Macroplastique® Urethral Bulking for Female Stress Urinary Incontinence скачать в хорошем качестве

Macroplastique® Urethral Bulking for Female Stress Urinary Incontinence

This video demonstrates the use of Macroplastique, a urethral bulking agent used to treat stress urinary incontinence (SUI), primarily due to intrinsic sphincter deficiency (ISD) in an adult female. The technique in this video uses a total of 5 ml of Macroplastique dispersed between the 6 o'clock, 10 o'clock, and 2 o'clock positions. However, volumes and locations for injection should be based on physician discretion, according to patient morphology. Note: this video is intended for healthcare professionals and may contain imagery that some people may find unpleasant. Macroplastique must be prescribed by a physician. For more information on indications or contraindications, visit http://www.macroplastique.com Video Transcript Macroplastique is an injectable soft tissue bulking agent. During the implantation procedure three boluses of Macroplastique are implanted in the submucosa of the urethral wall. These are referred to as the six o'clock, ten o'clock, and two o'clock positions. Macroplastique is injected using a tunneling technique. This technique is accomplished by utilizing a three step approach. First, while keeping the needle bevel facing the urethral lumen, insert the needle to the first circumferential mark--or approximately one half centimeter--into the mucosal lining at a 30 to 45 degree angle. Second, while maintaining this depth, reduce the needle angle to zero degrees. Third, advance the needle to the second circumferential mark -- or approximately another half centimeter -- creating a tunnel in the submucosal space. It is important to use this tunneling technique to prevent an injection that is too superficial or one that is too deep. The bolus created at the six o'clock position is the largest. You will inject one entire 2.5 milliliter syringe of Macroplastique in this position. Begin by locating the six o'clock position. Using tunneling technique, tilt scope to a 30 to 45 degree angle. While keeping the needle bevel facing the urethral lumen, insert needle tip into the urethral tissue, and then advance the needle to the first circumferential mark or approximately one half centimeter in depth. Return the scope to zero degrees. Advance the needle to the second circumferential mark to a depth of approximately one centimeter. Check needle placement by slowly and deliberately pulling on the administration device lever to implant a small amount of Macroplastique within the mucosa. If placed correctly, a bleb should be immediately visible through the cystoscope. It is important to implant the product slowly. Wait a few seconds between each pull of the administration device lever. It should take two or three minutes to inject the entire 2.5 milliliter syringe of Macroplastique. A slow, deliberate injection technique helps to equalize pressure in the submucosal plain. Once the entire syringe has been injected into the six o'clock position, wait approximately thirty seconds to further equalize pressure before retracting the needle from the injection site. This will minimize product loss due to extravasation. You will use the second 2.5 milliliter Macroplastique syringe to create boluses in the ten and two o'clock positions. Each of these boluses will hold approximately one half of a syringe, about 1.25 milliliters of Macroplastique. These boluses are created following the same tissue tunneling and injection procedure as demonstrated with the six o'clock location.