ES2226564A1 - Feminine urinary incontinence surgery suburethral sling includes a macroporous polypropylene mesh with zones adhering to the endopelvic zone - Google Patents

Feminine urinary incontinence surgery suburethral sling includes a macroporous polypropylene mesh with zones adhering to the endopelvic zone

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Publication number
ES2226564A1
ES2226564A1 ES200301134A ES200301134A ES2226564A1 ES 2226564 A1 ES2226564 A1 ES 2226564A1 ES 200301134 A ES200301134 A ES 200301134A ES 200301134 A ES200301134 A ES 200301134A ES 2226564 A1 ES2226564 A1 ES 2226564A1
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Spain
Prior art keywords
urinary incontinence
endopelvic
mesh
suburethral sling
zones
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Granted
Application number
ES200301134A
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Spanish (es)
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ES2226564B1 (en
Inventor
Juan Gambini Ricapa
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Individual
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Individual
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Filing date
Publication date
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Priority to ES200301134A priority Critical patent/ES2226564B1/en
Publication of ES2226564A1 publication Critical patent/ES2226564A1/en
Priority to ES200501090A priority patent/ES2264885B1/en
Application granted granted Critical
Publication of ES2226564B1 publication Critical patent/ES2226564B1/en
Anticipated expiration legal-status Critical
Expired - Fee Related legal-status Critical Current

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/0469—Suturing instruments for use in minimally invasive surgery, e.g. endoscopic surgery
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/0483—Hand-held instruments for holding sutures
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/06—Needles ; Sutures; Needle-suture combinations; Holders or packages for needles or suture materials
    • A61B17/06066—Needles, e.g. needle tip configurations
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/0004—Closure means for urethra or rectum, i.e. anti-incontinence devices or support slings against pelvic prolapse
    • A61F2/0031—Closure means for urethra or rectum, i.e. anti-incontinence devices or support slings against pelvic prolapse for constricting the lumen; Support slings for the urethra
    • A61F2/0036—Closure means for urethra or rectum, i.e. anti-incontinence devices or support slings against pelvic prolapse for constricting the lumen; Support slings for the urethra implantable

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  • Health & Medical Sciences (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Surgery (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Biomedical Technology (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Veterinary Medicine (AREA)
  • Engineering & Computer Science (AREA)
  • Animal Behavior & Ethology (AREA)
  • Molecular Biology (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Medical Informatics (AREA)
  • Urology & Nephrology (AREA)
  • Cardiology (AREA)
  • Oral & Maxillofacial Surgery (AREA)
  • Transplantation (AREA)
  • Vascular Medicine (AREA)
  • Prostheses (AREA)
  • Surgical Instruments (AREA)

Abstract

The feminine urinary incontinence surgery suburethral sling has a longitudinal-cut macroporous polypropylene single-filament strip or mesh (1) with two lateral smooth zones (4). The remainder of the sling is roughened to adhere to the endopelvic and adjoining zones.

Description

Cabestrillo suburetral para el tratamiento quirúrgico de la incontinencia urinaria femenina.Suburethral sling for treatment surgical of female urinary incontinence.

Objeto de la invenciónObject of the invention

La presente invención, según lo expresa el enunciado de esta memoria descriptiva, se refiere a un cabestrillo suburetral para el tratamiento quirúrgico de la incontinencia urinaria femenina, cuyas características aventajan notablemente a los cabestrillos o mallas que se emplean actualmente con este fin, tanto en lo que se deriva de su longitud que es más corta ya que solo se ancla en la fascia endopélvica, como en cuanto a las características que presenta el borde de su contorno para evitar la irritación de la uretra media y cuello vesical al ser abrazadas por la banda o malla que materializa su estructura.The present invention, as expressed by the set forth in this specification, refers to a sling suburethral for the surgical treatment of incontinence female urinary, whose characteristics significantly exceed the sling or tights currently used for this purpose, both in what is derived from its length that is shorter since it is only anchored in the endopelvic fascia, as in terms of features presented by the edge of its contour to avoid  irritation of the middle urethra and bladder neck when hugged by the band or mesh that materializes its structure.

