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Retropubic Approach of Sling Placement
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This segment will explain those factors in history and physical examination, presence of which will either be associated with poor outcome or will need further evaluation before planning procedure.
Keywords
- Relative contraindications
- Pregnancy
- stress leak
- standing
- supine
- full bladder
- cough induced
- detrusor overactivity
- Preoperative
- Urinalysis
- Postvoid Residual Urine Volume
- Multichannel Urodynamic Testing
Conflict of Interest
The author declares no conflict of interest.
About this video
- Author(s)
- Amita Jain
- First online
- 27 August 2020
- DOI
- https://doi.org/10.1007/978-981-15-8738-2_1
- Online ISBN
- 978-981-15-8738-2
- Publisher
- Springer, Singapore
- Copyright information
- © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2020
Video Transcript
Patient evaluation and selection. Contraindications. Symptoms of predominant urgency, incomplete emptying, incontinence associated with chronic urinary retention, functional impairment, and continuous leakage are consistent with complicated stress urinary incontinence, and are relative contraindication of sling surgery, as their presence warrants more outcomes. And their presence in history requires further evaluation.
Additionally, this procedure should not be performed in pregnant patients, because the mesh will not stretch significantly. Also, it should not be performed in patients with future growth potential, including women with plans for future pregnancy. Cough stress test. A stress urinary incontinence should be objectively demonstrated before any anti-incontinence surgery.
Visualization of fluid loss from the urethra, simultaneous with a cough, is diagnostic. Delayed fluid loss is considered a negative cough stress test result, and suggests cough-induced detrusor over-activity, or urge urinary incontinence. Urinary tract infections should be identified using urinalysis and treated before initiating further investigation, or therapeutic intervention for urinary incontinence.
An elevated postvoid residual urine volume in the absence of pelvic organ prolapse is uncommon, and should trigger an evaluation of the bladder-emptying mechanism, usually with a pressure flow urodynamic study.