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Overview Risk Factors Causes Management Injectables Nonsurgical Treatment Medications Surgical Treatment Treatment Profiler Find a Urologist [an error occurred while processing this directive] Adrenal Cancer Bladder Cancer Bladder Control BPH/Enlarged Prostate Emergencies Epididymitis/Orchitis Erectile Dysfunction Female Sexual Dysfunction Hematuria HIV/AIDS Incontinence Interstitial Cystitis Kidney Cancer Kidney Infection Kidney Stones Male Infertility Overactive Bladder Pediatric Urology Peyronie's Disease Premature Ejaculation Prostate Cancer Prostatitis STDs Testicular Cancer Testicular Pain/Scrotal Pain Testosterone Deficiency Upper Tract Tumors Urethral Cancer Urinary Tract Infection Vaginal Prolapse Varicocele
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IncontinenceSurgical Treatment of Stress Incontinence
Marshall Marchetti Krantz (MMK)
Burch Colposuspension
Needle Suspension
The Stamey technique is performed vaginally or through a small incision above the pubic bone. A nylon suture is used to suspend the urethra on each side and cystoscopy ensures that the urethra and bladder are not injured during the procedure. The Raz procedure corrects urethral and bladder neck hypermobility when there is minimal or no herniation of the bladder into the vagina. An inverted U-shaped incision is made in the vaginal wall and bands of fibrous tissue around the bladder neck and urethra are released. A needle is passed through the incision, and the suspending sutures are pulled, lifting the front of the vagina and urethra. In the Gittes procedure, a small puncture is made above the pubic fat pad. A suture is transferred by a needle through the muscle of the pubic crest to the vaginal wall, where it is looped and drawn back through the puncture. A second suture is made through the puncture to create a strong suspension support. The process is repeated through another puncture made 1.5 to 2 cm from the first site. Both suspending sutures are tied at their puncture sites.
Sling Procedures
There are two techniques:
transvaginal, which is performed through the vagina. The pubovaginal sling is made of a strip of tissue from the patient's abdominal fascia (fibrous tissue). A synthetic sling may be used, but urethral tissue erosion commonly occurs. An incision is made above the pubic bone, and a strip of abdominal fascia (the sling) is removed. Another incision is made in the vaginal wall, through which the sling is grasped and adjusted around the bladder neck. The sling is secured by two sutures loosely tied to each other above the pubic bone incision, providing a hammock to support the bladder neck. After this procedure, patients generally regain bladder control for more than 10 years. Possible complications include accidental bladder injury, infection, and prolonged urinary retention, which may require chronic intermittent self-catheterization.
Transvaginal slings
No abdominal incision is required and a small incision is made in the vaginal wall. Two small tacks are placed in the pubic bone and a sling is inserted into the vagina and attached to the tacks with sutures. The sling supports the bladder, bladder neck, urethra, and urethral sphincter so urine can flow and be held properly.
Gynecare TVT®
The tape is placed beneath the middle of the urethra in an outpatient surgical procedure that takes 30 to 50 minutes to perform. The procedure is performed under local, regional, or general anesthesia and does not require a urinary catheter. If local or regional anesthesia is used, adjustments can be made during the procedure to ensure that adequate support is provided. Cystoscopy is performed to make sure there has been no injury to the bladder during the procedure. Gynecare TVT does not require anchors or sutures and produces minimal scarring. Recovery from the procedure takes 3 to 4 weeks. Heavy lifting and sexual intercourse should be avoided for 4 to 6 weeks. Normal daily activity can resume within 1 to 2 weeks. Complications are rare and include bleeding; blood vessel, bladder, and bowel injury; and urinary retention. If painful urination (dysuria), bleeding, or other concerns arise, the patient should contact her physician immediately. Newer procedures such as the Monarc subfascial hammock and transobturator tape (TOT) also can be used to correct stress incontinence and combined stress and urge incontinence in women. These techniques may result in fewer complications (e.g., blood vessel, bladder, and bowel injury) than other transvaginal procedures.
Artificial Sphincter
The device has three components: a pump, a balloon reservoir, and a cuff that encircles and closes the urethra. All three components are filled with fluid (e.g., saline). The cuff is connected to the pump, which is surgically implanted in the scrotum (in men) or the labia (in women). The pump is activated by squeezing or pressing a button. The fluid in the cuff empties into the reservoir, the urethra opens, and the bladder empties. Fluid from the reservoir returns to the cuff, which again closes the urethra. Possible complications include infection, tissue breakdown, and mechanical failure.
Postsurgical Complication
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Overview
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| This page last modified: Friday, May 18, 2007 | |||||
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