Surgical Management of Urinary Incontinence
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Transcript of Surgical Management of Urinary Incontinence
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Sayantika Dhar
Urinary IncontinenceSURGICAL MANAGEMENT
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Sayantika Dhar
Before the surgery:
• accurate diagnosis• assessment by- incontinence specialist,
urologist or urogynecologist.• For pre-natal women or women planning to
bear a child, doctors recommend holding off the surgery- it may undo any surgical fixture.
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Sayantika Dhar
Aim of surgical management:
• recreating urethral support allowing for the normal functioning of the urethra during increased abdominal pressures.
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Sayantika Dhar
Approaches for Stress Incontinence
Abdominal approaches• Retropubic colpo-suspension
– Burch– Marshall-Marchetti-Krantz (MMK)
Contemporary• Pubo-vaginal sling• Tension free vaginal tape (TVT)• Trans-obturator tape (TOT)
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Sayantika Dhar
Retropubic Colpo-suspension
• Retropubic suspension surgery is used to treat urinary incontinence by lifting the sagging bladder neck and urethra that have dropped abnormally low in the pelvic area.
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Sayantika Dhar
Retropubic Colpo-suspension
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Sayantika Dhar
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Pubo-vaginal Slings
• The procedure involves placing a band of sling material directly under the bladder neck (ie, proximal urethra) or mid-urethra, which acts as a physical support to prevent bladder neck and urethral descent during physical activity.
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Tension Free vaginal Taping (TVT):
• Through a small vaginal incision, permanent mesh-like material is placed underneath the urethra and anchored to the abdominal muscles above the pubic bone.
• The mesh-like material remains as a permanent sling under the urethra, preventing incontinence when straining or coughing.
• General anesthesia or local anesthesia is required.
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• Less invasive, Small incisions- Local anesthesia • Same day or overnight surgery stay• Return to work in 2 - 3 weeks
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Transobturator Sling (TOT)
• The transobturator sling (tot sling) is subfascial, ie the needle or the sling NEVER enters the retropubic space.
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Complications:
• Difficulty urinating and incomplete emptying of the bladder (urinary retention), although this is usually temporary
• Urinary tract infection• Difficult or painful intercourse
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Approach for Urge incontinence:
Augmentation Cystoplasty
Aim: increase bladder size
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• Augmentation cystoplasty is the most often performed surgical procedure for severe urge incontinence.
• In this surgery, a segment of the bowel is added to the bladder to increase bladder size and allow the bladder to store more urine.
Augmentation cystoplasty
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Augmentation cystoplasty
Contraindications• Patients who are unable or unwilling to perform life-
long intermittent catheterization should not undergo augmentation cystoplasty because of the high likelihood of ultimately requiring catheterization.
• In addition, patients with inflammatory bowel disease, bladder tumors, or severe renal insufficiency should not undergo augmentation cystoplasty.
• Patients with a short life expectancy - consider alternatives such as continued medical management.
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Urethral Bulking
Indications:• Stress or Urge incontinence• Poor or no response to conservative
management
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Aim of bulking
• Build up the thickness of the wall of the urethra so it seals tightly when you hold back urine.
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• Performed under local anaesthesia• Collagen used as bulking agent • a skin test is done to check for allergies before
the procedure
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Risks:
• pain at the injection site• injury to the urethra, and • Migration/ dislodging of the bulking material
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Sayantika Dhar
THANK YOU