UroGynecology Simplified Nandita Palshetkar, Shakir Tabrez Z, Rubina Shanawaz Z, Selvapriya Saravanan
Page numbers followed by b refer to box, f refer to figure, fc refer to flowchart, and t refer to table
Abdomen 35, 118
examination 29
ultrasound of 102
Abdominal apical suspension procedures 185
Abdominal leak point pressure 49
Abdominal procedure 185
concomitant 73
Abdominal uterosacral ligament suspension 182, 185, 189
Acupuncture 59
Adhesions 129
Adnexal mass 153
Aesthetic gynecology 222t
Aesthetic vaginal surgery 209
Albumin, serum 21
Albuminuria 22
Ambulatory urodynamics monitoring 43, 50, 51
American Association for Surgery of Trauma 122
American College of Obstetricians and Gynecologists 162, 209
American Society of Plastic Surgeons 209
American Urological Association 30, 80, 108
Analgesia, regional 136
Anesthesia 60, 62, 108, 186, 189, 197
general 68
local 68
regional 68
Angiogenesis 222
Angiotensin converting enzyme inhibitors 55
Anterior mesh placement 187
Anterior sacrospinous suspension technique 168
Anterior vaginal wall
closure of 76f
cyst of 153
dissection of 187
prolapse 151, 151f, 152, 195f
Antibiotic prophylaxis 108
Anticholinergic 85
agents 58
Anticipatory pelvic floor contractions 59
Anti-incontinence sling surgeries 112
Antimicrobial prophylaxis 99, 108t
Apex, reconstruction of 198
Apical suspension procedures 156f, 165
Arcus tendineus fascia pelvis 6, 10f, 167
Augment apical suspension 165, 172
Augmentation cystoplasty 86
Autologous fascial sling 72, 77, 78f, 80
Autologous retropubic midurethral sling 79
Autologous transobturator midurethral sling 79
Bacteria 21
promote colonization of 97
Baden-Walker halfway scoring system 152
Behavioral therapies 58, 82
collecting system 36
ureter 36
Bilateral iliococcygeus fascia suspension 169, 169f
Bile salts 22
Bilirubin 22
Birth injury 150
Bladder 26, 51, 68, 113, 140
autoaugmentation of 86
catheterization 117
compliance 27
contractions 82
diary 82
diverticula 112
emptying requires 42
examination of 111
function 27, 82
hypocontractility 47f
injury 111, 117, 119, 129, 130, 132f
location of 130t
prevention of 132
recognition of 130
repair of 131
risk factors for 129, 129b
timing of 130, 130t
innervation 42f
lesions 112
neck 111
neoplasm 98
neurogenic 38f
outlet obstruction 93f
overactive 84f, 92, 138
perforation 79
pillars 18
sensation 27
stones 98
training 59, 82
visualization of 107
ipsilateral side of 126
irregular thickening of 31f
thickness 38
Bleeding 113
complications 187
Blood 22
examination of 20, 21, 24
sugar 57
urea nitrogen 154
Board of North American Menopause Society 218
Boari flap 126, 126f
Body, perineal 153
Bony pelvis 5f
Botulinum toxin 85
injection of 96
intravesical 85
Breisky-Navratil retractors 167
Broad ligament fibroids 115
Burch colposuspension 6, 62
Burch sutures, placement of 63f
Calcium 23
Candidal infections 55
Cardiac failure, congestive 55
Cardinal ligament 18
Casts 21
Catheter 44
externalized 108
types of 45f
Cell 222
therapy method 200
Cellulitis 55
Central nervous system 55, 85
cytology 153
fibroids 115
stroma 18
stump 198f
Cervix, congenital elongation of 153
Cesarean delivery 129
previous 129
Cesarean section 129, 136
analysis 20, 22t
peels, perineal 219
Chest X-ray 154
Chloride 23
Chronic obstructive pulmonary disease 55, 185
Ciprofloxacin 99, 108
Clean intermittent
catheterization 73, 136
self-catheterization 84, 94, 95f
Clitoral hood 212
reduction 211, 212, 212f, 219
Coccygeus-sacrospinous ligament complex 166
Colpocleisis 158f, 159f
total 158
Colpoperineoplasty 212, 213f
Colpoperineorrhaphy, posterior 157, 178
Colpopexy, sacrospinous 156f
anterior 155, 157, 157f
posterior 155, 157f
Combination therapy 85
Comorbidity, history of 28
Complete blood count 154
Complete urethral obstruction 107
Complex neuropathic bladder dysfunction 146
Compression 34
Computed tomography scan 35, 93
Connective tissue 18
Conservative treatment 144
Constipation 98
Continuous antibiotic prophylaxis 99
Cooper's ligament 5, 6, 18
Corticosteroid 108
Cosmetic vaginal surgery 209
Cosmeto-plastic gynecology 209
Cotton swab test 57
chronic 55
test 219
Crawford fascial stripper 78
Crystals 21
Cystitis 136
acute 137
complicated 99
recurrent 31f
uncomplicated 99
Cystocele 40
formation 9f
Cystogram 31f
Cystometry 43, 48
Cystoplasty 86
flexible 109, 110
sheath 109, 109f
types of 109
Cystoscopic-guided ureteric catheterization 116f
Cystoscopy 29, 58, 61, 76f, 93, 98, 107, 108, 111, 112, 118f, 119, 120f, 123, 188, 190
basics of 107
use of 112
Cystotomy 107, 131b
intentional 118
Cystourethroscope, flexible 111f
da Vinci robotic system 204, 204f
components of 205
parts of 204
Darifenacin 58, 85
Deep perineal reflexes 153
Deep tendon reflexes 56
Depression 55
instability, stress-induced 57
myomectomy, partial 86
pressure 48, 49
Diabetes mellitus 28, 55
Diarrhea 98
Dietary modifications 59
Diode laser 222
Distal ureteral calculus 102f
