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|Type:||Artigo de periódico|
|Title:||The Absorbable Collagen Sling For Stress Urinary Incontinence|
Netto Jr. N.R.
|Abstract:||This videotape shows the construction of a new highly purified and polymerized type collagen pubovaginal sling. Autologous material has been preferred over the synthetic ones based upon the concern about an increased incidence of infection or urethral erosion induced by synthetic materials. On the other hand synthetic materials allow for performing a pubovaginal sling with minimal dissection, simplifying the surgery and reducing operative time and hospital stay. The collagen used here is a biocompatible material ttiat underwent a cryopolimerization process resulting in biomechanical properties similar to tendons. Our experimental data in dogs showed that this sling is replaced by autologous collagen after 3 months, that will keep the urethrovesical junction in the proper position. The procedure is performed under spinal anesthesia with the patient in the lithotomy position. An inverted U incision is made in the vaginal wall. Dissection is carried out toward the inferior pubic ramus. The endopelvic fascia is perforated using a Metzembaum scissors and the Retzius space is bluntly dissected. The same maneuvers are repeated on the other side. A small transverse suprapubic incision is made. Two small incisions are made in the reclus fascia, the index finger is introduced in the Retzius space reaching the rectus muscles that will be perforated and the clamp will be brought to the vaginal incision. One of the extremities of the sling is grasped and brought to the suprapubic region. After repeating the same maneuvers on the other side, cystoscopy is performed to rule out bladder lesions. The sling is sutured at the bladder neck and mid urethra and to the abdominal aponeurosis and the vaginal wall is closed. A Foley catheter is left in place for 7 days. This sling associates the advantages of autologous materials with those of the synthetic ones, producing 85% of cure and 10% improvement in the first 20 patients treated and may be an attractive alternative in complex cases of stress urinary incontinence.|
|Appears in Collections:||Unicamp - Artigos e Outros Documentos|
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