SURGICAL TREATMENT FOR URINARY INCONTINENCE

Question 1

referred to as traditional slings, are performed through two incisions, one in the vagina to pass the sling around the urethra, and one through the abdomen to gain access around the space of Retzius.

Answer 1

Pubovaginal slings

Question 2

plicate the pubovesical fascia around the bladder neck and proximal urethra to give it the necessary support and to assist in the sphincteric closing mechanism by preventing urine loss

• not recommended to treat women with stress urinary incontinence

Answer 2

Anterior vaginal wall repair

Question 3

introduced by Pereyra in 1959

passage of a special needle carrier introduced bilaterally through an abdominal incision down into the vagina.

• sutures were placed on both sides of the urethra within the vaginal and underlying connective tissue, brought up and then attached to the rectus fascia

• no longer recommended for the treatment of stress urinary incontinence

Answer 3

Needle suspension surgeries

Question 4

• was initially described in a man with urinary incontinence following prostatectomy where the endopelvic fascia was attached to the pubic bone

Answer 4

Marshall-Marchetti Krant (MMK)

Retropubic colposuspension surgeries

Question 5

the periurethral tissue was fixed to Cooper ligament

Answer 5

Retropubic Colposuspension Surgeries

Burch procedure

Question 6

• developed as a direct consequence of the integral theory that was promoted
by Petros et al.

Answer 6

Mid-Urethral Slings

Question 7

• a synthetic sling is placed under the mid-urethra (in contrast to pubovaginal slings that are placed at the bladder neck) in a tension-free manner
• The two ends of the sling are not attached or sutured to a pelvic structure, but rather the urethra is free of any tension upon placement of the sling.

Answer 7

Polypropylene tension-free vaginal tape (TVT)

Question 8

commonly placed in a bottom-up direction through a small 1 to 2 cm mid-urethral vaginal incision, and the two free ends are passed up and behind the pubic bone through the space of Retzius and out through two suprapubic incisions

Answer 8

TVT

Question 9

• where the sling position is still mid-urethral, however its general direction is through the ischiorectal fossa and the free ends exit via the obturator canal and out through the genitofemoral creases bilaterally
  • can be placed in an outside-in or inside-out direction

Answer 9

Transobturator tape (TOT) (Delorme in 2001)

Question 10

have become the procedure of choice in treating women with stress urinary incontinence

Answer 10

mid-urethral slings

Question 11

• A unique complication associated with mid-urethral slings is

Answer 11

erosion of the sling material

Question 12

an accepted treatment option for women with stress urinary incontinence

• typically injected around the proximal urethra submucosally to give it bulk, either transurethrally or periurethrally, using an operative cystoscope.

Answer 12

Bulking agents

Question 13

a neurotoxin that produces its paralytic effect on the detrusor muscle of the bladder by blocking the calcium channels and inhibiting release of acetylcholine at the presynaptic neuromuscular junction

Answer 13

OnabotulinumtoxinA (Botox)