Willia ms GYNECOLOGY MCGH363_FM_pi-xxvi.indd 1 20/01/16 6:36 PM NOTICE Medicine is an ever-changing science. As new research and clinical experience broaden our knowl- edge, changes in treatment and drug therapy are required. The authors and the publisher of this work have checked with sources believed to be reliable in their efforts to provide information that is complete and generally in accord with the standards accepted at the time of publication. However, in view of the possibility of human error or changes in medical sciences, neither the authors nor the publisher nor any other party who has been involved in the preparation or publication of this work warrants that the information contained herein is in every respect accurate or complete, and they disclaim all responsibility for any errors or omissions or for the results obtained from use of the information contained in this work. Readers are encouraged to confirm the information contained herein with other sources. For example and in particular, readers are advised to check the product information sheet included in the package of each drug they plan to administer to be certain that the information contained in this work is accurate and that changes have not been made in the recom- mended dose or in the contraindications for administration. This recommendation is of particular importance in connection with new or infrequently used drugs. MCGH363_FM_pi-xxvi.indd 2 20/01/16 6:36 PM Willia ms GYNECOLOGY T H I R D E D I T I O N Barbara L. Hoffman, MD John O. Schorge, MD Karen D. Bradshaw, MD Lisa M. Halvorson, MD Joseph I. Schaffer, MD Marlene M. Corton, MD New York Chicago San Francisco Lisbon London Madrid Mexico City Milan New Delhi San Juan Seoul Singapore Sydney Toronto MCGH363_FM_pi-xxvi.indd 3 20/01/16 6:36 PM Copyright © 2016, 2012, 2008 by McGraw-Hill Education. All rights reserved. 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Under no circumstances shall McGraw-Hill Education and/or its licensors be liable for any indirect, incidental, special, punitive, consequential or similar damages that result from the use of or inability to use the work, even if any of them has been advised of the possibility of such damages. This limitation of liability shall apply to any claim or cause whatsoever whether such claim or cause arises in contract, tort or otherwise. DEDICATION This edition of Williams Gynecology is dedicated to David L. Hemsell, MD, who served as Director of the Division of Gynecology at the University of Texas Southwestern Medical Center and Parkland Memorial Hospital for more than 20 years. During this tenure, his national awards have included a Meritorious Achievement award from the Infectious Diseases Society of America and an Outstanding Service award from the American College of Obstetricians and Gynecologists. Early in his training, Dr. Hemsell joined the Air Force and served our country as a Flight Medical Officer. In these years, he pursued specialty training in reproductive endocrinology with Dr. Paul MacDonald. He joined our faculty as the Division Director of Gynecology in 1977. In addition to his Director role, Dr. Hemsell was the Chief of Gynecology at Parkland Memorial Hospital and Medical Director of the Parkland Obstetrics and Gynecology Emergency Room. In these roles, Dr. Hemsell created an environment in which evidence-based medicine was the standard for care. Accordingly, patients, residents, and junior faculty all benefitted from this scientific health care approach. He also served as Director of the Faculty Sexual Assault Examination and Testimony Program. In that role, he coordinated the examinations of many thousands of sexual