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NUP procedures (fairly long)From: dahmd@gate.netFri Mar 22 16:51:26 1996
>On Thu, 21 Mar 1996 ENDODOK@aol.com wrote:
>> Unless we instill a vigorous injection of clinically relevant material, I'm
>> 4)Comments on percutaneous bladder neck suspension for SUI-- Some time ago I asked about "bone anchors" for vaginal needle urethropexy (NUP) procedures such as the Raz, Pereyra, Stamey, etc procedures. The list has grown considerably since then, however. I do a fair number of NUP procedures, and some of the local Ob/Gyn's have been talking about these anchor procedures. Both Vesica and Mitak make bone anchors, and I have seen a grand total of 1 of these anchor procedures, using the Vesica anchor. The technique involvs making 2 incisions above the pubic symphysis and drilling a bone anchor into the pubic symphysis, then doing a blind puncture using a specialized needle, similar to the Stamey needle, through the undissected space of Retzius into the vagina. Three or 4 bites are taken of the periurethral vaginal tissue (again, without dissection), in a fashion similar to the Gittes procedure (or, I suppose, the original Pereyra procedure) and the needle is brought back up through the incisions and the sutures are tied to the bilateral anchors. Cystoscopy confirms patent ureters and rules out bladder trauma. Here's my thoughts on this procedure: I believe that it would be better to dissect the vaginal mucosa and enter the space of Retzius using a technique like the modified Pereyra or Raz, and that this anchor technique offers no real advantage. I believe that the Mitak device *does* utilize the standard dissection technique, but have not seen one of these. The Gittes procedure has a higher failure rate, and the above technique appears to be very similar to the Gittes technique, where the sutures may be anchored to the bone, but can still pull out through the vagina. Does anybody "out there" use this technique (or the Gittes)? Any comments on this, or other, NUP procedures? Eagerly awaiting the deluge of replies :) Ashley Hill D. Ashley Hill, M.D. dahmd@gate.net
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