Type of Surgery
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Last updated: 02/17/2009
The most common complications of sling procedures are voiding problems (10.4%), new detrusor instability (7–27%), and lower urinary tract damage (3%). Some of the complications depend upon tension issues as well as on the materials used for the sling....
There are recent and well-designed studies of patient fascia and donor fascia used for slings in five centers with follow-up from 30 to 51 months that report no erosions or vaginal wall complications in any patients. Prolonged retention or voiding issues occurred in 2.3% of patients and de novo or spontaneous urge incontinence developed in 6%. These figures relate only to a large study utilizing patient or donor fascia and one that did not control for other factors like techniques of anchoring. In general, studies of the sling procedure are small and have many variables. There are no long term studies (over five years) of this most popular procedure.
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The sling procedure, or suburethral sling procedure, refers to a particular kind of surgery using ancillary material to aid in closure of the urethral sphincter function of the bladder. It is performed as a treatment of severe urinary incontinence. The sling procedure, also known as the suburethral fascial sling or the pubovaginal sling, has many forms due to advances in the types of material used for the sling. Some popular types of sling material are Teflon (polytetrafluoroethylene), Gore-Tex®, and rectus fascia (fibrous tissue of the rectum). The surgery can be done through the vagina or the abdomen and some clinicians perform the procedure using a laparoscope—a small instrument that allows surgery through very small incisions in the belly button and above the pubic hairline. The long-term efficacy and durability of the laparoscopic suburethral sling procedure for management of stress incontinence are undetermined. A new technique, the Tension-Free Vaginal Tape Sling Procedure (TVT), has gained popularity in recent years and early research indicates high success rates and few postoperative complications. This procedure is done under local anesthetic and offers new opportunities for treatment of stress incontinence. However, TVT has not been researched for its long-term effects. Finally, there are many surgeons who use the sling procedure for all forms of incontinence.
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Circumcision is a controversial topic, because there is so much misinformation and emotion included as fact; the facts are fairly straightforward and there are some definite biological advantages to circumcision.
-Gerald McMorrow
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