Surgical procedure

Positioning under perineal body

The catheter is inserted and a median perineal incision is carried out.

 

Colles’ fascia is opened and cleavage prepared between the perineal body and the iliac branch. After careful isolation of the latter, the lateral-urethral surface is prepared until the obturator foramen is displayed digitally. The transobturator tunnel is created in this way - also from the contralateral side.

 

The Herniamesh helicoidal needle is then inserted, first from one side then the other, and Heracle® positioned, with central section under the perineal body.

 

After removal of the protective sheath, the sling is stretched to re-align the urethra with the bladder and loosen the anastomosis. Since there is no direct contact with the urethral bulb, the tension can be at a maximum, without risk of obstruction or damage to the urethra.

 

Pointed pliers or closed scissors are then inserted under the skin, from the perineal incision to the obturator foramen incision, to grasp the free end of the sling. The same procedure is then carried out on the other side.

 

The two ends are secured together.

 

Any excess is trimmed; subcutaneous tissue, perineal skin, and the two transobturator access points are stitched.


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Urethral bulb positioning

After initial cystoscopic examination, an incision is made at the anterior perineal level, extending the dissection until the urethral bulb is separated from the central perineal tendon. This allows total mobilisation of the urethra.

 

The muscle of the bulb is then opened and, via transobturator access, the sling is inserted, with the widest central portion placed in contact with the urethral bulb.

 

The Heracle sling has a transparent sheath, which, in addition to protecting the prosthesis, facilitates passage through the tissue. Both ends have pre-assembled positioning sutures for quick attachment using the Herniamesh introducer needles.

 

After removal of the protective sheaths, the central portion is stitched to the bulb using dissolvable stitches: two laterally in the upper part and one below in the centre.

 

The sling tension is set under cystoscopic examination. The tension is applied during surgery to re-position the urethra and re-align it into its natural pre-prostatectomy position, at the same time providing support to the sphincter structures, which have partially compromised functionality. The force applied must be sufficient for urethral suspension and re-alignment, but not excessive.

 

After closing the bulbocavernous muscle, pointed pliers or closed scissors are then inserted under the skin, from the perineal incision to the obturator foramen incision, to grasp the free end of the sling. The same procedure is then carried out on the other side. These are then crossed above the bulbocavernous muscle and stitched together with two non-dissolvable stitches and an additional stitch to the bulbocavernous muscle.

 

Any excess is trimmed; subcutaneous tissue, the skin, and the transobturator access points are stitched.


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