Book Review

Multidisciplinary Management of Female Pelvic Floor Disorders

N Engl J Med 2007; 356:2009May 10, 2007

Article

Multidisciplinary Management of Female Pelvic Floor Disorders
Edited by Christopher R. Chapple, Philippe E. Zimmern, Linda Brubaker, Anthony R.B. Smith, and Kari Bø. 369 pp., illustrated. Philadelphia, Churchill Livingstone, 2006. $179. ISBN: 978-0-4430-7272-7

Traditionally, the pelvis has been a field of battle among urologists, colorectal surgeons, and gynecologists. Simplistically speaking, urologists pay attention to the bladder, gynecologists the reproductive organs, and colorectal surgeons the alimentary tract. Pelvic-floor disorders often overlap, including both urinary and fecal incontinence and pelvic-organ prolapse. These disorders are common and costly, and their care is complicated by turf battles that result in the piecemeal treatment of women with these conditions. The problem is further compounded because pelvic-floor disorders are often treated by surgeons, when better treatment might be nonsurgical. This multidisciplinary book brings together urologists, urogynecologists, gynecologists, geriatricians, physiotherapists, and pharmacists to provide a comprehensive approach to the treatment of disorders of the pelvic floor.

The book is well organized. Like most reference books on pelvic disorders, this one begins with a review of anatomy and physiology, proceeds to clinical evaluation, and concludes with medical and surgical management. What is different about this book is how it links the chapters on anatomy and physiology explicitly to clinical intervention. Often, reference books outline pathophysiology in detail but provide little insight into clinical management or give few reasons why certain treatments work. Here, clear anatomical and physiological explanations accompany guides to patient care. The authors consistently present a wide-angle view of the pelvic floor by explaining the current thinking in approaches to treatment and reviewing how that thinking evolved. Although this book is not a surgical atlas, ample photographs and illustrations provide added insight into the descriptions in the text. The text is well referenced, and I found the tables that summarize the current literature helpful in forming my own opinions about treatment outcomes.

My criticisms of this book are few. Although there is a chapter on the painful bladder syndrome, the text does not address pelvic pain in a comprehensive manner. None of the authors are colorectal surgeons, and aside from a brief description of anal-sphincter imaging, little attention is paid to the role of imaging in the evaluation of women with pelvic-floor disorders.

I am often asked, “What book should I purchase to use as a reference on pelvic-floor disorders when I am in practice and have to look something up?” Usually, I respond that most reference books are too outdated to serve this purpose. This book is an exception to that rule. As for my own practice, my colleagues and I plan to use this book as the background for a didactic series in fellow and resident training.

Rebecca G. Rogers, M.D.
University of New Mexico Health Sciences Center, Albuquerque, NM 87131
rrogers@salud.unm.edu