RU2453279C1 - Device for control of suburetral loop tension in treatment of urinary incontinence - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to field of medicine, namely to devices for control of suburethral sling tension in case of urinary incontinence both in women and in men. Device represents a chamber made from tight elastic material, filled with liquid and attached to non-crushed holder. On the anterior surface of chamber there is a line of rupture on which during chamber deformation its destruction takes place.

EFFECT: ensuring control of suburethral sling tension and prevention of urethra compression.

2 dwg

Description

The invention relates to medicine, namely to devices used to control the tension of the suburethral loop used in the treatment of urinary incontinence in both women and men.

Urinary incontinence is called any involuntary, uncontrolled volitional urine output from the external opening of the urethra, regardless of the circumstances and situation that led to the latter and is a social and medical problem [3], [6]. Incontinence is found in 25% of the entire female population of the planet, while at the age of 20-24 they suffer from 15%, by 50 years old - 30%, older than 90 years - up to 40% of women, but only 4% of them actively seek medical attention . The risk of developing urinary incontinence in women under the age of 60 depends on an obstetric history, and after a hysterectomy is 60%. In nulliparous women, the disease develops in 10.1%, in those undergoing cesarean section - in 15.9%, after delivery through the natural birth canal - in 21% of cases. Urinary incontinence in men is most often the result of operations on the prostate gland [1], [2], [4].

For over 100 years, various loop operations have been used in the treatment of stress urinary incontinence. In 1996, a Swedish scientist Ulf Ulmsten proposed a sling operation using a synthetic loop, which had a number of fundamental differences from previously used methods. First of all, this concerned the localization of the loop, which was now located under the middle urethra, and not under the proximal, as was previously accepted. In addition, the loop was installed under the urethra without tension, without creating obstruction. These new principles, formed by Ulmsten, along with the use of polypropylene for the manufacture of loops, had a truly revolutionary significance on the effectiveness of operations for urinary incontinence in women [6], [7].

A synthetic loop, installed without tension, does not cause the urethra to bend, but creates only a rigid inextensible support under its middle third. The loop located in this way replaces the damaged ligamentous apparatus of the urethra and pubocervical fascia. And with an increase in intra-abdominal pressure, the urethra is pressed against an inextensible loop, which leads to the closure of its lumen.

Despite the high efficiency of this method, there is currently no single way to adjust the loop tension during installation. An insufficiently tight fit of the loop often leads to a lack of effect from the operation. At the same time, excessive tension exerted by the loop on the urethra is the cause of iatrogenic infravesical obstruction, which often leads to the need to dissect the loop. Thus, the introduction of a device into clinical practice to control the tension of the suburethral loop for the treatment of urinary incontinence may be a very topical issue. In available literature, we did not find data on the existence of similar devices.

The technical result of this invention is to control the tension of the suburethral loop used in the treatment of urinary incontinence at the time of its installation, and to prevent excessive compression of the urethra.

The specified technical result is achieved in that the device for controlling the loop tension is a chamber made of a tight elastic material, filled with liquid and attached to a non-crushable holder, while on the front surface of the chamber there is a break line along which, when the chamber is deformed, it breaks. The destroyed chamber is removed from the space between the urethra and the suburethral loop using the holder, without shifting the loop. Using the above device will help to establish a suburethral loop tight enough in relation to the urethra, without causing obstruction of the latter.

Figure 1 shows a General view of the device; figure 2 - use of the device at the time of installation of the loop.

The device for controlling the tension of the suburethral loop in the treatment of urinary incontinence is a chamber (1) made of a parallelepipedal material in the form of a parallelepiped, 10-20 mm, 10-20 mm and 5-10 mm in size, filled with liquid, and attached to a non-cremable holder ( 2), while on the front surface of the chamber there is a line of discontinuity (3) along which, when the chamber is deformed, it is destroyed. The thickness of the opposite walls of the chamber should not exceed 3-4 mm in total.

After the suburethral loop is performed by the surgeon during the operation, the device chamber is placed between the urethral wall (4) and the loop (5). When the loop (5) is installed, the chamber is compressed under the pressure exerted by the loop and collapses along the rupture line (3) on its front wall. At break, the volume of the chamber decreases. The next step, the surgeon removes the device using a crush-resistant holder, while the suburethral loop should not be significantly displaced or deformed.

The device was tested in the pathological department of the Moscow city hospital No. 50 during operations using a suburethral loop on corpses.

In the invention used by us, the camera had the shape of a parallelepiped with dimensions of 15 mm by 15 mm and 5 mm, however, this indicator as well as the shape of the camera can be changed, for example, a camera in the shape of a cylinder or a flattened sphere, which does not affect the technical result of the invention. The length of the non-creaseable tube of the model used by us was 150 mm. This length can vary significantly, but should be sufficient so that the surgeon can freely manipulate the device, while at the same time not making the device bulky.

LITERATURE

1. Laurent O. B. Epidemiology, etiology, pathogenesis, diagnosis of urinary incontinence. // Materials of the Plenum of the Board of the Russian Society of Urology, Yaroslavl, May 21-24, 2001 - M. - P. 21-41.

2. Pushkar D.Yu., L.M. Gumin. - Pelvic disorders in women. M .: MEDpress-inform, 2006.9-36.

3. Abrams P, Cardozo L, Fall M et al. The standartization of terminology of lower urinary tract function: report from the standartization sub-committee of the international continence society. Neurol Urodyn 2002; 21: 167-78.

4. Hannestad Y.S., Rortveight G, Sandvick H, Hanskaar S. A community-based epidemiological survey of female urinary incontinence: EPINCONT study. JClinEpidemiol 2000; 53: 1150-7.

5. Rortveight G, Daltveit A.K., Hannestad Y.S., Hanskaar S. Urinary incontinence after vaginal delivery or cesarean section.

6. Kan D.V., Mazo V.E., Gumin L.M. Urodynamic criteria in evaluation and management in stress incontinence in female. ICS, 19th Annual meeting. Ljubljana, 1989 .-- P.96.

7. Ulmsten U. Herniksson L. Johnson P. Varhos G. An ambulatory surgical procedure under local anesthesia for treatment of female urinary incontinence. Int Urogynecol J Pelvic Floor Dysfunct 1996; 7: 81-5.

Claims (1)

A device for controlling the tension of the suburethral loop in the treatment of urinary incontinence, which is a chamber made of a taut-elastic material, filled with liquid, and attached to a non-crushable holder, while on the front surface of the chamber there is a line of rupture along which, when the camera is deformed, it breaks.

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