经阴道无张力尿道中段吊带术V术.ppt

GYNECARE TVT * Before starting the tension test, place scissors or a hemostat between the tape and urethra. Pull the abdominal end of the tape until there is slight contact between the tape and the instrument. Cut the needles from the tape. Do not remove the plastic sheath. GYNECARE TVT * 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. GYNECARE TVT * GYNECARE TVT * GYNECARE TVT * 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