This excellent textbook provides up-to-date information on all aspects of pelvic floor disorders. After an opening section on anatomy and physiology, it explains the methodology, role and application of the integrated imaging approach in detail, including the most advanced 3D, 4D, and dynamic ultrasound techniques, illustrated with hundreds of images. It then discusses in depth the epidemiology, etiology, assessment, and management of the full range of pelvic floor disorders from multidisciplinary and practical perspectives. The book also provides information on the various forms of obstetric perineal trauma, urinary incontinence and voiding dysfunction, anal incontinence, pelvic organ prolapse, constipation and obstructed defecation, pelvic pain and sexual dysfunction, and fistulas, and includes treatment algorithms as well as helpful guidance on what to do when surgical treatment goes wrong. The authors are leading experts in the field from around the globe. Since the first edition from 2010 (more than 200,000 chapter downloads), the book has been extensively rewritten and features numerous additional topics. The result is a comprehensive textbook that is invaluable for gynecologists, colorectal surgeons, urologists, radiologists, and gastroenterologists, beginners and veterans alike.

Giulio A. Santoro was educated at the University of Naples and at the University of Siena, Italy. He has been Chief of the Tertiary Referral Pelvic Floor and Incontinence Center and Consultant General Surgeon and Colorectal Surgeon, IV DegreesDivision of Surgery at Treviso Regional Hospital, Italy, for 20 years. He was Consultant Colorectal Surgeon at Cleveland Clinic Abu Dhabi, UAE for 1 year from August 2014 to 2015. He holds academic appointments as Professor of Surgery at University of Padua, Italy and as Honorary Professor of Surgery at Shandong University, China. He is Director of the Italian School of Pelvic Floor Ultrasonography and Past-President of the Italian Society of Colorectal Surgery (in 2015 he was President of the VI Degrees National Congress of the society). He is member of the editorial board of World Journal of Gastrointestinal Surgery, Female Pelvic Medicine Reconstructive Surgery, Pelviperineology and Journal of Ultrasonography. He is also author of more than 200 chapters and articles published on peer-review journals as well as author of four books. He was part of the faculty of more than 300 international Congresses, Workshops and Courses.

Andrzej Pawel Wieczorek is a Professor of Radiology and Head of the Department of Pediatric Radiology at the Medical University of Lublin, Poland. Besides pediatric radiology, one of his main scientific focus is uroradiology and pelvic floor ultrasound, as well as ultrasound diagnostics of male and female urinary incontinence in adults and children, pelvic organ prolapse in women, male and female infertility, diagnostics of prostate diseases. He authored several articles published in peer-review journals covering these topics. He is actively teaching pelvic floor ultrasound on numerous Polish and international congresses and workshops propagating the idea among various specialties in medicine. He is a lecturer on congresses, workshops and courses organized by Polish Society of Ultrasound (PTU), Polish Medical Society of Radiology (PLTR), International Urogynecological Association (IUGA), European Society of Coloproctology (ESCP), European Society of Uroradiology (ESUR). In the past he was playing a role of Vice-President of the Polish Society of Ultrasound (PTU) for 8 years. He is also author of more than 170 chapters and articles published on peer-review journals as well as an author of one book. He is an organizer of annual course about most recent developments in ultrasound since 17 years. He was part of the faculty of more than 300 international Congresses, Workshops and Courses.

Abdul H Sultan is a Consultant Obstetrician and UroGynecologist at Croydon University Hospital and honorary Reader at St George's University of London. He completed his basic medical training (MB.ChB) in South Africa prior to moving to the United Kingdom in 1984 and obtained the MRCOG degree in 1990 (FRCOG 2003). He subsequently he took up a research post under the supervision of Prof Chris Hudson at St Bartholomews and Homerton Hospitals and Professors Clive Bartram and Mike Kamm at St Mark's Hospital. The research involved studying the effects of childbirth on the pelvic floor and anal sphincters. This led to a landmark paper published in the New England Journal of Medicine and to a Doctorate (MD). His pioneering work highlighted the deficiencies in training of doctors and midwives in detecting and repairing injuries to the perineum and anal sphincter after childbirth. His past academic positions include: executive member of the British Society of Urogynaecology, International Consultation on Incontinence, The Scientific Advisory Committee (RCOG), and the scientific committee of The International Urogynecological Association. He is the co-director of a tertiary referral urogynecology Unit at Croydon University Hospital with subspecialty training and has an active research programme. He has over 200 publications and has produced the first comprehensive textbook, 'Perineal and Anal Sphincter Trauma'. He is the co-director of the popular international Perineal Trauma and Pelvic Floor Ultrasound courses conducted in Croydon. He was awarded the prestigious overall "UK Hospital Doctor of the Year" award and is the past President of the Section of Obstetrics and Gynaecology of the Royal Society of Medicine.

