Explain: Genuine stress incontinence

Content: Raz operation

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, Stamey, TVT, anterior colporraphy, posterior colporraphy, VTH, colposacropexy, S-S ligament suspension, others]]

Operative Procedures:

Type of operation: Paz operation + [[VTH, anterior colporraphy, posterior colporraphy, S-S ligament suspension]].

Cyctoscopy was done initially to evaluate bladder landmarks .The bladder neck and ureteral orifices were noted . A Foley catheter was inserted into the bladder and inflated. A {{longitudinal, inverted U, transveres}} incision was made in the anterior vaginal wall under the bladder neck, and a plane was developed between the vaginal mucosa and the urethra. Used Metzenbaum scissor or finger blunt dissection to enter the retropubic space through vagina. With tip of index finger flexed anteriorly against posterior symphysis¡Mparaurethral attachmant to pubic bone was perforated downward toward ischial spine¡Mcompletely detaching endopelvic fascia . Finger was placed behind detached endopelvic fascia, mobilizing it into vaginal field to faciliated placement of helical suture. No 1 prolene was anchored in pubourethral ligament; then several helical passes were taken through detached endopelvic fascia. One transverse incision approximately 2-3 cm in length were made and 1 to 2 finger-breadth above the suprapubic area. V aginal finger was inserted to posterioraspect of rectus muscle. Passage of needle was under direct finger guidance .The catheter was then removed and the cystoscope , with 30 and 70 degree lens, was inserted into the urethra to ascertain that the needle has not performed the bladder and was not lying just submucosally . No. 1 prolene was then passed through the eye of the needle. The needles were pulled up suprapubically. The same procedure were performed on the opposite side .The vaginal mucosa was closed with 1-0 Vicryl . The sutures were tied with light tension that allowed the vesical neck to elevate and close. A small segment of silicon mesh was used under the suprapubic knot. The suprapubic incisions were closed. {{A suprapubic cystotomy catheter, A Foley urethral catheter}} was introduced.

Operative Findings:

{{Bilateral vaginal fascia, Right vaginal fascia, Left vaginal fascia}} was sutured

Suprapubic cystostomy: {{ yes, no}}

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: _______________.