La aplicación de este cabestrillo suburetral a una paciente, supone un tratamiento quirúrgico de la incontinencia urinaria de esfuerzo y tiene como fin sujetar la uretra media y el cuello vesical para evitar el escape de orina durante los esfuerzos.The application of this suburethral sling to a patient, supposes a surgical treatment of incontinence urinary effort and aims to hold the middle urethra and the bladder neck to prevent urine leakage during efforts

Antecedentes de la invenciónBackground of the invention

Actualmente se emplea un procedimiento realizado por vía abdominal mediante una incisión suprapúbica transversa de 6-7 cm de longitud, profundizando en la herida hasta llegar al peritoneo, cortando la fascia de los rectos anteriores abdominales, despegando este peritoneo hasta llegar al espacio de Retzius, zona que muchas veces sangra al ser despegada y diseccionada, se identifica el cuello vesical y se colocan unos puntos de sutura a ambos lados del cuello vesical y uretra media, para luego atarlos a ambos lados de la pared pélvica en los ligamentos de Cooper y así se sujeta la uretra. En este caso se usa la anestesia general y el tiempo de intervención puede durar de 60 a 70 minutos. Otros cirujanos hacen esta operación mediante laparoscopia y en estos casos no hay incisión suprapúbica, sino solo un punto de entrada del laparoscopio y otras veces se añade un manipulador, se insufla con CO_{2} para tener campo de visión para la disección del espacio de Retzius, se sujeta la uretra en la forma anteriormente descrita, usando dos cintas sintéticas irreabsorbibles. El tiempo de intervención es en este caso de 70 a 120 minutos, no hay heridas grandes pero es más larga la intervención, se necesita anestesia general, es necesario ser experto en
laparoscopia, y el material quirúrgico necesario para realizarlo es muy costoso y se han dado casos de lesiones vasculares y vesicales e incluso en alguna ocasión ha habido que laparotomizar, para solucionar el problema. Otras veces se usa la vía vaginal y abdominal combinada, pasando una malla desde la vagina hasta la pared abdominal, también con anestesia general, o a veces con anestesia loco-regional (raquianestesia) o anestesia local, en estos casos se usa una cinta larga de 50-60 cm de material sintético no reabsorbible, unida a unas agujas especiales, con un aparato especial para dirigir dichas agujas, que pasará desde la zona vaginal (suburetral) atravesando éstas una serie de tejidos, como son el tejido parauretral, fascia endopélvica, la vagina, la aponeurosis de los rectos anteriores abdominales, los músculos rectos anteriores con sus arterias perforantes, hasta llegar a la piel de la región suprapubiana; en estos casos se han descrito perforaciones vesicales, hemorragias al lesionar las arterias abdominales, equimosis e infecciones en la piel (celulitis). El material quirúrgico para realizarlo
es costoso y requiere un aprendizaje esmerado.An abdominal procedure is currently used through a transverse suprapubic incision of 6-7 cm in length, deepening the wound until reaching the peritoneum, cutting the fascia of the rectus abdominis, taking off this peritoneum until reaching the space of Retzius, area that often bleeds when detached and dissected, the bladder neck is identified and some stitches are placed on both sides of the bladder neck and middle urethra, then tied to both sides of the pelvic wall in Cooper's ligaments and so the urethra is held. In this case, general anesthesia is used and the intervention time can last from 60 to 70 minutes. Other surgeons perform this operation using laparoscopy and in these cases there is no suprapubic incision, but only a laparoscope entry point and other times a manipulator is added, insufflated with CO2 to have a field of vision for dissection of the space of Retzius, the urethra is fastened in the manner described above, using two non-absorbable synthetic tapes. The intervention time is in this case 70 to 120 minutes, there are no large wounds but the intervention is longer, general anesthesia is needed, it is necessary to be an expert in
laparoscopy, and the surgical material necessary to perform it is very expensive and there have been cases of vascular and bladder lesions and even on some occasion it has been necessary to laparotomize, to solve the problem. Other times the combined vaginal and abdominal route is used, passing a mesh from the vagina to the abdominal wall, also with general anesthesia, or sometimes with loco-regional anesthesia (spinal anesthesia) or local anesthesia, in these cases a long ribbon of 50-60 cm of non-absorbable synthetic material, together with special needles, with a special device for directing said needles, which will pass from the vaginal (suburethral) area through a series of tissues, such as paraurethral tissue, endopelvic fascia, the vagina, the aponeurosis of the anterior abdominal rectus, the anterior rectus muscles with their perforating arteries, until they reach the skin of the suprapubian region; In these cases, bladder perforations, hemorrhages have been reported when the abdominal arteries are injured, ecchymosis and skin infections (cellulite). The surgical material to perform it
It is expensive and requires careful learning.

