Pelvic Dysfunction in Men

List of Figures xiii List of Tables xvii Preface xix Acknowledgements xxi 1 History of the Male Pelvic Floor 1 Introduction 1 Physiotherapy development 1 Assessment of the male pelvic floor 2 Pelvic floor exercises 3 Posture 3 Detrusor underactivity 3 Detrusor overactivity 4 Nocturnal enuresis 5 Post-prostatectomy incontinence 5 Post-micturition dribble 6 Constipation 6 Faecal incontinence 7 Erectile dysfunction 7 Conclusion 8 2 Lower Urinary Tract Symptoms 9 Male lower urinary tract symptoms 9 Male questionnaires 10 Prevalence of lower urinary tract symptoms 12 Summary 13 3 Anatomy and Physiology of the Lower Urinary Tract 15 Male lower urinary tract 15 Prostate gland 17 Pelvic floor muscles 18 Penis 22 Nerve supply to the urinary system 22 Congenital abnormalities 24 Summary 27 4 Nervous Control of Lower Urinary Tract Function 29 Introduction 29 Urinary continence 29 Micturition cycle 29 Neurological control of the bladder 31 Integral bladder storage and voiding reflexes 33 Summary 35 5 Prostate Conditions and their Treatment 37 Investigations for prostate conditions 37 Benign prostatic hyperplasia 38 Prostate cancer 40 Prostatitis 41 Summary 41 6 Urinary Incontinence 43 Definition of urinary incontinence 43 Prevalence of urinary incontinence in men 43 Incidence of urinary incontinence following transurethral resection of the prostate 44 Incidence of urinary incontinence following radical prostatectomy 44 Classification of lower urinary tract symptoms 45 Storage symptoms 45 Voiding symptoms 47 Post-micturition symptoms 47 Signs suggestive of lower urinary tract dysfunction 47 Urodynamic terminology 50 Summary 51 7 Pelvic Pain in Men 53 Introduction 53 Definitions of pelvic pain 53 Acute pelvic pain 54 Chronic pelvic pain syndromes 54 Penile pain 54 Prostatitis 55 Sexual pain 55 Incidence of pelvic pain 55 Aetiology of acute pelvic pain 56 Aetiology of chronic pelvic pain 57 Assessment of pelvic pain 58 Treatment of acute pelvic pain 58 Treatment of chronic pelvic pain 58 Summary 61 8 Patient Assessment 63 Introduction 63 Subjective assessment 63 Bowel activity 65 Objective assessment 69 Urodynamics 70 Summary 74 9 Conservative Treatment 75 Conservative treatment for men with lower urinary tract symptoms 75 Stress urinary incontinence 77 Urge urinary incontinence 87 Post-prostatectomy incontinence 90 Post-micturition dribble 91 Chronic retention of urine 91 Extra-urethral urinary incontinence 93 Functional incontinence 94 Follow-up treatment 94 Treatment outcomes 94 Prevention of urinary incontinence 94 Pads 94 Appliances 96 Skin care 96 Research opportunities 97 Case studies: Questions and answers 98 Summary 100 10 Literature Review of Treatment before and after Prostatectomy 101 Introduction 101 Literature search 102 Results 103 Conclusions 111 11 Treatment of Post-prostatectomy Patients 113 Introduction 113 Assessment 113 Treatment 114 Post-prostatectomy complications 117 Post-prostatectomy erectile dysfunction 119 Summary 120 Frequently asked questions 120 12 Medication 123 Introduction 123 Pharmacotherapy for detrusor overactivity 124 Pharmacotherapy for stress urinary incontinence 126 Pharmacotherapy for nocturnal enuresis 127 Medication for nocturia 127 Medication which may have an adverse effect on lower urinary tract function 128 Medication which reduces the size of the prostate gland 130 Medication which relaxes the smooth muscle of the bladder neck 130 Medication for prostate cancer 130 Medication for hypocontractile bladder 131 Medication for erectile dysfunction 131 Medication which changes the colour of the urine 131 Summary 131 13 Faecal Incontinence 133 Introduction 133 Digestive system 133 Defaecation 134 Pelvic floor muscles 134 Causes of faecal leakage 137 Treatment for faecal leakage 138 Summary 144 14 Male Sexual Dysfunction 145 Introduction 145 Low libido 145 Erectile dysfunction 146 Orgasmic and ejaculatory disorders 153 Anorgasmia 154 Anejaculation 154 Retrograde ejaculation 155 Retarded ejaculation 156 Premature ejaculation 157 Aspermia 158 Haemospermia 158 Low-volume ejaculate 159 Painful ejaculation 159 Anhedonia 159 Sexual pain 160 Summary 160 15 Treatment of Male Sexual Dysfunction 161 Introduction 161 Low libido 161 Erectile dysfunction 162 Literature review of physical therapy for erectile dysfunction 163 Premature ejaculation 174 Conclusions 176 16 Setting up a Continence Service 177 Introduction 177 Integrated continence services 177 Director of continence services 179 Contacts for specialist groups 182 Suppliers 183 Helplines for men in the UK 183 Books and videos for professionals 185 Books for patients 186 Video for patients 187 Summary 187 Appendix: Male Continence Assessment Form 189 Glossary 197 References 201 Index 217