Explain: Genuine stress incontinence

Content: Endoscopic Suspension of Bladder Neck

Clinical Information:

The female patient had urinary leakage during physical exercise, coughing and sneezing for years.

Urodynamic study {{GSI, D.I., mixed incontinence}} was noted.

Micro-tip urodynamic study {{not done, GSI, D.I., mixed incontinence}} was noted.

Pad test : gm.

Pelvic examination: [[No, Vaginal wall]] protruding prolapsed was noted.

ICS staging {{I, II, III, IV}}.

Menopause {{ +, -}}.

Hormone replacement therapy: {{yes, no}}

Urogynecologic ultrasonography {{ +, -}}.

Previous pelvic surgical history: [[no, Burch, Laparoscopic Burch, EBNS, Raz, Stamy, TVT, anterior colporraphy, posterior colporraphy, VTH, colposacropexy, S-S ligament suspension, others]]

Operative Procedures:

Type of operation: Endoscopic Suspension of Bladder Neck. [[VTH, anterior colporraphy, posterior colporraphy,S-S ligament suspension]].

1. Two short suprapubic incisions about 2 cm long, were made to left and right of the midline at the level of the upper border of the symphysis pubis.

2. An incision was made on the anterior vaginal wall below the urethra at a convenient point to expose the urethrovesical junction.

3. A stamey needle was introduced through prevesical space space from one of the two suprapubic incisions. By felling the distal edge of the Foley ballon, the needle was guided through the endopelvic and pubocervical fascia into the vaginal incision.

4. A telescope was introduced into the bladder for checking the path of the needle was not in the urinary bladder.

5. A No. 1 nylon was threaded into eye of needle as it rested within vaginal incision.

6. The needle was then withdrawn into the suprapubic incision and two kelly clamps placed on the nylon suture as it exited from the vaginal incision.

7. The second passage of the needle 1 cm lateral to the 1st nylon has been accomplished.

8. The vaginal end of the nylon suture had been threaded through 1 cm tube of arterial dacron, the nylon was then passed through the eye of the needle preparatory to withdrawing the needle into the suprapubic incision.

9. By pulling up on suprapubic ends of the nylon sling and guiding the Allis clamp holding the dacron tube, the dacron buttress were allowed to settle into its final position beside the internal vesical neck.

10. Proedures 7-12 were repeated on the other side.

11. The nylon sutures were then tied onto the rectus fascia.

12. The suprapubic and vaginal wounds were closed.

13. A Folly catheter was introduced into the bladder for straight driange of urine.

Operative Findings:

Urethral orifice: {{patent, obstuct}}

Urethral canal: {{intact, disrupted}}

Right ureter orifice: {{patent, not seen}}

Left ureter orifice: {{patent, not seen}}

Trigone: {{smooth, hemorrhage, congestive}}

Bladder mucosa: {{smooth, hemorrhage, congestive}}

Cystocele grade {{ I, II, III }}

Rectocele {{ I, II, III }}

Enterocele{{ +, -}}

{{Uterine prolapse, Vaginal cuff eversion}}: {{ I, II, III }}

Complication: [[massive bleeding, ureter injury, bladder injury, urethra injury, _______________]].

Dr:________________. Date: _______________.