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Live Surgery Workshop and Scientific Symposium | 2011

STRESS URINARY INCONTINENCETRANS OBTURATOR TAPE

K.LALITHA

Consultant Urologist & Urogynaecologist

Yashoda hospital

Somajiguda



Types of Incontinence

• Stress

• Urge

• Mixed

• Overflow


Classification of SUI

• Type I & II Anatomical

• Type III Int. Sphincter

defect


Evaluation of Patient

• History

• Examination

• Stress test - postural

• Bonney's test - false positive


Urodynamics

• Uroflow

• Cystometry

FILLING/VOIDING

• Urethral Pr. profile

• EMG

Video - urodynamics

• Differentiate types of SUI


Role of Urodynamics

• Is it essential in all patients ?

• Role of ALPP and UCP ?

• Prediction of post op voiding dysfunction ?

• Effect on surgical outcome ?


Grades of SUI

• I Severe stress

• II Minimal stress

• III Leakage thru

out


GYNECARE TVT Device


AnesthesiaAbdomen


Dissection of Anterior Wall


TVT-O(Obturator)

• Advantage over TVT

– Eliminates entry into retropubic space

– No risk of injury to bladder or bowel


Complications

• Functional

– Voiding dysfunction

– Detrusor instability

• Technical

• Obturator nerve injury


COMPLICATIONS OF TVT Vs TOT

• TVT TOT• BLADDER INJURY 4% RARE

• VOIDING DYSFUN. 8% 2%

• De NOVO URGENCY 14% 6%


COMPLICATIONS

EROSION

QUALITY OF MESH

HOST FACTOR

SURGICAL TECHNIQUE


MINI SLINGS

• MINI-ARC

• TVT-ABBREVO

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