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Surgical Treatment of Stress Urinary Incontinence

Surgical Treatment of Stress Urinary Incontinence. Hann-Chorng Kuo Department of Urology Buddhist Tzu Chi General Hospital. Surgical Goals for Stress Urinary Incontinence. To restore urinary continence To preserve normal micturition Free of bladder outlet obstruction

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Surgical Treatment of Stress Urinary Incontinence

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  1. Surgical Treatment of Stress Urinary Incontinence Hann-Chorng Kuo Department of Urology Buddhist Tzu Chi General Hospital

  2. Surgical Goals for Stress Urinary Incontinence • To restore urinary continence • To preserve normal micturition • Free of bladder outlet obstruction • Not to create newly developed urge incontinence or exacerbate existing urge incontinence • Not to jeopardize renal function

  3. Historical surgical procedures for stress urinary incontinence • Kelly plication procedure • Marshall-Marchetti-Kratz procedure • Pereyra procedure • Stamey bladder neck suspension • Raz bladder neck suspension • Gittes bladder neck suspension

  4. Marshall Marchetti Krantz Procedure

  5. Repair of Paravaginal defect

  6. Current popular surgical procedures for SUI • Burch colposuspension procedure • Fascial pubovaginal sling procedure • Vaginal sling procedure • Collagen, Teflon, fat injection • Synthetic pubovaginal sling procedure • Tension free vaginal tape • Laparoscopic bladder neck suspension

  7. Burch colposuspension

  8. Periurethral injection for SUI

  9. Laparoscopic Bladder neck suspension

  10. Laparoscopic Colposuspension

  11. Long term (5-year) results of Anti-incontinence surgery

  12. Surgical results by Types of stress incontinence

  13. Success rates of SUI in Different surgical procedures

  14. Goals for Surgical correction of Stress incontinence • Adequate vaginal support of the urethra and bladder neck for urethral hypermobility • Restoration of hammock effect during stress for damages in attachments to fascia pelvis • Increase urethral coaptation if intrinsic sphincteric deficiency exists • Correct prolapse concomitantly • Do not create bladder outlet obstruction

  15. Elevated bladder neck after Incontinence surgery

  16. Defects in vaginal attachment and vaginal wall weakness

  17. Anterior colporrhaphy with pubovaginal sling procedure

  18. Pubovaginal Sling procedures • Fascial sling – rectus fascia, fascia lata • Sling on a string • Artificial sling - mersilene silastic dacron marlex • Cadaveric or porcine collagen sling • Bone anchor sling • TVT / SPARC – polypropylene mesh

  19. Techniques of Pubovaginal sling procedure

  20. Fascial and Silastic slings • Silastic and fascial slings are not elastic • Both form rigid support at bladder neck • Move very little – 1 to 2 mm only • Produce proximal compression • More likely to be obstructive • Mersilene more likely to erode

  21. TVT – tension-free vaginal tape • First published 1996 by Ulmsten • >200,000 performed worldwide to date • Innovative in: • Midurethral positioning • Stretchable woven Prolene™ mesh • Rough edge for fixation to tissues • Local or regional anaesthesia / day surgery

  22. MECHANICAL PROPERTIES OF IMPLANT MATERIALS

  23. Obstruction of TVT Sling

  24. Operative success rate in SUI

  25. Prolene mesh Pubovaginal sling procedure • 64 patients, aged 37 – 82 years • Mean follow-up 24 months • 52 were dry, 2 were dry after a second sling, 10 had improvement but mild SUI • Satisfactory rate 86% • Persistent DI in 3, resolution of DI in 3, De novo DI in 4

  26. Polypropylene mesh sling

  27. Techniques in performing prolene mesh pubovaginal sling

  28. Urodynamic results after pubovaginal sling procedure

  29. Videourodynamic results after Pubovaginal sling procedure

  30. Detailed surgical techniques for Prolene pubovaginal sling

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