Customised Treatment for Female Stress Urinary Incontinence
Adjustability
There is a delicate balance between incontinence, continence and obstruction and calculating the required degree of tension presents a challenge to even the most experienced surgeon. The A.M.I. TOA (Trans Obturator Adjustable) and TVA (Trans Vaginal Adjustable) Slings are equipped with two groups of integrated sutures which are left outside the skin following surgery and enable optimal fine-tuning of tension up to five days post-operatively, with active participation from the patient. One group of sutures can be pulled down to reduce tension if there are signs of urinary retention, while the other can be pulled up to increase tension if incontinence persists. Once the appropriate adjustments have been made, the sutures are removed. The option of post-operative adjustment has been proven particularly effective for high-risk groups (e.g. combined SUI and voiding dysfunction), severe SUI or patients in whom previous suburethral sling implantation has failed.
The evidence
Results from a total of 469 patients in six different studies (see literature overview):
- Adjustment was necessary in 27.3%
- 90.4% of the patients were completely dry
- The erosion rate was very low at just 0.6%
The materials
- Soft, but non-elastic monofilament polypropylene mesh which is firm enough lengthwise to provide the necessary support
- Optimally-sized pores that allow seamless tissue integration, thereby reducing risk of infection
- A PE sleeve covering the mesh to facilitate less traumatic placement
Tools of the trade
The A.M.I. tunnellers are made of high-grade materials, with ergonomically-designed handles to fit comfortably in the surgeon’s hand. The flattened, spatula-shaped, rounded tip design allows smooth tissue and good instrument control during penetration. All tunnellers feature a flattened tip for slightly wider dissection to better accommodate the sling’s shape. A.M.I. reusable tunnellers are available for all commonly used tunnelling techniques.
