ES2226564B1 - Suburethral sling for the surgical treatment of female urinary incontinence. - Google Patents

Suburethral sling for the surgical treatment of female urinary incontinence.

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Publication number
ES2226564B1
ES2226564B1 ES200301134A ES200301134A ES2226564B1 ES 2226564 B1 ES2226564 B1 ES 2226564B1 ES 200301134 A ES200301134 A ES 200301134A ES 200301134 A ES200301134 A ES 200301134A ES 2226564 B1 ES2226564 B1 ES 2226564B1
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ES
Grant status
Grant
Patent type
Prior art keywords
urinary incontinence
surgical treatment
suburethral sling
female urinary
mesh
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Active
Application number
ES200301134A
Other languages
Spanish (es)
Other versions
ES2226564A1 (en )
Inventor
Juan Gambini Ricapa
Original Assignee
Juan Gambini Ricapa
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Grant date

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Classifications

    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/04Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, E.G. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/0004Closure means for urethra or rectum, i.e. anti-incontinence devices or support slings against pelvic prolapse
    • A61F2/0031Closure means for urethra or rectum, i.e. anti-incontinence devices or support slings against pelvic prolapse for constricting the lumen; Support slings for the urethra
    • A61F2/0036Closure means for urethra or rectum, i.e. anti-incontinence devices or support slings against pelvic prolapse for constricting the lumen; Support slings for the urethra implantable

Abstract

Cabestrillo suburetral para el tratamiento quirúrgico de la incontinencia urinaria femenina. Suburethral sling for the surgical treatment of female urinary incontinence.
Está destinado a sujetar la uretra media y el cuello vesical para evitar el escape de orina durante los esfuerzos. It is intended to hold the middle urethra and bladder neck to prevent urine leakage during efforts. Está constituido por una banda o malla (1) monofilamento de polipropileno macroporo de corta longitud pues se ancla solamente a la fascia endopélvica. It consists of a web or mesh (1) monofilament macropore length polypropylene anchor as it is only the endopelvic fascia. Su zona central presenta ambos bordes lisos (4) y el resto está desflecada en dirección oblicua para conformar a modo de una flecha que quedará adherida a la fascia endopélvica y a los tejidos adyacentes y que no puede salirse. The central area has both smooth edges (4) and the rest is frayed obliquely to form by way of an arrow will be attached to the endopelvic fascia and into adjacent tissues and can not escape.

Description

Cabestrillo suburetral para el tratamiento quirúrgico de la incontinencia urinaria femenina. Suburethral sling for the surgical treatment of female urinary incontinence.

Objeto de la invención OBJECT OF THE INVENTION

La presente invención, según lo expresa el enunciado de esta memoria descriptiva, se refiere a un cabestrillo suburetral para el tratamiento quirúrgico de la incontinencia urinaria femenina, cuyas características aventajan notablemente a los cabestrillos o mallas que se emplean actualmente con este fin, tanto en lo que se deriva de su longitud que es más corta ya que solo se ancla en la fascia endopélvica, como en cuanto a las características que presenta el borde de su contorno para evitar la irritación de la uretra media y cuello vesical al ser abrazadas por la banda o malla que materializa su estructura. The present invention as expressed in the title of this specification, refers to a suburethral sling for the surgical treatment of female urinary incontinence, the characteristics significantly outstrip slings or meshes currently used for this purpose, both which it derives its length which is shorter since only links in the endopelvic fascia, and in terms of the features presented by the edge of its contour to avoid irritation at the mid urethra and bladder neck to be embraced by the band or mesh structure embodying.

La aplicación de este cabestrillo suburetral a una paciente, supone un tratamiento quirúrgico de la incontinencia urinaria de esfuerzo y tiene como fin sujetar la uretra media y el cuello vesical para evitar el escape de orina durante los esfuerzos. The application of this suburethral sling to a patient is a surgical treatment of stress urinary incontinence and is intended to hold the mid urethra and bladder neck to prevent urine leakage during efforts.

