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Vaginal Surgery for Incontinence and Prolapse - part 5

tổng hợp lưới để tránh các bệnh tật sau thu hoạch fascial, thay đổi độ dài của cáp treo, từ fulllength ghép vá lỗi, các trang web khác nhau vào việc định hình cho sling các, như dây chằng Cooper, suprapubic hoặc qua âm đạo neo xương mu cố định, và định hình thụ động tuân thủ mô để lưới trong không gian retropubic hoặc-lỗ bịt. | 114 Vaginal Surgery for Incontinence and Prolapse Figure 9.3. Traditional technique for sling placement. A Retropubic space is entered laterally through the vaginal incision. B Curved clamp passed through the retropubic space with direct finger guidance. C Sling pulled up to the suprapubic incision by clamp From Hinman F. Atlas of Urologic Surgery 2nd ed. pp. 566-567. Copyright 1998 with permission from Elsevier. Stress Urinary Incontinence Secondary to Intrinsic Sphincteric Deficiency 115 synthetic mesh to avoid the morbidity of fascial harvest varying lengths of slings from fulllength to patch grafts and different sites of fixation for the sling such as Cooper s ligament suprapubic or transvaginal pubic bone anchor fixation and passive fixation by tissue adherence to the mesh within the retropubic space or obturator foramen. Currently there are no randomized trials comparing the different variations of slings with respect to treatment of ISD. The choices of which sling material and which method of sling placement are at the discretion of the surgeon 130 . For all types of SUI urethral hypermobility and ISD autologous fascial pubovaginal slings are reported to have cure rates of 70 to 90 and cure improved rates of 85 to 95 15 16 18 23 24 . Continence rates for patients with pure ISD appear to be slightly lower than that of patients with urethral hypermobility. With a mean follow-up of 22 months Cross and colleagues 25 reported continence rates confirmed by videourodynamics of 96 43 45 in patients with preoperative urethral hypermobility vs. 89 65 73 in patients with preoperative ISD. With a mean follow-up of 51 months Morgan and associates 16 reported continence rates of 91 for SUI due to urethral hypermobility vs. 84 for SUI owing to ISD. Results of various sling procedures as treatment for SUI owing to ISD are noted in Table 9.2. Allograft Xenograft Slings To decrease operative time and avoid the morbidity of autologous fascial harvest the use of cadaveric .