[Results of the treatment and prevention of urinary stress incontinence by Bologna's operation in prolapse with voluminous cystoceles].
Bologna's operation to relieve stress incontinence in patients with large cystoceles uses two vaginal strips to form a subcervical sling. Of 60 patients treated in this way, urodynamic exploration was performed preoperatively in 83% and postoperatively in 50%, while 42% underwent lateral retention and pressure cystography. All patients presented at least a stage II cystocele and hysteroptosis, 47% a patent and 93% a potential stress incontinence and 40% a sphincter incompetence. Anatomic results were excellent: 77% of total relief and 23% improvement in the cystoceles. Of greatest interest was efficacy against urinary incontinence: all patent stress incontinences were cured; none occurred after correction of cystocele, and only two cases of potential incontinence due to anatomic failure were observed. These good clinical results could be correlated with postoperative urodynamic exploration findings: the lack of persistent dysuria was related to the correction or even hypercorrection of the transmission anomaly without alteration of sphincter function. Paradoxically, images of pressure cystography showed elevation of the bladder neck in relation to symphysis pubis to be limited in extent. In 26% of cases the neck was in fact below this limit. These findings raise the question of the mechanism of re-establishment of pressure transmission. Because of the simplicity of technic of Bologna's operation, its low morbidity and it very great reliability with respect to urinary results, this method is now practised routinely in cases of prolapse with marked cystocele and patent or potential stress incontinence, even in the presence of major sphincter incompetence.
Service Chirurgical et Gynécologique, Hôpital de la Salpétrière, Paris.
D
D
Salet-Lizee
F
F
Rolet
A
A
Zamora
J P
JP
Lefranc
J
J
Blondon
D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D059685:Herniorrhaphy; D006801:Humans; D008722:Methods; D008875:Middle Aged; D011183:Postoperative Complications; D011859:Radiography; D001743:Urinary Bladder / Q000000981:diagnostic imaging; D001745:Urinary Bladder Diseases / Q000601:surgery*; D014550:Urinary Incontinence, Stress / Q000517:prevention & control / Q000601:surgery*; D014596:Uterine Prolapse / Q000601:surgery*
Résultats de la cure et de la prévention de l'incontinence urinaire d'effort par l'intervention de Bologna dans les prolapsus avec volumineuse cystocèle.