Bladder Sling Surgery Georgia

Bladder sling Surgery 

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Slings

The procedure of choice for stress urinary incontinence in females is what is called a sling procedure. A sling usually consists of a synthetic mesh material in the shape of a narrow ribbon but sometimes a biomaterial (bovine, porcine) or the patients' own tissue that is placed under the urethra through one vaginal incision and two small abdominal incisions. The idea is to replace the deficient pelvic floor muscles and provide a "backboard" or "hammock" of support under the urethra. According to published peer-reviewed studies, these slings are approximately 85% effective. There is a great variety of slings that have been marketed in the U.S. Three of the most common are the Tension-free Transvaginal Tape, The Trans-obturator Tape, and the Minislings. Currently there is minimal long term data to show better success with one variety of sling over the others. The decision in regards to what brand or type of sling to utilize is based primarily with an individual surgeon's experience, patient preference and comorbidities such as prior abdominal surgery or previous anti-incontinence surgery.
Tension-free transvaginal (TVT) sling
The tension-free transvaginal (TVT) sling procedure treats urinary stress incontinence by positioning a polypropylene mesh tape underneath the urethra.[11] The 20-minute outpatient procedure involves two miniature incisions and has an 86–95% cure rate.[12] Complications, such as bladder perforation, can occur in the retropubic space if the procedure is not done correctly. However, recent advancements have proven that the minimally invasive tvt sling procedure is regarded as a common treatment for SUI[13] There are many other complications associated with the Tension Free Transvaginal (TVT) Sling including mesh erosion from day 1 up to 7 years later.
Transobturator tape (TOT) sling
First developed in Europe and later introduced to the U.S. by urogynecologist Dr. John R. Miklos, the transobturator tape (TOT) sling procedure is meant to eliminate stress urinary incontinence by providing support under the urethra[12] The minimally-invasive procedure eliminates retropubic needle passage and involves inserting a mesh tape under the urethra through three small incisions in the groin area.[14]
] Mini-sling procedure
The mini-sling procedure was released in the United States in late 2006 by Gynecare/Johnson and Johnson under the name of TVT-Secure. AMS have released a similar version called MiniArc. The TVT-SECUR was designed to overcome two of the perioperative complications reported with use of TVT-Obturator: thigh pain and bladder outlet obstruction. The TVT-SECUR was designed to minimize the operative procedure as much as possible in order to reduce those undesired complications. This new device is composed of an 8 cm long laser cut polypropylene mesh and is introduced to the internal obturator muscle (Hammock position) by a metallic inserter, while no exit skin cuts are needed.The MiniArc is also quite simple and again eliminates the need for skin incisions other than the vaginal incision.[15]
Bladder repositioning
Most stress incontinence in women results from the urethra dropping down toward the vagina. Therefore, common surgery for stress incontinence involves pulling the urethra up to a more normal position. Working through an incision in the vagina or abdomen, the surgeon raises the urethra and secures it with a string attached to muscle, ligament, or bone. For severe cases of stress incontinence, the surgeon may secure the urethra with a wide sling. This not only holds up the bladder but also compresses the bottom of the bladder and the top of the urethra, further preventing leakage.
Marshall-Marchetti-Krantz
The Marshall-Marchetti-Krantz (MMK) procedure, also known as retropubic suspension or bladder neck suspension surgery, is performed by a surgeon in a hospital setting. Developed in 1949 by doctors Victor F. Marshall (urologist), Andrew A. Marchetti (OB/GYN), and Kermit E. Krantz (OB/GYN) is the standard by which new procedures are measured. In 1961 Dr. Burch reported a modification of the MMK operation (the Burch modification.)
The patient is placed under general anesthesia, and a long, thin, flexible tube (catheter) is inserted into the bladder through the narrow tube (urethra) that drains the body's urine. An incision is made across the abdomen, and the bladder is exposed. The bladder is separated from surrounding tissues. Stitches (sutures) are placed in these tissues near the bladder neck and urethra. The urethra is then lifted, and the sutures are attached to the pubic bone itself, or to tissue (fascia) behind the pubic bone. The sutures support the bladder neck, helping the patient gain control over urine flow. The Burch modifications involved placing the surgical sutures at the bladder neck and tying them to the Cooper ligament.
Approximately 85% of women who undergo the Marshall-Marchetti-Krantz procedure are cured of their stress incontinence.[

Peri/Trans Urethral Injections

A variety of materials have been historically used to add bulk to the urethra and thereby increase outlet resistance. This is most effective in patients with a relatively fixed urethra. Blood and fat have been used with limited success. The most widely used substance, gluteraldehyde crosslinked collagen (GAX collagen) proved to be of value in many patients. The main downfall was the need to repeat the procedure over time.[16]

Artificial urinary sphincter

In rare cases, a surgeon implants an artificial urinary sphincter,[17] a doughnut-shaped sac that circles the urethra. A fluid fills and expands the sac, which squeezes the urethra closed. By pressing a valve implanted under the skin, the artificial sphincter can be deflated. This removes pressure from the urethra, allowing urine from the bladder to pass.

