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Chapter-44 Bladder, Urethra and Incontinent Surgery

BOOK TITLE: Operative Obstetrics and Gynecology

Author
1. Sinha Rooma
2. Sinha Sanjay
ISBN
9788184485370
DOI
10.5005/jp/books/11088_44
Edition
1/e
Publishing Year
2009
Pages
13
Author Affiliations
1. Medwin Hospital, Hyderabad, India, Hyderabad, Hyderabad, India, Apollo Hospital, Hyderabad, Andhra Pradesh, India, Hyderabad, Andhra Pradesh, India, Apollo Health City, Hyderabad, Telangana, India
2. Medwin Hospital, Hyderabad, India, Oxford Radcliffe Hospital, Headington, Oxford, Apollo Hospital, Hyderabad, Andhra Pradesh, India; IUGA Exchange Steering Committee (IESC), Hyderabad, Andhra Pradesh, India, Hyderabad
Chapter keywords
POP surgery, concomitant surgeries, pubovaginal sling, incontinence, vaginal wall, foramen, vaginal dissection, incision, cystoscopy, plastic sheaths, anesthesia, tension, voiding trials, sutures, pubocervical fascia, voiding dysfunction, rhabdosphincter, normal pliability, void urine, rectus fascia sling, tension-free tape

Abstract

This chapter discusses rectus fascia sling operations for bladder, urethra and incontinent surgery. In this method, preoperative evaluation focuses on the type of incontinence: stress, urge or mixed, voiding diary, and assessment of pelvic anatomy including pelvic floor strength. Urinary retention is uncommon after sling surgery provided the sling is kept without any tension. pubovaginal rectus fascia slings have proved to be excellent long-term results with upwards of 80% remaining continent beyond 5y. Synthetic suburethral slings are now the most commonly performed procedure for stress urinary incontinence. Urodynamic testing prior to POP surgery may unmask stress incontinence. Such evaluation may save the woman from repeat surgery and the surgeon from unnecessary embarrassment. Burch operation should not be offered to women with recurrent stress urinary incontinence unless it can clearly be demonstrated that recurrence has occurred in a setting of hypermobility without ISD.

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