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
