[The treatment of stress incontinence in women by aponeurotic "supporting" of the neck of the bladder. A new improved technique (author's transl)].
The authors describe a number of new technical details concerning surgery for stress incontinence in the woman using a sub-cervical strip. This involves the taking of a free aponeurotic strip from the upper lip of a Pfannensteil incision (which eliminates all possibility of incisional hernia), extensive pre-vesico-cervico-urethral dissection which is particularly important during reoperation (which allows the neck to rise up into its "normal" position in a patient placed in the Trendelenburg position), preparation of the sub- and latero-cervical course via a vaginal approach (avoiding tearing of the bladder and malposition of the strip), accurate placing along a straight line of the two "legs" of the U-shape given to the strip under visual control, without any tension (which avoids dysuria and should be adequate to ensure continence during stress) and finally attachments of the free ends of the aponeurotic strip to the medial end of the ligaments of Cooper using non-absorbable sutures (which leaves the strip at the desired length). Results : nine patients who had never undergone previous surgery, with nine cures ; ten patients operated upon after the failure of previous surgery for stress incontinence (8 successes and 2 failures including one reoperation with success using the same technique) ; finally, five patients operated upon for stress incontinence occurring after pelvic surgery of another type : 3 successes and 2 imperfect results. The authors briefly mention the 21 failures seen in a series of 26 cases of uplifting of the neck using a strip of skin and the 18 failures in a series of 30 reoperations for the treatment of stress incontinence in which there was no cervico-urethrolysis prior to passage of the strip.
D005260:Female; D006801:Humans; D008722:Methods; D001743:Urinary Bladder / Q000601:surgery*; D014550:Urinary Incontinence, Stress / Q000601:surgery*
Traitement de l'incontinence des urines à l'effort de la femme par "soutènement" aponévrotique du col vésical. Une amélioration technique nouvelle.