Pelvic Dysfunction in Men

Professor Grace Dorey Phd FCSP, UK.  Professor of Physiotherapy (Urology), University of the West of England, Bristol, UK .

• List of Figures xiiiList of Tables xviiPreface xixAcknowledgements xxi1 History of the Male Pelvic Floor 1Introduction 1Physiotherapy development 1Assessment of the male pelvic floor 2Pelvic floor exercises 3Posture 3Detrusor underactivity 3Detrusor overactivity 4Nocturnal enuresis 5Post-prostatectomy incontinence 5Post-micturition dribble 6Constipation 6Faecal incontinence 7Erectile dysfunction 7Conclusion 82 Lower Urinary Tract Symptoms 9Male lower urinary tract symptoms 9Male questionnaires 10Prevalence of lower urinary tract symptoms 12Summary 133 Anatomy and Physiology of the Lower Urinary Tract 15Male lower urinary tract 15Prostate gland 17Pelvic floor muscles 18Penis 22Nerve supply to the urinary system 22Congenital abnormalities 24Summary 274 Nervous Control of Lower Urinary Tract Function 29Introduction 29Urinary continence 29Micturition cycle 29Neurological control of the bladder 31Integral bladder storage and voiding reflexes 33Summary 355 Prostate Conditions and their Treatment 37Investigations for prostate conditions 37Benign prostatic hyperplasia 38Prostate cancer 40Prostatitis 41Summary 416 Urinary Incontinence 43Definition of urinary incontinence 43Prevalence of urinary incontinence in men 43Incidence of urinary incontinence following transurethral resection of the prostate 44Incidence of urinary incontinence following radical prostatectomy 44Classification of lower urinary tract symptoms 45Storage symptoms 45Voiding symptoms 47Post-micturition symptoms 47Signs suggestive of lower urinary tract dysfunction 47Urodynamic terminology 50Summary 517 Pelvic Pain in Men 53Introduction 53Definitions of pelvic pain 53Acute pelvic pain 54Chronic pelvic pain syndromes 54Penile pain 54Prostatitis 55Sexual pain 55Incidence of pelvic pain 55Aetiology of acute pelvic pain 56Aetiology of chronic pelvic pain 57Assessment of pelvic pain 58Treatment of acute pelvic pain 58Treatment of chronic pelvic pain 58Summary 618 Patient Assessment 63Introduction 63Subjective assessment 63Bowel activity 65Objective assessment 69Urodynamics 70Summary 749 Conservative Treatment 75Conservative treatment for men with lower urinary tract symptoms 75Stress urinary incontinence 77Urge urinary incontinence 87Post-prostatectomy incontinence 90Post-micturition dribble 91Chronic retention of urine 91Extra-urethral urinary incontinence 93Functional incontinence 94Follow-up treatment 94Treatment outcomes 94Prevention of urinary incontinence 94Pads 94Appliances 96Skin care 96Research opportunities 97Case studies: Questions and answers 98Summary 10010 Literature Review of Treatment before and after Prostatectomy 101Introduction 101Literature search 102Results 103Conclusions 11111 Treatment of Post-prostatectomy Patients 113Introduction 113Assessment 113Treatment 114Post-prostatectomy complications 117Post-prostatectomy erectile dysfunction 119Summary 120Frequently asked questions 12012 Medication 123Introduction 123Pharmacotherapy for detrusor overactivity 124Pharmacotherapy for stress urinary incontinence 126Pharmacotherapy for nocturnal enuresis 127Medication for nocturia 127Medication which may have an adverse effect on lower urinary tract function 128Medication which reduces the size of the prostate gland 130Medication which relaxes the smooth muscle of the bladder neck 130Medication for prostate cancer 130Medication for hypocontractile bladder 131Medication for erectile dysfunction 131Medication which changes the colour of the urine 131Summary 13113 Faecal Incontinence 133Introduction 133Digestive system 133Defaecation 134Pelvic floor muscles 134Causes of faecal leakage 137Treatment for faecal leakage 138Summary 14414 Male Sexual Dysfunction 145Introduction 145Low libido 145Erectile dysfunction 146Orgasmic and ejaculatory disorders 153Anorgasmia 154Anejaculation 154Retrograde ejaculation 155Retarded ejaculation 156Premature ejaculation 157Aspermia 158Haemospermia 158Low-volume ejaculate 159Painful ejaculation 159Anhedonia 159Sexual pain 160Summary 16015 Treatment of Male Sexual Dysfunction 161Introduction 161Low libido 161Erectile dysfunction 162Literature review of physical therapy for erectile dysfunction 163Premature ejaculation 174Conclusions 17616 Setting up a Continence Service 177Introduction 177Integrated continence services 177Director of continence services 179Contacts for specialist groups 182Suppliers 183Helplines for men in the UK 183Books and videos for professionals 185Books for patients 186Video for patients 187Summary 187Appendix: Male Continence Assessment Form 189Glossary 197References 201Index 217

"The glossary of terms is useful and contains many common terms used in the specialty; for the student, it would be helpful to provide clarification of the terms 'nocturia' and 'urgency'." (Physiotherapy Journal, March 2010)"This is a welcome addition to the field and should be of interest to a wide variety of healthcare providers who care for these patients." (Doody's Health Services)"...an essential reference book for physiotherapists working in the field of male pelvic floor disorders …simple layout...." (Association of Psychotherapists in Women's Health, September 2006)