Distant coexistent infection 108
acquired 39
congenital 39
formation 146
Dorsal lithotomy position 68
Double collecting system 36
Double lens laparoscope 205f
Double ureter 36
Double-kink sign 103f
Duplex kidney 36
Dye testing 29
Dyspareunia 69, 146, 157, 219
Dysuria 98
symptoms of 137
Electrical stimulation 59, 86
Electrocardiography 154
Electrolytes, serum 22
Electromyography 43, 49, 93, 94
Emergency delivery 129
E-mesenchymal stem cells 201f
Endocrine therapy 218
Endometrial mesenchymal stem 201
Endopelvic fascia, hammock of 12
Episeotomy scar lightening 219
Episode, acute 99
Epithelial cells 21
Erbium: YAG laser 220
360° scanning scope 220f
carbon dioxide 222
Escherichia coli 39, 98, 99
Estrogen 58
Excretory system, duplication of 36f
Extended-spectrum beta-lactamase 137
Extracorporeal magnetic resonance therapy 59
Fascia lata 77, 78, 78f, 79
pubovaginal sling 62
suburethral sling 62
Fascial repair, anterior 177
Fat 18
Fecal incontinence 98
Fecaluria 98
Female cosmetic genital surgery 194, 209, 215, 219
emerging functional role of 194
Feminizing genital reconstructions surgery 141
Fesoterodine 58
Fever 131
Fibrin glue, use of 146
Fibrinogen 21
Fibroid 153
Fistula 40, 140
classification systems 143
iatrogenic 140
postpartum 40
urogenital 140f
Flank pain 98
Fluoroscopy 43
Foley bulb
appearance of 131
visualization of 118
Foley catheter 68, 74, 76, 77
intraperitoneal 118f
Fowler's syndrome 94f, 96
Fractional CO2 laser 219
Fractures 55
Fulcrum effect, elimination of 208
Genital hiatus 153
Genital malignancy 219
Genital prolapse 150
Genital symptoms 218
Genital wart removal 219
Genitalia, female 210, 213, 217
Genitourinary fistula
identification of 140
management of 140
Globulin, serum 21
Glomerular filtration rate 24, 101
measurement of 24
Glucose 22
Goh's classification system 144
Gonadotropin-releasing hormone agonists 218
Granulomas 146
Growth factors 222
Hand tremor, elimination of 208
Hematuria 98, 118, 131
Hemoglobin 22
Hemorrhage 68
Hiatus urogenitalis 153
High-intensity focused ultrasound 221, 222
principle of 221, 221f
High-uterosacral ligament suspension 165, 175
Himenoplasty 219
Hormone replacement therapy 28, 95, 154
Horseshoe kidney 36f
Hyaluronic acid 213
Hydrodissection 167f
Hydronephrosis 102f
gestational 101
Hydroureteronephrosis 37, 37f
Hymen 210
Hymenoplasty 214, 214f
Hypercalcemia 23
Hyperchloremia 23
Hyperkalemia 23
Hypernatremia 23
euvolemic 23
hypervolemic 23
hypovolemic 23
Hyperphosphatemia 23
Hypersensitivity 26
Hypocalcemia 23
Hypochloremia 23
Hypokalemia 23
Hypomagnesemia 23
Hyponatremia 23
hypervolemic 23
hypovolemic 23
Hypophosphatemia 23
Hysterectomy 160, 190
abdominal 123f
laparoscopic 207
robotic 207
Hysteropexy 196
procedures 196
sacrospinous 196
Ileal ureter 127f
Ileum, arcuate rim of 17
Ileus 131
Iliac artery, internal 18
Iliococcygeus fascia 170
Iliopectineal ligament 5f, 198f
fixation 192f
Inadvertent cystotomy, urological assessment of 131fc
Incision 186, 189
Incontinence 40, 98
types of 27t
Indocyanine green 207
Indwelling catheter drainage 144
Infections 112
persistent 99
Infertility 146
iatrogenic 1
mechanism of 114, 122
perineal 136
prevention of 119
site of 114
International Consultation on Incontinence Committee 138
International Continence Society 53, 67, 135
classification 27t
Female Lower Urinary Tract Symptoms 88
International Federation of Gynaecology and Obstetrics with International Society of Obstetric Fistula Surgeon 144
International Prostate Symptom Score 89, 89t
International Society for Study of Women's Sexual Health 218
Intestine 140
Intravenous indigo carmine 122
Intravesical pressure 48
Intrinsic sphincter deficiency 53, 54, 72
Invasive urodynamic 44
evaluation, indications of 47
Joel-Cohen and Misgav-Ladach methods 130
Kegel's exercises 58
Kelleher questionnaire 55
Kelly's stitch 157
Ketone bodies 22
Kidney 20
autotransplanted 127f
normal sonographic appearance of 34f
central wedge of 211
majora 210, 213, 213f
majoraplasty 213
minora 210, 212, 213
Labiaplasty 210, 210f, 219
Labor 129, 130
Laceration, perineal 153
Laparoscopic electrosurgical complications 116
Laparoscopic procedure 165, 185
Laparoscopic uterosacral ligament suspension 182
Laparoscopy 117f, 118f
Lasers, advantages of 221
Le Fort's colpocleisis 158
Goodall-power modification of 158
Le Fort's modifications 154
Le Fort's operation 154
ani muscle 6f, 18, 195f
complex 54f
detachment 7
muscles 153
Lichen sclerosis 219
Light amplification by stimulated emission of radiation 222
Light source 109
Lignocaine gel, local application of 108
Linear edge resection 211
Lower ureteric injury 123f
Lower urinary tract 26, 28t
afferent pathways of 11
symptoms 26, 47, 88, 98, 146
Lumbar sympathetic nerves 10
Lynch syndrome 161
Mackenrodt's complex 171f, 172f
Mackenrodt's ligament 171, 172
Magnesium 23
Magnetic resonance imaging 31, 33, 35, 93, 102, 103, 194
Malignancy 39
Manchester operation 154
