Suprapubic endoscopic vesical neck suspension.

Experience with 20 endoscopic vesical neck suspensions (Stamey procedure) is compared to 20 matched anterior cystourethropexies (Marshall-Marchetti-Krantz procedure) performed by the same staff. The present procedure is a transvaginal vesical neck suspension, described in 1959 by Pereyra, modified in 1973 by Stamey and further modified in 1975 by Mason. The long-term success rate for relief of urinary stress incontinence was 90 per cent with either procedure. Advantages and disadvantages of the endoscopic vesical neck suspension are discussed.     

Suprapubic endoscopic vesical neck suspension (Stamey procedure) for control of urinary incontinence in a woman following cauda equina injury

Suprapubic endoscopic suspension of the vesical neck is a popular and effective procedure for the treatment of stress urinary incontinence in women. A woman who suffered a traumatic cauda equina injury had areflexic detrusor dysfunction with normal intravesical filling pressure. The patient had moderate proximal urethral dysfunction resulting in incontinence despite an adequate intermittent self-catheterization regimen and treatment with an alpha-sympathomimetic drug. Following suprapubic endoscopic vesical neck suspension she has remained totally continent on intermittent self-catheterization.     

Endoscopic suspension of vesical neck for urinary incontinence*

Surgically curable urinary incontinence in women is achieved by restoration of the vesical neck from a dependent position in the pelvis to one high behind the symphysis pubis. Endoscopic suspension, which accomplishes this by elevating the internal vesical neck on both sides with two permanent buttressed nylon loops is effective for correcting primary or recurrent stress urinary incontinence and even total incontinence in over 90 per cent of patients. Technical advantages over retropubic vesical neck suspensions include less postoperative morbidity, functional measurements and anatomic visualization of a restored vesical neck during the procedure, easy access to the surgically difficult pelvis, and simultaneous repair of significant rectoceles or substantial cystoceles through the same operative field.     

A comparison of endoscopic suspension of the vesical neck with suprapubic vesicourethropexy for treatment of stress urinary incontinence

To compare the efficacy of the Stamey endoscopic vesical neck suspension with the Marshall-Marchetti-Krantz vesicourethropexy in the correction of stress urinary incontinence, we studied retrospectively 127 consecutive patients who underwent either procedure during a defined interval at our institution. Of 95 women for whom adequate data were available 41 (group 1) underwent the Stamey and 54 (group 2) underwent the Marshall-Marchetti-Krantz procedures. Characteristics of the 2 groups were similar. A cure was obtained 21 to 118 months postoperatively in 61 per cent of the patients in group 1 and in 57 per cent in group 2. Cured and improved rates for the 2 groups were 78 and 80 per cent, respectively. Cure rates decreased with time in both groups. Complications occurred in 37.5 per cent of the patients in group 1 and in 18.5 per cent in group 2. Risk factors implicated in the pathogenesis of primary or recurrent stress urinary incontinence did not predispose to failure in either group. Adequate interpretation of our lower cure rates vis-à-vis those reported previously is hampered by the variability between series in the definition of cure and length of postoperative followup.     

A comparison of endoscopic suspension of the vesical neck versus anterior urethropexy for the treatment of stress urinary incontinence

Endoscopic suspension of the vesical neck has been reported to be as effective as anterior urethropexy in the treatment of female stress urinary incontinence. We compared our first 29 patients treated with endoscopic suspension of the vesical neck between 1982 and 1985 to our last 21 patients treated with anterior urethropexy between 1979 and 1985. Both groups were comparable in regard to age, parity, duration of symptoms and previous surgery for stress urinary incontinence. All patients underwent thorough preoperative urodynamic testing. Endoscopic suspension of the vesical neck successfully cured stress urinary incontinence in 26 patients (90 per cent), while anterior urethropexy resolved the incontinence in 20 (95 per cent). Of the 3 failures of endoscopic suspension 2 probably were related to technique or material failure. Hospitalization was reduced for endoscopic suspension versus anterior urethropexy (mean 4.04 versus 6.00 days, respectively). The most common complication after endoscopic suspension of the vesical neck was transient urinary retention (34 per cent). We conclude that endoscopic suspension of the vesical neck is an effective method to treat stress urinary incontinence, and that it also reduces hospital stay and postoperative recovery.     

