Women's Health and Education Center (WHEC)


List of Articles

  • Urinary Tract Injury: Prevention & Management
    The evolution of pelvic surgical procedures has been influenced by uncommon but potentially devastating injuries to the lower urinary tract (bladder and ureters). These injuries are associated with known risk factors, though not all such injuries are predicable or avoidable. Knowledge of anatomy and careful intraoperative ureteral identification are hallmarks in injury prevention. Accurate diagnosis and safe, timely repair of bowel, bladder and ureter is crucial in reducing morbidity, and potentially mortality. This review focuses on the literature regarding the incidence, diagnosis and management of injuries to the lower urinary tract. Diagnosis of such injuries requires careful attention to surgical entry and dissection techniques and employment of adjuvant diagnostic modalities. Identifying the injury intraoperatively reduces postoperative complications and long-term sequalae. The use of cystoscopy and agents that allow for easy discernment of ureteral efflux aid in identifying urinary tract injuries intraoperatively.

  • Current Concepts in Pelvic Floor Anatomy
    Exploring current concepts in pelvic floor anatomy and support. The endopelvic fascia divides the lesser pelvis in a manner that is similar to the way the urorectal septum divides the embryonic cloaca. Connecting descriptions of the geometry of the organs visible by magnetic resonance imaging with descriptions of their individual connections to the endopelvic fascia is also discussed. The study aims to discuss the applied anatomy and embryology of pelvic floor structures. The relevance of pelvic floor to anal opening and closure function discusses new findings with regards to the role of three muscles in the vaginal closure mechanisms. The anal-rectal angle was previously thought to be important in maintaining fecal continence, but its importance has been questioned. More recent studies suggest that fecal incontinence in women is often related to denervation of the muscles of the pelvic diaphragm, as well as to disruption and denervation of the external anal sphincter.

  • Neurophysiology Of The Lower Urinary Tract
    Discussing the normal function and neurologic control of the lower urinary tract in women. The nervous system is arranged into the central and the peripheral systems. The central nervous system includes the brain and spinal cord. Twelve paired cranial and 31 paired spinal nerves with their ganglia compose the peripheral nervous system. The somatic component of the peripheral system innervates skeletal muscle, and the autonomic division innervates skeletal muscle, and the autonomic division innervates cardiac muscle, smooth muscle, and glands. Historically, urologic complications were the main cause of death in spinal cord injury patients. Now their life expectancy is almost normal. Urodynamic diagnosis and guidance toward proper treatment is a key reason for the improved survival. Lifelong urologic surveillance is a central component to the routine care of the spinal cord injury patient. The article outlines neurologic pathways.

  • Urodynamic Assessment: Patient Evaluation & Equipment
    An overall perspective of the urodynamic assessment and have a basic understanding of the principles involved and what to be done looking for with different patient populations. It gives an overview of the procedures to assist healthcare providers in conducting urodynamic assessment. Obtaining a good medical history, concentrating on urologic complaints, is critical to do before embarking on urodynamic assessment. Urodynamics encompasses all the diagnostic modalities used in the evaluation of bladder and urethral function. It describes a number of complimentary tests of varying degrees of complexity that can be performed individually or in combination depending on the clinical circumstances. It has improved our ability to select therapy that addresses the underlying pathophysiology in a rational way. Advances in urodynamics and video-urodynamics has improved our understanding of the normal and abnormal functions of the bladder and sphincter.

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