basic physiology and patholoy of the two types of inconetinence
pelvic diaphragm maintians the uetrthrovesical angle which is lost when the bladder neck descends as a resut of urethral hypermobility when the urethral support sgtes weaker.
another reaso is with the smooth muscles of the urethra which gets defective. intrinsic sointure gets defective
both Q tip test and bonneys test is used to determine whether there is urethrovesical hypermobility.
But these arent done anymore because the surgeyr treatment options is the same for all types of SUI
1 tip is by placing the tip isnide the urethra and ask to cough. if the tip moves in a greater angle then urethrovesical hyperobility is present.
Bonneys test is done by asking to cough then drops leaks out. then you put fingers in vagina and then up front to stabalise the urethra push..and then ask to cough..then the stress inconditnnecne wont be there ebecause urethra is fixed. IT then conforms the presence of stress incontincne due to urethrovesical hyperobility.
TO TREAT FOR SUI MUST RULE OUT URGE INCONTINCENCE AND UTI
lifestyle modfication and weight reduction also may go a long long way in relieving incontinence
there is the only approved drug called duloxetine but its not a mainstay of treatment.
how to tell the woman to practice kejel's exercises ⇒ must make sure she's pratciing contractig the correct muscles...for that put your finger in and tell her to greasp it...and make sure she's using the muscles of pelvic diaphragm and the levator ani and not abdominal muscles.....tell her to change until she gets the mudcle right n-..and then tell her to practice these muscle contractions.
the first two surgeries and the sigrery is general help to adress the utrthral hypermobility.
its just like the fingerss in the vgaina test helping to keep th irethra fixed and in place.
kelly's pilication does this by puttig up stiches in between the baldder and the vagina region..where the finger would press but it was ineffecitve and let to damage in a while.'
then needle suspesnios where its lie s ling around the urethra neck and keeping it up and stable.
but thn composuspension was done...was about suspendings and supporting the structures around the vgaina.
Althought the above is the most effective and best 10 years success rate, its not preferred because its a difficult surgery to do.
mid urethral sling are less effective but much easier a surgery to do - so its preferred these days.
pexy is whenever we put in a mesh or whenever we attache or hitch a structure to something else.
in this the appraoch is retropubic and its used to fix the urethra that way. two bits of situres are put around the urethra and then a sling is used to tie these bites either to the pubic bone or the coopers ligament. both have bleeding during surgery complications. but the pubic has osteitis complications.
and it was a difficult procedure to do even though it was the best. so the next one is considered standard as its sorta effective and easier to do.
above is the most commonly done!
complications of the tvt tape and procedure
to avoid the above injuries can instead of going through the retropubic space go trhough another space.
so instead done from down and going though the obturator foramen.
But can injure the obturator vessel and nerves here
So its got its own complications
So the bottom line is both has its complication and what preferred is based on the surgeons choice as wel.
TOT is a procedure.
The mechanism is same as the tvt
occludes it when abdominal pressure increases.
the needle is put into the vagina
but instead of them going to the anterioir abdominal wall it goes though the obturator foraemn and then outside.and slung like that.
procedure can be done in ten minutes ut it takes years to master!!!!!
the best proecure for incontinence is the colposuspesion but thats difficut a proecure because it requiresopening up the abdomen etc (not like ten minute proceure like TOT or TVT)...but if doing a repair for vault prolapse (sacralpexy...then can do this colposuspesion i the same procedure). So this becomes the treatment of choice.
INVESTIGATIONS ARE USELESS IF IT DOESNT CHANGE YOUR TREATMENT OPTIONS OR MODALITY !!!!!!!!!!!!!!!!!!!!1
Urinary incontinecnee
