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Stress Urinary Incontinence Panel. Marie Fidela R. Paraiso, M.D. Head, Division of Urogynecology Professor of Surgery Cleveland Clinic Lerner College of Medicine at Case Western Reserve University Cleveland, OH. What I Do Surgically For My Patients With SUI, cont’d. Situation Surgery.

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stress urinary incontinence panel

Stress Urinary Incontinence Panel

Marie Fidela R. Paraiso, M.D.

Head, Division of Urogynecology

Professor of Surgery

Cleveland Clinic Lerner College of Medicine at

Case Western Reserve University

Cleveland, OH

slide2

What I Do Surgically For My Patients With SUI, cont’d.

Situation Surgery

Primary or recurrent TVT or

SUI with hypermobility – TOT

older, LPP > 60

SUI with Stage 2 or 3 TOT

prolapse, vaginal repair

Recurrent SUI with “tight” TVT or

hypermobility – Rectus Fascia

LPP < 60 (ISD) Patch Sling

slide3

What I Do Surgically For My Patients With SUI, cont’d.

Situation Surgery

Recurrent SUI with Periurethral

Q-Tip < 30º; any bulking with

LPP collagen

“Potential” SUI with TOT or Mini-sling prolapse reduced, with cystocele

vaginal repair repair

slide4

Office Procedures for Stress Urinary Incontinence: Bulking Agent Injections and Autologous Stem Cells

Stem-Cell Homing with or without a scaffold

AUGS, IUGA, ICS 2009: Chemokines, myoblasts, and fibroblasts

stem cell injection for stress urinary incontinence
Stem Cell Injection for Stress Urinary Incontinence

Do you think that this treatment will be available on the market in the near to moderately near future?

Which of these alternatives is/are financially feasible?

Commercially proliferated autologous stem cells

Regenerated donor stem cells

Stem cell homing

graft implants
Graft Implants

Tissue and organ engineering

What’s the Price / Value proposition to the patient ?

Cellular: regenerate or signal to scaffold

Price

Bioactive, conductive, remodeling tissues

Inert, inactive, permanent materials

Volume & Value

0

slide7
Urethral Bulking AgentsReference: 4th ICI 2008, Surgery for Urinary Incontinence in Women, ARB Smith et al
  • No evidence that any one bulking agent is more effective than any other (EL=2)
  • No data comparing urethral bulking agents with non-surgical treatments or with other minimal access surgical techniques.
urethral bulking agents
Urethral Bulking Agents
  • RECOMMENDATIONS
    • Women should be aware that:
      • Efficacy diminishes with time
      • Repeat injections may be required
      • Efficacy inferior to that of other surgical techniques (Grade B)
    • Research recommendation
      • Impact on other techniques?

(Does or how does previous collagen affect future anti-incontinence surgery results?)