Newsletter aug12.cwk (dr)

(Obstetrics, Gynaecology & Urogynaecology)
Since 1998 I have maintained a surgical database of all procedures performed. In May of this year I reached a
1,000 Slings
significant surgical milestone with the 1,000th suburethral
sling. Over this time the sling technology has improved from
retropubic slings (TVT/Sparc) to obturator (Monarc) to Miniarc Since my commencement of practice in Canberra in 1998, there has been significant developments in the treatment of female “ success rate
of
In the 1990's the gold standard was the Burch colposuspension 92.1%
- a major procedure with a lower abdominal incision, with the at six months”
suturing of the bladder neck to the ileopectinal ligaments. Hospitalisation was usually for 6 days with recovery over 6 Suburethral slings were performed in additon to other weeks. Surgery was usually only recommended for severe procedures (n=339), such as vaginal hysterectomy, sacrospinoous colpopexy, and sacral colpopexy (Table 1). These additional procedures were excluded from the operating time, blood loss, and recovery time.
Table 2 shows complication rates which are all within the usual rates seen in the literature. Most cases of urgency responded to short term courses of an anticholinergic such as oxybutynin, whilst UTI’s usually responded to short courses Table 1: Dr Foote Sling Audit (1998-2012)
Total Cases
This all changed in 1996 with the introduction of the transvaginal tape (TVT) by Ulmstein, with the use of a polypropylene synthetic sling under the mid urethra, and introduced by two 5mm suprapubic incisions and one small vaginal incision. A large trial in 2001 (Hilton) found the Table 2: Common Complications
procedure was as successful as the Burch colposuspension, however with significantly less complications and recovery A further refinement was the obturator sling (Delorme 2001), with the introduction of the sling via two 5mm labial incisions and one small vaginal incision. This had the added benefit of avoiding the retropubic space and further reducing In summary, minimally invasive suburethral sling has a good succes rate and a low incidence of complications in my practice. Sling surgery should be considered for those women In 2008 Erikson introduced the miniarc sling, with a single who have failed three months of conservative treatment with small vaginal incision only and self retaining anchors. The pelvic floor exercises, and who are bothered by their procedure could be done as day surgery with a further reduction symptoms. Successful surgery should lead to a significant improvement in quality of life and a resumption of vigorous Obstetrician, Gynaecologist & UrogynaecologistPelvic Reconstructive & Advanced Laparoscopic SurgerySenior LecturerUrodynamics, Ultrasound, Colposcopywww.canberracuresclinic.com.au • Suite 16, Calvary Clinic, Mary Potter Circuit, Bruce. &• Suite 9/3 Sydney Ave, BartonP: 6253 3399

Source: http://www.canberracuresclinic.com.au/images/NewsletterAug12b.pdf