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Device to treat urinary stress incontinence eliminates need for abdominal incisions

Emory University : 17 January, 2002  (Technical Article)
Of the 13 million people in the United States who experience urinary incontinence, the vast majority are women. Stress urinary incontinence is the most common, but treatable, form of incontinence in women. It surfaces as a result of physical changes during pregnancy, childbirth, menopause or aging.
Traditional surgical treatments use both a transvaginal approach and abdominal incisions to insert a sling under the weakened or damaged urethra. But a device used by an Emory gynecologist eliminates the need for additional abdominal incisions, thus affording the patient a shorter recovery period.

Rony Adam, M.D., assistant professor, Department of Obstetrics and Gynecology, University School of Medicine, is one of two Georgia physicians currently using the Capio CL, a device that allows attachment of a supportive sling to Cooper's ligament through the vagina. The Capio CL is designed to throw, capture and retrieve suture through Cooper's ligament with the press of a single button. Additionally, the device is equipped with an indicator to align the device with the patient's anatomy and a rotating head to assist with positioning.

'By eliminating the abdominal incision, the Capio CL not only shortens the patient's hospital stay, but decreases her chances for infection,' Dr. Adam says. 'Mild cases of surgical wound infection mostly cause discomfort and additional costs since dressing changes are often needed several times a day. Cases of deep infection can be life threatening and always requires additional surgery to manage.'

In people with stress incontinence, the pelvic floor muscles and ligaments that support the vagina weaken and fail, which may cause the bladder to push downward toward the bottom of the pelvis. Physical stress such as coughing, sneezing, laughing, bending or lifting, puts pressure on top the bladder and the urethra is unable to stay closed, resulting in stress incontinence. Consequently, urine leaks through the urethra (the tube through which urine leaves the body).

A particularly difficult type of stress incontinence to treat is termed 'intrinsic sphincter deficiency'. Patients with ISD are particularly likely to benefit from suburethral sling procedures.

The Cooper's Ligament, located at the top of the pubic area, is frequently used by physicians as a fixation point when operating on women with stress incontinence. Suburethral slings are made from the patient's own body tissue or a strip of synthetic or processed biologic material. When suspended between both Cooper's ligaments, the sling forms a hammock-like structure to support the urethra and bladder neck thus restoring continence.

'Sling procedures to cure stress incontinence are effective in about 90-95% of patients,' Adam says.
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