Antecedentes de la invención BACKGROUND OF THE INVENTION

Actualmente se emplea un procedimiento realizado por vía abdominal mediante una incisión suprapúbica transversa de 6-7 cm de longitud, profundizando en la herida hasta llegar al peritoneo, cortando la fascia de los rectos anteriores abdominales, despegando este peritoneo hasta llegar al espacio de Retzius, zona que muchas veces sangra al ser despegada y diseccionada, se identifica el cuello vesical y se colocan unos puntos de sutura a ambos lados del cuello vesical y uretra media, para luego atarlos a ambos lados de la pared pélvica en los ligamentos de Cooper y así se sujeta la uretra. Currently a procedure performed abdominally used by a transverse suprapubic incision 6-7 cm in length, deepening the wound until the peritoneum cutting the fascia of the abdominal rectus, peeling the peritoneum until the retropubic space, area often bleeds to be peeled and dissected, the bladder neck is identified and a few stitches are placed on either side of the bladder neck and middle urethra and then attach them to both sides of the pelvic wall in Cooper's ligaments and thus the urethra is held. En este caso se usa la anestesia general y el tiempo de intervención puede durar de 60 a 70 minutos. In this case the general anesthesia is used and the operation time can last 60 to 70 minutes. Otros cirujanos hacen esta operación mediante laparoscopia y en estos casos no hay incisión suprapúbica, sino solo un punto de entrada del laparoscopio y otras veces se añade un manipulador, se insufla con CO_{2} para tener campo de visión para la disección del espacio de Retzius, se sujeta la uretra en la forma anteriormente descrita, usando dos cintas sintéticas irreabsorbibles. Other surgeons make this operation laparoscopically and in these cases no suprapubic incision, but only one point of entry of the laparoscope and sometimes a manipulator is added, is insufflated with CO {2} have view to dissection space Retzius, the urethra is held in the manner described above, using two nonabsorbable synthetic ribbons. El tiempo de intervención es en este caso de 70 a 120 minutos, no hay heridas grandes pero es más larga la intervención, se necesita anestesia general, es necesario ser experto en Time intervention in this case is 70 to 120 minutes, no major injuries but is longer surgery, general anesthesia is required, you need to be an expert in
laparoscopia, y el material quirúrgico necesario para realizarlo es muy costoso y se han dado casos de lesiones vasculares y vesicales e incluso en alguna ocasión ha habido que laparotomizar, para solucionar el problema. laparoscopy, and surgical equipment necessary to perform it is very expensive and there have been cases of vascular and bladder injuries and even on occasion have had to laparotomizar to solve the problem. Otras veces se usa la vía vaginal y abdominal combinada, pasando una malla desde la vagina hasta la pared abdominal, también con anestesia general, oa veces con anestesia loco-regional (raquianestesia) o anestesia local, en estos casos se usa una cinta larga de 50-60 cm de material sintético no reabsorbible, unida a unas agujas especiales, con un aparato especial para dirigir dichas agujas, que pasará desde la zona vaginal (suburetral) atravesando éstas una serie de tejidos, como son el tejido parauretral, fascia endopélvica, la vagina, la aponeurosis de los rectos anteriores abdominales, los músculos rectos anteriores con sus arterias perforantes, hasta llegar a la piel de la región suprapubiana; Sometimes vaginal and abdominally combined is used, having a mesh from the vagina to the abdominal wall, also under general anesthesia, or sometimes with regional anesthesia (spinal) or local anesthesia, in these cases a long tape used 50-60 cm of non-resorbable synthetic material, coupled with special needles, with a special device to direct said needles which pass from the vaginal area (suburethral) through a number of these tissues, such as the para-urethral tissue, endopelvic fascia, vagina, abdominal aponeurosis of the rectus, rectus muscle with its perforating arteries, to reach the skin of the supra-pubic region; en estos casos se han descrito perforaciones vesicales, hemorragias al lesionar las arterias abdominales, equimosis e infecciones en la piel (celulitis). in these cases they have been described bladder perforation, bleeding to injure the abdominal arteries, ecchymosis and infections in the skin (cellulitis). El material quirúrgico para realizarlo es costoso y requiere un aprendizaje The surgical material to realize it is expensive and requires learning
esmerado. careful.

