Transobturator sling

A trans-obturator sling procedure corrects stress incontinence by supporting the urethra to keep it in its correct position.

Trans-obturator sling procedures have a success rate of about 90%.

Stress incontinence occurs when weak pelvic floor muscles, or pressure from other organs shift or weaken the bladder neck.

With an impaired bladder neck, the urethral sphincter may not be able to keep the bladder neck closed under physical stress.

The surgically implanted sling corrects stress incontinence by supporting and repositioning the bladder neck and urethra in their correct position.

Transobturator sling is also good for men who have undergone prostate surgery, but not radiation theapy and hive mild to moderate urinary incontinence.

The transobturator sling an effective surgical treatment for female stress urinary incontinence.

A relatively rapid and low-risk surgery that provides comparative effectiveness to other surgical options while avoiding abdominal incisions or the passage of a needle or trocar through the Space of Retzius.

Compared to retropubic tension-free vaginal tape, it has similar rates of cure with fewer perforations into the bladder and perhaps less post-operative irritative voiding symptoms and urinary retention, but have more symptoms referable to the groin pain, leg weakness or numbness.

Slings currently on the market utilize a large-pore light-weight polypropylene mesh strip, usually covered with a plastic sheath.

Most of devices used to place the transobturator sling involve a helical trocar that curves around the ischiopubic ramus connecting the inner thigh to a space created in the ipsilateral peri-urethral tissues.

Slings can be placed outside-to-inside or inside-to-outside and the effectiveness, indications, and complication rates seem to be similar between these variations.

After anesthesia, the patient is placed in lithotomy position, and an appropriate intravenous dose antibiotic is given within one hour of the incision.

The insertion points of the trocars should be at the intersection of the level of the clitoris with the lateral edges of the ischiopubic rami; this is near the lateral folds of the labia majora on the most inner thighs, but below the adductor longus tendons.

A skin incision on the lateral edge of the labial majora parallel to or in a small skin fold may minimizes scarring after the surgery.

Stab incisions at the previously marked points on the inner thighs for the insertion of both helical trocars.

Once correct positioning of the trocars is verified, the sling end is connected to the trocar tip and withdraw it through the tissues.

Cystitis and temporary voiding difficulties are the most common problems following this procedure.

Dehiscence of the suburethral incision is uncommon at 1 – 2%.

Ten to fifteen percent of women have some temporary inner thigh or groin pain or weakness.

Major vascular injuries and perforations into the bladder are extremely rare with transobturator slings, perhaps 1 – 2/1,000 cases.

Transobturator slings have similar effectiveness for cure of stress incontinence compared to retropubic slings.

It is suggested that irritative voiding symptoms such as urgency or voiding difficulty are a little less common after transobturator slings compared to retropubic slings.

For women with concurrent pelvic organ prolapse and symptoms of urinary tract infections, mid-urethral slings are just as effective if done during a prolapse repair, and can be combined procedures at one surgery.

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