TREATMENT OF FEMALE STRESS URINARY INCONTINENCE (SUI)

1. TREATMENT OF FEMALE STRESS URINARY INCONTINENCE(SUI) Entrer la date

2. Mini Invasive Vaginal Tape MIVT

3. MIVT PRESENTATION • Polypropylene monofilament tape • Macropores > to 75 microns • => Meets the AFNOR requirements • Sizes: 11 x 1.2 cm. • Both ends are fitted with 1 gusset for a good anchorage into the tissue • Provided with 1 insertion tool in case of difficulties to find the dissection tunnel

4. MIVT PRESENTATION

5. MIVT PRESENTATION

6. MIVT PRESENTATION A mini invasive vaginal tape has to meet to 2 main important characteristics: • EASY AND REPRODUCIBLE MANOEUVRE • ANCHORAGE • ADJUSTMENT

7. MIVT PRESENTATION • Anchorage: the double gussets assure a good positioning of the tape. One side: tension strength: 19.75 N Two sides: tension strength: 25.5 N • Adjustment: As the tape is exclusively composed of monofilament polypropylene, the surgeon can push or release the tape as many times as he wants. (tissues are usually shred but not with a polypropylene tape => MiniArc tissues are shred)

8. MIVT PRESENTATION Selling point: • Easy and reproducible manoeuvre • Efficiency: Similar to the TVT/TOT

9. MIVT PRESENTATION • No need to cross the obturator membrane: Reduction of the immediate post-operative pains(3 to 10% of all cases). => Reduction of the post-operative neuralgic risks: even if it is very rare, it is one of the most dangerous accident that can occur after a TOT intervention.

10. ANATOMIC DISSECTION Pubic bone MIVT exit TOT entrance Neuro-vascular bundle Posterior branch of obturator nerve Bladder

11. PRESENTATION OF MIVT IMPLANTATION • Anaesthesia: - local, regional or general.

12. PRESENTATION OFMIVT IMPLANTATION • Installation of the patient:Gynaecological position

13. PRESENTATION OFMIVT IMPLANTATION • Material:

14. PRESENTATION OF MIVT IMPLANTATION OPERATING TECHNIQUE: • The draining of the bladder must be performed before the incision, as for the TVT or TOT methods. • A 2 cm deep median incision is made on the anterior vaginal wall, 1.5 cm under the urinary meatus. • A dissection from both part of the urethra is made with Metzenbaum scissors until the ischio-pubic ramus and behind to open the pelvic aponeurosis or urogenital membrane (a dip must be felt by the surgeon).

15. PRESENTATION OF MIVT IMPLANTATION OPERATING TECHNIQUE:

16. PRESENTATION OF MIVT IMPLANTATION OPERATING TECHNIQUE: • The point of the Jones scissors is slipped into the gusset of the tape. Using the scissors, locate the middle of the tape (screw or opening line of the scissors). • Take the dissection tunnel with the scissors + the tape, go behind the ischio-pubic ramus, through the urogenital membrane or pelvic aponeurosis, then push the tape until the mark on the scissors. • The same manoeuvres are performed on each side.

17. PRESENTATION OFMIVT IMPLANTATION OPERATING TECHNIQUE: • The middle of the tape must be marked. Middle

18. PRESENTATION OF MIVT IMPLANTATION OPERATING TECHNIQUE:

19. PRESENTATION OFMIVT IMPLANTATION OPERATING TECHNIQUE: • Other possibility: If the surgeon experienced some difficulties to find the tunnel, the guide (slide) may be used to find the dissection tunnel.

20. PRESENTATION OF MIVT IMPLANTATION OPERATING TECHNIQUE:

21. PRESENTATION OFMIVT IMPLANTATION Operating technique: • Adjustment: the MIVT tape is inserted against the urethra without tension.

22. PRESENTATION OFMIVT IMPLANTATION OPERATING TECHNIQUE:

23. PRESENTATION OFMIVT IMPLANTATION • Extraction of the tape(from a suprapubic incision view)

24. PRESENTATION OFMIVT IMPLANTATION • Extraction of the tape(from a suprapubic incision view)