Descripción de la invención DESCRIPTION OF THE INVENTION

En líneas generales, el cabestrillo suburetral para el tratamiento quirúrgico de la incontinencia urinaria femenina, objeto de la presente invención, hace posible el uso de una técnica de anclaje libre endopélvico, consistente en hacer una pequeña incisión en la pared anterior de la vagina a nivel de la uretra media, de unos 2 cm, se disecan ambos espacios parauretrales hasta llegar al borde inferior de la rama de hueso púbico, mediante una pinza curva larga se introduce la malla o banda que materializa el cabestrillo suburetral, por un extremo hasta perforar la fascia endopélvica, se suelta la pinza, se repite lo mismo en el otro lado, quedando dicha cinta o banda en contacto con la uretra sujetándola libre de tensión, sin que ésta pueda moverse donde ha sido colocada. In general, the suburethral sling for the surgical treatment of female urinary incontinence, object of the present invention makes use of a technique of free anchor endopelvic, consists of making a small incision in the anterior wall of the vagina at level possible the mid urethra, about 2 cm, both parauretrales spaces are dissected until the lower border of the ramus of the pubic bone, through a curved clamp long mesh or strip embodying the suburethral sling at one end is inserted to pierce the endopelvic fascia, the clamp is released, the same is repeated on the other side, said belt or band being in contact with the free grasping voltage urethra, without it to move where it has been placed. Por el trayecto que pasa la cinta no existen estructuras que puedan ser lesionadas y para su implantación se utiliza la anestesia local. By passing the tape path there are no structures that can be injured and for implantation local anesthesia is used.

El cabestrillo está materializado pues por una banda o malla monofilamento de polipropileno macroporo que queda anclada como hemos dicho anteriormente en las fascia endopélvica. The sling is then materialized by a band or macroporous polypropylene monofilament mesh which is anchored as stated above in the endopelvic fascia. La zona central de esta banda tiene ambos bordes lisos para evitar la irritación de la uretra media y cuello vesical al ser abrazados por la cinta, pero el resto de la misma está desflecada en dirección oblicua a modo de una punta de flecha, que al ser introducida no puede salirse, y que servirá para adherirse fuertemente a la fascia endopélvica ya los tejidos adyacentes, quedándose en el sitio donde ha sido colocada. The central area of ​​this band has both smooth edges to prevent irritation of the mid-urethra and bladder neck to be embraced by the tape, but the remainder thereof is frayed in oblique direction like an arrowhead, which when introduced can not escape, and will serve to adhere strongly to the endopelvic fascia and adjacent tissue, staying at the site where it has been placed.

Las ventajas que tiene esta técnica usando el cabestrillo suburetral acorde con la invención, sobre las actuales para corregir la incontinencia urinaria de esfuerzo son las siguientes: The advantages of this technique using the suburethral sling according to the invention, the current for urinary incontinence are:

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Muy fácil aprendizaje. Very easy to learn.

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No hay que profundizar hacia los órganos más internos, por lo que no hay peligro de lesiones y está exento de morbilidad. No need to delve into the internal organs, so there is no danger of injury and is free of disease.

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Mínimo material quirúrgico para realizarlo (bisturí, pinza de disección, pinza curva), por lo tanto más económico. Minimum surgical material to realize it (scalpel, dissecting forceps, curved forceps), therefore more economical.

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Menor cantidad de material usado (cinta corta), por lo que es también mucho más económico. Less material used (short film), so it is also much cheaper.

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Se puede realizar con anestesia local. It can be performed under local anesthesia.

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Tiempo de realización de 10 a 15 minutos, lo que supone más economía en el uso del quirófano, por lo que puede ser considerado como cirugía mayor de corta estancia. Timescale 10 to 15 minutes, which means more economic use of the operating room, so it can be considered major surgery short stay.

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Se reduce el tiempo de ocupación de cama hospitalaria, redundando también en mayor economía. Time is reduced hospital bed occupancy, also leading to greater economy.

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Excelentes resultados, semejantes a las actuales técnicas de suspensión suburetral. Excellent results, similar to current techniques suburethral suspension.

