RU2281044C2 - Method for surgical therapy of stress urinary incontinence in women with genital prolapse - Google Patents

Abstract

FIELD: medicine, gynecology.

SUBSTANCE: one should dissect and separate mucous membrane of anterior vaginal wall to introduce a netting made of certain biocompatible material - super-elastic titanium nickelide. Moreover, posterior edge of the netting should be fixed with uninterwoven ligatures towards intrapelvic fascia. The innovation enables to minimize post-operational complications and decrease the relapse rate of the above-mentioned disease.

EFFECT: higher efficiency of therapy.

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Description

The invention relates to medical surgical equipment.

Incontinence in people, in particular and most often in women, is a disease that does not lead to death or a serious direct violation of the physiology of the body, but leads patients to social ostracism, the psychoemotional suffering from which is no less severe than physical, and increases the possibility any pathology.

This problem is so serious with the prevalence of the disease and the social consequences that the International Society for Urinary Incontinence was organized, and in Russia it was comprehensively discussed at the next plenary session of the Board of the Russian Society of Urology. [one]

Stress urinary incontinence or stress urinary incontinence (NMPD) in women of active working age was noted according to a survey and examination in 38% of respondents. Of these, a significant proportion are patients with a severe degree of the disease.

A typical etiological factor in these cases is ptosis (prolapse) of the anterior vaginal wall, or more severe - prolapse (prolapse) of the genitals. A change in anatomy leads to impaired function of the urethral sphincter. A disease at this stage is not treated with conservative methods. Surgical intervention required.

A known method of etiotropic surgical treatment of stress urinary incontinence in women [2] by excision of the hernial sac and suturing tissue with tension (anterior colporaphia). The method is ineffective and with severe degrees of the disease is not shown.

Known methods of etiotropic surgical treatment of stress urinary incontinence in women [1], using loops (slings) made of various biocompatible materials to support and stretch prolated tissues - flaps of the anterior vaginal wall, fascial auto or artificial slings, injection of substances (collagen, autogyro, teflon) . These methods are ineffective, leading to relapse of the disease due to erosion of the bed of the loop and prolonged infection in the wound.

A known method of surgical treatment of stress urinary incontinence in women [3], using in a sling operation, supplemented by anterior colporaphia, prolene mesh. During the operation, the mesh is placed under the separated mucous membrane and sutured to the front wall of the vagina. This method is selected for the greatest similarity as a prototype of the invention.

The disadvantage of this method is the high recurrence of the disease due to the low biocompatibility of the mesh material. Prolen is an expensive material that makes this operation economically inaccessible to patients in our country.

The technical result of the invention is to increase the viability of the operation, reduce the recurrence of the disease.

The specified technical result is achieved by the fact that in the method of surgical treatment of stress urinary incontinence in women with genital prolapse, which includes dissecting and separating the mucous membrane of the anterior vaginal wall, introducing a mesh of biocompatible material under the separated mucous membrane, superelastic titanium nickelide is used as the biocompatible material, posterior the edge of the mesh is fixed with non-woven filaments to the pelvic fascia.

The attainability of the technical result is due to the combined effect of the properties of the titanium nickelide alloy: biochemical and biomechanical compatibility, superelasticity property, accentuated in the structure of the woven mesh.

As a result of the operation, the weakened and labeled along with the urethral tissue of the anterior vaginal wall acquire additional support, the mechanical and deformation characteristics of which, from the currently known medical materials, correspond to them as much as possible. The long-term successful action of the formed support is facilitated by the initial fixation of the mesh organized during the operation (with non-woven strands to the pelvic fascia, tissue retention and mesh structure) and subsequent mesh ingrowth and the formation of strength reinforcement of the front wall. Correction of the anatomy of the anterior wall leads to the restoration of the normal geometry of the urethra (vesicourethral angle), the function of the sphincter and cure the disease.

