Obstructing Sling Procedures

In the severely incontinent patient whose condition is refractory to a standard anti-incontinence procedure, an obstructing sling is a good option. The basics of the approach may be as simple as a standard sling procedure that is ultimately fixed or tied down with more tension than in usual circumstances with the intent to obstruct the outlet. It should be noted that extreme degrees of tension may create more problems and irritation, so a balanced approach to the nature of outlet resistance should be maintained. We typically prefer the use of biological tissues when placing them under more tension. In cases in which a synthetic sling may be preferred, our choice has been the use of the circumferential or spiral sling. We initially begin by performing a complete urethrolysis and obtain access to the supraurethral space. We then use a large strip of polypropylene mesh trimmed to 2.0 x 30 cm and create a slit inside it so as to be able to pass the sling through itself (Figure 6-7.1). The needle passers are passed from one side suprapubically to the opposite side vaginally so the sling spirally encompasses the entire urethra (Figure 6-7.2). A pressure test or cough test is performed to assure good coaptation and lack of leakage with Valsalva/cough/Credé maneuvers. It remains imperative that the patient and physician realize that the patient will likely require inter mittent postoperative self-catheterization, permanently in the majority of these types of cases. The goal of the procedure is truly not to achieve spontaneous balanced voiding at low pressures, but rather, a continent and well-coapting urethral mechanism.

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.

Get My Free Ebook


Post a comment