Transurethral Approach

A transurethral approach for a bulking agent injection is usually performed in an office or outpatient setting with local urethral anesthesia. The patient is placed in the dorsal lithotomy position, and the surgical field is prepared and draped in a sterile manner. Local anesthesia consists of 2% lidocaine jelly placed intraurethrally and left in place for approximately 5 to 10 minutes. With the cystoscope inserted into the mid urethra,the tip of the injection needle is inserted underneath the mucosa and the bulking agent is deposited precisely into the sub-lamina propria tissue plane until complete coaptation of the urethral mucosa is visualized (Figure 6-4.1). To assess for potential cure in patients given local anesthesia, the surgeon performs a

Figure 6-4.1. Transurethral approach for bulking agents. (Reprinted with the permission of The Cleveland Clinic Foundation.)

compromise the inner luminal radius of the needle, which would potentially increase the resistance to injection of the implant material. Because of the shorter working length and variation of gauge selection available with needles that may reduce resistance to implant flow characteristics, the bent-needle technique for a periurethral approach can be used for all implant materials available for injectable bulking agents and is generally thought to be easier to perform and more efficacious than the original periurethral and transurethral approaches. The smaller needle gauges selected for a periurethral approach of this technique allow the injection of bulking agents for patients taking medications, producing a hypocoagulable condition without the need for interrupting their therapy. Using a transurethral approach with larger-gauge needles not only increases the potential for persistent bleeding and obscures direct observation of the resolution in the postprocedural time period, but the shorter needle track also lessens the compressive hemostatic influences provided from a longer needle track of the periurethral approach.

Depending on the material chosen for injection, the bent-needle technique requires the selection of a preformed needle (22 gauge for Contigen or a tapered-hub 19-21 gauge for Durasphere) bent at the midpoint to 15 degrees toward the luminal side of the needle. At the 3- or 9-o'clock position of the urethral meatus, the point of the

Figure 6-4.2. The bent-needle technique for the submucosal/periurethral approach.

(Reprinted with the permission of The Cleveland Clinic Foundation.)

cough stress test before the injection and then may use this finding as a baseline guide for determining if further implant material is needed during the injection procedure.

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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