Descripción de la invenciónDescription of the invention

En líneas generales, el cabestrillo suburetral para el tratamiento quirúrgico de la incontinencia urinaria femenina, objeto de la presente invención, hace posible el uso de una técnica de anclaje libre endopélvico, consistente en hacer una pequeña incisión en la pared anterior de la vagina a nivel de la uretra media, de unos 2 cm, se disecan ambos espacios parauretrales hasta llegar al borde inferior de la rama de hueso púbico, mediante una pinza curva larga se introduce la malla o banda que materializa el cabestrillo suburetral, por un extremo hasta perforar la fascia endopélvica, se suelta la pinza, se repite lo mismo en el otro lado, quedando dicha cinta o banda en contacto con la uretra sujetándola libre de tensión, sin que ésta pueda moverse donde ha sido colocada. Por el trayecto que pasa la cinta no existen estructuras que puedan ser lesionadas y para su implantación se utiliza la anestesia local.In general, the suburethral sling for the surgical treatment of urinary incontinence Feminine, object of the present invention, makes possible the use of an endopelvic free anchoring technique, consisting of making a small incision in the anterior wall of the vagina at the level of the middle urethra, about 2 cm, both paraurethral spaces are dissected until you reach the lower edge of the pubic bone branch, using a long curved clamp, the mesh or band is introduced that materialize the suburethral sling, at one end until pierce the endopelvic fascia, the clamp is released, what is repeated same on the other side, said tape or band being in contact with the urethra holding it tension free, without it being able to move Where it has been placed. On the path the tape does not there are structures that can be injured and for implantation local anesthesia is used.

El cabestrillo está materializado pues por una banda o malla monofilamento de polipropileno macroporo que queda anclada como hemos dicho anteriormente en las fascia endopélvica. La zona central de esta banda tiene ambos bordes lisos para evitar la irritación de la uretra media y cuello vesical al ser abrazados por la cinta, pero el resto de la misma está desflecada en dirección oblicua a modo de una punta de flecha, que al ser introducida no puede salirse, y que servirá para adherirse fuertemente a la fascia endopélvica y a los tejidos adyacentes, quedándose en el sitio donde ha sido colocada.The sling is materialized by a remaining monofilament polypropylene band or mesh anchored as we have said before in the endopelvic fascia. The central area of this band has both smooth edges to avoid irritation of the middle urethra and bladder neck when hugged by the tape, but the rest of it is deflected in oblique direction by way of an arrowhead, which being introduced can not leave, and that will serve to adhere strongly to the endopelvic fascia and adjacent tissues, staying in the place where it has been placed.

Las ventajas que tiene esta técnica usando el cabestrillo suburetral acorde con la invención, sobre las actuales para corregir la incontinencia urinaria de esfuerzo son las siguientes:The advantages of this technique using the Suburethral sling according to the invention, on the current to correct stress urinary incontinence are the following:

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Muy fácil aprendizaje.Very easy learning.

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No hay que profundizar hacia los órganos más internos, por lo que no hay peligro de lesiones y está exento de morbilidad.Not to delve deeper into the innermost organs, so there is no danger of injury and is exempt from morbidity.

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Mínimo material quirúrgico para realizarlo (bisturí, pinza de disección, pinza curva), por lo tanto más económico.Material minimum Surgical to perform it (scalpel, dissection forceps, forceps curve), therefore more economical.

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Menor cantidad de material usado (cinta corta), por lo que es también mucho más económico.Smaller amount of material used (short tape), so it is also much more economic.

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Se puede realizar con anestesia local.Can be done With local anesthesia.

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Tiempo de realización de 10 a 15 minutos, lo que supone más economía en el uso del quirófano, por lo que puede ser considerado como cirugía mayor de corta estancia.Time of completion of 10 to 15 minutes, which means more economy in the use of the operating room, so it can be considered as surgery Short stay major.

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Se reduce el tiempo de ocupación de cama hospitalaria, redundando también en mayor economía.Time is reduced Occupancy of hospital bed, also resulting in greater economy.

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Excelentes resultados, semejantes a las actuales técnicas de suspensión suburetral.Excellent results, similar to current suspension techniques suburethral

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Dada la ausencia de morbilidad, se puede aplicar a pacientes de alto riesgo quirúrgico.Given the absence of morbidity, can be applied to high-risk patients surgical.

