Dr. Bahaa Malaeb performs a Urinary Incontinence Treatment to a 69 years old male.
Technique Description:
Placement of the urethral male sling (AdVanceTM XP) through a perineal incision.
Procedure Steps:
- 1) Patient position in lithotomy
- 2) Preop and drape
- 3) Perineal ring retractor
- 4) Foley placement
- 5) Perineal incision
- 6) Dissection of bulbospongiosus muscle off of the urethra
- 7) Mobilization of the perineal body
- 8) Passage of the trocars
- 9) Placement of the sling
- 10) Fixation of the sling
- 11) Cystoscopy and direct visualization of the lumen during tensioning of the sling
- 12) Foley catheter replacement
- 13) Trimming of the sling arms
- 14) Wound closure
Learning Points:
- Dissection of the urethra
- Mobilization of the perineal body
- Identification of the entry point for the trocar, and the exit point
- Trocar passage
- Spread fixing the sling
- Tightening/tensioning of the sling under vision with cystoscopy
- Cystoscopy to ensure absence of injury
- Fixation of the sling in place
- Ensuring ability for catheter placement
Clinic History:
- 69-year-old male patient with a history of prostate cancer, Gleason 7
- Robot-assisted laparoscopic prostatectomy in October 2014
- Developed urinary incontinence that gradually got better over 2 years and stabilized at 2-3 pads per day. Incontinence with activity only. No urgency or urge incontinence
- Significantly bothered by his symptoms
- He does not experience incontinence when lying down
- Can interrupt stream
- No history of radiation
