Mini-Slings
A number of new slings for the treatment of stress incontinence have become
available in the last year. The concept of these slings is very attractive.
Until now slings for incontinence have been placed through the abdominal cavity
or through the obturator fossa and groin.
The transobturator slings are essentially safer than the retropubic or
transabdominal slings and seem to be equal in efficacy in most cases. In some
special situations the traditional retropubic sling has advantages.
The new Mini-slings are a drastic change from what has previously been
available to treat stress incontinence. They are only about 8cm long and
do not
pass through the body and exit through the skin like other slings. These slings
are self fixing to the soft tissues of the pelvis. There is minimal pain and a much
better safety profile than before.
The first mini sling made available in Australia was the TVT Secur. Dr Farnsworth commenced using the TVT Secur in December 2006. In
his first 30 cases performed Dr Farnsworth has noticed a lower success rate than
the more traditional techniques.
Mini-arc
Recently a new Mini-Sling the MiniArc has been introduced into
Australia by American Medical Systems. Reports from overseas suggest that this
device may have a greater durability than the TVT Secur. At present Dr
Farnsworth is recommending caution with regard to these technologies until more
long term results are available.
The Mini-arc is especially suited to
mild incontinence in a patient who is unsuitable for a more significant
anaesthetic and is prepared to sacrifice lack of long term data for the ease and
painfree mini procedure.
This is a small electronic device similar to a pacemaker that is placed in
the body and used to send an electrical signal to interfere with the messages
between the bladder and the brain. Dr Farnsworth is currently an investigator in
the first international multicentre trial to evaluate this device as a treatment
for urge incontinence. The Accessa is not yet available commercially but
implantation is available to suitable patients as part of a clinical trial..
Shirley (left) from AMS and Clinical Nurse Specialist Robyn with an Accessa®
device and computerised telemetry device used to adjust the stimulation
parameters after implantation.
Pelvisoft®
A new biological implant has become available in Australia with
significant potential advantages over the previously available biological
material known as Pelvicol. Both materials are made of collagen extracted from
Porcine dermis and then crosslinked to make them resistance to breakdown in the
body. Pelvisoft differs from Pelvicol in that it contains multiple perforations
which increase the surface area of the implant and enables the biological mesh to integrate
into the patient more effectively.
Pelvicol and Pelvisoft are permanent biological implants which are
useful when a permanent synthetic implant such as polypropylene is
contraindicated.
Biological mesh has the advantage that if it becomes infected or eroded
after surgery it does not necessarily need to be removed. It will heal and recover like
natural issue. Pelvisoft can be used as a sling or in sheets to relace
fascia. It has also been used to augment traditional repairs and found to be
soft and pliable so as to retain the original shape and contours of the host
tissues.
The Electric Chair®
A new way to strengthen the Pelvic Muscles seems to the best when used in conjunction with Pelvic Floor Training.
The treatment consists of sitting in a special chair while an electromagnetic
signal penetrates the muscles from below. There is a sensation of muscle
contraction which can result in discomfort afterwards much like after strong
exercise.
There is a bear in there and he seems to like the electric chair....