assault victims and the collection of legal evidence. As a result of his efforts, Dallas County has a system regarded as among the best in medical and legal care for these victims. During his academic career, Dr. Hemsell added foundational knowledge regarding the etiology, pathogenesis, and treatment of female pelvic infections, especially those following gynecologic surgeries. With this expertise, he served as journal reviewer for multiple journals. He has added to academic knowledge through his nearly 50 book chapters and 100 peer-reviewed articles on multiple gynecologic topics. For us in the Department of Obstetrics and Gynecology, Dr. Hemsell plays an important role of mentor and colleague. His experience and clinical expertise are invaluable and provide a valuable sounding board for challenging gynecology cases. On so many levels, we have benefitted greatly from his academic and clinical contributions. MCGH363_FM_pi-xxvi.indd 5 20/01/16 6:36 PM This page intentionally left blank CONTENTS Editors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xiii Contributors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xv Artists . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xix Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xxi Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xxiii SECTION 1 BENIGN GENERAL GYNECOLOGY 1. Well Woman Care . . . . . . . . . . . . . . . . . . . . . . 2 8. Abnormal Uterine Bleeding . . . . . . . . . . . . . 180 2. Techniques Used for Imaging 9. Pelvic Mass . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 202 in Gynecology . . . . . . . . . . . . . . . . . . . . . . . . . . 22 10. Endometriosis . . . . . . . . . . . . . . . . . . . . . . . . . . 230 3. Gynecologic Infection . . . . . . . . . . . . . . . . . . 50 11. Pelvic Pain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 249 4. Benign Disorders of the 12. Breast Disease . . . . . . . . . . . . . . . . . . . . . . . . . . 275 Lower Genital Tract . . . . . . . . . . . . . . . . . . . . 86 13. Psychosocial Issues and 5. Contraception and Sterilization . . . . . . . . .105 Female Sexuality . . . . . . . . . . . . . . . . . . . . . . . 297 6. First-Trimester Abortion . . . . . . . . . . . . . . . .137 14. Pediatric Gynecology . . . . . . . . . . . . . . . . . . . 318 7. Ectopic Pregnancy . . . . . . . . . . . . . . . . . . . . . .161 vii MCGH363_FM_pi-xxvi.indd 7 20/01/16 6:36 PM viii Contents SECTION 2 REPRODUCTIVE ENDOCRINOLOGY, INFERTILITY, AND THE MENOPAUSE 15. Reproductive Endocrinology . . . . . . . . . . . 334 19. Evaluation of the Infertile Couple . . . . . . . 427 16. Amenorrhea . . . . . . . . . . . . . . . . . . . . . . . . . . . 369 20. Treatment of the Infertile Couple . . . . . . . 449 17. Polycystic Ovarian Syndrome 21. Menopausal Transition . . . . . . . . . . . . . . . . . 471 and Hyperandrogenism . . . . . . . . . . . . . . . . 386 22. The Mature Woman . . . . . . . . . . . . . . . . . . . . 492 18. Anatomic Disorders . . . . . . . . . . . . . . . . . . . . 404 SECTION 3 FEMALE PELVIC MEDICINE AND RECONSTRUCTIVE SURGERY 23. Urinary Incontinence . . . . . . . . . . . . . . . . . . . 514 25. Anal Incontinence and Functional Anorectal Disorders . . . . . . . . . . . . . . . . . . . . 561 24. Pelvic Organ Prolapse . . . . . . . . . . . . . . . . . . 538 26. Genitourinary Fistula and Urethral Diverticulum . . . . . . . . . . . . . . . . . . 577 SECTION 4 GYNECOLOGIC ONCOLOGY 27. Principles of Chemotherapy . . . . . . . . . . . . 592 33. Endometrial Cancer . . . . . . . . . . . . . . . . . . . . 702 28. Principles of Radiation Therapy . . . . . . . . . 610 34. Uterine Sarcoma . . . . . . . . . . . . . . . . . . . . . . . 