• Anterior transvaginal mesh for reparation of the anterior vaginal wall (cystocele)
The patient is placed in a lithotomic position then urinary catheterization is done. Under regional anesthesia, 2 incisions are made each 4mm superficially on the skin. The first is placed at the level of the urethra orifice overlying the skin, at the junction of inferior pubis rami with the body of pubis overlying the anterior middle edge of the obturator foramen. The second is at 1cm lateral and 2cm below the first. Therefore, an anterior longitudinal colpotomy is performed guided by a hydro dissection using a saline solution (figure 1, 2). An incision in made on the anterior vaginal wall; from the lower part of the vagina to the vesicourethral junction, 1 cm below the urethral meatus; consequently, the vesicovaginal fascia is accessed. Next, the bladder is dissected with scissors and pushed away from the vaginal mucosa (figure 3). The trocar passes through the skin incisions to reach the pubovesical space, a finger is placed in the vagina for the incoming instrument. Hence, a precut mesh monofilament polypropylene (Avaulta Solo, Bard Covington USA) is used, the arms of the mesh pass into the paravesical area, and then through the obturator internus muscle, the obturator membrane, the adductor muscles, subcutaneous, fascia lata, skin. …show more content…
At left and right side, the arms of the mesh pass through the pararectal region cross the sacrospinous ligament 2cm from the ischion spine, to attend the skin incisions below the anus. The mesh is then positioned. The posterior colpotomy is sutured. a compress is left in place for 1 day. The procedure is completed by a cystoscopy in order to rule out any bladder
The patient is placed in a lithotomic position then urinary catheterization is done. Under regional anesthesia, 2 incisions are made each 4mm superficially on the skin. The first is placed at the level of the urethra orifice overlying the skin, at the junction of inferior pubis rami with the body of pubis overlying the anterior middle edge of the obturator foramen. The second is at 1cm lateral and 2cm below the first. Therefore, an anterior longitudinal colpotomy is performed guided by a hydro dissection using a saline solution (figure 1, 2). An incision in made on the anterior vaginal wall; from the lower part of the vagina to the vesicourethral junction, 1 cm below the urethral meatus; consequently, the vesicovaginal fascia is accessed. Next, the bladder is dissected with scissors and pushed away from the vaginal mucosa (figure 3). The trocar passes through the skin incisions to reach the pubovesical space, a finger is placed in the vagina for the incoming instrument. Hence, a precut mesh monofilament polypropylene (Avaulta Solo, Bard Covington USA) is used, the arms of the mesh pass into the paravesical area, and then through the obturator internus muscle, the obturator membrane, the adductor muscles, subcutaneous, fascia lata, skin. …show more content…
At left and right side, the arms of the mesh pass through the pararectal region cross the sacrospinous ligament 2cm from the ischion spine, to attend the skin incisions below the anus. The mesh is then positioned. The posterior colpotomy is sutured. a compress is left in place for 1 day. The procedure is completed by a cystoscopy in order to rule out any bladder