Explain: Genuine stress incontinence

Content: Tension free vagina tape procedure

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: Tension free vagina tape procedure + [[VTH, anterior colporraphy, posterior colporraphy, S-S ligament suspension]].

Two minimal incisions 5 cm apart were made in the abdominal skin just above the superior rim of the pubic bone and a 1.5 cm long sagittal incision was made in the anterior vaginal wall 1 cm from the external urethral meatus. With the aid of an applicator and a two-component needle instrument (Ethicon), a specific prolene tape (Ethicon) covered by a plastic sheath was introduced from the vaginal incision and brought up to the abdominal incision bilaterally. While the patient was asked to cough, the tape was adjusted to ensure continence but without tension under the area of midurethra. Then, the plastic sheath covering the prolene tape was removed and no fixation was carried out. The vaginal and abdominal incisions were closed after the abdominal ends of the tape were cut subcutaneously.

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: _______________.