Sample Report: Pubovaginal Sling
PROCEDURE PERFORMED: Pubovaginal sling.
DETAILS OF PROCEDURE: In lithotomy position, the patient was prepped and draped in sterile fashion. A 16-French Foley catheter was placed initially into the bladder. An Allis clamp was placed on the vaginal mucosa. The bladder neck was then identified and marked using a sterile marking pencil. The vaginal mucosa was then infiltrated using 1% Xylocaine with epinephrine to help aid in hydrodissection. Following this, Malis scissors were then used to dissect the vaginal flap, which was in the shape of an inverted U. Dissection was performed laterally to the pelvic sidewalls and in the retropubic space bilaterally. Following this, a transverse incision was made in the suprapubic region down to the level of the rectus fascia. Stamey needles were then placed on either side of the bladder neck.
Following this, the fascia lata graft was then prepared using a mattress suture of 0 Prolene on either side. Having marked the midline, the 0 Prolene suture was then placed through either eye of the Stamey needles, and the sutures were brought out through the abdominal wall. Cystoscopy was then performed, which was within normal limits. A 4-French open-ended catheter was placed up each ureteric orifice and easily passed, and normal efflux of urine could be seen from each ureteral orifice. The midline of the fascia lata flap was then attached to the underlying vaginal wall in the midline using 4-0 Vicryl. A running suture of 2-0 chromic was used to approximate the vaginal incisions. The sutures of 0 Prolene were then tied across each other along the anterior rectus fascia and allowed good suspension of the bladder neck. The subcutaneous tissue in the abdominal incision was then approximated using interrupted sutures of 3-0 chromic. The skin edges were approximated using a running suture of 4-0 Vicryl. The patient tolerated the procedure well.