治疗女性压力性尿失禁_1课件.ppt

GYNECARE TVT * Perforation of the bladder will be identified cystoscopically. The introducer needle should be removed and replaced where it does not impinge on the urinary tract. An indwelling catheter is placed and left to drainage for 1-2 days. GYNECARE TVT * Bleeding occasionally occurs and is limited by the retropubic space. This can usually be successfully managed with a vaginal pack, although Percutaneous drainage may be necessary. GYNECARE TVT * Infection is managed with appropriate antibiotics. GYNECARE TVT * GYNECARE TVT * A large number of patients have undergone the procedure since 1995, verifying that the procedure is safe. Follow-up at 2 years indicates 84% cure. The procedure is safe and effective. All recent peer reviewed clinical studies are included in the Preceptee binders. GYNECARE TVT * GYNECARE TVT * GYNECARE TVT * GYNECARE TVT * GYNECARE TVT * GYNECARE TVT * GYNECARE TVT * GYNECARE TVT * GYNECARE TVT * GYNECARE TVT * GYNECARE TVT * GYNECARE TVT * Apply local anesthesia in the skin just above the symphysis on both sides of the midline. Continue on each side in the abdominal wall, down in the muscles and fascia. Anesthesia is placed behind this symphysis in the retropubic space. GYNECARE TVT * GYNECARE TVT * Insert speculum. Local anesthesia is applied sub-urethrally. Starting approximately 1.0 cm from the external urethra meatus. Apply local on each side of the urethra into the retropubic space. 3-4 minutes should be allowed for the anesthesia at act. GYNECARE TVT * GYNECARE TVT * The anterior vaginal wall overlying the mid to distal urethra is elevated with Allis clamps and incised vertically in the midline. The incision should begin approximately 1.0 cm from the external urethra meatus and extend for 1.5 cm. The incision should be long enough to accommodate the width of the TVT tape. GYNECARE TVT * GYNECARE TVT * GYNECARE TVT * Two small incisions of .5 cm - 1.0 cm are made just above the pubic symphysis. These incisions are m