1 ID: 841659
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1 1 NON-MESH ANTERIOR REPAIRJORGELOCKHART,
1 NON-MESH ANTERIOR REPAIRJORGELOCKHART,M.D.PROFESSORDEPARTMENT McGuire and Lytton (1978) reintroducedRectus fascia / Bladder neck ISDDurability superior to needle suspensions and similar to retropubic suspensionsHighly effective What Is The Best Surgical Technique? 204050607090 Dry (%)Improved (%) Retropubic
2 (Burch) Transvaginal (Needle) Anterior R
(Burch) Transvaginal (Needle) Anterior Repair Sling MainConcern with Post OperativeComplicationswithSynthetic SlingsPersistence or Worsening of SUIDe-Novo Frequency Vesical, Urethral or De-Novo Frequency and Urgency -IncidencePubo-Vaginal Sling: Haab JU 158:1997 TVT:Abouassaly BJU 94:2004 Levin Neur Uro 23
3 :2004 2 De-Novo Frequency and Urgency -C
:2004 2 De-Novo Frequency and Urgency -CausesUrethral Irritationusually non-responsive to drugs De-Novo Frequency and Urgency -TreatmentPharmacologicUrethral DilationTransvaginal Sling ResectionVideoUrodynamics Essential When to Transect a Sling?Clinical and cystoscopic indication ofbladder neck overcorrectionVideoUr
4 odynamics Showing Obstruction:Sometimes
odynamics Showing Obstruction:Sometimes a low, intermittent flow rate isthe main indicator of obstruction. 3 4 SYNTHETIC SLINGS LITIGATIONMORE THAN 10 CLASS ACTION SUITS FROM COMPLICATIONS RELATED TO URETHRAL OR BLADDER SUSPENTION SLINGS .THERE ARE A VARIETY OF SUSPENSION PROCEDURES IN THE LITERATURE FOR PROLAPSE
5 REPAIR. AMONG THEM, WE REPORTED A DOUBL
REPAIR. AMONG THEM, WE REPORTED A DOUBLE LAYERED CORRECTION UTILIZING A SUSPENDED DEMUCOSALIZED IN SITU VAGINAL FLAPCARRION ET AL: J GYN SURG 2002 DOUBLE LAYERED ANTERIOR WALL PROLAPSE CORRECTION25 PATIENTS S/P HYSTERECTOMY21 HAD PREVIOUS REPAIR16 WITH SUI12 WITH VV DESCENTCARRION ET AL 2002
6 5 6 DOUBLE LAYERED ANTERIOR WALL PR
5 6 DOUBLE LAYERED ANTERIOR WALL PROLAPSE CORRECTION:23/25 92% improved postoperatively14/16 86% improved their SUIComplications: SP wound infection-1 pt 4%IC postop-3 pts 12%Carrion et al: J Gynec Surg 2002 DOUBLE LAYERED ANTERIOR PROLAPSE CORRECTION (New series):8/8 pts improved2/8 require IC (25 %