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Dada la ausencia de morbilidad, se puede aplicar a pacientes de alto riesgo quirúrgico. Given the absence of disease, it can be applied to high-risk surgical patients.

Para facilitar la comprensión de las características de la invención y formando parte integrante de esta memoria descriptiva, se acompaña una hoja de planos en cuya figura única, con carácter ilustrativo y no limitativo se ha representado lo siguiente: To facilitate understanding of the characteristics of the invention and forming an integral part of this specification, a sheet of drawings in whose sole figure is accompanied with an illustrative and nonlimiting character, it represents the following:

Breve descripción de la figura BRIEF DESCRIPTION OF THE FIGURE

Figura 1.- Es una vista esquemática en planta, de un cabestrillo suburetral para el tratamiento quirúrgico de la incontinencia urinaria femenina, acorde con la invención. Figure 1 is a schematic plan view of a suburethral sling for the surgical treatment of urinary incontinence in women, according to the invention.

Descripción de la forma de realización preferida Description preferred embodiment

Haciendo referencia a la numeración adoptada en la figura, podemos ver cómo el cabestrillo suburetral para el tratamiento quirúrgico de la incontinencia urinaria femenina, que la invención propone, está constituido por una banda o malla monofilamento de polipropileno macroporo, de 0,30 mm de grosor y cuyos poros miden 1,1 mm, en un ejemplo de realización preferente. Referring to the numbering in the figure, we can see how the suburethral sling for the surgical treatment of female urinary incontinence, which the invention proposes, is constituted by a band or monofilament mesh macroporous polypropylene, 0.30 mm thick and whose pores measure 1.1 mm in a preferred embodiment.

Esta banda o malla monofilamento tiene de largo 16 cm y posee una zona central de 4 cm de longitud y 1,30 cm de ancho con los bordes lisos. This band or monofilament mesh has long 16 cm and has a central area 4 cm long and 1.30 cm wide with smooth edges. El resto de la cinta, es decir, los 6 cm extremos de cada lado, tiene una anchura de 1,26 cm y sus bordes quedan desflecados cuyas puntas se dirigen en sentido oblicuo al centro de la cinta para que actúe a modo de flecha. The rest of the tape, ie the ends of 6 cm each side, has a width of 1.26 cm and whose edges are frayed ends are directed obliquely to the center of the tape to act as an arrow.

Como característica adicional y útil para su correcta instalación, en la mitad de la cinta cruza entrelazado un filamento de seda negra del número 1, de 6 cm de longitud, que indica la parte media de la banda o malla. As additional feature and useful for proper installation in the middle of the tape crosses a filament interlacing black silk number 1, 6 cm long, indicating the middle part of the web or mesh.

En la figura se ha referenciado en general con el número (1) la banda o malla monofilamento de polipropileno macroporo, con sus extremos rematados en punta de flecha (2). In the figure it has been generally referenced with the number (1) the band or monofilament mesh macroporous polypropylene endcapped with arrowhead (2). Los bordes (3) están desflecados y cuyas fibras se dirigen en sentido oblicuo hacia el centro de la banda. The edges (3) are frayed and whose fibers are directed obliquely towards the center of the band. La zona central de la malla (1), referenciada con el número (4), posee sus bordes lisos. The central area of ​​the mesh (1), referenced with number (4), has its smooth edges.

La referencia (5) designa el filamento de seda negra que cruza transversalmente la línea media de la banda o malla, marcando la parte media de la misma. Reference (5) designates black silk filament transversely crossing the midline of the web or mesh, marking the middle part thereof.

