Jaypee Brothers
In Current Chapter
In All Chapters
X
Clear
X
GO
Normal
Sepia
Dark
Default Style
Font Style 1
Font Style 2
Font Style 3
Less
Normal
More
Laparoscopic Management of Prolapse and Stress Urinary Incontinence
Nutan Jain
1:
The Concept of Laparoscopic Management of Pelvic Floor Defects
INTRODUCTION
OLDER CONCEPT OF PELVIC FLOOR REPAIR
NEWER CONCEPT OF PELVIC FLOOR REPAIR
2:
Pelvic Anatomy
INTRODUCTION
ABDOMINAL WALL STRUCTURES
Deep Aspect of Anterior Abdominal Wall
Relevant Arteries of the Abdominal Wall
SUPERFICIAL INTRAPERITONEAL ANATOMY
PELVIC BRIM
AVASCULAR SPACES OF THE PELVIS
RETROPUBIC SPACE OF RETZIUS
PARAVESICAL SPACE
PARARECTAL SPACE
VESICOVAGINAL AND RECTOVAGINAL SPACES
PRESACRAL (RETRORECTAL) SPACE
URETERS
BLADDER
UTERUS
FALLOPIAN TUBES (OVIDUCTS)
OVARIES
PELVIC FLOOR
3:
Pelvic Support Anatomy
PELVIC FLOOR
SUPPORT OF PELVIC ORGANS
BONY PELVIS
Muscles of the Pelvic Floor (Fig. 3.7)
THE PERINEUM: SUPPORT OF THE PELVIC OUTLET
ENDOPELVIC FASCIA
CARDINAL/UTEROSACRAL LIGAMENT COMPLEX
PUBOCERVICAL FASCIA
RECTOVAGINAL FASCIA
The Axes of the Pelvic Support
Upper Vertical Axis: Cardinal and Uterosacral Ligament
The Horizontal Axis Pubocervical Fascia and Rectovaginal Septum
THE LOWER VERTICAL AXIS
Urethral Support Anatomy and Mechanism of Continence
4:
Gradation of Prolapse: The Pelvic Organ Prolapse Quantification (POPQ) System
INTRODUCTION
Technique
5:
Urodynamic Studies and Evaluation for Incontinence Surgeries
INTRODUCTION
MICTURITION DIARY
PAD TEST
UROFLOWMETRY (FIG. 5.1)
URODYNAMIC STUDY
When do We do an Urodynamic Study?
How does Urodynamic Study Help?
How is Urodynamic Study Done?
Procedure
Points to Note in Incontinent Females
Valsalva Leak Point Pressure (VLPP)
Pitfalls of VLPP
Voiding Pressures
VIDEO URODYNAMICS
TYPES OF STRESS URINARY INCONTINENCE
Type O (Fig. 5.9)
Type I (Fig. 5.10)
Type II A (Fig. 5.11)
Type II B (Fig. 5.12)
Type III (Fig. 5.13)
AMBULATORY URODYNAMICS
Urethral Pressure Profilometry (UPP)
EMG
SURGICAL DECISION-MAKING BASED ON URODYNAMIC STUDIES
6:
Suturing Application in Pelvic Floor Repair Sliding Knots
INTRODUCTION
THE SLIDING SQUARE KNOT
THE MODIFIED ROEDER KNOT
THE WESTON KNOT
KNOT PUSHERS
CONCLUSIONS
7:
Laparoscopic Extracorporeal Suturing
INTRODUCTION
EQUIPMENT
INTRODUCTION OF SUTURE
PLACEMENT OF LIGATURES
EXTRACORPOREAL KNOT TYING
8:
Intracorporeal Suturing
INTRODUCTION
EQUIPMENT
NEEDLE HOLDERS
PREREQUISITE FOR INTRACORPOREAL SUTURING
BASIC TECHNIQUE
ADJUSTING THE NEEDLE
TECHNIQUE OF INTRACORPOREAL SUTURING
TECHNIQUE OF INTRACORPOREAL KNOTS-TYING
EXACT TECHNIQUE
TIPS
LOOSENING OF KNOT
COMPLICATIONS OF LAPAROSCOPIC SUTURING
CONCLUSION
9:
Management of Stress Urinary Incontinence by TVT
INTRODUCTION
10:
TOT Sling for Stress Urinary Incontinence
INTRODUCTION
RISKS OF RETROPUBIC NEEDLE PASSAGE (Fig. 10.1)
ADVANTAGES OF TRANSOBTURATOR APPROACH (Fig. 10.2)
TRANSOBTURATOR ANATOMY (Figs 10.3A and B)
TOT NEEDLE PASSAGE (FIGS 10.4A TO 10.5)
TOT MIMICS NORMAL ANATOMY
SURGICAL SYNOPSIS-TOT SLING (Figs 10.9 to 10.16)
CLINICAL OUTCOMES
OUTSIDE-IN SAFER THAN INSIDE-OUT APPROACH
TIPS AND PEARLS (RARE COMPLICATIONS)
CONCLUSIONS
11:
Trocar Assisted Sling Suspension (TASS for Stress Urinary Incontinence
INTRODUCTION
SURGICAL TECHNIQUE
DISCUSSION
12:
Laparoscopic Paravaginal Repair and Burch Urethropexy
INTRODUCTION
Equipments and Sutures
POTENTIAL COMPLICATIONS AND INJURIES
Lower Urinary Tract Injuries
Vascular Injuries
CONCLUSION
13:
Reich Modification of the McCall Culdoplasty for Prevention and/or Repair of Prolapse during Total Laparoscopic Hysterectomy (Without Mesh, Please!)
