gineco
ro
increase of intraabdominal pressure.
Urinary loses that appear after the
patient coughs raise the suspicion of
associated detrusor instability. It is
compulsory that the test be taken also
in standing position ( figure 7), and
when the patient presents an associated
cystocel there must be searched for
the occult incontinence (the rise of the
cystocel with an applied tampon or a
valve, asking the patient to cough).
The ultrasound follows the dynamics of
the opening and closer of the bladder neck;
videourodynamic, colpocistography,
colpocystodefecography, MRI, being
expensive explorations with limited
indications. Generally, the urodynamic
testing is not able to anticipate the
answer to the treatment (Artibani W.),
and there are authors that consider
urodynamic testing at patients with
detrusor instability a negative factor
for rehabilitation, because after tape
Figure 6
surgery also those patients with
write the number of the micturitions, the alterated vaginal compartment. detrusor instability have 60% chances
the urine volume, and the urgency In order to underline the stress urinary for rehabilitation [7]. Nevertheless,
hours, because it may become a mean of incontinence, the patient will be set in urodynamic test is a mandatory
re-education of the bladder[6]. gynecological position, the bladder will exploration at patients with backsliding
The abdominal examination, perine- be filled with 250-300 ml of salt solution after pelvic surgery, vaginal surgery or
ogenital (bulbocavernous reflex), the at room temperature, and then the radiotherapy
emphasize of the urethral hipermobility patient will be asked to cough. Up-to-date surgical guidelines for the
(Q test), the profile urinary cistography Stress urinary incontinence is treatment of urinary incontinence and
( figure 4), are also important; valves appreciated to be only when the urinary urogenital prolapse.
vaginal examination ( figure 5) will show loses appears at the same time with the
Up-to-date surgical treatment.
1. Burch technique ( figure 8) – the
anchorage of the vagina to the Cooper
ligament, still remain an intervention
commonly used for the treatment of stress
urinary incontinence. There are authors
that consider this technique useful only
if there is no detrusor instability [8].
Further more, post operator obstructive
subvesical phenomena leads in same
cases to urethral catheterization.
2. TVT (Tension-free Vaginal tape)
procedure ( figure 9), published in by
Ulmsten in 1995, and then by Papa Petros
under the name of IVS (Intravaginal
sling) procedure, consists in setting a
polypropylene sling under the middle
part of the urethra in order to restore
the urethral hammock at the site of
the compression of urethra during the
increase of the abdominal pressure; this
will avoid the urinal flow. The sling is
lead suprapubian, retropubic, through
the space of Rhetzius [9].
Figure 7. The test with the patient in standing position.
3. TOT (Transobturator sling) ( figure
Vol. 4, Nr. 1/februarie 2008
pag. 51
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