This technique calls for epidural anaesthetic or local anaesthetic plus adrenaline injected into the Retzius cavity and periurethral cavity, respectively, through the suprapubic skin or transvaginally. Two 1cm long transverse skin incisions are performed, symmetrical to the centre line of the body and 5 cm apart, in correspondence with the upper fissure of the pubic bone.
A 16 Ch Foley catheter is positioned in the bladder and a 1.5 cm long sagittal incision is made along the centre line of the front vaginal wall (suburethral), at approximately 0.5 cm from the external urethral meatus. The incision must not reach the neck of the bladder so as to avoid post-operative urinary stream problems. A delicate bevelled dissection is then performed using scissors, by 0.5-1 cm to each side of the urethra for the correct positioning of the needle entry points.
The pre-assembled prosthesis sutures are then inserted into the eye of the Herniamesh transvaginal needle, which is then passed through the sides of the mid-urethral section and, on perforation of the urogenital diaphragm, is pushed behind the symphysis pubis, remaining in strict contact with it. From this point, through the sheath of the rectus abdominis muscles, the needle is made to follow the surface of the abdominal wall through the skin incision described previously and, after attaching the sutures, the needle is made to follow the same route in reverse. The same surgical steps are then followed on the opposite side.
The steps described above are performed with the bladder empty and the insertion of each needle must be accompanied by deflexion of the neck of the bladder from the opposite side by means of a Foley catheter with a special rigid guide attached. A cystoscopy is performed after the passage of each needle to exclude accidental injury to the bladder.
Once the sling has been positioned to support the mid-urethral section, the plastic protective sheaths are removed, taking care to place a closed, blunt instrument behind the central absorbable or not absorbable section to ensure an adequate distance from the urethra is maintained so as to avoid urinary retention as a result of compression of the urethra.
The two ends of prosthesis are then sectioned below skin level and the surgery is completed by suture of the vaginal wall and the two suprapubic incisions.
On completion of the entire operation the bladder catheter is removed.
Every patient must receive an antibiotic and anti-thrombotic prophylaxis.
Discharge from the surgical unit is possible after 24 hours.
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