Artificial Urinary Sphincters

The AUS is currently not approved for use in females in the United States.2 Although it is not approved, it is used for circumstances similar to those for which the spiral or obstructing slings are used; in other words, a severely incompetent outlet. Often, these patients have had multiple, failed anti-incontinence procedures and have a "pipestem" urethra that does not coapt well even with injectable therapies. One must realize that the successes with this procedure have been detailed in two approaches, and there exists no consensus as to which approach is best or most efficacious.

Transvaginal placement of the AUS entails a transvaginal incision and placement of the cuff via this route. All tubing and connections can be transvaginally done before pump and reservoir placement into the labia and perivesi-cal spaces, respectively. The typical size of cuff used for female AUS is approximately 5.0 cm. The main risks of complications after abdominal/retropubic placement are erosion and infection. The vaginal incision does allow the potential for nonhealing of the space under the cuff, thereby allowing it to be exposed and resulting in either an erosion or infection. By placement of the device via a retropubic approach, erosion may be minimized, if not eliminated. One may adjunctively use a Martius flap or omental flap to place underneath the cuff, between it and the vaginal wall to minimize the potential for erosion. As in other surgical procedures for complex, refractory incontinence, many of these patients have had multiple failed procedures, and the tissue planes for dissection may, in fact, be fused, thus creating an inadvertent incision and increased risk for erosion potential. Similarly, as in the

Figure 6-7.2. Synthetic sling in cross-sectional view after sling has been transferred suprapubically. (Reprinted with the permission of The Cleveland Clinic Foundation.)

male patient with an AUS, infection, tissue atrophy, and mechanical failure may occur.

Herbal Remedies For Acid Reflux

Herbal Remedies For Acid Reflux

Gastroesophageal reflux disease is the medical term for what we know as acid reflux. Acid reflux occurs when the stomach releases its liquid back into the esophagus, causing inflammation and damage to the esophageal lining. The regurgitated acid most often consists of a few compoundsbr acid, bile, and pepsin.

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