Live Surgery Workshop and Scientific Symposium | 2011

STRESS URINARY INCONTINENCETRANS OBTURATOR TAPE

K.LALITHA

Consultant Urologist & Urogynaecologist

Yashoda hospital

Somajiguda

Live Surgery Workshop and Scientific Symposium | 2011

Live Surgery Workshop and Scientific Symposium | 2011

Types of Incontinence

• Stress

• Urge

• Mixed

• Overflow

Live Surgery Workshop and Scientific Symposium | 2011

Live Surgery Workshop and Scientific Symposium | 2011

Classification of SUI

• Type I & II Anatomical

• Type III Int. Sphincter

defect

Live Surgery Workshop and Scientific Symposium | 2011

Evaluation of Patient

• History

• Examination

• Stress test - postural

• Bonney's test - false positive

Live Surgery Workshop and Scientific Symposium | 2011

Urodynamics

• Uroflow

• Cystometry

FILLING/VOIDING

• Urethral Pr. profile

• EMG

Video - urodynamics

• Differentiate types of SUI

Live Surgery Workshop and Scientific Symposium | 2011

Live Surgery Workshop and Scientific Symposium | 2011

Live Surgery Workshop and Scientific Symposium | 2011

Role of Urodynamics

• Is it essential in all patients ?

• Role of ALPP and UCP ?

• Prediction of post op voiding dysfunction ?

• Effect on surgical outcome ?

Live Surgery Workshop and Scientific Symposium | 2011

Grades of SUI

• I Severe stress

• II Minimal stress

• III Leakage thru

out

Live Surgery Workshop and Scientific Symposium | 2011

Live Surgery Workshop and Scientific Symposium | 2011

Live Surgery Workshop and Scientific Symposium | 2011

GYNECARE TVT Device

Live Surgery Workshop and Scientific Symposium | 2011

AnesthesiaAbdomen

Live Surgery Workshop and Scientific Symposium | 2011

Dissection of Anterior Wall

Live Surgery Workshop and Scientific Symposium | 2011

Live Surgery Workshop and Scientific Symposium | 2011

TVT-O(Obturator)

• Advantage over TVT

– Eliminates entry into retropubic space

– No risk of injury to bladder or bowel

Live Surgery Workshop and Scientific Symposium | 2011

Live Surgery Workshop and Scientific Symposium | 2011

Complications

• Functional

– Voiding dysfunction

– Detrusor instability

• Technical

• Obturator nerve injury

Live Surgery Workshop and Scientific Symposium | 2011

COMPLICATIONS OF TVT Vs TOT

• TVT TOT• BLADDER INJURY 4% RARE

• VOIDING DYSFUN. 8% 2%

• De NOVO URGENCY 14% 6%

Live Surgery Workshop and Scientific Symposium | 2011

COMPLICATIONS

EROSION

QUALITY OF MESH

HOST FACTOR

SURGICAL TECHNIQUE

Live Surgery Workshop and Scientific Symposium | 2011

MINI SLINGS

• MINI-ARC

• TVT-ABBREVO

Live Surgery Workshop and Scientific Symposium | 2011