Explain: Genuine stress incontinence

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

Operative Procedures:

Type of operation: Stamey 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 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 . Two transverse incision approximately 2-3 cm in length was made 2 to 4 cm from midline and 1 to 2 finger-breadth above the pubic symphysis. Suture placement was accomplished by passage of a long needle. While the needle was advanced , the free hand palms pulled the urethral catheter .The index finger was put aside the bladder neck to meet the tip of the needle and guide it into the vagina just distal to the Foley balloon . 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 perforated the bladder and was not lying just submucosally. Once the needle was successfully passed, Foley catheter was reinserted and the second needle was placed through the same suprapubic incision on its lateral aspect. The position was again checked cystoscopically. No. 1 prolene was then passed through the eyes of the needles with a segment of silicon (Gortex) between them . The needle were pulled up suprapubically . The same procedure were performed on the opposite side .The vaginal mucosa was closed with 2-0 Vicryl . The sutures were tied with light tension allow the vesical neck to elevate. A small segment of Marllex 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: _______________.