Kinh nghiệm lâm sàng với mục tiêu đánh giá urodynamic hỗ trợ phân loại này. Mục đích của phương pháp điều trị phẫu thuật là (1) phục hồi của niệu đạo vào vị trí nghỉ ngơi thích hợp và ổn định của vị trí này trong quá trình gia tăng áp lực intraabdominal; | Chapter 8 Female Urinary Incontinence 163 mechanism. Clinical experience with objective urodynamic evaluations supports this classification. The aims of surgical treatments are 1 restoration of the urethra to its proper resting position and stabilization of this position during increases in intraabdominal pressure 2 augmentation of intraurethral pressures for restoration of intrinsic urethral closure or 3 a combination of both restoration of support and augmentation of urethral closure. Implants Periurethral and transurethral injections of bulking agents at the level of the proximal urethra have been used extensively for years to increase the outflow resistance of the urethra for the treatment of SUI caused by ISD. Injectables are able to increase urethral closure function without significantly resulting in increases of urethral closure pressure which would lead to a rise in voiding pressure. The overall effect is to correct the incompetent urethral closure mechanism without clinically disturbing voiding function 15 . Many choices for injectable substances exist they include sclerosing solutions polytetrafluoroethylene paste glutaraldehyde cross-linked bovine collagen GAX collagen carbon particles Durasphere autologous fat silicone particles and many more. Currently the only injectable materials acceptable for use in the United States are autologous materials such as fat xenogenic collagen Contigen TM C. R. Bard Inc. Covington GA and carbon particles known as Durasphere Carbon Medical Technologies Inc. St. Paul MN . The ideal material is still being sought and should combine ease of administration with minimal tissue reaction no material migration and persistence over time. Placing the bulking agents between the 5 and 7 o clock position is warranted to preserve a coapted urethral closure mechanism despite anatomic movement or location. All patients may receive this therapy in the office or in an outpatient surgical setting under a local block. There are no .
