Urinary Incontinence
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
Advantages of Endopeel vs Other Tools for the Treatment of 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.
Eventual Combination
Endopeel-Threads
Endopeel-Threads
In case you add threads, use a resorbable mesh,
in the fatty layer of the urethro-vaginal space.
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
Factors of Success
Physiopathology of 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
- Grade I : Great Efforts
- Grade II : Moderate Efforts
- Grade III : Minimum Efforts
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)
Movie
Clinical Study
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%)