CONTENTS

Section I - Pelvic Floor Anatomy and Physiology: 1. State of the Art Pelvic Floor Anatomy - 2. Biochemical Properties and Hormonal Receptors of Pelvic Floor Tissues.- 3. The Integral Theory: A Musculo-elastic Theory of Pelvic Floor Function and Dysfunction.- 4. The Pelvic Floor: Functional Concepts and Neurocontrol.- Section II - Pelvic Floor Imaging: 5. Principles and Technical Aspects of Integrated Pelvic Floor Ultrasound.- 6. Transperineal Ultrasonography: Methodology and Normal Pelvic Floor Anatomy.- 7. Endovaginal Ultrasonography: Methodology and Normal Pelvic Floor Anatomy.- 8. Endoanal and Endorectal Ultrasonography: Methodology and Normal Pelvic Floor Anatomy.-9. Technical Innovations in Pelvic Floor Ultrasonography - 10. X-ray Techniques: Methodology and Normal Pelvic Floor Anatomy.- 11. Magnetic Resonance Imaging: Methodology and Normal Pelvic Floor Anatomy.- 12. Dynamic Magnetic Resonance of the Pelvic Floor: Technique and Methodology. Section III -Obstetric Pelvic Floor and Anal Sphincter Trauma: 13. Mechanisms of Pelvic Floor Trauma During Vaginal Delivery.- 14. Obstetric Perineal and Anal Sphincter Trauma.-15. Neurogenic Trauma During Vaginal Delivery.- 16. Prevention of Perineal Trauma. Section IV -Urinary Incontinence and Voiding Dysfunction: 17. Overview: Epidemiology and Etiology of Urinary Incontinence and Voiding Dysfunction. Assessment: 18. Patient-Reported Outcome Assessment.- 19. Urodynamics Techniques and Clinical Application.- 20. Ultrasonographic Techniques and Clinical Application. Management: 21. Behavioural Therapies and Biofeedback.- 22. Selection of Midurethral Slings for Women with Stress Urinary Incontinence.- 23. Tape Positioning- Does it matter?.- 24. Colposuspension and Fascial Slings.- 25. Injectable Biomaterials.- 26. Artificial Urinary Sphincter in Women.- 27. Pharmacological Treatment of Urinary Incontinence, Overactive Bladder and Voiding Dysfunction.- 28. Intravesical Botulinum toxin for treatment of Overactive Bladder 29. Sacral Nerve Stimulation for overactive bladder and voiding dysfunction. Section V - Anal Incontinence: 30. Overview: Epidemiology and Etiology of Anal Incontinence.- Assessment: 31. Patient-Reported Outcome Assessment.- 32. Anorectal Manometry: Techniques and Clinical Application.- 33. Three-dimensional Endoanal Ultrasonography.- 34. Transperineal Ultrasonography.- 35. Magnetic Resonance Imaging.- 36. Neurophysiological Evaluation: Techniques and Clinical Application. Management: 37. Treatment: Which Outcome Should We Measure?.- 38. Behavioural therapies and biofeedback.- 39. Pharmacological Treatment of Anal Incontinence: the Evidence.- 40. Sphincter Repair and Postanal Repair.- 41. Dynamic Graciloplasty.- 42. Injectable Biomaterials .- 43. Artificial Bowel Sphincter and Magnetic Anal Sphincter.- 44. Sacral Nerve Stimulation.- 45. Posterior Tibial Nerve Stimulation.- 46. Radiofrequency.- 47. Other Surgical Options for Anal Incontinence: From End Stoma to Stem Cell. Section VI - Pelvic Organ Prolapse: 48. Overview: Epidemiology and Etiology of Pelvic Organ Prolapse - Assessment: 49. Patient-Reported Outcome and Clinical Assessment .- 50. Integrated Imaging Approach to Pelvic Organ Prolapse.