Tension-free Vaginal Sling Procedures: Transobturator Tape Procedure
Tension-free vaginal sling procedures: transobturator tape procedure (TOT) is a treatment for urodynamically proven stress incontinence in women. TOT is a minimally invasive procedure that involves the placement of a small piece of polypropylene mesh around the pubic bones underneath the urethra. The urethra is the tube through which urine passes from the bladder to the outside of the body. With the TOT procedure, the tape for the sling is routed through a 3mm incision within both inguinal (groin) folds and through the obturator foramen, the space created by the ischium and pubis pelvic bones. The mesh tape is manually guided through a small incision in the vagina and positioned under the urethra. The ends of the tape are secured to the groin incisions and adjusted just enough that its tension supports the urethra. TOT has been shown to have fewer side effects than the other major tension-free vaginal sling procedure, called transvaginal tape procedure (TVT). Operative times for TOT vary greatly depending on the findings at the time of surgery. Average times range from 20 to 40 minutes with the patient under local anesthesia plus intravenous sedation, regional, or general anesthesia. TOT is a day surgery or a 23-hour observation surgery.
UAB Urogynecology and Pelvic Reconstructive Surgery provides the highest level of evidence-based care for the full spectrum of women’s pelvic floor disorders. We stand apart from other programs because our board-certified or board-eligible physicians offer the full range of treatment options for women with urinary and bowel incontinence, pelvic organ prolapse, and other pelvic floor conditions. We feature minimally invasive surgical treatments for urinary and bowel incontinence and pelvic organ prolapse, and we collaborate with colleagues in providing nonsurgical options for pelvic floor conditions.
Our urogynecologic and pelvic reconstructive surgeons and physicians are recognized nationally and internationally, including service as president of the prestigious Society of Gynecologic Surgeons, a select member group of more than 250 physicians involved in teaching and practicing advanced gynecologic surgery. In addition, our leadership has been appointed to the National Institutes of Health (NIH) Urologic and Genitourinary Physiology and Pathology Study Section at the NIH Center for Scientific Review.
Urogynecology is all that we do, so you can depend on us to deliver individualized care in a sensitive fashion that fulfills your specialized needs.
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Robot-Assisted Hysterectomy at UAB Medicine
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UAB Hospital first in Alabama to offer first-of-its-kind dissolving heart stent
The interventional cardiology team at UAB Hospital recently added to its longstanding reputation as a pioneer in the development and implementation of stents by becoming the first in Alabama to offer patients with coronary artery disease a new treatment option that disappears over time.
On July 20, Massoud Leesar, M.D., a professor in UAB’s Division of Cardiovascular Disease, implanted a patient with the world’s first FDA-approved dissolving heart stent for the first time in Alabama. The Absorb bioresorbable vascular coronary stent is a major advance in the treatment of coronary heart disease, which is responsible for about 370,000 deaths each year in the United States, according to the National Heart, Lung, and Blood Institute. This type of stent has been in the making for nearly 15 years.
While stents are traditionally made of metal, the Absorb stent is made of a naturally dissolving material called polylactide, similar to dissolving stitches or sutures.
“Since the Absorb stent gradually dissolves, this may be a safer long-term option for patients because metal stents can clot and occlude the artery,” Leesar said.
The stent is placed into the artery on a balloon at the end of a thin flexible tube, much like the procedure used to place bare metal and drug eluting coronary stents. It is then expanded by inflating the balloon that pushes the plaque against the artery wall to enable greater blood flow. The balloon is removed, leaving the Absorb stent to slowly release medication to the diseased area. With blood flow restored, the stent begins dissolving.
After Absorb dissolves, it allows the artery to pulse and flex naturally. It may also reduce the risk of future blockages that occur with metallic stents, and makes it easier for doctors to offer additional interventions in the future if necessary. During the dissolving period, Absorb metabolizes into water and carbon dioxide, two elements that occur naturally in the body. All that remain in the artery are two pairs of tiny metallic markers that enable a physician to see where the device was placed. After three years, the device is completely dissolved and the vessel can remain open and pulsate on its own.
Calvin Burnett of Albertville, Alabama, is the first patient in the state to receive the new Absorb stent. After Burnett was diagnosed with rectal cancer in September 2015, his oncologist recommended he see a cardiologist at UAB following complaints of tightness in his chest.
“I’ve always been kind of physically active, so this kind of threw me for a loop,” Burnett said.
Two days after his stress test, an Absorb stent was placed. Burnett says he is grateful that medicine has come so far.
“I think this is such a great thing,” he said. “I’m looking forward to getting back to riding horses.”
Burnett says he could not imagine having his procedure done anywhere other than at UAB.
To ensure optimal patient selection and implant technique, UAB’s interventional cardiology team underwent extensive training on the new device.
“One of the advantages of this new stent is that the risk of a metal stent’s suddenly clotting is a major issue long-term,” Leesar said. “Since the new stent dissolves over time, this risk can be eliminated, and the vessel has the potential to be open more than to before with the stent.”
Currently, patients who receive the new dissolving stent will have to meet certain criteria. Leesar suggests patients talk with their cardiologists to see if they meet those criteria, and to learn more about the Absorb stent and its capabilities.
Source: UAB News