Stamey endoscopic vesical neck suspension in female urinary stress incontinence: Results and changes in various urodynamic parameters

A total of 32 female patients with urinary stress incontinence who underwent a Stamey endoscopic bladder neck suspension were clinically and urodynamically studied pre- and postoperatively. Complete cure was obtained in 78% of the patients and improvement in 6%, the overall success rate being 84% for a mean follow-up of 11.1 months (range 6–19). Complications occurred in 22% of the patients. Comparison of the pre- and postoperative urodynamic data revealed that the maximum urine flow rate, functional urethral length and maximum urethral closure pressure were changed significantly after operation. In addition, when studying the abdominal pressure transmission to the entire urethra during stress, there was a significant conversion of negative to positive pressure transmission after surgical repositioning of the urethra.     

Suprapubic suspension of Kaufman urinary incontinence prosthesis: New technique

Many operative procedures have been devised to treat postprostatectomy urinary incontinence. The most widely employed technique today is implantation of the Kaufman urinary incontinence prosthesis. This device maintains continence by passive compression of the bulbous urethra. Unfortunately, it is associated with a 39-per cent failure rate. We have modified Kaufman's operative technique by suspending the posterior straps of the device to the anterior rectus fascia. Passive urethral compression is thus augmented by partial transmission of increases in intra-abdominal pressure. This article describes the details of the surgical procedure and the results in 3 cases.     

Suprapubic wad suspension Combined perineal-abdominal approach for correction of postprostatectomy urinary incontinence

A three-year experience with 20 patients who became incontinent after various types of prostatectomies is described. A new method of repair using a combined approach is presented. The perineal component allows the insertion of a pliable prosthetic “wad.” The posterior edge of the wad is held in a position inclined 20 degrees toward the vertical plane of the recumbent patient's perineum by two heavy nylon sutures. The sutures are brought into the previously dissected retropubic space by the use of a 10-cm. long Keith needle which is passed through the urogenital diaphragm. The ends of the sutures are tied over small marlex pledges over the abdominal fascia. There were two failures and one case in which urethral stricture developed among the 20 patients undergoing surgery.     

Comparison of the Stamey bladder neck suspension procedure with a modified endoscopic suspension for the treatment of stress urinary incontinence

Endoscopic vesicourethral suspension is an acceptable procedure for the treatment of stress urinary incontinence and is associated with a high success rate and little morbidity. Classical endoscopic vesical neck suspension was performed in 93 patients with cure of incontinence in 89 (95.7%). Cost-effectiveness and simplification were introduced to Stamey's technique. Modifications introduced to the Stamey technique were found to be simpler and to provide cost savings with fewer complications. Eighty-six women were operated on by this method, with 84.9% of success. A total of 133 (74.3%) of the patients had previous surgical procedures to correct incontinence, demonstrating the indication of the endoscopic vesicourethral suspension in case of failures with other techniques.     

Endoscopic transvaginal bladder neck suspension for stress urinary incontinence

We report the short-term results in 23 women who underwent endoscopic transvaginal bladder neck suspension for stress urinary incontinence. During follow-up for 3–14 months (mean 6 months) complete dryness was achieved in 15 (79%) of the 19 patients. Significant improvement with only minor occasional leaks after surgery was observed in 2 patients (10.5%) and the remaining 2 cases (10.5%) were failures. Four patients were lost to follow-up. No serious complication was noted. This relatively easy operation with acceptable success and morbidity rates has been found to be comparable with the other surgical techniques being used.     

Combined bladder augmentation and bladder neck suspension for neuropathic incontinence in girls

We treated five girls with congenital neuropathic bladder, who had genuine stress incontinence combined with reduced detrusor compliance and/or detrusor hyperreflexia, by simultaneous Marshall-Marchetti-Krantz bladder-neck suspension and bladder augmentation using a sigmoid or ileocecal pouch. All are dry on 3 to 4 hourly intermittent self-catheterization and we suggest that this method represents a useful and much cheaper alternative to the artificial urinary sphincter.     

