2. Sayantika Dhar B efor e t h e sur ger y: accurate diagnosis
assessment by- incontinence specialist,urologist or
urogynecologist. For pre-natal women or women planning tobear a
child, doctors recommend holding offthe surgery- it may undo any
surgical fixture. 3. Sayantika Dhar A i m of su r gi calm an agem
en t : recreating urethral support allowing for thenormal
functioning of the urethra duringincreased abdominal pressures. 4.
Sayantika DharA ppr oach es for St r ess I n con t i n en ce
Abdominal approaches Retropubic colpo-suspension Burch
Marshall-Marchetti-Krantz (MMK) Contemporary Pubo-vaginal sling
Tension free vaginal tape (TVT) Trans-obturator tape (TOT) 5.
Sayantika DharRetropubic Colpo-suspension Retropubic suspension
surgery is used totreat urinary incontinence by lifting thesagging
bladder neck and urethra that havedropped abnormally low in the
pelvic area. 6. Sayantika DharRetropubic Colpo-suspension 7.
Sayantika Dhar 8. Sayantika Dhar 9. Sayantika Dhar 10. Sayantika
Dhar 11. Sayantika Dhar 12. Sayantika Dhar 13. Sayantika Dhar P u
bo-vagi n al Sl i n gs The procedure involves placing a band of
slingmaterial directly under the bladder neck (ie,proximal urethra)
or mid-urethra, which actsas a physical support to prevent bladder
neckand urethral descent during physical activity. 14. Sayantika
Dhar 15. Sayantika Dhar 16. Sayantika DharTension Free vaginal
Taping (TVT): Through a small vaginal incision, permanent mesh-like
material is placed underneath the urethra andanchored to the
abdominal muscles above the pubicbone. The mesh-like material
remains as a permanent slingunder the urethra, preventing
incontinence whenstraining or coughing. General anesthesia or local
anesthesia is required. 17. Sayantika Dhar 18. Sayantika Dhar 19.
Sayantika Dhar Less invasive, Small incisions- Local anesthesia
Same day or overnight surgery stay Return to work in 2 - 3 weeks
20. Sayantika DharTransobturator Sling (TOT) The transobturator
sling (tot sling) is subfascial, iethe needle or the sling NEVER
enters the retropubicspace. 21. Sayantika Dhar Complications:
Difficulty urinating and incomplete emptyingof the bladder (urinary
retention), althoughthis is usually temporary Urinary tract
infection Difficult or painful intercourse 22. Sayantika
DharApproach for Urge incontinence:Augmentation CystoplastyAim:
increase bladder size 23. Sayantika Dhar Augmentation cystoplasty
Augmentation cystoplasty is the most oftenperformed surgical
procedure for severe urgeincontinence. In this surgery, a segment
of the bowel isadded to the bladder to increase bladder sizeand
allow the bladder to store more urine. 24. Sayantika Dhar
Augmentation cystoplastyContraindications Patients who are unable
or unwilling to perform life-long intermittent catheterization
should not undergoaugmentation cystoplasty because of the
highlikelihood of ultimately requiring catheterization. In
addition, patients with inflammatory boweldisease, bladder tumors,
or severe renal insufficiencyshould not undergo augmentation
cystoplasty. Patients with a short life expectancy -
consideralternatives such as continued medical management. 25.
Sayantika Dhar 26. Sayantika Dhar Ur et h r al B ul k i n
gIndications: Stress or Urge incontinence Poor or no response to
conservativemanagement 27. Sayantika Dhar A i m of bul k i n g
Build up the thickness of the wall of theurethra so it seals
tightly when you hold backurine. 28. Sayantika Dhar Performed under
local anaesthesia Collagen used as bulking agent a skin test is
done to check for allergies beforethe procedure 29. Sayantika
DharRisks: pain at the injection site injury to the urethra, and
Migration/ dislodging of the bulking material 30. Sayantika
DharTHANK YOU
