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stress urinary incontinence

The Problem. Symptom- the complaint of involuntary leakage of urine during effort, exertion, coughing or sneezingSign-The observation of leakage from the urethra synchronous with cough or exertion or spontaneously. DEFINITION OF URINARY INCONTINENCE. The objective loss of urine that presents a social or hygienic problem to the individual. Incontinence is not a normal part of aging nor is it a disease..

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stress urinary incontinence

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    1. Stress Urinary Incontinence MONARC vs. Paravaginal wall Repair: A system and surgeon perspective Dr. Richard McClain, MD, FACOG Chief of OB/GYN, Chickasaw Nation Health System

    3. DEFINITION OF URINARY INCONTINENCE The objective loss of urine that presents a social or hygienic problem to the individual. Incontinence is not a normal part of aging nor is it a disease.

    6. (SUI Continued) TWO MAIN CATEGORIES HYPERMOBILITY Loss of urine related to movement of the bladder neck and urethra triggered by abdominal straining (lifting, jogging) INTRINSIC SPHINCTER DEFICIENCY (ISD) Leakage of urine with minimal exertion related to an intrinsic weakening of the bladder outlet closure mechanism

    7. URGE INCONTINENCE Sudden, uncontrollable urge to void, resulting in leakage of urine CAUSES Urinary tract or vaginal infections Bladder tumor/stones Neurological causes (MS, Parkinson’s, spinal cord injury)

    8. CLINICAL EVALUATION by a Thorough evaluation physician: History: symptoms, bowel habits, medical history Physical Examination: neurologic examination, abdominal exam, pelvic examination Urodynamics: a series of diagnostic tests used to measure how the bladder fills, stores and expels urine

    9. My Approach Subjective- affects lifestyle/activity, Sandvik Severity Scale and Incontinence Quality of Life Questionaire (included) Objective- leaking with cough or Valsalva in the clinic Conservative therapy- one month trial of Kegel’s exercises and Ditropan Urodynamics for special cases

    10. SURGICAL TREATMENTS The goal of a surgical procedure to correct SUI is to: Reposition the bladder neck to minimize hypermobility of the urethra during stress Improve the coaptation of the urethra so it closes more effectively

    11. HYPERMOBILITY: Needle suspensions (Urethropexies) Stamey, Raz, Gittes Retropubic suspensions (Urethropexies) Burch, MMK Sling procedures Suprapubic and Transvaginal

    12. ParaVaginal Wall Repair -Retro pubic repair that seeks to recreate normal anatomy -Modified to include a mid-urethral stitch in some patients -Requires transverse incision -Equivalent success to Burch Colposuspension -Gold Standard for SUI surgery

    20. Monarc® Mesh Position

    21. Needle Path Use thumb of hand in vaginal incision to perforate Rotate the needle after obturator membrane perforation to exit the vaginal incision

    23. System Issues Efficacy of current procedures Patient Benefit of new procedure Safety of new procedures Cost of the procedure/kit Credentialing for new procedures

    24. System Issues Efficacy of current procedure- were doing Burch with 50% effectiveness, had been doing TVT and SPARC Higher than expected bladder perforation rate Post operative hospitalization for Retro- pubic procedures was 76 hours (3rd day)

    27. Outcome for our Facility Monarc/SPARC- 70 procedures done Average operative time- 45 minutes Post-operative stay- 34 hours 10% done as an outpatient Decreased bed usage translated to fewer transfers Patient recovery time markedly improved

    28. Outcome for our Facility (cont) Reproducible between providers Significant improvement in patient satisfaction Enhanced reputation/standing in the eyes of the patients and community

    29. Pearls from Experience Make sure patients understand that some will have to be tightened, loosened or replaced Not all incontinence is treated with surgery No one can guarantee they’ll never leak again Cystoscope everyone!!

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