治疗女性压力性尿失禁1ppt课件.ppt

GYNECARE TVT * A tension test that requires patient participation is conducted during the TVT procedure. Therefore it is recommended that the TVT procedure be preformed under local anesthesia with IV sedation. However, regional or general can be used. If it is your choice to use regional, selection of anesthesia should be made with the understanding that the patient will need to cough during the procedure. It is recommended that the surgeons should work closely with the anesthesiologist to choose a regional that will not relax the pelvic anatomy and will allow the patient to cough normally. General anesthesia should be used only by surgeons experienced with the TVT technique. Before conducting the TVT procedure under general, the surgeon should be comfortable with the tension free application of the mesh. Due to the inability to complete the tension test during a procedure under general anesthesia, the surgeon must be comfortable leaving the mesh placed loosely under the mid urethra. The only measurement here of tension will be spacing with a blunt instrument. GYNECARE TVT * GYNECARE TVT * Apply local anesthesia in the skin just above the symphysis on both sides of the midline. Continue on each side in the abdominal wall, down in the muscles and fascia. Anesthesia is placed behind this symphysis in the retropubic space. GYNECARE TVT * GYNECARE TVT * Insert speculum. Local anesthesia is applied sub-urethrally. Starting approximately 1.0 cm from the external urethra meatus. Apply local on each side of the urethra into the retropubic space. 3-4 minutes should be allowed for the anesthesia at act. GYNECARE TVT * GYNECARE TVT * The anterior vaginal wall overlying the mid to distal urethra is elevated with Allis clamps and incised vertically in the midline. The incision should begin approximately 1.0 cm from the external urethra meatus and extend for 1.5 cm. The incision should be long enough to accommodate the width of the TVT tape. GYNECARE TVT * GYNE