Cystoscopy with bladder neck suspension

In 1973, Stamey applied cystoscopy to treat female stress urinary incontinence. After long-term clinical application, the technology is gradually improved, with the advantages of simple operation, small damage and reliable suspension. Treating diseases: uterine prolapse Indication 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. Abdominal wall incision pubic symphysis combined with 2 cm on both sides of the midline of the transverse abdomen, respectively, made a 1cm long transverse incision, incision of the skin, subcutaneous, direct to the rectus abdominis anterior sheath. 2. The vaginal incision is inserted into the bladder through the urethra into the bladder, and the balloon is filled with water for about 15 to 20 ml. Use the vaginal hook to expose the anterior wall of the vagina, make a "T" shaped incision under the urethral opening, cut the vaginal mucosa and release it to the sides until the bladder in the bladder neck can be clearly touched. 3. For the first puncture, use a straight needle with a gap at the tip (can be made with a Kirschner wire, the tip can be slightly bent), and puncture the vagina along the posterior pubic and lateral neck of the bladder through a transverse incision on one side of the abdomen. At the same time, the assistant gently pulls the balloon catheter, and the operator points to the position of the balloon (representing the position of the bladder neck) in the incision of the anterior wall of the vagina, and the other hand continues to follow the direction of the finger. The needle tip is placed out of the anterior wall of the vagina slightly outside the bladder neck. 4. Cystoscopy remove the balloon catheter, insert the cystoscope and observe the bladder neck. Swinging the puncture needle left and right, such as the movement of the bladder neck with the needle, indicates that the puncture needle is at the level of the bladder neck, and careful observation shows that the puncture needle does not enter the bladder urethral cavity. 5. Hang the thread and hang the No. 7 thread on the puncture needle and pull out the puncture needle. The thread is taken out of the abdominal incision with the needle. Then, along the ipsilateral abdominal incision and the first needle parallel to the second puncture, the intravaginal needle point is located 1 cm above the needle point of the first needle, and the other end of the same 7th thread is hung on the second needle gap and then the needle is pulled. Pulling the end of the wire can raise the vaginal wall on one side together with the urethra. One side of the puncture line is completed, and then the opposite side puncture line is used in the same way. 6. Suspension surgeon performed urethroscopic examination, and at the same time, the assistant lifted the suspension line on both sides of the incision. Under the microscope, the upper and lower lips of the urethra were contacted and the suspension was moderately suspended through the F24 mirror sheath. 7. Fix the bladder neck in the vaginal position with your hand in the hanging position, remove the urethra mirror, keep the suspension line tight and knot. The abdominal incision and vaginal incision were sutured, and the F18 double-chamber balloon catheter was inserted from the urethra and indwelled.