gineco
ro
tehnici chirurgicale
10) procedure was described in 2002 by
Delorme. It consists in the obturatory
placement of the sling, avoiding the
blind retropubic passage and, unlike
the TVT (where the urethra is being
suspended by the sling), in this case
the urethra is supported. This will lead
to the decrease of the de novo urgency
which might appear after this type of
procedures [10,11].
4. The reinforcement of the vaginal
hammock, the curtailment of the
external urethral ligament, represent
complementary steps of these sling
procedures that are necessary sometimes
in order to regain the continence.
5. The polypropylene meshes for the
central, lateral and mix cystocel are
procedures realized in the spirit of Papa
Petros’ integral theory, which relates the
appearance of prolapse to the alteration
of the conjunctive tissue. The classic
procedures are frequently followed by
Figure 8. Burch technique
relapses; therefore the defects must be
reinforced with these polypropylene
implants. The arms of the implant
must be lead transobturatory over
the tendinous arch of the endopelvic
fascia and the sling must be lead under
the bladder on a tension-free manner
( figure 11).
6. In order to fix the vagina, repair the
rectocel and reinforce the utherosacral
ligaments, the arms of the implant are
lead through the ischioanal fossa with
the implant covering the rectovaginal
defect.
7. The Bridge technique ( figure 13, 14)
strengthens the anterior or the posterior
vaginal wall using an autologus vaginal
flap which will become included into
Figure 9. TVT technique
the normal vaginal mucosa after
cauterization.
8. Colposacropexy is a procedure that
tightens the vagina, or the vagina and the
uterus, in case of vault or uterine prolapse.
It is a difficult procedure that modifies the
vaginal axis and must be avoided in case
of a sexually active patient. To diminish
the modification of the vaginal axis, some
authors recommend the fixation of the
vagina on the S2-S3, but in this case there
are severe hemorrhagic risks [12].
9. Le Fort technique is a limited
procedure which can only be used at old
patients ( figure 16). The created septum
support the uterus and the laterovaginal
spaces assure the drainage of the
Figure 10. TOT technique secretions.
pag. 52 Vol. 4, Nr. 1 /februarie 2008
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