Colpovesical neck suspension for the correction of female stress urinary incontinence

A new surgical approach for the correction of female urinary stress incontinence has been devised. The retropubic space is entered through a dome-shaped incision in the vaginal vestibule. The bulbocavernosus muscles are separated from the urethra and the layers of the genitourinary diaphragm are opened beginning behind the symphysis pubis. The retropubic cavity is exposed and the junction of the vesical neck and vagina is identified. Double helical bites with 2-zero polypropylene sutures are taken from each side of the junction. The 2 ends of the sutures are brought ventrally with a suture carrier through a small incision just above the symphysis pubis in the midline and tied. This procedure moves the bladder neck forward and upward to the desired level by observing movement of the bladder neck through the vestibule. Of 20 patients treated 17 are fully continent and 3 remain much improved after 2 years.     

The surgical management of urinary incontinence in myelodysplastic children

Over a 4-year period, 69 patients with intractable urinary incontinence secondary to myelodysplasia have undergone surgical therapy to try to achieve continence. Preoperative evaluation used uroradiological and urodynamic studies, including measurement of leak point pressure and leak point volume. Twenty-one patients had a procedure to increase outlet resistance, 30 patients had bladder augmentation, and 18 patients had both procedures performed. Fifty-seven of the 69 patients have achieved total continence for a success rate of 83%.     

Radiofrequency bladder neck suspension for the treatment of genuine stress urinary incontinence

Radiofrequency energy has been used for numerous medical applications including orthopedic, oncologic, and ophthalmologic indications. Characteristics of this energy source also allow it to be used for precisely controlled thermal therapy directed at soft tissues so as to induce such changes as collagen deposition and tissue shrinkage. These soft tissue effects have recently been used for the treatment of genuine stress urinary incontinence in women. As experience with this modality has matured, improved and less invasive methods of energy application have been developed. Large-scale clinical trials using this energy modality via laparoscopic and transvaginal approaches have either recently been completed or are near completion. A completely noninvasive approach is presently undergoing early clinical trials. The efficacy and safety profiles of this therapy support radiofrequency treatment of the endopelvic fascia as an option for the management of stress urinary incontinence in women.     

膀胱颈和盆底肌联合悬吊术治疗儿童神经源性尿失禁

目的　评价膀胱颈和盆底肌联合悬吊术治疗括约肌功能不全所致儿童神经源性尿失禁的临床效果。　方法　先天性脊髓发育不良所致神经源性尿失禁患儿 2 3例 ,年龄 5～ 1 4岁 ,均行锥状肌膀胱颈悬吊和髂腰肌盆底悬吊术 ,1 4例同时行双层回肠浆肌层膀胱扩大术。　结果　 2 3例术后随访 5～ 32个月 ,平均 1 8个月 ,控尿满意 (昼夜均能保持 3h以上完全干燥 ) 1 3例 ,好转 (部分控尿 ,白天偶有尿失禁或夜间尿床 ) 7例 ,无效 (症状无改善 ) 3例 ,总有效率为 87%。术前最大膀胱容量 (1 51 .5± 72 .8)ml、漏点压 (32 .3± 6 .5)cmH2 O(1cmH2 O =0 .0 98kPa)、最大尿道压 (38.4± 1 3 .7)cmH2 O、最大关闭压 (2 2 .8± 1 3 .2 )cmH2 O、功能尿道长度 (3 .9± 1 .8)cm ;术后分别为 (2 1 1 .6± 63 .3)ml、(49.8± 1 6 .4)cmH2 O、(50 .8± 1 2 .3)cmH2 O、(32 .9± 1 2 .5)cmH2 O、(5 .6± 2 .0 )cm ,均较术前明显增高 (P<0 .0 1 )。膀胱造影显示膀胱颈漏斗状开放下垂状态得到明显改善。　结论　膀胱颈和盆底肌联合悬吊术可增加尿道静息压和动力压 ,改善盆底肌功能 ,提高控尿能力 ,是治疗儿童膀胱出口阻力较低所致神经源性尿失禁的较好方法之一     

Review of an 8-year experience with modifications of endoscopic suspension of the bladder neck for female stress urinary incontinence

Several modifications of endoscopic suspension of the bladder neck for treatment of female stress urinary incontinence have been used during an 8-year period. Of 154 patients treated 25 failures occurred, for an over-all success rate of 84%. Fifteen patients had postoperative complications for an over-all complication rate of 9.8%. Hospital stay decreased steadily throughout the review period to a current average of 2.2 days, with many patients presently undergoing an operation on an outpatient basis.