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Cartoon of taking fascia

Cartoon of taking fascia. Surgical Technique. Horizontal suprapubic incision (4 cm) Excise rectus fascial strip (6 – 8 cm) Temporarily leave fascia open Horizontal incision over vesical neck. Surgical Technique. Mobilize vesical neck from below Perforate endopelvic fascia

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Cartoon of taking fascia

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  1. Cartoon of taking fascia

  2. Surgical Technique • Horizontal suprapubic incision (4 cm) • Excise rectus fascial strip (6 – 8 cm) • Temporarily leave fascia open • Horizontal incision over vesical neck

  3. Surgical Technique • Mobilize vesical neck from below • Perforate endopelvic fascia • Create tunnel & pass slingaround vesical neck • Cystoscopy

  4. Surgical Technique • Close vaginal wound • Bring sutures through fascia • Close rectus fascia • Suture ends of sling togetherin midline without tension • Close abdominal wound

  5. Cartoon of skin incision

  6. Balloon Incision

  7. Allis clamps

  8. Push up withindex finger onvaginalwall Traction ofclamp

  9. Left index finger pushing up on vaginal wall Shiny white surface superficialto pubo-cervical fascia

  10. Right wrist flexed downward

  11. Incorrect (deep) plane Correct (superficial) plane

  12. Correct (superficial) plane Pubo-cervical fascia Incorrect (deep) plane

  13. Index fingerbetween clamp& urethra &bladderat all times

  14. Sutures through separate stabwounds in rectus fascia Ends of sling thru fascia

  15. How much tension? • None (create a backboard) • (Almost) can’t make it too loose • Make sure Q-tip is not negative(elevation of vesical neck)

  16. Take slack out ofsling Push down on cystoscope parallel to thefloor

  17. Tie loosely with no tension

  18. PVS for Simple SUI OUTCOME SCORE 100% 0%

  19. Mixed Incontinence • Cure/Improved Rates (UIOS <= 4) : • SUI: 97% (n= 44) • MUI: 93% (n= 47)non-significant difference (p: 0.33), with study powered a priori to detect > 20% difference in outcome score Chou et al, J Urol, 2003

  20. Autologous Sling Outcomes • Cure/Improve rate - 82% at 4 years • Urinary Retention requiring intervention - 8% • De Novo OAB - 9% (Dmochowski, et al. AUA Guidelines on the Surgical Management of Female Stress Urinary Incontinence, 2010)

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