RU2219860C2 - Method for retropubic calposuspension at stress incontinence of urine in women - Google Patents

Abstract

FIELD: medicine, urogynecology. SUBSTANCE: one should carry out incision of abdominal wall at the length of 3-4 cm, rectus muscles of abdomen are bluntly forced apart. Retroperitoneoscope is installed into prevesicular fiber to bluntly make there a tunnel towards bladder's cervix. By not increasing cutaneous wound one should perform an access to bladder's cervix and anterior vaginal wall by not mobilizing the whole part of bladder's anterior wall. Sutures are applied at both sides against bladder's cervix. Perivaginal tissues and lateral vaginal arches are sutured up to lacunar ligaments from both sides against bladder's cervix. EFFECT: decreased operational trauma. 1 ex

Description

 The invention relates to medicine and can be used in surgery, namely in urogynecology, mainly minimally invasive.

 Closest to the claimed invention is a method of surgery for stress urinary incontinence in women, proposed Burh (AS Pereverzev. Clinical urogynecology, Kharkov, 2000. - S. 217-220), called "colposuspension".

 The essence of this method is to raise the neck of the bladder by suturing the peri-vaginal tissues and lateral arches of the vagina to the tissues of the ipsilateral pelvic wall - iliac scallop ligament - lig. iliopectineum (Cooper ligament).

 According to this method, median suprapubic access to the prebubble space is made, the front wall of the bladder is completely isolated, then the neck of the bladder and the front wall of the vagina are isolated on both sides of the neck of the bladder.

 Suture on both sides of the neck of the bladder and tighten the threads, bringing together the wall of the vagina, the peri-vaginal fascia with the Cooper ligament.

 Wide surgical access used in the known method, and the mobilization of the entire front wall of the bladder can lead to its perforation, bleeding and a long pain reaction after surgery.

 The objective of the present invention is to reduce operational trauma, prevent complications associated with wide surgical access and mobilization of the entire front wall of the bladder.

 To solve the problem, in contrast to the prototype, to exclude the neck of the bladder, an abdominal wall skin is cut 3-4 cm long, the rectus abdominis muscles are stupidly pushed apart, an instrument is installed in the pre-cystic fiber, with which they access the bladder neck and the front wall of the vagina without increasing the size of the skin wound.

 The essence of the new method is to use minimally invasive access to the neck of the bladder to perform colposuspension during stress urinary incontinence in women, the implementation of which is carried out using a tool installed in the prevesical tissue to access the neck of the bladder without mobilizing its entire front wall.

 The result of the method is the early activation of patients, a lesser pain response, and a shorter hospital stay.

 The method of posadilon colposuspension for stress urinary incontinence in women is as follows.

 A transverse incision is made of the skin of the anterior abdominal wall 3-4 cm long 2 cm above the pubic junction, subcutaneous fatty tissue and aponeurosis are dissected, the rectus abdominis muscles are bluntly pushed apart in the midline, and a retroperitoneoscope is installed in the prevesical tissue.

 Under control of vision, a tunnel in the prebubular tissue is bluntly made towards the neck of the bladder. The front wall of the vagina is isolated on both sides of the neck of the bladder catheterized by a Foley catheter, the balloon of which is pre-installed in the neck of the bladder.

 In some cases, for minimally invasive access to the neck of the bladder, it is justified to use articulated retractors mounted on the ring, the design of which allows the optimal surgical space to be formed in the prevesical tissue without enlarging the skin wound.

 Retreating 0.5-1.0 cm on both sides of the neck of the bladder, lay 2-3 sutures on the wall of the vagina under the control of a finger inserted into the vagina, the free ends of the ligatures are sutured to the Cooper ligaments on both sides and tightened, lifting the vaginal wall with the neck of the bladder and the initial section of the urethra.

 Establish drainage in the prevesical space, the surgical wound is sutured in layers.

 Anesthesia is determined by specialist anesthetists, usually intravenously.

 Example. M-a A.A., 46 years old. Complaint of urinary incontinence with little physical activity, sick for about 5 years, conservative treatment is ineffective. During the examination, cystocele was found, a positive symptom of a cough impulse, type 2 stress urinary incontinence was established, an urodynamic study showed normal detrusor contractility, and the functional length of the urethra was 26 mm. The pulse is rhythmic, 78 beats per minute. Hell - 120/80 mm Hg. Art. Renal function is satisfactory, indicators of nitrogen excretion function are normal.

 Preparation for surgery is traditional. Before surgery, a Foley catheter was inserted into the urethra. A 3 cm long skin incision was made under intravenous anesthesia, the rectus abdominis muscles were spread, a retroperitoneoscope was installed in the prevesical tissue. The bladder of a retroperitoneoscope mobilized the neck of the bladder, the inner wall of the vagina, 2 stitches were placed on either side of the neck of the bladder, ligatures were fixed to the Cooper ligaments.

 For the implementation of operational access and manipulation, tools for minimally invasive operations of the SAN firm (Ekaterinburg) were used in it.

 Installed drainage of the prebubble space. The surgical wound was sutured in layers. Trap drainage was removed after 1 day, the Foley catheter was removed on 3 days. As a result of the operation, independent urination was restored, urine was retained.

 Anesthesia after surgery was required only in 1 day. The patient was discharged for outpatient treatment on the 4th day, the intradermal suture was removed on the 7th day, wound healing by primary intention. No complications of the operation were noted.

 According to this method, 5 patients were operated on. The postoperative period was satisfactory, there were no complications. The average bed day after surgery is 4-5.

Claims (1)

The method of post-colonic colposuspension during stress urinary incontinence in women, including the allocation of the neck of the bladder, suturing on both sides of it and suturing of the near-vaginal tissues and lateral vaults of the vagina to Cooper’s ligaments on both sides of the bladder neck, characterized in that an abdominal skin incision is made 3-4 cm long, the rectus abdominis muscles are stupidly pushed apart, a retroperitoneoscope is installed in the prebubular tissue, with which a tunnel in the prebubular tissue is stupidly made in the direction of the neck of the the cheek bladder and without enlarging the skin wound, they access the neck of the bladder and the front wall of the vagina without exposing the entire front wall of the bladder.