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Urologic Involvement
Published in Nazar N. Amso, Saikat Banerjee, Endometriosis, 2022
Jörg Keckstein, Gernot Hudelist, Simon Keckstein
Excision of parametrial and ureteral endometriosis begins with opening of the medial and lateral paravesical space. Anatomical landmarks are the umbilical artery, pubic symphysis and pelvic floor. Careful mobilization of all structures ensures a largely tension-free anastomosis between the ureter and bladder. In particular, the bladder must be mobilized out of its fixation in the direction of the space of Retzius (retropubic space) and the lateral pelvic wall.
Urethra and Penis
Published in Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie, Bailey & Love's Short Practice of Surgery, 2018
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie
Extravasation of urine This can occur with extraperitoneal rupture of the bladder, pelvic fracture urethral disruption or in the rare cases where the level of the disruption is the prostatic urethra. Urine extravasates in the layers of the pelvic fascia and the retroperitoneal tissues. Treatment is by suprapubic cystostomy. In rare cases where the extravasation persists despite the suprapubic tube, drainage of the retropubic space and definitive repair of the urethral, prostatic or bladder rupture is required
Urogynaecology and pelvic floor problems
Published in Helen Bickerstaff, Louise C Kenny, Gynaecology, 2017
Burch colposuspension was the primary procedure for stress incontinence for many years before the midurethral tapes were developed. At colposuspension, the retropubic space is opened via a Pfannenstiel incision in the abdomen, and the bladder reflected medially on each side to allow the placement of two or three sutures (either absorbable or permanent) into the paravaginal fascia on each side at the level of the bladder neck (Figure 10.7). These sutures are placed through the pectineal ligament on the pubic ramus on the same side, and then tied to provide support to the bladder neck and prevent descent during coughing or straining. The cure rate for incontinence is the same as for midurethral tapes (80–85%), and complications are similar.
Transurethral high-intensity ultrasound for treatment of stress urinary incontinence (SUI): simulation studies with patient-specific models
Published in International Journal of Hyperthermia, 2018
Dong Liu, Matthew S. Adams, E.C. Burdette, Chris J. Diederich
While these simulations highlight the promise of high-intensity ultrasound for SUI thermal treatment, the proposed treatment strategy also has some potential barriers when considering translation to a practical clinical setting. As seen in the patient-specific models, the treatment zones were largely affected by the spatial proximity of the vagina and bone structures relative to the urethra. A larger retropubic space might allow placement of more ultrasound shots and hence enhance the treatment effect, whereas a smaller retropubic space and/or an ‘H shaped’ vagina morphology which surrounds the urethra could constrain treatment zone coverage and possibly increase the risk of thermal insult to non-target tissues. Cooling of the vaginal wall through a cooled obturator positioned in the anterior portion of the vagina could be considered for expanding the treatment volume and enhancing vaginal sparing, following approaches similar to endocavity cooling used for laser treatment of SUI [25], as well as prostate and cervical thermal therapy [53,69,73]. Further, this cooling obturator could be positioned or shaped in a way to retract vaginal wall away from the target zones. Additionally, image based feedback using ultrasound elasticity or time series imaging, or MRI can be considered for more precise treatment application and monitoring. MRI thermometry can be applied to monitor the volumetric temperature evolution in target and non-target tissues in real-time [74,75], and provide for the means of feedback control to compensate for tissue heterogeneities and dynamic changes to properties. Ultrasound imaging can also be applied to aid applicator positioning and targeting, as well as potential for temperature or ablation monitoring [76].
Intraoperative Vaginal Perforation During Various Mid-Urethral Sling Procedures Treating Female Stress Urinary Incontinence
Published in Journal of Investigative Surgery, 2020
Peng-Hu Lian, Zhi-Gang Ji, Han-Zhong Li, He Xiao, Wei-Gang Yan, Zhong-Ming Huang
Mid-urethral slings (MUS)operations are the most commonly performed surgeries for women with stress urinary incontinence (SUI) [5, 6]. The commonest types of MUS used are those traversing the transobturator route (TOR) or the retropubic route (RPR) like Sparc, with entry or exit points at the lower abdomen or groin, respectively [3]. Besides, with the invention of mesh, mid-urethral sling procedures passing the transobturator route (TOR), including standard transobturator mid-urethral slings (SMUSs), such as transobturator vaginal tape inside-out (TVT-O) by Jean de Leval. in 2003 [7], has been rapidly adopted. In addition, the original TVT-O procedure was modified as TVT-ABBREVO (Ethicon Women's Health and Urology, Somerville, NJ, 2012) with the aim of reducing the incidence of postoperative groin pain as well as the rather theoretical risk of obturator nerve injury [8, 9]. The Tension-free vaginal tape (TVT) provided a less-invasive, outpatient-based treatment for SUI [10, 11]. The long-term cure rates with the TVT have been significant, with “cured/dry” rates comparable or superior to those seen with the Burch colposuspension [11, 12]. However, the TVT has developed specific complications, including bladder, bowel, and vascular injury, owing to the blind passage of trocars through the retropubic space [13, 14]. In response to these risks, the TVT was modified by Delorme in 2001, using the ‘outside-in’ technique of a transobturator route for suburethral tape placement-the transobturator tape (TOT) [15, 16]. With comparison to traversing the retropubic space, the TOT procedure passes blindly through the obturator foramen in an “inside-out” or “outside-in (MONARC)” route [11]. Nevertheless, the success rates of both procedures were similar, ranging from 90% to 95% [17].
Safety and efficacy of robotic-assisted Burch for pure stress urinary incontinence: a large case series
Published in Journal of Obstetrics and Gynaecology, 2021
Toy G. Lee, Bekir S. Unlu, Victoria A. Petruzzi, Mostafa A. Borahay, Furkan Dursun, Antonio F. Saad, Gokhan S. Kilic
Diminished urethral support and urethral sphincter weakness are generally attributed to urethral hypermobility, which is the main cause of SUI. Urethropexy (retropubic colposuspension) is a traditional repair in women with incontinence secondary to urethral hypermobility. It was first described in 1961 (Burch 1961). Periurethral tissue is elevated and reinforced by a mini-laparotomy incision and open dissection of the retropubic space. Although a systematic review of 53 trials had reported success rates of 85−90% one year postoperatively and 70% five years postoperatively, the Burch procedure lost its popularity following the introduction of the mid-urethral sling (MUS) due to its surgical practicality (Lapitan and Cody 2012). Later, minimally invasive techniques for Burch described the advantages over open surgeries, such as shorter length of hospital stays, faster recovery, and faster return to activity (Tan et al. 2007). A recent Cochrane review of laparoscopic urethropexy included 22 randomised controlled trials (Dean et al. 2017). Cure rates of laparoscopic and open Burch urethropexy were similar, but this review revealed that laparoscopy was associated with a shorter length of hospital stays, lower morbidity, significantly fewer postoperative complications, lower estimated blood losses, shorter duration of catheterisation and significantly less pain (Dean et al. 2017). Another minimally invasive technique for Burch urethropexy is the robotic-assisted Burch urethropexy, which was first reported with two cases in 2007 by Khan et al. (2007). Our group published our initial experience with robotic retropubic urethropexy compared to open retropubic urethropexy in 2013 (Patel et al. 2013). As a result, the Burch procedure continues to have a place in the operative armamentarium of the gynaecologist and urologist.