Claims (2)

  1. 1. Cabestrillo suburetral para el tratamiento quirúrgico de la incontinencia urinaria femenina, cuya finalidad es sujetar la uretra media y el cuello vesical para evitar el escape de orina durante los esfuerzos, caracterizado porque está constituido por una banda o malla (1) monofilamento de polipropileno macroporo, o similar, cuya longitud se corresponde con la de la fascia endopélvica a la que se ancla, cuya zona central presenta ambos bordes lisos (4), estando el resto de la cinta desflecada en dirección oblicua a modo de una punta de flecha que quedará adherida a la fascia endopélvica ya los tejidos adyacentes. 1. suburethral sling for the surgical treatment of female urinary incontinence, whose purpose is to hold the middle urethra and bladder neck to prevent urine leakage during efforts, characterized in that it consists of a web or mesh (1) polypropylene monofilament macropore, or the like, whose length corresponds to the endopelvic fascia to which it is anchored, whose central area has both smooth edges (4), the rest of the fringed tape in oblique direction like an arrowhead that It shall be attached to the endopelvic fascia and adjacent tissues.
  2. 2. Cabestrillo suburetral para el tratamiento quirúrgico de la incontinencia urinaria femenina, según reivindicación 1, caracterizado porque la citada banda o malla (1) lleva dispuesto transversalmente y cruzando entrelazado, un filamento (5) de seda negra que marca su parte media. 2. suburethral sling for the surgical treatment of urinary incontinence in women, according to claim 1, wherein said web or mesh (1) has arranged transversely across and interlaced, a filament (5) of black silk marking the middle.
ES200301134A 2003-05-16 2003-05-16 Suburethral sling for the surgical treatment of female urinary incontinence. Active ES2226564B1 (en)

Priority Applications (1)

Application Number Priority Date Filing Date Title
ES200301134A ES2226564B1 (en) 2003-05-16 2003-05-16 Suburethral sling for the surgical treatment of female urinary incontinence.

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
ES200301134A ES2226564B1 (en) 2003-05-16 2003-05-16 Suburethral sling for the surgical treatment of female urinary incontinence.
ES200501090A ES2264885B1 (en) 2003-05-16 2005-05-06 Improvements in the patent np200301134 by: suburethral sling for the surgical treatment of female urinary incontinence.

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ES2226564A1 true ES2226564A1 (en) 2005-03-16
ES2226564B1 true ES2226564B1 (en) 2006-05-16

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ES200301134A Active ES2226564B1 (en) 2003-05-16 2003-05-16 Suburethral sling for the surgical treatment of female urinary incontinence.
ES200501090A Active ES2264885B1 (en) 2003-05-16 2005-05-06 Improvements in the patent np200301134 by: suburethral sling for the surgical treatment of female urinary incontinence.

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Families Citing this family (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
ES2226564B1 (en) * 2003-05-16 2006-05-16 Juan Gambini Ricapa Suburethral sling for the surgical treatment of female urinary incontinence.
ES2630852T3 (en) * 2005-05-06 2017-08-24 Juan Gambini Ricapa suburethral sling for the surgical treatment of female urinary incontinence and surgical instruments used for placement

Family Cites Families (8)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US4452245A (en) * 1980-06-06 1984-06-05 Usher Francis C Surgical mesh and method
US7226407B2 (en) * 1999-06-09 2007-06-05 Ethicon, Inc. Surgical instrument and method for treating female urinary incontinence
US6596001B2 (en) * 2000-05-01 2003-07-22 Ethicon, Inc. Aiming device for surgical instrument and method for use for treating female urinary incontinence
DE60117977D1 (en) * 2000-06-05 2006-05-11 Boston Scient Ltd Devices for treating urinary incontinence
US6612590B2 (en) * 2001-01-12 2003-09-02 Tokyo Electron Limited Apparatus and methods for manipulating semiconductor wafers
US20030004523A1 (en) * 2001-07-02 2003-01-02 Cornell Research Foundation, Inc. Multi-needle holding device
DE10138955A1 (en) * 2001-08-03 2003-02-20 Aesculap Ag & Co Kg Surgical instrument has curved shaft, handle with fastening, pointed shaft ends, locking slide-piece and sprung detents
ES2226564B1 (en) * 2003-05-16 2006-05-16 Juan Gambini Ricapa Suburethral sling for the surgical treatment of female urinary incontinence.

Also Published As

Publication number Publication date Type
ES2264885B1 (en) 2008-04-01 grant
ES2226564A1 (en) 2005-03-16 application
ES2264885A1 (en) 2007-01-16 application

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