Key Surgical Points

Place the patient in the lithotomy position with legs fully abducted. Indwell a urinary catheter to preliminarily assess the position and length of the urethra.
Inject hydrodissection fluid and incise the anterior vaginal wall mucosa. Use the index finger as a guide during puncture to avoid perforating the lateral vaginal sulcus mucosa.
Slide the trocar toward the patient’s shoulder or below the junction of the pubic symphysis and inferior pubic ramus. Immediately adjust the trocar to the posterior side of the pubic symphysis once a slight breakthrough sensation is felt after gentle force application. Press the puncture handle firmly to allow the trocar to penetrate closely behind the pubic bone. The suprapubic abdominal puncture site is 2 cm lateral to the midline, right against the superior pubic margin.
Monitor urine color throughout the puncture procedure to confirm no injury to the bladder or urethra.
Instill 250–300 mL normal saline into the bladder. Adjust sling tension by compressing the bladder area. A slight urine leakage resembling "tear drops" at the urethral meatus after compression indicates appropriate tension. Flatten the sling, then suture the anterior vaginal wall mucosa.
Indwell an indwelling urinary catheter for 24 hours postoperatively.

Medical History Data

Patient Basic Information

A 60-year-old female admitted for "involuntary urine leakage for over 10 years, aggravated for 1 year".

Present Illness

The patient has experienced urine leakage during brisk walking and coughing for more than 10 years, with worsening symptoms over the past year. No lower abdominal distension, frequent micturition, urgent micturition or nocturia.

Special Gynecological Examination

Vulva: Multiparous type, no masses visible; urine leakage occurs when the patient coughs as reported.

Vagina: Patulous, no anterior or posterior vaginal wall prolapse.

Cervix: Smooth.

Uterus: Anteverted, atrophic, medium texture.

Adnexa: No obvious abnormalities palpable.

Admission Diagnosis

Stress Urinary Incontinence

Surgical Procedure

Transvaginal Retropubic Midurethral Sling (TVT)

Surgeon Profile

Zhu Ru

MD, Chief Physician, Associate Professor, Master’s Supervisor, Deputy Administrative Director, Department of Obstetrics and Gynecology, Anqing Municipal Hospital, Anhui Province; Recipient of the First Outstanding Health Talents Award of Anhui Province.

Young Committee Member of the Reproductive Medicine Branch, Anhui Medical Association; Committee Member of the Anhui Reproductive Plastic Surgery Special Committee; Standing Committee Member of the Obstetrics and Gynecology Branch, Anqing Medical Association.

Specialties: 15 years of clinical experience in obstetrics and gynecology. Specializes in minimally invasive gynecological surgery and infertility diagnosis and treatment. Possesses extensive clinical experience in common obstetric and gynecological diseases including intrauterine adhesions, abnormal uterine bleeding, uterine fibroids, adenomyosis, uterine prolapse, stress urinary incontinence, benign and malignant ovarian tumors, cervical malignancies, and critical obstetric emergencies. Awarded the title of "Anhui Provincial Young Expert" in 2013. Completed advanced training in assisted reproductive technology and minimally invasive gynecological surgery at Anhui Medical University, Beijing Obstetrics and Gynecology Hospital and Tongji Hospital of Wuhan University. Skilled in transvaginal ultrasonography and saline infusion sonohysterography.

Strong capabilities in scientific research and innovation: Published more than 10 medical papers, including 5 SCI-indexed articles. Presided over 3 provincial and municipal research projects, among which the "Innovative Diagnosis and Treatment System Research on Post-Cesarean Uterine Scar Diverticulum" received funding from the Anhui Provincial Health Commission. Holds more than 10 utility model patents and 3 invention patents (1 already applied in clinical practice, 2 undergoing clinical transformation).

Editor-in-Charge: Qinghuan

Reviewer: Ma Ye