Marshall and Boney's test 57
Master-Slave system 204
Matrix metalloproteins 217
Maximum urethral closure pressure 50, 50f
McCall culdoplasty 158, 165, 170, 170f, 171, 172
modified 171
technique of 171
McCall procedure 172
McCall sutures 171
external 171
internal 171
McGuire's technique 72
Meatal stenosis 47f
Medical therapy 82
Medicolegal issues 92
Menopause, genitourinary syndrome of 217
Menstrual periods 219
Mesh 156f
erosion 188
placement 187, 188
Methylene blue dye 122
Metzenbaum scissors 68
Michigan four-wall technique 168
Microvascularization 222
Micturition, dynamics of 42
Midurethral complex deficiency 72
Midurethral sling 60, 73
placement, types of 60f
Minimally invasive sacrocolpopexy 189, 198
Mirabegron 85
Mixed urinary incontinence 63, 72
Mons pubis 210, 214
reduction 214
Mons veneris 214
Movement, enhanced range of 208
Multipara, risk factors in 150
Muscles forming pelvic floor 6
Myelodysplasia 72
Myomectomy, Robotic 206, 207
Native tissue repair 200
Natural orifice transluminal endoscopic surgery 199
Nephrogram 34
Nephrographic phase 5f, 35
Nephrolithotomy, percutaneous 105
Nephrostomy, percutaneous 124, 124f
Neurogenic incontinence 72
Neurogenic lower urinary tract symptoms 51
Neurological disorders 43, 92
Neuromodulation 95
Nifedipine 104
Nitrite 22
Nocturia 98
Non-antimicrobial prophylaxis 99
Non-contrast computed tomography 35, 102
Noninvasive tests 43
Noninvasive urodynamics 45
Nonsteroidal anti-inflammatory drugs 103
Nonsurgical cosmetic vulvovaginal procedures 214
Normal sonographic appearance 33, 34f
Normal uroflowmetry
curve 46, 46f
graph 91f
Nulliparous prolapse 150
Obesity 55, 115
Obliterative procedures 158, 159f
Obliterative surgery 158
Obstetric fistula 138, 140, 143
Obstructive lower urinary tract symptoms 88
causes of 88t
Obturator internus 18
fascia 6, 6f
One-hour pad test 29b
Onuf's nucleus 11
Operative injuries 138
Oral contraceptive pills 28
Ovarian cysts 115
Overflow incontinence 88
Oxybutynin 58
Packed cell volume 25
Pad tests 29
Pain management 103
Para-aminohippuric acid 25
Paracervix 15, 18
Parametrium 15, 18
Pararectal space 15, 18
Paraurethral bulking agents 63
Paravaginal defect 10f
Paravesical spaces 15, 17, 18f
Patch slings 62
Pectineal ligament
anatomy of 192f
hysteropexy 197
Pectopexy 185, 191, 197
Pelvic fascia 8
Pelvic floor 5, 135
dysfunction 6, 194
examination 56
exercises 82
map 152f
muscle training 58, 59, 84, 138
repair 199
supporting pelvic organs 59f
Pelvic hypogastric plexus, formation of 11f
Pelvic mass 118
Pelvic medicine, female 30, 194
Pelvic nerves, importance of 10
Pelvic node lymphadenectomy 206
Pelvic organ 32f
prolapse 55, 150, 152, 154, 155t, 165, 175, 176f, 185, 194, 197, 201
after surgery, recurrence of 163
burden 150
etiology of 150
examination of 153b
functional anatomy of 194
management of 154
pessary treatment of 154, 154b
prophylaxis of 154
quantification system 150, 153
risk factors for 150, 150b
surgery 195
symptoms of 150, 151b
types of 151, 151b
vaginal repair 201f
Pelvic reconstructive surgery 198, 200, 201
tissue engineering for 200
Pelvic repair 194
Pelvic retroperitoneum 14
Pelvic ureter 1, 15, 18, 19f
course of 1, 1f
crossing uterine artery 2f
Pelvic viscera 15f
Pelvic walls 18
Pelvis 35, 181f
female 15
ultrasound of 102
Perineal skin
anti-wrinkle treatment 219
resurfacing 219
Perineal whitening 219
Perineoplasty 212, 213f, 219
postoperative 196f
preoperative 196f
Perineorrhaphy 155
Perineum, sensation of 56
Peripheral nervous system 10
Peritoneal cavity 131
Peritoneal closure 188
Peritoneal incision 186
Peritonitis 131
Pessary 156f
Pfannenstiel method 130
Pharmacotherapy 95
Phosphates 23
Plasma clearance 24
Plasma proteins, estimation of 21
Platelet rich plasma 213, 222
Plexuses, importance of 10
Pneumaturia 98, 118
Polyp 153
Polypropylene suture 78
Poor urinary stream 88
Port placement 189
Postcoital prophylaxis 99
Posterior abdominal wall, muscles of 16f
Posterior vaginal wall 10f, 151, 172f
deflection 167f
dissection of 187
prolapse 151f, 152, 157
Post-hysterectomy vault prolapse 165
Postvoid residual urine 30, 43, 46
Potassium 23
Pregnancy 219
test 219
Pressure 48
abdominal 48
flow study 43, 49
Prolapse 40
anterior 161
apical 152f
posterior 161
Prolene sutures, retrieval of 76f
Prophylaxis management 99
Protein 22
total 21
Proteinuria 22
Psoas hitch 126
Pubic bone 7f
Pubis liposuction 219
Pubocervical fascia 8, 8f, 9f, 17, 177, 177f
detachment of 9f, 10f
Puborectalis 7f
detachment 7f
unilateral 7f
sling 6f
Pubourethral ligament supporting proximal urethra 54f
Pubovaginal sling 62, 72, 80
surgery 64
Push and spread technique 74
Pyelogram 34
Pyelography, intravenous 36f, 116
Pyelonephritis 137, 146
Pyeloureterography, retrograde 123, 123f
Radiation 141
Radical hysterectomy, Robot enabled 206
Radiofrequency 220222
Randomized controlled trial 146
Reconstructive surgery 158, 160, 194
Rectal catheter 45
Rectal prolapse 153