High biocompatibility of titanium nickelide material provides an increase in the viability of the operation, i.e. minimization of postoperative complications and relapse of the disease itself.

An additional favorable factor is the free (seamless) laying of the mesh. Reliable fixation of the mesh when it is freely located in the submucosal bed eliminates the need for hemming, i.e. additional trauma, as is the case in the prototype. Thus, the chances of the viability of the operation are increased, the healing time and overall rehabilitation of the patient are reduced.

The following is presented in the illustrations.

Figure 1. Grid-implant for implementing the method of surgical treatment of stress urinary incontinence in women.

Figure 2. The grid installation scheme (operation step).

Figure 3. Urethrocystomanogram of the patient: 1 - before surgery, 2 - after surgery.

Achievability of the technical result is proved by examples of specific implementation of the proposed method when used in clinical conditions in the regional clinical hospital of Novosibirsk.

Example.

Patient Zhukova, 67 years old. The diagnosis of the disease: vaginal prolapse of the 4th degree, stress urinary incontinence at rest (Fig. 3.1).

The patient underwent a sling operation, supplemented by anterior colporaphia - according to the proposed method using a mesh - 1 (Fig. 1) of nickelidotitan titanium wire with a diameter of 0.5 mm with dimensions of 4 × 5 cm and two unwoven threads 2.

The method during the operation is as follows.

After preparatory steps, catheterization of the bladder and opening of the vagina with mirrors, an oval flap with oval points is cut out from the anterior vaginal wall stretched by Kocher's clamp. One vertex of the flap is oriented to the external opening of the urethra, the second to the transitional fold of the mucous membrane of the anterior part of the vaginal fornix. After pulling the tops of the flap, the connective bundles between the urethra and the vaginal wall are cut. The flap is separated and removed. The edges of the vagina are separated to the sides by 2 cm, the bladder is isolated and, after dissection of the bundles of connective tissue, it is moved away from the cervix to the peritoneum of the vesico-uterine cavity. Directly behind the neck of the bladder, a sterilized mesh is laid, the angular ends of which are fixed to the intrathic fascia suburethrally with two unwoven threads 2 (figure 1) (figure 2). The edges of the vaginal wound without tension are connected by knotted catgut sutures with simultaneous stitching of the underlying tissues.

After the initial healing of the surgical wound, the patient was discharged from the hospital in satisfactory condition on the 7th day (while standing and lying, she holds urine). The maximum flow of urine during emptying is 16 ml / sec.

A month after the operation, the patient was examined. The restoration of the sphincter (Fig.3.2) is established. The implanted mesh was integrated into the vaginal tissues of its own, becoming a functional structure of the body for a long time.

Statistical processing of the results of a number of similar operations carried out indicates the advantage of the nickelidotitan network compared to the prototype prolenium network, which is isolated in the body as a foreign body (prosthesis). Associated with this and the technical result of the proposed method.

Sources used in compiling the description

1. Materials of the plenum of the Russian Society of Urology (Yaroslavl, May 21-24, 2001). M., 2001.

2. Buyanova S. N., Petrova V. D., Shaginyan G. G., Smolyaninova T. Yu. The effectiveness of various methods of treating women with genital prolapse complicated by urinary incontinence // Bulletin of the Russian Association of Obstetricians and Gynecologists. 1999. No3. S.87-89.

3. Pushkar D.Yu., Tevlin K.P., Laurent O. B. Surgical treatment of complex forms of urinary incontinence // Obstetrics and gynecology. 2000. No1. S.23-25 (prototype).

Claims (1)

A method for surgical treatment of stress urinary incontinence in women with genital prolapse, including dissecting and separating the mucous membrane of the anterior vaginal wall, introducing a mesh of biocompatible material under the mucous membrane, suturing the wound, characterized in that superelastic titanium nickelide is used as the biocompatible material, the posterior edge nets are fixed with non-woven filaments to the pelvic fascia.

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