Urination disorders
Urination disorders
Urination disorders are a problem for almost half of women over 50. 25-30% of them suffer from static or stress urinary incontinence (SUI). In the treatment of SUI, trends include placing polypropylene strips under the middle third of the urethra (midurethral slings), and in the treatment of pelvic floor defects, in addition to classic surgical methods that use native tissue, we also use top-quality titanium-coated polypropylene meshes. With these methods, the duration of hospitalization is significantly shortened, full quality of life and work capacity are established faster, damage to the surrounding tissue is minimal, and the connection of the executive and sensory organs with nerves remains intact. Treatment of a prolapse is a surgical method, while static incontinence can be treated conservatively and surgically. There are more than a hundred surgical methods of treating SUI.
Miduretralni “sling”
The placement of a midurethral sling is a surgical procedure performed on patients with isolated static urinary incontinence. There are two basic indications for the procedure: hypermobile urethra and intrinsic deficit of the urethral sphincter. During the preoperative treatment, these defects can be diagnosed by clinical examination and urodynamic treatment. If there are associated defects of the pelvic floor, the surgical procedure can be combined with other reconstructive procedures.
A polypropylene strip is used for the procedure, which is introduced with specially patented needles through a small incision on the anterior wall of the uterus. The strip is placed under the middle third of the urethra, without tension. After each procedure, any injuries to the bladder need to be ruled out with a cystoscope. At the end of the procedure, a gauze strip as well as a urinary catheter are inserted into the vagina, which are removed the next morning. Prior to discharge, the possibility of retention of urine in the bladder needs to be eliminated (using ultrasound or catheterization).
Ti-LOOP* TITANIUM-COATED MESHES
Ti-LOOP ANTERIOR* is a procedure performed on patients with an anatomical defect of the anterior wall of the uterus (cystocele) due to a central or paravaginal defect of the endopelvic (pubocervical) fascia. If there are associated anatomical defects or static urinary incontinence, the procedure can be combined with other reconstructive procedures in the small pelvis.
The procedure begins with the separation of the birth canal epithelium from the underlying pubocervical fascia and bladder. After that, four small incisions are made through the skin, two at the height of the clitoris and two in the area of the gluteal region. Through the incisions, the arms of the polypropylene mesh, located on the layer between the urinary bladder and the anterior wall of the vagina, are pulled out with specially designed needles. Depending on the size of the defect, the mesh can be additionally modeled and strengthened with sutures. The arms of the mesh are cut off, and the wall of the birth canal is sewn up. At the end of the procedure, a gauze strip is placed in the birth canal, and a catheter is placed in the bladder. The gauze is removed the next morning, and the catheter on the fifth day after surgery.
At the end of the procedure, a cystoscopic examination needs to be performed to rule out any injuries to the bladder.
Ti-LOOP POSTERIOR*
Ti-LOOP POSTERIOR* is a procedure performed on patients with a defect of the posterior vaginal wall (rectocele, enterocele) and on patients with vaginal vault prolapse after vaginal or abdominal hysterectomy. If there are associated anatomical defects or static urinary incontinence, the procedure can be combined with other reconstructive procedures in the small pelvis.
The procedure begins with the separation of the anterior wall of the birth canal from the underlying prerectal and pararectal (Denonvilliers) fascia and preparation of the pararectal space. After that, two small incisions are made through the skin, 3 cm lateral and inferior to the anus. Through these incisions, the arms of the polypropylene mesh placed on the layer between the rectum and the back wall of the vagina are pulled out with specially designed needles. Depending on the size of the anatomical defect, the mesh can be additionally modeled and strengthened with sutures in the apical segment of the birth canal. The arms of the mesh are cut off, and the wall of the birth canal is sewn up. At the end of the procedure, a gauze strip is placed in the birth canal, and a catheter is placed in the bladder. The gauze is removed the next morning, and the catheter is removed on the fifth day after surgery.
Laparoscopic lateral suspension according to dubuisson
Laparoscopic lateral suspension according to Dubuisson is a laparoscopic procedure for treating uterine prolapse or vaginal vault prolapse after hysterectomy. It is most often used in patients who want to treat uterovaginal prolapse and preserve the uterus. The suspension is achieved by laparoscopic placement of a specially constructed titanium-coated mesh on the isthmic part of the uterus or the vault (apex) of the birth canal.
The procedure begins with the insufflation of gas into the abdominal cavity and the placement of working channels and instruments for manipulation. During the procedure, the uterus and the upper third of the birth canal must be separated from the urinary bladder. Then, the mesh is introduced into the abdominal cavity and attached to the uterus or birth canal with specially patented absorbable tackers. The arms of the mesh are pulled through two anatomical channels, which are prepared just below the surface of the abdomen and pulled out through two lateral incisions on the abdominal wall. The mesh is additionally attached with stitches to the uterus or birth canal in order to ensure a reliable and long-lasting anatomical result of the procedure.
A catheter is placed in the bladder, which is removed the next day.
