An overactive bladder can be treated surgically.

Knowledge of the anatomical fundamentals of the upper, intermediate and lower levels of the pelvic floor, as well as the main support elements and the nerve fibers, such as the pubouretral and uterosacral ligaments, is essential before any urinary incontinence surgery.

Natalia Gennaro, expert gynecologist, specialised in laparoscopic surgery and the pelvic floor

Image courtesy of DynaMesh® «CESA/VASA system»

At present, treatment for urinary incontinence cannot be provided without taking into account the integral theory of continence which considers that stress incontinence, urge incontinence and impaired bladder emptying are linked to the changes that occur to the support elements of the pelvic floor.

The tension applied by the juxtaposed muscles and the fascia determine the opening and closing of the bladder neck and the urethra. Changes in tension, such as an elongation or rupture in these structures, can lead to the premature activation of urination, triggering involuntary contractions from the detrusor.

Depending on the location of the muscle or fascia damage and the sensitivity of the nerve endings, stress incontinence, urge incontinence, impaired bladder emptying or various combinations of these conditions can occur.

Depending on the location of the muscle or fascia damage and the sensitivity of the nerve endings, stress incontinence, urge incontinence, impaired bladder emptying or various combinations of these conditions can occur.

Treatment consists of attaching a bladder sling between the cervix and the sacral bone, which will provide the function of the ligaments that run between the uterus and the sacral bone and communicate between the nerve fibres and pelvic structures and therefore provide stability to this zone.

Primarily over 150 open operations have been performed using this German technique (currently more than 4000 cases) (it was originally performed with an incision in the abdomen, similar to that of a cesarean) and in 75% of these cases, patients have been cured or have noticed an improvement. This leads us to consider this technique as an important option for women who suffer from this type of incontinence. This technique is considered an advanced treatment for urge incontinence and/or apical prolapse.

It wasn’t long before we tried this technique by laparoscopic route and I became the second doctor in the world who is able to perform this surgery. My objective is to be able to offer my patients the best possible treatment and perform the most advanced surgery with the most advanced techniques, providing twice the benefits.

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