Suprapubic endoscopic vesical neck suspension for the management of urinary incontinence in myelodysplastic girls

Urinary incontinence may be a formidable hardship in many girls with myelodysplasia. In those patients who fail treatment with intermittent self-catheterization and pharmacotherapy surgical augmentation of outlet resistance may successfully alleviate incontinence. In patients with less severe degrees of urethral sphincteric incompetence suprapubic endoscopic vesical neck suspension in conjunction with intermittent self-catheterization can be successful. Patients must be selected carefully, with particular attention directed at detecting decreased detrusor compliance. Poor detrusor compliance must be controllable or corrected before augmentation of urethral resistance to prevent postoperative upper urinary tract deterioration.     

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.     

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.     

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.     

Stamey膀胱颈悬吊术治疗女性压力性尿失禁远期疗效观察

目的　评价Stamey膀胱颈悬吊术治疗女性压力性尿失禁的远期疗效。　方法　 5 2例接受Stamey手术患者 ,平均年龄 46岁 ,平均尿失禁 7.5年 ,Ⅰ°尿失禁 18例、Ⅱ°2 1例、Ⅲ°13例。　结果　 1994年以前手术 3 2例因并发症失败 3例 ,随访 3 .6年时治愈率 87.5 %、改善率 6.2 %、失败率 6.2 % ,随访 9.6年时治愈率 68.8%、改善率 9.3 %、失败率 2 1.9% ;1994年以后手术 2 0例随访 4.3年 ,治愈率 90 .0 %、改善率 10 .0 % ,无失败病例。　结论　Stamey手术治疗压力性尿失禁疗效随时间延长而下降 ,术前准确区分尿失禁类型和发病机制、降低并发症是提高疗效的关键     

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.     

Success and patient satisfaction following the Stamey procedure for stress urinary incontinence.

A long-term followup survey to determine patient satisfaction following Stamey endoscopic vesicourethral suspension was obtained by means of a mail-in questionnaire. A total of 284 charts was reviewed and surveys were mailed, 17 of which were returned for lack of a forwarding address. A total of 192 replies was received for a 72% response rate. Overall improvement was found to be 82%, with approximately half of these patients found to be totally dry. When asked if they would be willing to go through the experience again 65% said they would. Criteria for the success or failure of the procedure were determined, weighing the degree of dryness against the previously mentioned question. With these criteria there was an overall success rate of 73%. Pulmonary disease, body weight greater than 86 kg., prior Marshall-Marchetti-Krantz procedure and concomitant abdominal hysterectomy lowered the success rate. Prior hysterectomy and concomitant vaginal hysterectomy had no influence on the success rate.     

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.     

Complications of Stamey needle suspension for female stress urinary incontinence

INTRODUCTION: The Stamey bladder neck suspension for stress urinary incontinence in females is thought to be an excellent procedure. However, recent studies revealed that complications of this procedure have not been negligible. In this retrospective study, complications of the Stamey needle bladder neck suspension were examined. MATERIALS AND METHODS: The Stamey procedure was performed either alone or in combination with anterior colporrhaphy for 86 female patients with stress urinary incontinence between 1989 and 1999. The mean follow-up period was 37.6 months and the mean age was 59.1 years. We studied the complications postoperatively pointed out by patients' complaint and image examination. RESULTS: The overall incidence of complications was 37.2%. Voiding difficulties and lower abdominal pain were present in 15 cases, respectively. We experienced 2 unusual cases in whom suspensory stitches had to be removed due to abdominal pain. CONCLUSIONS: Although the Stamey bladder neck suspension is thought to be an excellent procedure for stress urinary incontinence, surgeons should beware of possible complications and be alert of the symptoms, such as abdominal pain and bladder irritation.     

Stamey与TVT手术治疗女性压力性尿失禁的疗效比较

目的评价Stamey膀胱颈悬吊术和无张力阴道吊带术（TVT）治疗女性压力性尿失禁的疗效.方法总结2种方法治疗49例女性压力性尿失禁的临床资料.Stamey组26例,平均年龄57岁.尿失禁Ⅰ度3例,Ⅱ度15例,Ⅲ度8例.TVT组23例,平均年龄58岁.尿失禁Ⅰ度2例,Ⅱ度13例,Ⅲ度8例.对2组术中记录,术后控尿、合并症以及复发情况进行比较.结果 Stamey和TVT组平均手术时间分别为43 min和27 min.术中膀胱穿孔发生率为19%（5/26）和4%（1/23）.拔尿管后无尿失禁者分别为92%（24/26）和96%（22/23）;尿潴留发生率为8%（2/26）和0%.术后6个月,无尿失禁者分别为89%（23/26）和100%（23/23）.合并耻骨上区疼痛者分别为58%（15/26）和9%（2/23）;排尿不畅或剩余尿＞50 ml者分别为15%（4/26）和9%（2/23）;尿频尿急发生率分别为54%（14/26）和17%（4/23）.结论 2种方法治疗女性压力性尿失禁初期疗效均较好,但TVT法术后指标优于Stamey法.     

A trial comparing the Stamey bladder neck suspension procedure with colposuspension for the treatment of stress incontinence

Fifty-one women with urodynamically proven genuine stress incontinence were alternately allocated to either colposuspension or a Stamey-type bladder neck suspension. One year after operation 89% of the patients who had had a colposuspension were subjectively cured and 73% were objectively normal. In the Stamey procedure group these figures were 76 and 40% respectively. The Stamey procedure is a quicker, simpler and a lesser procedure but has a higher incidence of post-operative voiding difficulties and residual urge symptoms. Colposuspension is to be preferred for the younger, healthier patient. The Stamey procedure is useful in the elderly, obese or unfit patient or the patient who has had multiple previous surgical attempts at a cure.     