Rectocele 40
Rectovaginal fascia 8f, 9, 10f, 177, 177f
Rectovaginal fistula 140f
Rectovaginal septum 14, 16, 17f
Rectum 140
Rectus fascia
pubovaginal sling 62
suburethral sling 62
Rectus sheath
closure of 77f
defattening of 73f
Red blood cells 21
Regenerative medicine, integration of 222
Renal autotransplantation 127
Renal blood flow 24, 25
calculation of 25
measurement of 25
Renal disease 24
Renal function
assessment of 20
tests 20, 22, 24t
Renal plasma flow 24, 25
measurement of 25
acute 88
risk factors for 135
Retroperitoneum 14, 14f, 15f
Retropubic sling placement 61f
Retropubic space dissection 75f
initial steps of 75f
Retropubic space of Retzius 15, 17, 17f, 74
Rigid cystoscope 109, 111
parts of 109
Robotic gynecological oncology 207
Robotic procedure 165, 185
Robotic surgery 206, 207
advantages of 208
disadvantages of 208
fundamentals of 208
Robotic systems, alternative 208
Robotic vesicovaginal fistula repair 206, 207f
Royal College of Obstetricians and Gynaecologists 135, 209
agenesis 72
colpopexy 156f
neuromodulation 86
nerves 10
pathway 10
placement of 187
site, selection of 186
Sacrocolpopexy 160, 165, 185, 185f, 189, 199, 206f
abdominal 154, 155, 160, 178, 185, 198
laparoscopic 156f, 160b
robotic 199, 206, 207
Sacrohysteropexy, abdominal 197
Sacrospinous fixation 155, 198
Sacrospinous ligament 5f, 167f
anatomy of 166f
suspension 165, 166, 168f, 178
Sacrum 18
structure of 16f
Serotonin norepinephrine reuptake inhibitor 58
Sexual dysfunction 55, 146
Sexual enhancement therapy 219
Sexual gratification, enhancement of 219
Shirodkar's operation 154
Shock wave lithotripsy 105
Sims’ speculum 153
Single ureter 36
Skene's gland abscess 98
Skin 140
irritation 55
Sling, tension-free fixation of 77f
Sodium 23
fluorescein 120f
Solifenacin 58,85
Somatic efferent pathway 11
Somatic pudendal nerves 10
Sonography 37
Space of Retzius 18, 68
Speculum examination 153
Sphincter 51
Spinal cord
injury 72
issues 55
Squamous cell carcinoma 40
Stamey needle 77, 78f
Stress urinary incontinence 6, 11, 28, 51, 53, 54, 67, 72, 146, 157, 219
causes of 137
management of 53, 67
prevalence of 137
primary 70
surgery for 92
Stromal cells 201
Suburethral sling surgery 141
Sulfamethoxazole 108
Superficial perineal reflexes 153
Superior pedicle flap rotation 211
Suprapubic bruising 118
Surgery 122
combination of 219
contraindications for 214
previous abdominal 129
principle of 144
route of 145
timing of 145
Surgical cosmetic procedures 210
Surgical therapy 86
Surgical treatment 95, 144
Sutures, placement of 177f, 190
Synthetic mesh erosion 73
Tamsulosin 104
Telescope 109, 110
lenses 110t
Tension-free vaginal tape 60, 67, 70, 72
Thoracolumbar sympathetic pathways 10
Three swab test 141, 142f
Tibial nerve stimulation, posterior 86
flaps 146
lubrication 222
oxygenation 222
sensitivity 222
Tolterodine 58, 85
Transabdominal procedures 165
Transobturator tape 62
procedure 70
sling 61
Transobturator tension-free vaginal tape 71
Transureteroureterostomy 126, 126f
Transvaginal high uterosacral ligament suspension procedures, outcome of 179t
Transvaginal mesh
placement 165
use of 202
Transvaginal natural orifice transluminal endoscopic surgery 199
Transvaginal procedures 160
Trauma 141
psychological 146
Trimethoprim 108
Trocar placement 206
Trospium 58, 85
Tubo-ovarian mass 115
Tumor 153
Typical 3-day frequency volume chart 90t
Ultrasonography 30, 92, 154
transabdominal 102f
Umbilical folds, lateral 17
Upper genitourinary tract 33
Upper tract
imaging 98
instrumentation 108
Urea clearance test 25
Ureter 114
anatomy of 181f
duplex 4
identification of 181
heterotopic 37
orthotropic 37
malformations of 4
Ureteral defect 131b
Ureteral injury 107, 112, 115, 180
Ureteral orifice, normal fish mouth opening of 118f
Ureteral reimplantation technique 125f
Ureteric blood supply, surgical significance of 2, 3, 3f
Ureteric fistula, management of 147
Ureteric injury 122, 124f, 138, 141
incidence of 140
management of 122
risk of 140
Ureteric obstruction 146
management of 178
Ureteric patency, evaluation of 177
Ureteric stenting 124
Ureterocalycostomy 127, 127f
Ureterocele 40
Ureteroneocystostomy 125, 126f
Ureteropelvic junction 102f
Ureteroscopy 103
Ureteroureterostomy 124, 124f
Ureterovesical junction 102f, 103f
Urethra 68, 113
examination of 111
visualization of 107
Urethral dilatation 95
Urethral diverticulum 39, 39f, 98, 141, 153
complications of 39
Urethral function 27
Urethral hypermobility 53, 72
Urethral lumen 39f
Urethral meatus, external 210
Urethral obstruction 92
Urethral occlusive devices 60
Urethral pressure 48, 50
profile 43, 50
recording, types of 50
Urethral procedure, concomitant 73
Urethral sphincter
external 12f
incompetence 146
Urethral stricture 47f
Urethropelvic angle, measurement of 38f
Urethrotomy 95
Urethrovaginal fistula 140f, 141
management of 147
Urethrovesical junction 62, 111
Urge incontinence 51, 82, 138
