Explain: Genuine stress incontinence (ISD)

Content: Anterior vaginal wall sling (four-corner suspension)

Clinical Information:

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

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

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

Pad test : gm. Leak point pressure: mmH₂O

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: Anterior vaginal wall sling + [[VTH, anterior colporraphy, posterior colporraphy, S-S ligament suspension]].

A suprapubic Foley catheter is inserted via an intraurethral Lowsley retractor and another Foley catheter is inserted through urethra. An inverted U incision is made in the anterior vaginal wall with the apex located midway between the urethral meatus and bladder neck. Lateral dissection toward the pubic bone at the level of the bladder nect is performed and the glistening surface of the periurethral fascia guides the plane of dissection. The retropubic space then is entered, adhesion was freed and the urethropelvic fascia is detached. Two pairs of No. 1 prolene were placed on each side. The distal sutures were placed at the level of the bladder neck. The proximal sutures were placed at the base of the inverted U incision. These sutures incorporate the entire vaginal wall minus the epithelium, pubocervical fascia and anterior extension of the cardinal ligaments. The 4 sets of sutures are transferred to the suprapubic incision. Endoscopic visualization of the bladder neck at the point with lifting of the sutures confirmed the proper elevation of the bladder neck and proximal urethra. After closure of the vaginal wall, the 4 sutures were tied independently, the to each other across the midline. {{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: _______________.