722 29. Preinvasive Lesions of the 35. Epithelial Ovarian Cancer . . . . . . . . . . . . . . . 735 Lower Genital Tract . . . . . . . . . . . . . . . . . . . . 624 36. Ovarian Germ Cell and 30. Cervical Cancer . . . . . . . . . . . . . . . . . . . . . . . . . 657 Sex Cord-Stromal Tumors . . . . . . . . . . . . . . 760 31. Vulvar Cancer . . . . . . . . . . . . . . . . . . . . . . . . . . 679 37. Gestational Trophoblastic Disease . . . . . . 779 32. Vaginal Cancer . . . . . . . . . . . . . . . . . . . . . . . . . 694 MCGH363_FM_pi-xxvi.indd 8 20/01/16 6:36 PM Contents ix SECTION 5 ASPECTS OF GYNECOLOGIC SURGERY 38. Anatomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 796 41. Minimally Invasive Surgery Fundamentals . . . . . . . . . . . . . . . . . . . . . . . . . . 874 39. Preoperative Considerations . . . . . . . . . . . . 825 42. Postoperative Considerations . . . . . . . . . . . 908 40. Intraoperative Considerations . . . . . . . . . . 841 SECTION 6 ATLAS OF GYNECOLOGIC SURGERY 43. Surgeries for Benign 43-19. Bartholin Gland Duct Gynecologic Disorders . . . . . . . . . . . . . . 926 Marsupialization . . . . . . . . . . . . . . . . . . . . 973 43-1. Midline Vertical Incision . . . . . . . . . . . . . 926 43-20. Bartholin Gland Duct Cystectomy . . . . 975 43-2. Pfannenstiel Incision . . . . . . . . . . . . . . . . 929 43-21. Vulvar Abscess Incision and Drainage . . . . . . . . . . . . . . . . . . . . . . . 977 43-3. Cherney Incision . . . . . . . . . . . . . . . . . . . . 931 43-22. Vestibulectomy . . . . . . . . . . . . . . . . . . . . . 979 43-4. Maylard Incision . . . . . . . . . . . . . . . . . . . . . 932 43-23. Labia Minora Reduction . . . . . . . . . . . . . 981 43-5. Ovarian Cystectomy . . . . . . . . . . . . . . . . . 933 43-24. Vaginal Septum Excision . . . . . . . . . . . . 983 43-6. Salpingo-oophorectomy . . . . . . . . . . . . 935 43-25. McIndoe Procedure . . . . . . . . . . . . . . . . . 985 43-7. Interval Partial Salpingectomy . . . . . . . 937 43-26. Treatment of Preinvasive 43-8. Salpingectomy and Salpingostomy . . . 939 Ectocervical Lesions . . . . . . . . . . . . . . . . . 988 43-9. Cornuostomy and Cornual Wedge 43-27. Cervical Conization . . . . . . . . . . . . . . . . . . 992 Resection . . . . . . . . . . . . . . . . . . . . . . . . . . . 941 43-28. Treatment of Vulvar 43-10. Abdominal Myomectomy . . . . . . . . . . . 945 Intraepithelial Neoplasia . . . . . . . . . . . . . 995 43-11. Vaginal Myomectomy for 44. Minimally Invasive Surgery . . . . . . . . . 1003 Prolapsed Leiomyoma . . . . . . . . . . . . . . . 948 44-1. Diagnostic Laparoscopy . . . . . . . . . . . . 1003 43-12. Abdominal Hysterectomy . . . . . . . . . . . . 950 44-2. Laparoscopic Sterilization . . . . . . . . . . 1006 43-13. Vaginal Hysterectomy . . . . . . . . . . . . . . . 957 44-3. Laparoscopic Salpingectomy . . . . . . . 1011 43-14. Trachelectomy . . . . . . . . . . . . . . . . . . . . . . 962 44-4. Laparoscopic Salpingostomy . . . . . . . 1013 43-15. Sharp Dilatation and Curettage . . . . . . . . . . . . . . . . . . . . . . . 964 44-5. Laparoscopic Ovarian Cystectomy . . . 1015 43-16. Suction Dilatation 44-6. Laparoscopic and Curettage . . . . . . . . . . . . . . . . . . . . . . 966 Salpingo-oophorectomy . . . . . . . . . . . 1019 43-17. Hymenectomy . . . . . . . . . . . . . . . . . . . . . . 969 44-7. Ovarian Drilling . . . . . . . . . . . . . . . . . . . . 1021 43-18. Bartholin Gland Duct Incision 44-8. Laparoscopic Myomectomy . . . . . . . . 1022 and Drainage . . . . . . . . . . . . . . . . . . . . . . . . 971 44-9. Laparoscopic Hysterectomy . . . . . . . . 1026 MCGH363_FM_pi-xxvi.indd 9 20/01/16 6:36 PM