Urinalysis 20
Urinary bladder 42, 117f
dome of 118f
injuries 129
Urinary calculi, symptomatic 101
Urinary distress inventory 55
Urinary diversion 86
Urinary fistula 98, 140
initial management pathway of 145fc
Urinary incontinence 27, 28fc, 36f, 53, 153
postpartum 137
recurrence of 146
types of 53
Urinary infection
postpartum 136
treatment of 155
Urinary issues, postpartum 135
Urinary retention 70, 135
acute 68
chronic 135, 153
postpartum 135
Urinary stasis 88
Urinary stone
disease 101
formation 101t
Urinary symptoms 218
Urinary tract 1
anatomic anomalies of 108
calculi 101
infection 55, 88, 107, 146
active 107
chronic 55
complicated 98
recurrent 30, 97
risk factors for 97
injury 107, 114, 147
involvement 107
trauma 138
analysis 29, 57, 98
chemical analysis of 22t
composition of 20
culture 98
drainage 118
examination of 20, 24
extravasation 131
leak 219
microscopic examination of 21t
obstructed flow of 46f
physical examination of 21t
reduce flow of 97
solid components of 20f
Urobag 131
Urobilinogen 22
basics of 42
contraindications for 43
prerequisites for 43
study 30, 58, 80, 92, 94
clinical applications of 51
Uroflowmetry 43, 45, 90
abnormal patterns of 46
machine 43, 44f
parameters 46f
patterns 91f
test 90
Urogenital reconstruction 30
Urogram, intravenous 34t
Urogynecology 5, 10, 33
robotics in 204
Urolithiasis 55
diagnosis of 102
management of 104fc
Uropharmacology 82
Urosepsis 146
descent 151
incision, Misgav-Ladach technique of 130
preservation 160, 196, 202
prolapse 160
Uterosacral complex 172f
Uterosacral ligament 8, 155, 158, 171, 175, 176, 177f, 180, 189, 190
anatomy of 190f
colposuspension 165
fixation 191f
suspension 156f, 172, 178, 195f
robotic-assisted 199
visualization of 176
Uteroscacral complex 171f
Uterovesical fistula 141, 147
Uterus 115, 197
preservation of 161
size of 153
Vagina 140, 217
anatomy of 210
anterior compartment of 8
function of 210
improved functionality of 223
posterior compartment of 9
Vaginal aesthetics 222
Vaginal apex 177f
Vaginal apical suspension procedures 165
Vaginal atrophy 218
Vaginal bleeding 219
uncontrolled 219
Vaginal cones 59
Vaginal discharge 98
Vaginal dryness, perimenopausal 219
Vaginal epithelial penetration 188
Vaginal hysterectomy
laparoscopic-assisted 115
robotic-assisted 206, 207
Vaginal injury 219
Vaginal length, total 196
Vaginal mesh 172
Vaginal peritoneal closure 188
Vaginal prolapse
anterior 175
repair 157
Vaginal rejuvenation 209, 212, 219, 222, 223
latest procedures in 218
Vaginal repair
anterior 155
posterior 155
Vaginal sacrospinous fixation 198
Vaginal stenosis 146
Vaginal support, Delancey's three levels of 185t
Vaginal swab, high 154
Vaginal tightening 219
Vaginal toning 219
Vaginal transperitoneal HUSLS 176
Vaginal uterosacral ligament suspension 190
Vaginal wall 195f
suburethral sling 62
Vaginitis 154, 219
Vaginoplasty 195, 212, 213f
Valsalva maneuver 38
Vault prolapse 152f, 176f
classification of 152
prevention of 163
Vesicoureteric junction 38f
Vesicouterine fistula 140f
Vesicovaginal dissection 17f
Vesicovaginal fistula 112, 112f, 140f
Vesicovaginal septum 15, 17
Video cystourethrography 91
Video urodynamics 43, 50
Visceral ligaments 14, 16f
Visceral pelvic fascia 14
Visible detrusor muscle laceration 131
Visual urethral dilatation 107
cystourethrogram 30, 31f, 39f, 93
dysfunction 79, 92
postoperative 80
pressure-flow study of 49
Vulva 153, 217
anatomy of 210
function of 210
Vulval cyst 153
Vulvar vestibule 210
Vulvodynia 219
Vulvovaginal aesthetic surgery 209
Vulvovaginal atrophy 218
Waaldijk's classification system 143
Ward Mayo's hysterectomy 154
Wavelength 220
Wedge resection technique 211
law 4
rule 37
Weight loss 59, 82
White blood cells 21
Wound infection 69, 146
Z-shaped incision 211
Chapter Notes

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UroGynecology Simplified
UroGynecology Simplified
Editors Nandita Palshetkar MD FCPS FICOG FRCOG (UK) Scientific Director, Bloom IVF, Mumbai Professor Department of Obstetrics and Gynecology Dr DY Patil Medical College, Hospital and Research Centre Navi Mumbai, Maharashtra, India President, FOGSI (2019–20) President, AMOGS (2018–20) President, IAGE (2017–18) Chairperson, MSR (2017–18) Shakir Tabrez Z MS (General Surgery) MCh (Urology) FICS FIAGES Dip in MAS (Urology) Dip in Robotic Surgery (Lorraine University, France) Senior Consultant – Urology, Uro-Oncology, Andrology, Kidney Transplant and Robotic Surgery Fortis Hospitals Bengaluru, Karnataka, India Co-Editors Rubina Shanawaz Z MS (Obs & Gyn) FICS CU DRM (Germany) Consultant – Urogynecology, Gynec Endoscopy, and Robotic Surgery Fortis Hospitals Bengaluru, Karnataka, India Selvapriya Saravanan MD (Obs & Gyn) FICOG DRM (Kiel) Fellow in Fetal Medicine (MGR Univ) Director SPring Fertility Fetocare Fetogene Centre Kanyakumari, Tamil Nadu, India Forewords S Shantha Kumari Hrishikesh D Pai
