Method of surgical treatment of the stress urinary incontinence to women

摘要

The invention refers to medicine, in particular to urology.The claimed method consists in that into the urinary bladder there is introduced a Foley urethral catheter, into the balloon of which it is administered 7…10 ml of physiological solution and it is determined the position of the urinary bladder's cervix, as well as of the ureterovesical junction. Then, with a marginal incision it is marked, without decollement, a portion of the vaginal anterior wall of trapezoidal form, placed over the ureterovesical junction. It is carried out the median incision of the vaginal anterior wall digressing with 1 cm downwards from the urethral meatus up to the mucosa passage onto the uterine cervix, avoiding, at the same time, the marked portion. It is carried out the decollement of the vaginal mucosa in lateral directions from the portion, then of the vaginal wall from the urinary bladder and of the urinary bladder's fundus from the uterine cervix. From the trapezoidal portion of the vaginal anterior wall, keeping the vesicourethral segment in optimum position, there is resected a flap of triangular form, with its base directed to the uterine cervix. Afterwards, it is restored the integrity of the portion, suturing the margins obtained after resection of the flap of triangular form. The lateral margins of the obtained portion are sutured in a spiral with suspended threads. Above the pubian symphysis it is made the horizontal incision of the teguments up to the aponeurosis of the rectus abdomini muscles with a length of 4 cm. To one of the margins of the horizontal incision with the help of the needle-perforator it is made punction of the rectus abdomini muscles aponeurosis, it is avoided the symphysis, the urinary bladder through the Retzius space and going out laterally from the urethra. Two ends of the thread, passed close by the vesical cervix through the corresponding lateral margin of the flap, are run through the needle-perforator and drawn out into the suprapubian incision. The manipulation is repeated onto the opposite side. Controlling with the help of the cystourethroscope, it is carried out tension of the suspensory sutures up to the moment of visual obstruction of the vesicourethral junction, then they are tied in pairs. It is sutured the suprapubian incision. It is made suture of the paraurethral muscles with separate nylon sutures, it is removed the cystocele, it is carried out reposition of the urinary bladder's fundus. It is removed the surplus of the vaginal anterior wall's mucosa and the wall is sutured with continuous vicryl suture.