Promedon STEEMA Instructions For Use Manual page 6

7. The same procedure (detailed in points 3 to 6) is performed on the other
side of the patient, ensuring that the positioning tab is located under the
urethra and the sling is flat in the horizontal position.
8. Perform cystoscopy to ensure that the bladder has not been perforated.
9. Pull the connector arm until it completely passes through the skin, whereby
the sling with protective cover appears.
10. TENSION-FREE FIXATION. Place Metzenbaum scissors between the sling
and the urethra to ensure that it is tension-free and to prevent the sling from
folding in upon itself. Pull both ends of the connector arms of the sling up
until the scissors make contact with the urethra.
11. When the sling is located without any tension under the urethra, cut
the sling and protective cover below the connector arm and remove the
protective cover of the sling without removing the Metzenbaum scissors.
12. Remove the positioning tab by cutting the suture located at the front of
the tab, in order to release it from the sling. Once the suture has been cut, be
sure to remove the positioning tab and the suture from the vaginal channel.
13. Finally cut the mesh excess at skin level in the suprapubic area and suture
the incisions.
Attention:
Control cystoscopy is recommended. In the case of vesical perforation during
the suprapubic puncture, it is recommended to puncture the affected side
again, further out from the first puncture. This is done in order to create a
new transfer path for the sling, leaving enough tissue between the sling and
the punctured area of the bladder to enable the orifice to close and for the
body to spontaneously and effectively protect itself against infection. In this
case, leave a catheter for 10 to 15 days. Postoperative care and therapy are at
the surgeon's discretion.
If the implant needs to be removed, please note:
Polypropylene mesh integrates with the patient's tissue, so complete removal
may be difficult. If a mesh removal is necessary due to pain, we recommend
trying to cut all the tension areas identified by the surgeon. In most cases, the
risk of organ injury caused by mesh removal may be higher than the benefits
resulting from its removal, so each case should be assessed and the decision
should be made at the surgeon's discretion.
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