Minimally Invasive Therapy for Urinary Incontinence

Urinary incontinence often puts the patient into an embarrassing scene, sometimes accompanied by the smell of urine, seriously affecting the life and work, and even the loss of labor, to the mental trauma, and therefore do not want to go out, do not want to get close to other people, for fear of being ridiculed by others, and some even couples are not in a good relationship because of this. Severe incontinence often causes eczema and dermatitis in the pubic area. Transmenstrual women may have traces of perineal injury, and many patients are complicated by uterine prolapse and vesicourethral bulge. Their work and family life may be affected. Therefore, some people call incontinence a “social barrier” for good reason. In addition, it can cause a lot of physical discomfort. Leakage of urine can cause rashes, skin infections and ulcers on the perineum, lower abdomen and thigh roots, as well as urinary tract infections, bladder stones, and in severe cases, bilateral kidney function. Gan Xiuguo, Department of Urology, The First Affiliated Hospital of Harbin Medical University Female urinary incontinence can be divided into two kinds of urgency incontinence and stress incontinence. Urge incontinence is characterized by a strong urge to urinate, but involuntary leakage of urine before you reach the toilet, or when you hear the sound of running water, even if you drink a small amount of liquid, which can lead to involuntary leakage of urine. Stress incontinence, manifested as involuntary leakage of urine when walking, during general physical labor or when laughing or sneezing, patients often take the method of going to the toilet in advance many times beforehand in order to avoid leakage of urine. Its onset is mainly due to birth injuries. Stress urinary incontinence is a global disease, and is currently the highest incidence of female lower urinary tract disease, about 48% of adult women abroad suffer from urinary incontinence, the incidence rate of Chinese women is currently roughly 29%, and 40% of adult women over the age of 40 in Shanghai suffer from varying degrees of urinary incontinence. However, less than 10% of patients visit a hospital and only 0.7% actually find a urologist. Stress incontinence refers to the involuntary outflow of urine due to the patient’s increased abdominal pressure. The causes of its onset are very complex, and the main reasons found in current studies include: older age, history of multiple births, obesity, chronic constipation, history of gynecological surgery, decreased estrogen levels in postmenopausal females, and chronic smoking and alcohol intake. These factors can make the patient’s urethral sphincter can’t control urine or the pelvic muscle strength is weakened, so that the patient’s urethral pressure decreases, so that the urinary storage disorder occurs. So can stress incontinence be cured? With the emergence of new technologies, the efficacy of stress incontinence has been substantially improved. Different types of incontinence are treated differently, so the first and most important step in treatment is to identify which type of incontinence it is, which often requires an experienced specialist, a combination of incontinence manifestations and relevant tests to determine. Treatments for urinary incontinence generally include behavioral therapy, drug therapy, assistive device therapy, and surgery. With the continuous development of urology, the minimally invasive method currently used TVT surgery, only in the patient’s lower abdomen to cut two 1 cm incisions, from the vagina into the biosynthetic sling can be placed, the procedure is simple and easy to carry out, little damage, fast recovery, suitable for the treatment of various types of stress urinary incontinence. Transvaginal tension-free sling (TVT) technology is a new minimally invasive surgical method for treating female stress urinary incontinence, which has been developed rapidly abroad in recent years, with little trauma and good effect, and is very popular among patients. The technique uses a special puncture needle, through the patient’s vaginal anterior wall of the small incision, both sides of the urethra, the posterior pubic space into, and then from the suprapubic abdominal wall at both ends of the puncture, so that a polypropylene mesh belt in a U-shape suspension fixed in the urethra below the middle of the bladder, and then wait for the patient to do to increase the abdominal pressure after the bladder is full action, in order to adjust the mesh belt tension-free state of the control of the urine does not spillage of the position of the sling. The self-adhesive nature of the webbing allows it to be self-fixing without the need for surgical sutures. The surgically inserted mesh belt can form a “hammock-like” structure together with the surrounding hyperplastic tissue, replacing the loose and lengthened pelvic floor support structure and pubic urethral ligament, thus restoring the normal urethral closure function of incontinent patients. The patient’s quality of life was significantly improved after the operation.