Paraurethral Support Restoration Using Barbed Sutures
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Solution Overview
Problem
Current treatments for stress urinary incontinence in women often fail to fully restore continence due to the attenuation of paraurethral support mechanisms, which are crucial for maintaining urethral length and mobility, especially after vaginal delivery and increased intra-abdominal pressure over time.
Innovation Solution
A system comprising a rigid trocar, a flexible introducer, and barbed suture-type devices is used to implant suture devices bilaterally parallel to the urethra, attaching them to suprapubic support structures like fascia and ligaments to restore paraurethral support, thereby enhancing urethral stability and continence.
Engineering Contradictions & Design Principles
Engineering Contradiction Analysis
1Reliability
If mid-urethral sling procedures are used to provide pubo-urethral support, then continence is improved, but the success rate is limited to at most 90% due to inadequate restoration of paraurethral support
Solution Approach 1:
The invention divides the urethral support system into two distinct segments: mid-urethral support (pubo-urethral ligaments) and paraurethral support (bilateral longitudinal attachments to pubic symphysis). By segmenting the support mechanism and addressing both components separately through different surgical approaches, the patent achieves more comprehensive continence restoration beyond what mid-urethral slings alone can provide.
Solution Approach 2:
The patent introduces a new dimensional aspect to urethral support by restoring the paraurethral support mechanism that runs longitudinally along the urethra from the bladder neck to the distal urethra. This longitudinal dimension complements the transverse mid-urethral support, creating a three-dimensional support architecture that significantly improves continence success rates.
2Strength
If retropubic urethropexy with multiple sutures is used to attach urethra to Cooper's ligament, then urethral support is provided, but the procedure complexity and tissue trauma increase
Solution Approach 1:
The patent extracts and restores the specific paraurethral support function from the complex retropubic urethropexy procedure. By identifying and reconstructing only the essential paraurethral attachments to the pubic symphysis rather than performing complete retropubic urethropexy with multiple sutures, the patent reduces surgical complexity and tissue trauma while maintaining adequate urethral support strength.
Solution Approach 2:
The invention applies local quality by targeting specific paraurethral attachment points on the pubic symphysis rather than performing diffuse suturing throughout the retropubic space. This localized reconstruction of paraurethral support structures reduces overall procedure complexity and tissue disruption while providing concentrated support where it is most needed.
3Reliability
If vaginal delivery and repetitive intra-abdominal pressure increases occur, then paraurethral support becomes attenuated leading to stress incontinence, but reversing this attenuation requires complex reconstructive surgery
Solution Approach 1:
The patent performs preliminary identification and preparation of the paraurethral attachment sites on the pubic symphysis before reconstruction. By pre-marking and preparing the specific attachment points where the paraurethral support should be re-established, the surgery becomes more straightforward and less complex, making the restoration of support integrity more achievable.
Data Source
AI summary
Disclosed are a system and method to implement a novel treatment to restore bilateral longitudinal parallel paraurethral support, the system comprising a trocar, and introducer, and one or more barbed suture-type devices, the components used cooperatively to implant the one or more barbed suture-type devices in the patient to provide sufficient paraurethral support to restore continence in the patient.