INTRODUCTION
Laparoscopic Technique at the Time of Hysterectomy (TLH) to Prevent Future Prolapse
Repair of Prolapse or Occult Prolapse with Urinary Retention (High Cystocele) at Total Laparoscopic Hysterectomy
Repair of Vaginal Cuff Prolapse after Hysterectomy (Reich Modification of HM)
Posthysterectomy Excision of Vaginal Cuff Scar (Endometriosis or Adhesions). Followed by Elevation Ontouterosacral Ligaments for Pain and/or Dyspareunia (Reich Modification of HM)
CONCLUSION
14:
Sacrospinous Colpopexy
INTRODUCTION
ANATOMICAL CONSIDERATIONS
CLINICAL USEFULNESS OF THE SS LIGAMENT
Vault Prolapse
Alternative Supports in Cases of Vault Prolapse
Massive Prolapse—Primary Repair
Nulliparous Prolapse
TECHNICAL ASPECTS OF THE SS LIGAMENT FIXATION
A Case of Vault Prolapse
Preoperative Preparation
Position of the Patient
Instruments
Procedure
Repair of Enterocele
Modification of Technique in Cases of Massive Prolapse with Uterus in Place
Nulliparous Prolapse—Sacrospinous Cervicopexy
UNILATERAL OR BILATERAL PEXY
COMPLICATIONS
POSTOPERATIVE CARE
PERSONAL EXPERIENCE
CONCLUSIONS
15:
The Role of Mesh in Pelvic Floor Reconstruction
INTRODUCTION
AIM OF MESH REPAIR
DYNAMICS OF MESH
TYPES OF MATERIAL
IDEAL MATERIAL
Biologic Grafts
Autologous Grafts
Allografts
Xenograft
Synthetic Grafts
Type I Mesh
Type II Mesh
Type III Mesh
Type IV Mesh
Complications Specifically Related to the Mesh
Other Factors Associated with Mesh Complications
RECOGNIZING THE PROBLEM AND MANAGEMENT
Symptoms of Erosion or Extrusion
Evaluation
Conservative Management (Only in Extrusion)
Definitive Management
Erosion into Bladder
CONCLUSION
16:
Laparoscopic Sacralcolpopexy and Enterocele Repair with Mesh
INTRODUCTION
ANATOMY OF PELVIC SUPPORT
Endopelvic Fascia
LEVEL 1—APICAL SUPPORT
LEVEL I SUPPORT—LAPAROSCOPIC APPROACH TO ENTEROCELE REPAIR AND VAGINAL VAULT SUSPENSION
Site-specific Enterocele Repair and Vaginal Vault Suspension
Laparoscopic Enterocele Repair
Laparoscopic Sacralcolpopexy
Potential Complications and Injuries
Lower Urinary Tract Injuries
Bowel Injury
Vascular Injuries
LEVEL 1 SUPPORT PROCEDURES: CLINICAL RESULTS
CONCLUSION
17:
Laparoscopic Treatment of Genital Prolapse: Lateral Suspension Using a Mesh
INTRODUCTION
CLINICAL APPLICATION
INSTRUMENTS AND SUTURE MATERIAL REQUIRED
PORT PLACEMENT
OPERATIVE TECHNIQUE
Preparation of the Patient
Laparoscopy
Operative Technique of Laparoscopic Lateral Suspension using Mesh
ASSOCIATED PROCEDURE
PITFALLS/ SPECIAL POINTS TO BE HIGHLIGHTED
SUGGESTED POINTS WHERE BEGINNER CAN STUCK AND HOW TO GET OUT OF IT
DISCUSSION
18:
Prolapse Repair in Young Patients of Reproductive Age Group
ANATOMY OF PELVIC SUPPORT
SIMPLE MESH TECHNIQUE
SURGICAL TECHNIQUE
Postoperative Course
Future Reproductive Course
