At present, for the treatment of stress urinary incontinence offers over 250 types of transactions.They are directed to the correction or compensation of a condition which causes loss of urine.The efficiency of various operations ranges from 70 to 95%.
all current operations can be divided into four groups of interventions:
Sling operations involve fixing sagging or hypermobility of the urethra to the pelvic bone, the surrounding tissue or abdominal wall with special seams.Fixation of the urethra and bladder eliminates their sagging and prevents urine leakage.
most common and effective today are sling operations a synthetic prolene tape.Depending on the access distinguish TVT (tensionfreevaginaltape) - fixation to the heart of free synthetic loop, TVT-O (transobturatorvaginaltape) - fixation of the bladder transobturator access.
advantages of these operations is that they may be performed at any age patients incontinence degree II-III, which is caused by intrinsic sphincter deficiency or urethral hypermobility.
surgery technique has been proposed in 1995 and lies in the fact that a self-prolene tape placed in a special case, is carried out using hammers behind the pubic area under the urethra.After synthetic ribbon take its final position, a cover is removed and it is fixed to the tissues, through which passes the support carrying the bladder and urethra.
Operations TVT and TVT-O different surgical approaches and options for synthetic loop.The second option is surgery, in which the prolene loop is conducted through the obturator holes, it is preferable, since it appears far fewer complications.
This type of treatment is used in the presence or vezikotsele ureterovezikotsele.During the operation, an incision sagging anterior vaginal wall dissection of tissue flap and the formation of mucous dublication vnatyag.This approach eliminates the sagging tissue and strengthen the front wall of the vagina.Where indicated, this operation can be carried out simultaneously with the sling fixation of the urethra.
fixing operation can be done in two accesses: through an incision above the pubis or laparoscopically.
The operation is moving up and fixation of the tissues surrounding the urethra, the back surface of the symphysis pubis.There are several variants of this operation, different methods of fixation.In operation, according to different authors, is quite promising long-term results (about 70% of patients after 5 years normally hold urine).
This type of treatment is used in women is very rare because of the high cost, low efficiency and a large amount of the operation complications.
artificial sphincter consists of an inflatable cuff, which is set around the urethra, the button pump deactivation, which is implanted under the skin of the abdomen, the reservoir and the connecting tubes.When the balloon is filled with liquid, the cuff compresses the urinary canal.
Urination is possible only after emptying the container, which occurs after the compression of the pump.The liquid flows off through a special valve to a tank where it remains for 3-5 minutes, allowing the patient to urinate.After this time, the cuff is automatically filled with a liquid.
Injections are produced by various biological or synthetic substances.With the introduction of these substances into the space around the urethra is created as if the additional external sphincter, which reduces the urinary channel and does not allow urine to flow.This is the least invasive of all surgical procedures.
indication for the introduction of bulking agents is the failure of the sphincter.It is performed under local anesthesia.This manipulation is usually carried out patients who categorically refuse to correct urinary incontinence invasive surgical methods.
significant drawback of the method is the frequent occurrence of relapses (action bulking agent missing, usually 1-2 years), pain administration, complications such as urinary retention and violations of bladder emptying.
To date, there is no perfect method of surgical correction of stress urinary incontinence.Although the TVT-ON operation is considered the gold standard and its efficiency reaches 91%, it also carries a risk of complications, and the possibility of recurrence of the disease.During the TVT operation often occur injured bladder (approximately 1 in 25 transactions).
For all operations are characterized by complications such as urinary retention after surgery, urinary tract infections, recurrent detrusor instability.
It is due to the fact that it is absolutely reliable methods of treatment of stress incontinence is not yet developed as a first-line therapy with I and II degree of urinary incontinence include conservative methods.
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