Para facilitar la comprensión de las características de la invención y formando parte integrante de esta memoria descriptiva, se acompaña una hoja de planos en cuya figura única, con carácter ilustrativo y no limitativo se ha representado lo siguiente:To facilitate the understanding of characteristics of the invention and forming an integral part of this Descriptive report, a sheet of drawings is attached in whose figure unique, illustrative and non-limiting has been represented the next:

Breve descripción de la figuraBrief description of the figure

Figura 1.- Es una vista esquemática en planta, de un cabestrillo suburetral para el tratamiento quirúrgico de la incontinencia urinaria femenina, acorde con la invención.Figure 1.- It is a schematic plan view of a suburethral sling for surgical treatment of the female urinary incontinence, in accordance with the invention.

Descripción de la forma de realización preferidaDescription of the preferred embodiment

Haciendo referencia a la numeración adoptada en la figura, podemos ver cómo el cabestrillo suburetral para el tratamiento quirúrgico de la incontinencia urinaria femenina, que la invención propone, está constituido por una banda o malla monofilamento de polipropileno macroporo, de 0,30 mm de grosor y cuyos poros miden 1,1 mm, en un ejemplo de realización preferente.Referring to the numbering adopted in the figure, we can see how the suburethral sling for the surgical treatment of female urinary incontinence, which the invention proposes, is constituted by a band or mesh macroporo polypropylene monofilament, 0.30 mm thick and whose pores measure 1.1 mm, in an embodiment preferential.

Esta banda o malla monofilamento tiene de largo 16 cm y posee una zona central de 4 cm de longitud y 1,30 cm de ancho con los bordes lisos. El resto de la cinta, es decir, los 6 cm extremos de cada lado, tiene una anchura de 1,26 cm y sus bordes quedan desflecados cuyas puntas se dirigen en sentido oblicuo al centro de la cinta para que actúe a modo de flecha.This monofilament band or mesh is long 16 cm and has a central area of 4 cm in length and 1.30 cm of wide with smooth edges. The rest of the tape, that is, the 6 cm ends of each side, has a width of 1.26 cm and its edges they are deflected whose points are directed obliquely to the center of the tape to act as an arrow.

Como característica adicional y útil para su correcta instalación, en la mitad de la cinta cruza entrelazado un filamento de seda negra del número 1, de 6 cm de longitud, que indica la parte media de la banda o malla.As an additional and useful feature for your correct installation, in the middle of the ribbon cross interlaced a black silk filament number 1, 6 cm in length, which indicates the middle part of the band or mesh.

En la figura se ha referenciado en general con el número (1) la banda o malla monofilamento de polipropileno macroporo, con sus extremos rematados en punta de flecha (2). Los bordes (3) están desflecados y cuyas fibras se dirigen en sentido oblicuo hacia el centro de la banda. La zona central de la malla (1), referenciada con el número (4), posee sus bordes lisos.In the figure it has been referenced in general with the  number (1) the polypropylene monofilament band or mesh macropore, with its ends topped by arrowhead (2). The edges (3) are deflected and whose fibers are directed in the direction oblique towards the center of the band. The central area of the mesh (1), referenced with the number (4), has its smooth edges.

La referencia (5) designa el filamento de seda negra que cruza transversalmente la línea media de la banda o malla, marcando la parte media de la misma.Reference (5) designates the silk filament black that transversely crosses the midline of the band or mesh, marking the middle part of it.

Claims (2)

1. Cabestrillo suburetral para el tratamiento quirúrgico de la incontinencia urinaria femenina, cuya finalidad es sujetar la uretra media y el cuello vesical para evitar el escape de orina durante los esfuerzos, caracterizado porque está constituido por una banda o malla (1) monofilamento de polipropileno macroporo, o similar, cuya longitud se corresponde con la de la fascia endopélvica a la que se ancla, cuya zona central presenta ambos bordes lisos (4), estando el resto de la cinta desflecada en dirección oblicua a modo de una punta de flecha que quedará adherida a la fascia endopélvica y a los tejidos adyacentes.1. Suburethral sling for the surgical treatment of female urinary incontinence, whose purpose is to hold the middle urethra and the bladder neck to prevent urine leakage during efforts, characterized in that it is constituted by a polypropylene monofilament band or mesh (1) macropore, or similar, whose length corresponds to that of the endopelvic fascia to which it is anchored, whose central area has both smooth edges (4), the rest of the tape being deflected obliquely as an arrowhead that It will remain attached to the endopelvic fascia and adjacent tissues. 2. Cabestrillo suburetral para el tratamiento quirúrgico de la incontinencia urinaria femenina, según reivindicación 1, caracterizado porque la citada banda o malla (1) lleva dispuesto transversalmente y cruzando entrelazado, un filamento (5) de seda negra que marca su parte media.2. Suburethral sling for the surgical treatment of female urinary incontinence, according to claim 1, characterized in that said band or mesh (1) has a black silk filament (5) that marks its middle part transversely and interlaced crossing.
ES200301134A 2003-05-16 2003-05-16 SUBURETRAL CABESTRILLO FOR THE SURGICAL TREATMENT OF FEMALE URINARY INCONTINENCE. Expired - Fee Related ES2226564B1 (en)

