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Stress Urinary Incontinence Panel

Stress Urinary Incontinence Panel. Marie Fidela R. Paraiso, M.D. Head, Division of Urogynecology Professor of Surgery Cleveland Clinic Lerner College of Medicine at Case Western Reserve University Cleveland, OH. What I Do Surgically For My Patients With SUI, cont’d. Situation Surgery.

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Stress Urinary Incontinence Panel

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  1. Stress Urinary Incontinence Panel Marie Fidela R. Paraiso, M.D. Head, Division of Urogynecology Professor of Surgery Cleveland Clinic Lerner College of Medicine at Case Western Reserve University Cleveland, OH

  2. What I Do Surgically For My Patients With SUI, cont’d. Situation Surgery Primary or recurrent TVT or SUI with hypermobility – TOT older, LPP > 60 SUI with Stage 2 or 3 TOT prolapse, vaginal repair Recurrent SUI with “tight” TVT or hypermobility – Rectus Fascia LPP < 60 (ISD) Patch Sling

  3. What I Do Surgically For My Patients With SUI, cont’d. Situation Surgery Recurrent SUI with Periurethral Q-Tip < 30º; any bulking with LPP collagen “Potential” SUI with TOT or Mini-sling prolapse reduced, with cystocele vaginal repair repair

  4. Office Procedures for Stress Urinary Incontinence: Bulking Agent Injections and Autologous Stem Cells Stem-Cell Homing with or without a scaffold AUGS, IUGA, ICS 2009: Chemokines, myoblasts, and fibroblasts

  5. Stem Cell Injection for Stress Urinary Incontinence Do you think that this treatment will be available on the market in the near to moderately near future? Which of these alternatives is/are financially feasible? Commercially proliferated autologous stem cells Regenerated donor stem cells Stem cell homing

  6. Graft Implants Tissue and organ engineering What’s the Price / Value proposition to the patient ? Cellular: regenerate or signal to scaffold Price Bioactive, conductive, remodeling tissues Inert, inactive, permanent materials Volume & Value 0

  7. Urethral Bulking AgentsReference: 4th ICI 2008, Surgery for Urinary Incontinence in Women, ARB Smith et al • No evidence that any one bulking agent is more effective than any other (EL=2) • No data comparing urethral bulking agents with non-surgical treatments or with other minimal access surgical techniques.

  8. Urethral Bulking Agents • RECOMMENDATIONS • Women should be aware that: • Efficacy diminishes with time • Repeat injections may be required • Efficacy inferior to that of other surgical techniques (Grade B) • Research recommendation • Impact on other techniques? (Does or how does previous collagen affect future anti-incontinence surgery results?)

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