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UroGynecology Simplified
First Edition: 2022
Printed at
Our parents and teachers for guiding and encouraging us to keep learning and growing
Our patients for their unshakeable trust and faith in us
Fellowship in Gyn Endoscopy (Germany)
Consultant (Obstetrics and Gynecology)
Purandare Hospital, KJ Somaiya Medical College and Research Centre,
Sir HN Reliance Foundation Hospital and Research Centre, Bhatia Hospital, Masina Hospital, Mumbai Police Hospital
Mumbai, Maharashtra, India
2nd Vice President Elect, AMOGS (2022–24)
Joint Secretary, FOGSI (2019)
Peer Reviewer, Journal of Obstetrics and Gynaecology of India
Anuj Thakre MBBS
Welcare Speciality Hospital
Ahmedabad, Gujarat, India
IVF Consultant and Laparoscopic Surgeon
Ashakiran Hospitals and Asha IVF Centers
Pune, Maharashtra, India
Ashwin Shetty MD (Obs & Gyn) MRCOG FRCOG CCST
Consultant – Obstetrics, Gynecology and Urogynecology
Sir HN Reliance Foundation Hospital and Research Centre
Mumbai, Maharashtra, India
Basavaraj Neelagar MBBS MS (General Surgery) DNB (Urology)
Consultant – Urology, Uro-Oncology, Andrology, Renal Transplant and Robotic Surgery
Fortis Hospitals
Bengaluru, Karnataka, India
Visiting Specialist
Aster Al Raffah Hospital, Ghubra
Muscat, Oman
Bimal M John MS FMIGS (France)
Senior Laparoscopic Surgeon and IVF Specialist
Credence Hospital
Thiruvananthapuram, Kerala, India
Chander P Lulla MD DMRD
Consultant, Sonologist and Fetal Medicine Specialist
Head, Department of Ultrasound
Jaslok Hospital, Mumbai
Consultant, Department of Ultrasound
Sir HN Reliance Foundation Hospital and Research Centre, Mumbai
Consultant, Ria Clinic
Mumbai, Maharashtra, India
Deepa Chaudhary MBBS MS (Obs & Gyn) FMAS (Hysteroscopic and Laparoscopy)
Dip Urogyne (GERMANY) FARM (IVF)
Associate Professor
Department of Obstetrics and Gynecology
SMS Medical College
Jaipur, Rajasthan, India
Deepa Ganesh MBBS MS FMAS DMAS FICRS FIMA Dip in MIS (Germany) Dip in ALS (France)
Dip in ACG (USA) FIMSA Fellowship in Robotics (USA)
Gynecologist, Advanced Laparoscopic and Robotic Surgeon,
Cosmetic Gynecologist, and Vaginal Laser Surgery Specialist
Founder and Director, Laser Vaginal Rejuvenation Institute of India (LVRII)
DG Laser and Cosmetic Gynecology Clinic
Chennai, Tamil Nadu, India
Managing Director (ART)
Rainbow IVF Hospital, Agra, Uttar Pradesh, India
Professor, Dubrovnik International University, Croatia
Imm Past President, IMS
President Elect, SAFOMS (2019–2021); President Elect, ISPAT
Editor-in-Chief, SAFOMS and SAFOG Journal
Member, FIGO, Reproductive Endocrinology and Infertility
Member, FIGO, RDEH
Regional Director of South Asia Ian Donald School of Ultrasound
Vice President, ISARM
Karthik Rao MBBS MS MCh (Urology) DNB (Genitourinary Surgery)
Consultant – Urology, Uro-Oncology, Andrology and Renal
Transplant Surgery
Fortis Hospitals
Bengaluru, Karnataka, India
Kiran Ashok MS (Obs & Gyn) Fellowship in Urogynecology
Consultant – Gynecology and Urogynecology
ESIC Hospital, Peenya
Bengaluru, Karnataka, India
Madhusudhan Naidu MBBS DGO MRCOG CCST (Urogynecology, London)
Director and Consultant – Urogynecology
Bengaluru, Karnataka, India
Mala Raj MBBS DGO FICOG Dip in Advanced Endoscopic Surgery (Germany, France, Taiwan)
Dip in Reproductive Medicine (Germany) Fellowship in Aesthetic Gynecology (USA)
Managing Director
Firm Hospitals
Chennai, Tamil Nadu, India
Manish Machave MD DNB MNAMS LLB Dip in Endoscopy (Germany)
Adv Dip in Gyn Endoscopy (France) ISSA (Italy)
Director and Consultant
Machave Hospital—Center for High Risk Pregnancy and Advanced Endoscopy, Pune
Consultant Endoscopist and Postgraduate Teacher
Ruby Hall Clinic, Kamla Nehru Hospital
Pune, Maharashtra, India
Manjula Anagani MD FICOG
Padmashree Awardee
Clinical Director and Head
Department of Obstetrics and Gynecology
Care Hospitals
Hyderabad, Telangana, India
Manpreet Sharma MBBS MS (Obs & Gyn)
Department of Obstetrics and Gynecology
Rainbow Hospital
Agra, Uttar Pradesh, India
Mohan Balaiah Aswathaiya MBBS MS DNB (Urology)
Consultant – Urology, Andrology and Kidney Transplant Surgery
Fortis Hospitals
Bengaluru, Karnataka, India
Mohan Keshavamurthy MBBS MS MCh (Urology) FRCS(C) FASTS FICS Fellowship in Trans Surg (Canada) Fellowship in Urogyn Onc (TMH, Mumbai) Dip in Robotic Surgery (France)
Director – Urology, Uro-Oncology, Urogynecology, Andrology,
Transplantation and Robotic Surgery
Fortis Hospitals, Bengaluru, Karnataka, India
Visiting Consultant – Urology
Aster Al Raffah Hospital, Oman
Norvik Hospital, Uganda
Molina Patel MD Dip RM MRCOG
Akanksha Hospital and Research Institute, Anand
Assistant Professor, Shree Krishna Hospital and Medical Research Center
Anand, Gujarat, India
Fellow in Aesthetic Gynecology, IAAGSW, London School of Medicine
N Rajamaheswari MD DGO MCh (Urology)
Director, Urogynecology Research Center, Chennai
Consultant, Department of Urogynecology
