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Preliminary study
Since January 2003, 19 patients have been operated for stress urinary
incontinence, with or without associated prolapse, using a technique with a polypropylene mesh (Prolene). All patients, aged from 51 to 78 years (mean
age of 59,4), prior to any surgical intervention, underwent a gynaecological
clinical examination with bearing down, a pad test, a urodynamic test including uroflowmetry and cystometry, as well as a perineal
ultrasonography.(dynamic study of levator muscles).
Technique
The intervention is performed under subarachnoideal anaesthesia in patients
placed in a gynaecological position, with thighs in hyper flexion. A Foley catheter is first introduced into the bladder. The procedure begins with a
sub-urethral median incision halfway from the urethrovesical junction. One performs a median anterior incision downwards in order to dissect the
anterior colpocele. The lateral dissection is performed on a length of
approximately 1,5 cm on both sides of the median incision. After opening the
pelvic fascia with the tip of rounded scissors on a length of about 2 cm, one penetrates into the Retzius space.
The material used in this procedure is a Y-shaped polypropylene-monofilament
prosthesis. Both arms are introduced into the Retzius space on both sides without additional fixation, thus becoming the well-known "sub-urethral
hammock". The other extremity of the prosthesis is left unattached under the
vaginal fascia (this is still a "tension-free" procedure). The closure is realised by re-tending the vaginal fascia with single stitches (4 or 5) over
the polypropylene prosthesis, with a following partial resection of the vaginal wall - 1 to 2 cm on each side of the median incision.
Colporrhaphia is performed using a continuous 2/0 vicryl stitch. Depending on clinical conditions, the procedure is completed with a
posterior perineal plastic intervention. The vaginal incision is rectangular
and covers the entire posterior wall. The starting point for deep vaginal dissection is located above the
posterior commissure, the dissection itself is performed using a pair of soft scissors and reaches the vaginal vault. The dissection is continued
laterally in order to give access to the pararectal fossae. The prosthesis is shaped to meet desirable dimensions, that is approximately 3 cm in width
over 5-6 cm in length. The mesh is then placed and left without additional fixation. The vaginal closure is preceded by a closure and re-tension of the
fascia over the prosthesis using single stitches, then completed by a single
continuous 2/0 vicryl stitch.
Results
Preliminary results on such a short follow-up period seem to exceed 90%
(total continence without dysuria). We have noted a case of rejection or healing defect in one patient, which led us to the partial removal of
prosthetic material. There were no early post-operative complications. We are hereby presenting preliminary results of the first 19 cases. We are
looking forward to presenting our results after a 12 month follow-up period.
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