Results
Benefits of This Surgery
Disadvantages
Complications
Conclusion
TECHNIQUE OF REPAIR WITHOUT USE OF MESH
Postoperative Course
Results
Complications
Remedial Step
Future Reproductive Course
CONCLUSION
19:
Laparoscopic Management of Significant Uterovaginal Prolapse
INTRODUCTION
PRINCIPLES OF PELVIC FLOOR RECONSTRUCTION
Preoperative Preparation
Position of the Patient
Location of Trocars
INSTRUMENT, SUTURES AND MESH
TREATMENT OF PROLAPSE COMPRISES THREE PHASES
Technique
Posterior Dissection
PREPARATION OF THE PROMONTORY
PROMONTOFIXATION
Peritonization
Burch Procedure
Postoperative Course
Laparoscopic Burch Colposuspension
Laparoscopic Paravaginal Defects Repair
Special Points to be Highlighted
COMPLICATIONS
Complications with use of Mesh, Prevention and Management
Complications Following Sacrocolpopexy
RESULTS
CONCLUSION
20:
Laparoscopic Uterosacral Uterine Suspension(LUSUS)
INTRODUCTION
LITERATURE REVIEW
TECHNIQUE
POSTOPERATIVE CARE
CONCLUSIONS
21:
Laparoscopic Site Specific Repair for Pelvic Organ Prolapse (Without Use of Mesh)
INTRODUCTION
PELVIC FLOOR
ENDOPELVIC FASCIA
THE ANTERIOR COMPARTMENTS
THE MIDDLE COMPARTMENT
THE POSTERIOR COMPARTMENT
CONCLUSION
Sutures, Needle and Needle Holders
Port Placement
Technique
Postoperative Period and Follow-up
Results
COMPLICATIONS
22:
Current Concepts in Rectocele Repair
INTRODUCTION
PHYSICAL EXAMINATION
DIAGNOSTIC TESTING
POSTERIOR COLPORRHAPHY (TRADITIONAL)
SITE-SPECIFIC DEFECT REPAIR
GRAFT AUGMENTATION (TABLE 22.3)
PERINEORRHAPHY
ABDOMINAL SACRAL COLPOPEXY (COLPOPERINEOPEXY)
LAPAROSCOPIC RECTOCELE REPAIR
POSTOPERATIVE INSTRUCTIONS
COMPLICATIONS
ANALYSIS OF OUTCOMES
23:
Laparoscopic Approach to Genitourinary Fistulae in Women
INTRODUCTION
VESICOVAGINAL FISTULA
Surgical Technique
Transperitoneal Approach (O' Connor's Technique) (Figs 23.1A to O)
Transvesical Approach (Cystorrhaphy) (Figs 23.2A to J)
Follow-up
Laparoscopic VVF Repair (O' Connor's Technique)
Comment
URETEROVAGINAL FISTULA
Ureteroscopic Management (Figs 23.4A to F)
Ureteric Reimplantation/Boari Flap (Figs 23.5A to M)
VESICOUTERINE FISTULA
Laparoscopic Repair of VVF Transvesical Cystorrhaphy
Laparoscopic Repair of VVF Transvesical Cystorrhaphy
Laparoscopic Repair of Ureterovaginal Fistula (Boari Flap Reimplantation)
Surgical Technique
Follow-up
CONCLUSION
24:
Practical Cystoscopy for Gynecologist
INTRODUCTION
TYPES OF CYSTOSCOPE
HISTORY
Rigid Endoscope
FLEXIBLE ENDOSCOPES (FIG. 24.4)
ENDOSCOPIC EQUIPMENT
CARE AND STERILIZATION OF INSTRUMENTS
Decontamination
STERILIZATION
Steam
Gas
DISINFECTION
Cold Soak
Automated Soak
INDICATIONS FOR CYSTOSCOPY
As in Adjunct to Gyne Surgery
TECHNIQUE
Cystoscopy Boat
Anesthesia
DESCRIPTION OF THE PROCEDURE
COMPLICATION OF THE PROCEDURE