Chennai Urology and Robotics Institute
Chennai, Tamil Nadu, India
President, Urogynecology and Reconstructive Pelvic Surgery Society of India (URPSSI)
Managing Director
Global Rainbow Health Care and MNMH (P) Ltd, Agra, Uttar Pradesh, India
Professor, Sarajevo School of Science and Technology, Croatia
President, INSARG
Vice President, WAPM/SAFOG
Neeta Mishra MBBS MD (Obs & Gyn)
Department of Obstetrics and Gynecology
Nitya Maternity and Nursing Home
Ahmedabad, Gujarat, India
Neharika Malhotra MD (Obs & Gyn) DRM (Germany) ICOG
Fellowship in Reproductive Medicine and Ultrasound
Infertility Consultant
Rainbow IVF
Agra, Uttar Pradesh, India
Nita Thakre MD
Gynecologist, Obstetrician and Urogynecologist
Director, Welcare Speciality Hospital, Ahmedabad
Senior Consultant, KD Hospital
Ahmedabad, Gujarat, India
Hon Joint Secretary, AOGS (2021–22)
West Zone Coordinator, FOGSI (2020–21)
Chairperson, FOGSI Urogynaecology Committee (2017–19)
Prabha Agrawal MD FICOG FMAS
Senior Consultant
Department of Obstetrics and Gynecology
Care Hospitals
Hyderabad, Telangana, India
Prashanth K Adiga MD
Department of Obstetrics and Gynecology
Kasturba Medical College (KMC), Manipal
Manipal Academy of Higher Education (MAHE) University
Manipal, Karnataka, India
Premkumar Krishnappa MS (General Surgery) DNB (Genitourinary Surgery)
Urologist, Urogynecologist, Andrologist, Uro-Oncologist,
Robotic and Renal Transplant Surgeon
Fortis Hospitals
Bengaluru, Karnataka, India
Consultant Gynecologist
Credence Hospital
Thiruvananthapuram, Kerala, India
Ramesh Hanumegowda MS MCh (Urology)
Consultant – Urology, Andrology and Renal Transplant Surgery
Fortis Hospitals
Bengaluru, Karnataka, India
Ritu Hinduja MD MRM (UK) DRM (Germany) FICOG Fellowship in Reproductive Medicine (India, Spain, Israel) Certificate in Genetic Counseling
Senior Consultant
Fertility Specialist
Nova IVF Fertility Center
Mumbai, Maharashtra, India
Rohan Palshetkar MS (Obs & Gyn) FRM DRME (Germany) ADRM (Germany)
ART Consultant and Endoscopic Surgeon
Associate Professor, DY Patil Medical College, Hospital and Research Centre
Unit Head, DY Patil Bloom IVF, Navi Mumbai
Consultant, Department of Obstetrics and Gynecology
Surya Hospitals, Breach Candy Hospital Trust
Palshetkar Patil Nursing Home
Mumbai, Maharashtra, India
Rubina Shanawaz Z MS (Obs & Gyn) FICS CU DRM (Germany)
Consultant – Urogynecology, Gynec Endoscopy and
Robotic Surgery
Fortis Hospitals
Bengaluru, Karnataka, India
Santosh Kumar Subudhi MBBS MS DNB (Urology)
Consultant – Urology, Uro-Oncology, Andrology, Urogynecology and
Kidney Transplant Surgery
Fortis Hospitals, Bengaluru
Visiting Consultant, Jayashree Multispeciality Hospital, Bengaluru, Karnataka
Teja Nursing Home, Hindupur, Andhra Pradesh
Chirayu Hospital, Gulbarga, Karnataka, India
Selvapriya Saravanan MD OG FICOG DRM (Kiel) Fellow in Fetal Medicine (MGR Univ)
SPring Fertility Fetocare Fetogene Centre
Kanyakumari, Tamil Nadu, India
Shakir Tabrez Z MS (General Surgery) MCh (Urology) FICS FIAGES Dip in MAS (Urology) Dip in Robotic Surgery (Lorraine University, France)
Senior Consultant – Urology, Uro-Oncology, Andrology,
Kidney Transplant and Robotic Surgery
Fortis Hospitals
Bengaluru, Karnataka, India
Shemi Bansal MBBS DIPGO
Department of Obstetrics and Gynecology
Rainbow Hospital
Agra, Uttar Pradesh, India
Shreyas Nagaraj MBBS MS DNB (Urology)
Department of Urology
Fortis Hospitals
Bengaluru, Karnataka, India
Sreeharsha Harinatha MS (General Surgery) MCh (Urology) Dip in Robotic Surgery (France) Dip in Urogynecology (Germany)
Consultant – Urology, Uro-Oncology, Urogynecology, Andrology,
Transplant and Robotic Surgery
Fortis Hospitals
Bengaluru, Karnataka, India
T Srikala Prasad MD (Obs & Gyn) DGO MCh (Urology)
Professor and Head, Department of Urology
Chengalpattu Medical College
Chengalpattu, Tamil Nadu, India
Past Secretary, OGSSI
Secretary, Tamil Nadu Chapter of SOVSI (Society of Vaginal Surgeons of India)
Nominated Indian Member of the Urogynecology Committee of AOFOG
Urvashi Neelagar MBBS MS (Obs & Gyn) Fellowship in Fetal Medicine
Assistant Professor
Department of Obstetrics and Gynecology
Ramaiah Medical college,
Bengaluru, Karnataka, India
Vineet Mishra MD (Obs & Gyn)
SAFUG (South Asian Federation of Urogynecology)
Professor Director
Institute of Kidney Diseases and Research Centre, Medicity, Asarwa
Ahmedabad, Gujarat, India
Vishal MBBS MS MCh (Urology)
Consultant – Urology, Uro-Oncology, Urogynecology and Andrology
Fortis Hospitals
Bengaluru, Karnataka, India
UroGynecology Simplified is a novel attempt to enhance the knowledge of gynecologists with regard to female urological clinical dilemmas. The editors have aimed to include the most important topics which present in day-to-day clinical practice. The authors, each being doyens in their field, have presented their approach benefitting the reader with both their knowledge and perspective of the subject.
