Maier, MD Department of Radiology, Medical University of Wien, Wien, Austria Albert Mako, MD Division of Urogynecology, San Carlo-IDI Hospital, Roma, Italy Mauro Menarini, MD Unit of Visceral Disorders and Autonomic Dysfunction, Montecatone Rehabilitation Institute, University of Bologna, Imola, Italy Gianfranco Minini, MD Urogynecology Unit, Department of Obstetrics and Gy- necology, University of Brescia, Brescia, Italy Giovanni Morana, MD Department of Radiology, Regional Hospital, Treviso, Italy Elizabeth R. Mueller, MD Female Pelvic Medicine & Reconstructive Surgery, De- partments of Obstetrics and Gynecology and Urology, Loyola University Stritch School of Medicine, Chicago, IL, USA

Sthela M. Murad-Regadas, MD Department of Surgery, School of Medicine, Federal University of Ceará, Fortaleza, Ceará, Brazil

Loredana Nasta Italian Interstitial Cystitis Association, Roma, Italy

Franca Natale, MD Division of Urogynecology, San Carlo-IDI Hospital, Roma, Italy

Thang Nguyen, MD Division of Colorectal Surgery, Department of Academic Sur- gery, University of Otago, Christchurch, New Zealand

Edoardo Ostardo, MD Division of Urology, “Santa Maria degli Angeli” Hospital, Pordenone, Italy

Claudio Pastore, MD 1st Department of Surgery, Regional Hospital, Treviso, Italy

Luciano Pellegrini, MD Gastroenterology and Endoscopy Service, “MF Toniolo” Hospital, Bologna, Italy

Francesco Pesce, MD Neuro-Urology Unit, CPO Hospital, Roma, Italy

Peter Papa Petros, MD Formerly Department of Gynecology, Royal Perth Hospital, Perth, Australia, School of Engineering, University of Western Australia, Crawley, Australia Contributors XXIX

Johann Pfeifer, MD Department of General Surgery, Medical University of Graz, Graz, Austria

Vittorio L. Piloni, MD Diagnostic Imaging Centre, “Villa Silvia” Clinic, Senigallia, Italy Rodrigo A. Pinto, MD Division of Colon and Rectal Surgery, Cleveland Clinic Florida, Weston, FL, USA Filippo Pucciani, MD Department of Medical and Surgical Critical Care, University of Firenze, Firenze, Italy Dmitry Pushkar, MD Department of Urology, Moscow State Medical Stomatological University (MSMSU), Moscow, Russia Davide Quaresmini, MD Urogynecology Unit, Department of Obstetrics and Gy- necology, University of Brescia, Brescia, Italy Amrith Raj Rao, MS Laparoscopic Urology, Department of Urology, Kings College Hospital, London, UK Carlo Ratto, MD Department of Surgical Sciences, Catholic University, Roma, Italy

Tomasz Rechberger, MD 2nd Department of Gynecology, Medical University of Lublin, Lublin, Poland Caecilia S. Reiner, MD Institute of Diagnostic and Interventional Radiology, Uni- versity Hospital, Zurich, Switzerland

Marcella Rinaldi, MD Colorectal Unit, Department of Emergency and Organ Trans- plantation, University of Bari, Bari, Italy

Paul Riss, MD Department of Obstetrics and Gynecology, Landesklinikum Ther- menregion Moedling, Moedling, Austria

Joan Robert-Yap, MD Proctology Unit, University Hospital, Geneva, Switzerland

Bruno Roche, MD Proctology Unit, University Hospital, Geneva, Switzerland

Rebecca G. Rogers, MD Department of Obstetrics and Gynecology, University of New Mexico, Albuquerque, NM, USA

Giovanni Romano, MD, Division of Colon and Rectal Surgery, Department of On- cologic Surgery, National Cancer Institute “G. Pascale”, Napoli, Italy

Maurizio Roveroni, MD Department of General Surgery, U. Parini Hospital, Aosta, Italy

Andrea Rusconi, MD Department of General Surgery, “San Pio X” Hospital, Milano, Italy

Beatrice Salvioli, MD Department of Clinical Medicine, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy, Humanitas Institute, Rozzano (MI), Italy

Giulio Aniello Santoro, MD Pelvic Floor Unit and Colorectal Service, 1st Department of General Surgery, Regional Hospital, Treviso, Italy XXX Contributors

Jakob Scholbach, Dipl Math Mathematisches Institut, Albert-Ludwigs-Universität, Freiburg, Germany

S. Abbas Shobeiri, MD Section of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA Aleksandra Stankiewicz, MD Department of Pediatric Radiology, Children’s Teach- ing Hospital, Medical University of Lublin, Lublin, Poland

Erica Stocco, MD Department of Oncological and Surgical Science, 2nd Surgical Clinic, University of Padova, Padova, Italy Jaap Stoker, MD Department of Radiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands

Iwona Sudoł-Szopińska, MD Department of Proctology, Hospital at Salte, Warsaw; Department of Diagnostic Imaging, Medical University of Warsaw, Warsaw, Poland Abdul H. Sultan, MD Department of Obstetrics and Gynaecology, Mayday Uni- versity Hospital, Croydon, Surrey, UK

Natalia Sumerova, MD Department of Urology, Moscow State Medical Stomato- logical University (MSMSU), Moscow, Russia

Sondra L. Summers, MD Department of Obstetrics and Gynecology, Loyola Uni- versity Medical Center, Chicago, IL, USA

Michael Swash, MD Department of Neurology and Neuroscience, The Royal London Hospital, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK

Stuart Taylor, MD Department of Clinical Radiology, University College, London, UK

Ranee Thakar, MD Department of Obstetrics and Gynaecology, Mayday University Hospital, Croydon, Surrey, UK

Mario Trompetto, MD Colorectal Eporediensis Centre, “Santa Rita” Clinic, Vercelli, Policlinic of Monza, Italy

Giuseppe Tuccitto, MD Division of Urology, Regional Hospital, Treviso, Italy

Frank Van der Aa, MD Pelvic Floor Unit, UZ Gasthuisberg, Leuven, Belgium

Joan Veldman, MD Pelvic Floor Unit, UZ Gasthuisberg, Leuven, Belgium

Jasper Verguts, MD Pelvic Floor Unit, UZ Gasthuisberg, Leuven, Belgium

Dominik Weishaupt, MD Institute of Radiology, Triemli Hospital Zurich, Zurich, Switzerland

Erika Werbrouck, MD Pelvic Floor Unit, UZ Gasthuisberg, Leuven, Belgium

Steven D. Wexner, MD Division of Colon and Rectal Surgery, Cleveland Clinic Florida, Weston, FL, USA Contributors XXXI

Andrzej Paweł Wieczorek, MD Department of Pediatric Radiology, Children’s Teaching Hospital, Medical University of Lublin, Lublin, Poland

Magdalena Maria Woźniak, MD Department of Pediatric Radiology, Children’s Teaching Hospital, Medical University of Lublin, Lublin, Poland

Silvia Zanelli, MD Urogynecology Unit, Department of Obstetrics and Gynecology, University of Brescia, Brescia, Italy

Andrew P. Zbar, MD Division of Colon and Rectal Surgery, Universities of New England and New Castle, New South Wales, Australia

Guillaume Zufferey, MD Proctology Unit, University Hospital, Geneva, Switzerland