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Urinary Incontinence

urinary-incontinence-hero

Objectives

BEFORE 2018 , all treatments were using surgery, laser. HIFU.

Their goal was to correct  THE HYPER URETRAL MOTILITY.

NOWADAYS, we propose less invasive treatments using:

ENDOPEEL

no surgery
no risk
no-laser
no laser vaginal
no hifu vaginal

Advantages of Endopeel vs Other Tools for the Treatment of Urinary Incontinence 

tools for urinary incontinence
advantages-endopeel-vs-other-tools
3D Application for urinary Incontinence

3D Application for Urinary Incontinence

Where to Apply ENDOPEEL

The 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.

muscle puborectalis of the elevator of the anus
deep-transverse-perineum.jpg

Eventual Combination   
Endopeel-Threads

 

In case you add threads, use a resorbable mesh,
in the fatty layer of the urethro-vaginal space.

 
urinary-incontinence-threads
Urethra Anatomy

It is important to remember the anatomy of the urethra

with its 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 & Prof.Dr.Mohan Thomas

fenestrated-vaginal-speculum-tenenbaum-thomas

Factors of Success

FACTORS OF SUCCESS IN URINARY INCONTINENCE

Physiopathology of Urinary Incontinence

physiopathology-urinary-incontinence

Diagnosis of the Urinary Incontinence of Effort

  • The Presumptive Diagnosis is based on Clinical Examination
  • The Certainty Diagnosis is based on Urodynamic Examination

Classification of the Urinary Incontinence of Effort

in Different Grades
  • Grade I : Great Efforts
  • Grade II : Moderate Efforts
  • Grade III : Minimum Efforts

Protocol

protocol urinary incontinence

Ultrasonography

ultrasound machine
US-urinary-incontinence

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)

Ultrasonography

Movie

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%)