This book is a necessary addition to every aspiring pelvic surgeon, be it gynecologist or urologist or urogynecologist as it covers the most pertinent aspects right from basics to clinical approach to surgeries up to the latest advances.
Wishing the book all success.
S Shantha Kumari
President, FOGSI (2021–22)
Senior Consultant, Department of Obstetrics and Gynecology
Laparoscopic Surgeon, Yashoda Hospitals
Hyderabad, Telangana, India
Chairperson, ICOG (2018–19)
Secretary, ICOG (2015–17)
Member, FIGO Working Group on Violence against Women (2015–18)
ICOG Governing Council Member (2012–15)
IAGE Managing Committee Member (2012–18)
National Corresponding Editor for JOGI (2011–13)
Having been a part of various societies and panels over the past few decades, I have always noticed the lacunae when it comes to the specialty of urogynecology and the apprehensions by many fellow gynecologists in treating the conditions such as pelvic organ prolapse or genitourinary fistulae and many more. This compilation of chapters painstakingly put together, incorporates a wealth of information starting from the relevant clinical anatomy and physiology to the multifarious investigations available and including the various treatment modalities available to treat these conditions. It is an exhaustive body of work clearly elucidating comprehensively yet succinctly the otherwise complex world of Urogynecology and also aptly titled UroGynecology Simplified!
I congratulate the authors, renowned specialists from across the nation, for their earnest efforts in penning down these chapters and to the editors for having compiled this book, through this trying pandemic. I wish the authors and editors all the very best and hope it will serve to enlighten many in our fraternity, and enable them to not just counsel their patients appropriately but also treat them with absolute confidence and trust.
Hrishikesh D Pai
President Elect, FOGSI (2022)
Gynecologist and Head of IVF Unit
Lilavati Hospital
Mumbai, Maharashtra, India
Scientific Director, Bloom IVF
Chief Administrator, FOGSI Manyata Project
Director, Corporate Affairs, IFFS
Secretary General, FOGSI (2015–17)
Ever so often, we have so many of our gynecologist colleagues approaching us with various concerns ranging from urinary incontinence to pelvic organ prolapse to urinary calculi to bladder or ureteric injuries amongst others.
This book is our honest endeavor to reach out to all our gynecologist colleagues and general surgeons performing pelvic surgery and take that element of apprehension or anxiety out of this sometimes intricate field and allow them not just to understand it better but manage all these conditions and any possible complications on their own.
I would like to express our immense gratitude to the stellar group of contributors, all of whom are superstars in their chosen fields from across the nation who have taken the time and effort to put together this impressive tome.
The endeavor has been to cover the entire palette of topics which cover urogynecology, and present them in a format which would make an interesting read and also serve as a ready reckoner at any point for reference and application during everyday clinical practice.
Though COVID-19 and its various manifestations did delay our work significantly, with contributions pouring in from the length and breadth of our wonderful nation, we have had the pleasure of editing and compiling this one of a kind work, which we hope will reach and enlighten a wide section of gynecologists, and not just introduce them but give them a wholesome picture of the hitherto enigmatic field of urology and urogynecology.
Shakir Tabrez Z
From the Editor's Desk
Greetings on behalf of the editorial board on which I am privileged to be a part of, along with Dr Nandita Palshetkar, Dr Selvapriya Saravanan and Dr Shakir Tabrez Z.
With the ongoing pandemic, it has been a Herculean task to bring to reality our brainchild of collaborating Gynecologists, Urologists and Urogynecologists to share their knowledge in a single book.
The idea behind this book is to simplify the concepts of urogynecology for the Gynec practitioners and enable better quality-of-care delivered to the patient. We felt this comprehensive amalgamation of allied specialties is essential in this present day of subspecialization and rapidly evolving technology.
We are proud of the fact that ours is the first such venture in India where experts from the allied specialties have come together to share their knowledge in a single book. We hope every reader of this book is benefited and empowered with the right approach to various diagnostic dilemmas in urogynecology.
Rubina Shanawaz Z
We are grateful to Dr S Shantha Kumari and Dr Hrishikesh D Pai for taking time out to review our book and giving us a heartening feedback. We thank M/s Jaypee Brothers Medical Publishers (P) Ltd, New Delhi, India, for patiently working with us through the COVID-19 upheaval and making our efforts see the light of day. Our heartfelt gratitude goes out to each and every author for their well-researched and earnestly articulated chapters. We are indebted to the authors of the reference articles that we have used for paving the way for us and making our task smoother. None of this would have been possible, if not for the support of our spouses and families who have been our pillars of support and encouragement.
Thank you readers for trusting your time with us and we assure you, it will be worth it.