压力性尿失禁的非手术治疗 专科医师规范化培训.ppt

* The tension test should be conducted with a full bladder. The test should be preformed after removing all instruments. There should be no artificial pressure on the vaginal walls. During the tension test cooperation with the anesthesiologist is recommended. At this point in the procedure the patient should aware and able to generate a normal cough. After the first cough and the patient leaks, the tape should be pull upwards slightly from the abdominal ends. The patient should be ask to cough again. The tape should be positioned so that during the cough test only one or two drops of urine leak. The purpose of this is to ensure that the tape is not overly tensioned under the urethra. To simulate a closed vaginal wall during the stress test, reapproximate vaginal wall gently using small forceps. * * Identify the plastic sheath at the abdominal ends of the tape and grasp it with forceps. Place and instrument, scissors or forceps, between the urethra and the tape. Hold the tape in place and remove the plastic sheath. The sheath has preformed its two major task. It has protected the tape during insertion and it has provided a smooth transition for the tape through the tissues. The tape is now in place, without tension, underneath the mid-urethra. Cut the abdominal ends of the tape just below the surface of the skin. DO NOT SUTURE OT ANCHOR THE ABDOMINAL ENDS OF THE TAPE. The friction from the opposing tissues to the tape secures the tape in place. Close the incisions in a normal manner. Complete testing with a Hegar dilator number 7-8. When inserted through the urethra there should be no resistance, i.e., the tape should not be noticed, Also, check that the proximal urethra is not in a fixed position. The bladder neck should be mobile. Empty bladder and remove catheter. * * * 基于Kegel的基本原理，通过借着辅助器材来训练强化骨盆肌。以往是用各种“重锤”置于阴道内，通过收缩盆底肌含住“重锤”来强化骨盆肌。由于病人需要站立练习，较易疲劳，并且“重锤”不断置于阴道内很不方便，已经逐步淘汰。近年来已被盆底肌锻炼器取代。 * 盆底肌锻炼器的结构由上下两翼和二个相同大小的弹力装置S1和一个较小的弹力装置S2组成 S1