Goal is to get a 3D isovolumetric myoplasty, myopexy and myotension of the puborectalis of the elevator of the anus and deep transverse of the perineum.
on muscle puborectalis of the elevator of the anus
on muscle deep transverse of the perineum
It has been prooved scientifically that the use of threads if combined with Endopeel have no actions at all and just increase the price for the patient,
In case you do apply them,use a resorbable mesh,in the fatty layer of the urethro-vaginal space.
It is important to remember the anatomy of the urethra
with it s 3 layers
Mucosa
Fatty Layer
Muscle Layer
Instrumentation Recommended to use Endopeel in Gynecology
fenestrated ( window) vaginal speculum with urethral protection made by Dr.Alain Tenenbaum & Dr.Mohan Thomas
Factors of Success
Physiopathology of Urinary Incontinence
Diagnosis of the Urinary Incontinence of Effort
The diagnosis of presumption based on clinical examination
the diagnosis of certainty is based on the urodynamic examination
Classification of the Urinary Incontinence of Effort in Different Grades
Grade I : Great Efforts
Grade II : Moderate Efforts
Grade III : Minimum Efforts
Clinical Study
Authors: A.TENENBAUM,M.TIZIANI,& gynecology team
Study realized between November 2016 till August 2017 on
MATERIAL & METHODS N=40 female patients Age Range : 40-62 years old With 31 patients Grade I And 9 patients Grade II
ALL TREATED WITH ENDOPEEL-THREADS as described above
RESULTS FOR GRADE I
Symptomatic improvement at 7 days, 71%, (n = 22)
Without incontinence (clinical / urodynamics) at 30 days, 65% (n = 20)
Without incontinence (clinical / urodynamics) at 60 days, 97% (n = 30)
Treatment failure at 60 days, = 1 case (3%)
RESULTS FOR GRADE II
Symptomatic improvement at 7 days 30% (n = 2.7)
Without incontinence (clinical / urodynamics) at 30 days, 45% (n = 4)
Without incontinence (clinical / urodynamics) at 60 days, 68% (n = 6)
Without incontinence (clinical / urodynamic) at 90 days, 89% (n = 8)
Treatment failure = 1 case (22%)
Protocol
Ultrasonography
LEGEND:
The continuous line marks the horizontal with respect to the pubic
the discontinuous line marks the mobility of the urethra, which is obtained from the difference between A and B (rest and effort)