marshall-marchetti surgery

Marshall-marchetti surgery, also known as retropubic bladder urethral suspension, the mechanism is to improve the position of the bladder neck and posterior urethra, increase the posterior horn of the bladder urethra, extend the urethra, enhance urethral resistance, and achieve therapeutic purposes. The operation is better and the cure rate is up to 90%. Treatment of diseases: stress incontinence Indication The marshall-marchetti procedure is applicable to true stress urinary incontinence caused by dysfunction of the pelvic floor support. 1. Unmarried women. 2. No obvious bladder bulging and uterine prolapse. 3. Bladder urethrography, when the abdominal pressure increases, the bladder neck is lower than the normal position. 4. Bladder urethrography, the disappearance of the posterior horn of the bladder urethra. 5. Those who need to stretch the urethra. 6. Vulvar eczema has not been cured for a long time. 7. Patients who have failed surgery after vaginal surgery failure. Preoperative preparation 1. Patients with bladder urinary tract infection should be treated first, and surgery should be performed after the inflammation subsides. 2. Strengthen the exercise of the pelvic floor muscles and enhance their tension. 3. Patients with chronic cough should be treated after surgery. 4. Patients with perineal dermatitis, eczema, erosion, should be actively treated to keep the skin dry. 5. Other preoperative preparations are the same as general lower abdominal surgery. Surgical procedure 1. Incision and posterior pubic sulcus: After local disinfection, a balloon catheter with a scale is inserted through the urethra, and the balloon is filled with 15 ml of water to identify the bladder neck and urethra position. A straight incision in the lower abdomen or a transverse incision in the lower abdomen. Take a straight incision, the upper umbilicus, the pubic symphysis; the transverse incision, 2 cm in the pubic symphysis. The layers of the abdominal wall were sequentially cut until the extraperitoneal. The peritoneum is pushed up with the extraperitoneal fat to reveal the anterior wall of the bladder. Pressing the bladder backwards will clearly show the posterior pubic space. 2. Free bladder neck and urethra: close to the back of the pubic symphysis, blunt dissection of the pubic urethral ligament and pubic symphysis, push the bladder neck and urethra down, you can free the bladder neck and the anterior part of the urethra. The balloon catheter is gently pulled outward. The assistant inserts the finger into the vagina, touches the balloon and its distal catheter, determines the position of the bladder neck and urethra, and under the guidance of the assistant's finger, the surgeon is behind the pubis. The two sides of the bladder neck and urethra are further bluntly separated to separate from the anterior wall of the vagina until it is close to the urethral opening. In the free process, often encounter small venous plexus hemorrhage, need to be ligated with silk thread, pubic bone combined with bleeding point on the periosteum, feasible compression to stop bleeding. 3. Suspended urethra: recognize the position of the urethra and bladder neck, use the curved round needle, the 7th silk thread, under the guidance of the assistant inserted into the vagina, pass the muscle layer and fascia tissue of the vaginal wall next to the urethra, be careful not to Through the vaginal mucosa, it also avoids penetrating the urethra, and the suture is passed through the pubic periosteum at the opposite site. The urethra is bilaterally symmetrical, and 3 to 4 stitches are sutured from far and near. After the suture is completed, the sutures are tightened one by one, from far to near, and the left and right alternately knotted one by one, so that the vaginal wall is close to the pubic symphysis, forming a suspension of the urethra. After all the sutures are ligated, the balloon catheter with the scale is gently pulled to measure the length of the urethra. If it has reached about 4 cm, the surgical purpose has been achieved. If it is less than 4cm, the bladder neck should be shaped to extend the urethra to 4cm. 4. Suspended bladder: The bladder neck and the anterior wall of the bladder are also sutured on the rectus abdominis with a rounded needle through the 7th silk thread. Each side is 2 to 3 needles. After the knotting, the bladder is suspended under the abdominal wall, and the bladder urethra The back corner is rectified. After the pubis, the rubber tube was drained and the wound was sutured layer by layer.