Medications

The alpha-1 adrenergic receptor mediates contraction of the neck of urinary bladder and the urethra.
Alpha blockers are sometimes used to act at these receptors, but would actually worsen symptoms of stress incontinence, as an Alpha blocker would relax the internal urethral sphincter and tone the detrusor muscle of the bladder.

References

  1. ^ Haliloglu B, Karateke A, Coksuer H, Peker H, Cam C (February 2010). "The role of urethral hypermobility and intrinsic sphincteric deficiency on the outcome of transobturator tape procedure: a prospective study with 2-year follow-up". Int Urogynecol J Pelvic Floor Dysfunct 21 (2): 173–8. doi:10.1007/s00192-009-1010-y. PMID 19802505.
  2. ^ Crepin G, Biserte J, Cosson M, Duchene F (October 2006). "[The female urogenital system and high level sports]" (in French). Bull. Acad. Natl. Med. 190 (7): 1479–91; discussion 1491–3. PMID 17450681.
  3. ^ "Stress Incontinence Information". Retrieved 6 July 2005.
  4. ^ Kelly CJ, Vichayavilas PE (May 2009). "Weight loss for urinary incontinence in overweight and obese women". N. Engl. J. Med. 360 (21): 2256; author reply 2257. doi:10.1056/NEJMc090431. PMID 19458377.
  5. ^ "Incontinence reduced with diet and exercise reported by ACP Internist". Retrieved 02/10/2009.
  6. ^ a b c Choi H, Palmer MH, Park J (2007). "Meta-analysis of pelvic floor muscle training: randomized controlled trials in incontinent women". Nursing Research 56 (4): 226–34. doi:10.1097/01.NNR.0000280610.93373.e1. PMID 17625461.
  7. ^ Haddow (2005). "Effectiveness of a pelvic floor muscle exercise program on UI following childbirth". Western Australian Centre for Evidence-based Nursing 3 (5): 103–146.
  8. ^ a b http://www.bjui.org/ContentFullItem.aspx?id=427&LinkTypeID=1&SectionType=4
  9. ^ http://www.bmj.com/content/318/7182/487.abstract
  10. ^ Ogah J, Cody JD, Rogerson L. Minimally invasive synthetic suburethral sling operations for stress urinary incontinence in women. Cochrane Database of Systematic Reviews 2009, Issue 4. Art. No.: CD006375. DOI: 10.1002/14651858.CD006375.pub2 http://onlinelibrary.wiley.com/o/cochrane/clsysrev/articles/CD006375/frame.html
  11. ^ Meschia M, Pifarotti P, Bernasconi F, et al. (2001). "Tension-Free vaginal tape: analysis of outcomes and complications in 404 stress incontinent women". Int Urogynecol J Pelvic Floor Dysfunct 12 (Suppl 2): S24–27. doi:10.1007/s001920170008. PMID 11450976.
  12. ^ a b deTayrac R, Deffieux X, Droupy S, Chauveaud-Lambling A, Calvanèse-Benamour L, Fernandez H (March 2004). "A prospective randomized trial comparing tension-free vaginal tape and transobturator suburethral tape for surgical treatment of stress urinary incontinence". Am. J. Obstet. Gynecol. 190 (3): 602–8. doi:10.1016/j.ajog.2003.09.070. PMID 15041987.
  13. ^ Rardin CR, Kohli N, Rosenblatt PL, Miklos JR, Moore R, Strohsnitter WC (November 2002). "Tension-free vaginal tape: outcomes among women with primary versus recurrent stress urinary incontinence". Obstet Gynecol 100 (5 Pt 1): 893–7. doi:10.1016/S0029-7844(02)02278-0. PMID 12423849.
  14. ^ Stenchever MA (2001). "Physiology of micturition, diagnosis of voiding dysfunction and incontinence: surgical and nonsurgical treatment section of Urogynecology". Comprehensive Gynecology 4: 607–639.
  15. ^ Neuman M (September 2007). "TVT-SECUR:100 teaching operations with a novel anti-incontinence procedure". Pelviperineology 26 (3).
  16. ^ Appell RA, Macaluso JN, Deutsch JS, Goodman JR, Prats LJ, Wahl P (June 1992). "Endourologic control of incontinence with GAX collagen: the LSU experience". J Endourol 6 (3): 275–7. doi:10.1089/end.1992.6.275.
  17. ^ Ruiz E, Puigdevall J, Moldes J, et al. (October 2006). "14 years of experience with the artificial urinary sphincter in children and adolescents without spina bifida". J. Urol. 176 (4 Pt 2): 1821–5. doi:10.1016/j.juro.2006.05.024. PMID 16945659.

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