Παρουσίαση με θέμα: "TVT TVT-O TVT-S needless"— Μεταγράφημα παρουσίασης:
1 TVT TVT-O TVT-S needless ΦΑΤΛΕΣ Κ. ΓΕΩΡΓΙΟΣΧΕΙΡΟΥΡΓΟΣ ΟΥΡΟΛΟΓΟΣΟΥΡΟΛΟΓΙΚΗ ΚΛΙΝΙΚΗΙΠΠΟΚΡΑΤΕΙΟΘΕΣΣΑΛΟΝΙΚΗIt's becoming clear that stress urinary incontinence is not simply a binary type of condition in which the patient either has it or doesn't. The answer to the question of whether someone is stress incontinent is most often sometimes, and this is something that we have to take into account. This is a condition that affects people at certain times in their lives, but not other times, and this also has an impact on how we select therapy. I'm going to continue that theme in discussing some of our current therapies
2 Stress Incontinence causes Urethral hypermobilitya common cause of SUI,refers to significant displacement of the urethra (and bladder neck) during physical exertion when abdominal pressure is increasedHypermobility decreases pressure transmission and results in leakage of urineKEY POINT: .ADDITIONAL INFORMATION: The most common causes of SUI are urethral hypermobility and intrinsic (urethral striated muscle) sphincter deficiency (ISD). In some patients, these two conditions may coexist.Urethral hypermobility is caused by anatomical defects in the pelvic floor muscles as a result of which the urethra loses extrinsic support and may descend during stress (i.e. a sudden increase in abdominal pressure). This prevents the urethra from becoming compressed and the urethral closure pressure becomes insufficient to overcome the increased bladder pressure. The pressure transmission deficit results in leakage of urine.Staskin DR. In: Cardozo L, Staskin DR, eds.Textbook of female urology and urogynaecology, 2001 p. 84-9
3 Stress Incontinence causes ΦυσιολογικήσύγκλισηΠαθολογικήISD is another common cause of SUI.The urethra does not contract sufficiently and as a consequence it does not close completely.This permits leakage even with minimal stress / increase in abdominal / bladder pressure.KEY POINT:ADDITIONAL INFORMATION: There are gradations of ISD; it is not an all-or-none phenomenon.The decline in urethral function can be at the level of pudendal innervation, urethral striated sphincter mass and function, and urethral smooth muscle, mucosa and submucosal cushions (Mostwin J, et al. In: Abrams P, et al. (eds.). In: Abrams P, et al. Incontinence, 3rd ed. Paris: Health Publication Ltd 2005 p ).There is a growing clinical impression that some degree of ISD may exist in many patients, who until recently, were thought to have only hypermobility as a cause of their SUI (Mostwin J, et al. In: Abrams P, et al. (eds.). In: Abrams P, et al. Incontinence, 3rd ed. Paris: Health Publication Ltd 2005 p ).Staskin DR. In: Cardozo L, Staskin DR, eds.Textbook of female urology and urogynaecology, 2001 p. 84-9
10 TVT-Obturator - 47 publications 7 to 15 MinDaycare3 to 5 days to recoverSkin cutThigh pain of 1-7 days – 30%3% of P/O BOO (ΕΠΙΣΧΕΣΗ)
11 TVT-SECURThe TVT Secur was designed to minimize the operative procedure as muchas possible in order to reduce those undesired complicationsThis 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.This approach imitates the sub-mid-urethral support providedwith the TVT-Obturator, yet imitating the TVT is possible as well, by introducing the TVT-SECUR arms retropubically rather than to the Obturator area.The “U” position approach necessitates urethral catheterization as well asdiagnostic cystoscopy for recognition of possible bladder penetration.In summary, the TVT-SECUR procedure appears to be potentially easier to perform and relatively trouble-freefor both surgeons and patients and might not require urethral catheterization or diagnostic cystoscopy duringsurgery. Paying respect to procedural specific surgical steps might shorten the TVT-SECUR learning curve. Thenovel TVT-SECUR’s actual place among TVT and TVT-related procedures can only be determined with randomizedprospective longitudinal comparisons.
14 Advance the Inserter and contact the inferior edge of the pubic ramus Advance the Inserter and contact the inferior edge of the pubic ramus. While maintaining contact with the bone, continue to advance the Device into the obturator internus muscle in a controlled manner.
15 The mesh should be placed tension-free under the mid urethra The mesh should be placed tension-free under the mid urethra. Make FINAL adjustment if needed by reconnecting the driver/holder. Establish proper hand position and advance or retract either Inserter to make final adjustments. Assessment of tension-free tape positioning should be performed BEFORE the release wire is pulled.Note: Adjustment should be made by moving the Inserters and not by pulling on the mesh.Cystoscopy may be performed at the discretion of the surgeon.
16 TVT SECUR 3 to 7 Min Day care 2 to 4 days to recover No skin cut Minimal painNo P/O BOO
17 TVT SECURThe novel TVT-SECUR procedure for the treatment of female stress urinary incontinence is safe and simple to perform.The very early therapeutic effectiveness is promising, yet long term data is essential prior to drawing any recommendations.
18 Conclusions Η Stress ακράτεια είναι μια κοινή και ψυχοφθόρα κατάσταση Διεξοδικός έλεγχος για τη διάγνωση πριν τη θεραπεία.Εξατομίκευση θεραπείαςΤάσεις για less invasive surgery έχουν ελαττώσει την νοσηρότητα και την παραμονή στο νοσοκομείο.Η ακράτεια πρέπει να πάψει να θεωρείται φυσιολογική συνέπεια του γήρατος,Η stress ακράτεια πρέπει να αντιμετωπίζεται σαν μια θεραπεύσιμη νόσος.
19 Our experience Surgical outcomes Surgical outcomes can be summarized here. The TVT procedure, produces anywhere from 87% to 82% success rate. TVT-O is comparable to TVT and TVT-S is comparable -- at least in the early experience -- The complication rate varies with the series