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Described by one contemporary as the 'sweet singer of The Temple', George Herbert has long been recognised as a lover of music. Nevertheless, Herbert's own participation in seventeenth-century musical culture has yet to be examined in detail. This is the first extended critical study to situate Herbert's roles as priest, poet and musician in the context of the musico-poetic activities of members of his extended family, from the song culture surrounding William Herbert and Mary Sidney to the philosophy of his eldest brother Edward Herbert of Cherbury. It examines the secular visual music of the Stuart court masque as well as the sacred songs of the church. Arguing that Herbert's reading of Augustine helped to shape his musical thought, it explores the tension between the abstract ideal of music and its practical performance to articulate the distinctive theological insights Herbert derived from the musical culture of his time.

We gain bladder control as young children and from this time onwards a healthy bladder is controlled by the central nervous system. The detrusor will not normally contract until it is convenient to initiate a void. This contraction is initiated at the level of the cerebral cortex. When detrusor overactivity is present, however, the detrusor contracts spontaneously during the filling phase of the micturition cycle, when micturition would normally be inhibited. The true incidence of this condition is unknown; it is possible that we all exhibit detrusor overactivity on occasions. For example, many ‘healthy’ people will have symptoms of urinary urgency when the weather is cold, when they have drunk strong coffee or when they put their key in the front door with a full bladder. In some people, this condition causes great distress and can manifest as severe urinary frequency with urgency. There may be associated urge urinary incontinence; this can be particularly distressing as the bladder may empty completely off an unstable detrusor contraction. Definition and aetiology Detrusor overactivity is defined as a urodynamic observation characterised by involuntary detrusor contractions during the filling phase that may be spontaneous or provoked. It is apparent from this definition that, as there has to be objective evidence of a detrusor contraction, detrusor overactivity can be diagnosed only after a urodynamic study. It is neither necessary nor desirable to investigate all women presenting with symptoms of frequency, urgency and urge incontinence with a urodynamic study. When the history is typical, one can usually presume that there is underlying detrusor overactivity and treat empirically for 1–2 months. Urodynamics can be reserved for those in whom empirical treatment fails.

While the upper renal tract remains the sole preserve of the urologist, gynaecologists have traditionally been involved in the assessment and treatment of female lower urinary tract infection disorders. Childbirth is a major causal factor in urogynaecology, and women often present with a combination of menstrual, genital, urinary and colorectal symptoms which require a holistic approach. This book provides a comprehensive overview of the assessment and treatment of a range of urogynaecological problems: urinary incontinence; lower urinary tract symptoms; overactive bladder; recurrent urinary tract infection; haematuria; painful bladder syndrome and interstitial cystitis; pregnancy and the renal tract; ageing and urogenital symptoms; fistulae and urinary tract injuries; pelvic organ prolapse; colorectal disorders; obstetric anal sphincter injuries. It has been comprehensively updated to reflect current clinical practice and new research since publication of the original edition.

Introduction The assessment and investigation of the gynaecological patient are rapidly moving away from the operating theatre and ward environment and into the outpatient department. This move has been fuelled by the demands of the patient and the clinician for a rapid, accurate diagnosis, with the minimum of investigations and invasive procedures, as well as by the economic constraints of inpatient admission. Urinary incontinence and genital prolapse are common and debilitating conditions. Estimates of their prevalence vary considerably according to the different populations studied and the various definitions used. Whichever estimates are used, however, urinary incontinence and genital prolapse are undoubtedly common in apparently healthy women. Urinary incontinence may be defined as ‘the complaint of any involuntary leakage of urine’. Not everyone with incontinence is sufficiently bothered by the symptoms to want help. Furthermore, there is reluctance to seek help and only about one-third of regularly incontinent women discuss their problem with a nurse or general practitioner. In this chapter, we first describe what investigations and management can be undertaken at the primary care level for women with symptoms of urinary incontinence and genital prolapse, and we suggest referral guidelines that are vital for the effective use of secondary care resources. We then describe what can reasonably be covered in a single visit to a specialist urogynaecology clinic, the so-called the ‘one-stop urogynaecology clinic’.