Cadaveric Assessment of Synthetic Mid-Urethral Sling Placement英文文献资料.docVIP

Open Journal of Urology, 2011, 1, 19-24 doi:10.4236/oju.2011.12006 Published Online May 2011 (http://www.SciRP.org/journal/oju) Cadaveric Assessment of Synthetic Mid-Urethral Sling Placement Scott Serels Bladder Control Center of Norwalk, Norwalk CT, USA E-mail:scottserels@ Received March 5, 2011; revised April 25, 2011; accepted May 5, 2011 Abstract Purpose: To determine if 3 types of mid-urethral synthetic slings are visually the same. Materials and Methods: A retropubic, obturator, and single incision sling was individually placed in three cadavers. Tension was set using a spacer (obturator and retropubic). Single incision sling (SIS) tension was set by visual inspection. Thirty physicians were asked to determine placement method, tension, and location of the 3 slings. Results: Physicians were composed of 5 urolo- gists, 7 urogynecologist, and 18 general gynecologists, with an average of 53 slings performed per year. Conclusions: This study showed that after placement of a sling it is hard to tell how the sling was placed and that most physicians felt the SIS was tensioned the best and most likely at the mid-urethra. Retropubic Obturator SIS % correctly identified sling 40% 43% 23% % thought tension was just right % thought sling was at mid-urethra 33% 50% 47% 67% 73% 83% Keywords: Stress Incontinence, Surgical Correction of Incontinence, Single Incision Slings 1. Introduction development of the mid-urethral slings and corresponding placement methodologies have evolved to improve efficacy, safety, cost-effectiveness, and to minimize invasiveness. Currently, the three main approaches to placement of synthetic mid urethral sling include retropubic, transobturator, and the single incision mini sling. The Integral Theory of Female Urinary Incontinence by Ulmsten and Petros in the early 1990’s challenged our understanding of incontinence significantly and led to the market introduc