with Dr. Bahaa Malaeb
Dr. Bahaa Malaeb performs a Urinary Incontinence Treatment to a 69 years old male.
Placement of the urethral male sling (AdVanceTM XP) through a perineal incision.
Clinical Background
1) Patient position in lithotomy
2) Preop and drape
3) Perineal ring retractor
4) Foley placement
5) Perineal incision
6) Dissection of bulbospongiosus muscle off of the urethra
7) Mobilization of the perineal body
8) Passage of the trocars
9) Placement of the sling
10) Fixation of the sling
11) Cystoscopy and direct visualization of the lumen during tensioning of the sling
12) Foley catheter replacement
13) Trimming of the sling arms
14) Wound closure
Technique Description
Dissection of the urethra
Mobilization of the perineal body
Identification of the entry point for the trocar, and the exit point
Trocar passage
Spread fixing the sling
Tightening/tensioning of the sling under vision with cystoscopy
Cystoscopy to ensure absence of injury
Fixation of the sling in place
Ensuring ability for catheter placement
69-year-old male patient with a history of prostate cancer, Gleason 7
Robot-assisted laparoscopic prostatectomy in October 2014
Developed urinary incontinence that gradually got better over 2 years and stabilized at 2-3 pads per day. Incontinence with activity only. No urgency or urge incontinence
Significantly bothered by his symptoms
He does not experience incontinence when lying down
Can interrupt stream
No history of radiation
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