改良Stamey手术治疗Ⅰ型女性压力性尿失禁的疗效观察

目的　总结改良Stamey细针穿刺悬吊手术治疗Ⅰ型女性压力性尿失禁 (FSUI)的疗效。　方法　采用改良Stamey细针穿刺悬吊手术治疗Ⅰ型FSUI患者 4 2例。按随访时间分 2组观察患者术后近、远期疗效。　结果　 4 2例随访 2个月～ 6年 ,近期随访组 19例 ,平均随访 6个月 ,有效率为 74 % ,远期随访组 2 3例 ,平均随访 35个月 ,有效率为 70 % ,两组比较 ,差异无显著性意义 ,χ2=0 .86 ,P >0 .2 5。　结论　改良Stamey手术治疗Ⅰ型FSUI近、远期疗效满意。     

Application of transrectal ultrasonography in modified Stamey procedure for stress urinary incontinence

From June 1989 to August 1990, 21 women with genuine stress urinary incontinence were treated with the Gittes procedure combined with transrectal ultrasonography. The urethrovesical junction was well pinpointed on an ultrasonographic image. The strength of suspension providing the optimal posterior urethrovesical angle was changed by each patient. Posterior urethrovesical angles averaged 89.3 +/- 9.5 degrees at operation and 93.6 +/- 9.5 degrees (mean +/- standard deviation) on a postoperative lateral cystourethrogram with the patient straining while in the standing position. An indwelling urethral catheter was removed on postoperative day 1. None of the patients had residual urine of more than 50 ml. by 4 days postoperatively. Furthermore, the average maximum urinary flow rates significantly increased from 21.0 +/- 7.1 ml. per second preoperatively to 26.1 +/- 9.8 ml. per second postoperatively (p less than 0.01). Therefore, application of ultrasonography during bladder neck suspension is simple and reliable for determination of the optimal suspension as well as identification of the suspension site.     

应用吊带方法经皮膀胱颈悬吊治疗女性压力性尿失禁

目的：介绍吊带方法经皮膀胱颈悬吊术治疗女性压力性尿失禁的经验。方法：在近膀胱颈水平，阴道前壁与尿道之间隧道状切口内预置两端带有尼龙线的网状聚丙烯片，术中窥镜监视下，应用Vesica穿刺针经皮穿刺行膀胱颈悬吊治疗女性压力性尿失禁19例。结果：随访3－45个月，平均17个月，除1例逼尿肌反射低下排尿稍费力外，18例患者无尿失禁及排尿困难。结论：吊带方法经皮膀胱颈悬吊术治疗女性压力性尿失禁，操作简便，创伤小，恢复快，临床效果满意。     

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.     

The Bologna bladder neck suspension procedure for treatment of stress urinary incontinence associated with cystocele

The object was to study retrospectively the perioperative complications and results of the Bologna procedure for the treatment of stress urinary incontinence associated with cystocele grade 2 or more. In the study, 80 patients underwent a repair of all defects of pelvic support plus the Bologna procedure. Mean duration of follow-up was 40.2 months (range 3–127). The incidence of operative complications was 2.5% for inadvertent cystostomy and for hemorrhage. Mean hospital stay was 7.2 days (range 2–17). At 2-year follow-up 85% of the patients were completely free of incontinence symptoms (95% CI: 75–92) and 76% at 3-year follow-up (95% CI: 66–86). None of the parameters tested in a univariate analysis was independently linked with surgical failure. Further studies are needed to establish the place of this technique in the surgical management of urinary incontinence associated with genital prolapse.Editorial Comment: The Bologna procedure was first described in 1978 as a procedure to correct genuine stress incontinence via the suspension of the bladder neck from the anterior rectus fascia using pediculated vaginal bands. In using this vaginal tissue it is necessary that the patient have relaxation and redundancy of the anterior vaginal wall. The procedure has been popular in France, undergoing modification over time, specifically the addition of a standard anterior colporrhaphy to reduce the existing cystocele. The present authors report a 2-year follow-up of 80 women with urodynamically proven GSI with concurrent cystocele. Postoperative success is based on examination and repeat urodynamic evaluation. The procedure, based on the present study, as well as previous reports in the French literature, offers a reasonable objective success rate of 85% in treating GSI. Recurrence of significant cystocele is likewise respectable, with only 10% of patients having a grade 2 or 3 cystocele at 2 years. It is surprising to find such a low postoperative rate of enterocele, rectocele and vault prolapse following a procedure that deflects the vaginal axis anteriorly. This is probably related to the authors' attention to preoperative evaluation of pelvic relaxation at all sites, combined with the performance of surgical correction of such defects or potential defects at the time of surgery.     

An unusual foreign body in the bladder 7 years after a Stamey endoscopic bladder neck suspension

Delayed migration of the suture and bolster after an endoscopic bladder neck suspension across tissue planes, with subsequent erosion into the bladder, is uncommon. We present a case of late migration of the suture and bolster occurring 7 years after a Stamey endoscopic bladder neck suspension. A 56-year-old woman had undergone a Stamey procedure in June 1990. In January 1997 she presented with discomfort in the left iliac fossa and the groin. A midstream sample of urine showed microscopic hematuria. Imaging and endoscopic examinations revealed a calcified lesion on the left lateral wall of the bladder, attached to the Stamey sutures. Cystolitholapaxy was attempted, but during the procedure it became obvious that there was a calcified cuff attached to the suture. This was removed endoscopically, along with its suture. Cystoscopy should be considered early in the evaluation of patients presenting with lower abdominal discomfort or irritative voiding symptoms after retropublic bladder neck suspension.