- 51. Transperineal Ultrasonography for Pelvic Organ Prolapse and Levator ani Damage.- 52. Three-dimensional and Dynamic Endovaginal Ultrasonography for Pelvic Organ Prolapse and Levator ani Damage.-53. Magnetic Resonance and Levator Ani Damage.- 54. Dynamic Magnetic Resonance Imaging for Pelvic Organ Prolapse. Management: 55. Pelvic Floor Muscle Training in Prevention and Treatment of Pelvic Organ Prolapse.- 56. Use of Pessaries for Pelvic Organ Prolapse.- 57. Anterior and posterior colporrhaphy - native tissue versus mesh.- 58. The Abdominal versus Vaginal approach to middle compartment prolapse.- 59. The Laparoscopic Approach to Urogenital Prolapse - 60. The Robotic Approach to Urogenital Prolapse.- 61. Concurrent continence and prolapse surgery - 62. Multidisciplinary Approach for pelvic organ prolapse - the way forward?.-Section VII - Constipation and Obstructed Defecation: 63. Epidemiology, Phatophysiology, Evaluation and Management of Constipation and Obstructed Defecation. An Overview. Assessment: 64. Patient-Reported Outcome and Clinical Assessment.- 65. Anorectal Manometry, Rectal Sensory Testing and Evacuation Tests.-66. Transperineal Ultrasonography and Obstructed Defecation.-67. Echodefecography: Technique and Clinical Application.- 68 Evacuation Proctography.- Management: 69. Pharmacological Treatment of Irritable Bowel Syndrome and Constipation: the Evidence .- 70. The Abdominal Approach to Rectal Prolapse.- 71. The Perineal Approach to Rectal Prolapse.- 72. The Laparoscopic Approach to Posterior Compartment Prolapse.- 73. The Robotic Approach to Rectal Prolapse.-74. Sacral Nerve Stimulation in Constipation.- Section VIII - Pelvic Pain and Sexual Dysfunction.-75. Painful Bladder Syndrome.- 76. Pelvic Pain Associated with a Gynecologic Etiology.-77. Pelvic Pain Associated with a Coloproctologic Etiology.- 78 Female sexual dysfunction.- 79. Surface Electromyography and Myofascial Therapy.-80. Pharmacological Treatment of Chronic Pelvic Pain.-Section IX - Fistula: 81. Urogenital Fistulae.- 82. Rectovaginal Fistulae.- 83. Emerging Concepts in Classification of Anorectal Fistulae.- 84. Ultrasonographic Assessment of Anorectal Fistulae.- 85. MRI Assessment of Anorectal Fistulae.- 86. Surgical Treatment of Anorectal Fistulae.- 87. Management of Anorectal Fistulae in Crohn's Disease.- Section X - Failure or Recurrence after Surgical Treatment: What to Do When it All Goes Wrong: 88. Imaging of Complications After Urogynecologic Surgery.- 89. Surgical Management of Complications After Urogynecologic Surgery.- 90. Imaging of Complications After Colorectal Surgery.- 91. Surgical Management of Complications after Colorectal Surgery. Section XI - Miscellaneous: 92. Congenital Abnormalities of the Pelvic Floor: Assessment and Management.- 93. Male Urinary Incontinence:Assessment and Management. Appendix: A1. Algorithm Treatment for Urinary Incontinence; A2. Algorithm Treatment for Anal Incontinence; A3. Algorithm Treatment for Pelvic Organ Prolapse; A4. Algorithm Treatment for Constipation and Obstructed Defecation; A5. Algorithm Treatment for Chronic Pelvic Pain; A6. Algorithm Treatment for GenitoUrinary Fistulas, A6. Algorithm Treatment for Anorectal Fistulas