Priority Applications (2)

Application Number Priority Date Filing Date Title
ES200301134A ES2226564B1 (en) 2003-05-16 2003-05-16 SUBURETRAL CABESTRILLO FOR THE SURGICAL TREATMENT OF FEMALE URINARY INCONTINENCE.
ES200501090A ES2264885B1 (en) 2003-05-16 2005-05-06 IMPROVEMENTS INTRODUCED IN THE PATENT OF INVENTION NP200301134, BY: SUBURETRAL HORSE FOR THE SURGICAL TREATMENT OF FEMALE URINARY INCONTINENCE.

Applications Claiming Priority (1)

Application Number Priority Date Filing Date Title
ES200301134A ES2226564B1 (en) 2003-05-16 2003-05-16 SUBURETRAL CABESTRILLO FOR THE SURGICAL TREATMENT OF FEMALE URINARY INCONTINENCE.

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ES2226564A1 true ES2226564A1 (en) 2005-03-16
ES2226564B1 ES2226564B1 (en) 2006-05-16

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ES200501090A Expired - Fee Related ES2264885B1 (en) 2003-05-16 2005-05-06 IMPROVEMENTS INTRODUCED IN THE PATENT OF INVENTION NP200301134, BY: SUBURETRAL HORSE FOR THE SURGICAL TREATMENT OF FEMALE URINARY INCONTINENCE.

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WO2006136625A1 (en) * 2005-05-06 2006-12-28 Juan Gambini Ricapa Suburethral sling for the surgical treatment of female urinary incontinence and surgical instruments used to position same
ES2264885A1 (en) * 2003-05-16 2007-01-16 Juan Gamibini Ricapa Feminine urinary incontinence surgery suburethral sling includes a macroporous polypropylene mesh with zones adhering to the endopelvic zone
US7285086B2 (en) 2004-07-28 2007-10-23 Ethicon, Inc. Minimally invasive medical implant and insertion device and method for using the same
EP3747396A1 (en) * 2013-05-03 2020-12-09 James W. Cullison Urological implant

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ES2226564B1 (en) * 2003-05-16 2006-05-16 Juan Gambini Ricapa SUBURETRAL CABESTRILLO FOR THE SURGICAL TREATMENT OF FEMALE URINARY INCONTINENCE.

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US4452245A (en) * 1980-06-06 1984-06-05 Usher Francis C Surgical mesh and method
US20020165566A1 (en) * 1995-10-09 2002-11-07 Ulf Ulmsten Surgical instrument and method for treating female urinary incontinence
US20020188169A1 (en) * 1999-06-09 2002-12-12 Kammerer Gene W. Surgical instrument and method for treating female urinary incontinence
US20020068948A1 (en) * 2000-05-01 2002-06-06 Johan Stormby Aiming device for surgical instrument and method for use for treating female urinary incontinence
US20020094260A1 (en) * 2001-01-12 2002-07-18 Coomer Stephen D. Apparatus and methods for manipulating semiconductor wafers

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* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
ES2264885A1 (en) * 2003-05-16 2007-01-16 Juan Gamibini Ricapa Feminine urinary incontinence surgery suburethral sling includes a macroporous polypropylene mesh with zones adhering to the endopelvic zone
US7285086B2 (en) 2004-07-28 2007-10-23 Ethicon, Inc. Minimally invasive medical implant and insertion device and method for using the same
US7297102B2 (en) 2004-07-28 2007-11-20 Ethicon, Inc. Minimally invasive medical implant and insertion device and method for using the same
WO2006136625A1 (en) * 2005-05-06 2006-12-28 Juan Gambini Ricapa Suburethral sling for the surgical treatment of female urinary incontinence and surgical instruments used to position same
EP3747396A1 (en) * 2013-05-03 2020-12-09 James W. Cullison Urological implant

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ES2264885A1 (en) 2007-01-16
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