Remedial Steps for Complications of the Procedure
RISK FACTORS FOR CYSTOSCOPY
POSTCYSTOSCOPY CARE
CONCLUSION
25:
Newer Concepts in Vaginal Procedures in Reconstructive Surgery
POSTERIOR VAGINAL PROLAPSE—POSTERIOR COLPORRHAPHY USING THE “FASCIAL REPAIR” TECHNIQUE
Introduction
Clinical Application
Instruments Required
Suture Material
Patient Preparation
Exact Technique
Pitfalls/Complications
POSTERIOR VAGINAL PROLAPSE—SITE-SPECIFIC REPAIR (SEE ACCOMPANYING OPERATIVE DVD)
Introduction
Clinical Application
Instruments
Suture and Graft Material
Patient Position
Exact Technique
Special Point
Complications
ANTERIOR VAGINAL PROLAPSE
Preamble
ANTERIOR COLPORRHAPHY WITH VAGINAL SKIN GRAFT (REFER TO OPERATIVE DVD)
Clinical Application
Instruments Required
Suture Material
Patient Positioning
Exact Technique
Special Points
Complications
SITE-SPECIFIC ANTERIOR REPAIR WITH SURGISIS® ESTM REINFORCEMENT
Clinical Application
Instruments, Suture/Graft Material and Patient Positioning
Exact Technique
Paravaginal Repair
Pitfalls
Complications
ANTERIOR REPAIR WITH PERMANENT MESH
Clinical Application
Nomenclature
Constitution
Needle System
Arm Retrieval System
Dissection
Additional Procedures
APICAL COMPARTMENT REPAIR
SACROSPINOUS FIXATION
Clinical Application
Instruments, Suture Material and Patient Position
Exact Technique
Results and Complications
MESH-KIT REPAIR OF APICAL PROLAPSE
MESH-KIT REPAIR OF GLOBAL PROLAPSE
POSTOPERATIVE ORDERS—OUR STANDARD PROTOCOL FOR ALL PELVIC RECONSTRUCTIVE PROCEDURES
CONCLUSION
26:
Interstitial Cystitis in 2007
INTRODUCTION
DEFINITION
PROPOSED PATHOPHYSIOLOGY OF INTERSTITIAL CYSTITIS
SYMPTOMS
PHYSICAL EXAMINATION
INVESTIGATIONS
Copenhagen Cystoscopic Classification of Bladder Mucosa (May 2003)
SCREENING AND DIAGNOSTIC TOOLS
URINARY MARKERS
TREATMENT
INTRAVESICAL COCKTAILS (RESCUE SOLUTIONS)
Anesthetic Cocktail—Robert Moldwin, MD
Marcain with Steroid Cocktail—Nagendra Mishra, MD
DMSO Cocktail—Philip Hanno, MD
Heparin Cocktail—Kristene Whitmore, MD
Pentosan Polysulfate Cocktail—Jurjen J Bade, MD
Heparin Cocktail with Alkalinized Lidocaine—C Lowell Parsons, MD
DISEASE UNDERDIAGNOSED
CHANGE OF NOMENCLATURE
INTERSTITIAL CYSTITIS IN CHILDREN
CONCLUSION
27:
Complications of Transvaginal Tape (TVT)
INTRODUCTION
TECHNICAL STEPS AND ITS IMPORTANCE
MAJOR COMPLICATIONS
Bleeding/Hemorrhage
Perforation of Bladder
RETENTION OF URINE (Table 27.2)
BOWEL PERFORATION (Fig. 27.4)
MINOR COMPLICATIONS
Voiding Dysfunction
EROSIONS
Urethral Erosion (Tables 27.4 and 27.5)
Incidence
Causes
Management
RETENTION
RECURRENCE OF SUI
RECURRENT URINARY TRACT INFECTION
THROMBOEMBOLISM
65-YEAR-OLD POST-TVT
POST-TVT VESICOVAGINAL FISTULA
NEUROLOGICAL INJURIES
CELLULITIS ABSCESS FORMATION
INDEX
TOC
Index
×
Chapter Notes
Save
Clear