[Urethro-cervico-cystopexy using aponeurotic colposuspension: an original technic in the treatment of stress urinary incontinence. Apropos of 32 long-term reviewed cases].
This is an original technique for the treatment of isolated urinary stress incontinence without associated cystocele, designed to obtain a good result, stable in the long term, which avoids dysuria and phenomena of bladder irritation (frequency, urgency) inherent to suspension cervicopexy. It consists of a Gobell-Stoeckel operation, modified at two points: retrocervical dissection exclusively via a retropubic incision and fixation of a band of aponeurosis to the vagina before fixing it to Cooper's ligament to prevent compression of the posterior lip of the bladder neck. Thirty two patients with a mean age of 56 years (range: 41-83 years) were operated by this technique between 1986 and 1991. Sixteen of the 32 patients (50%) had a history of previous pelvic surgery: 14 hysterectomies, 4 cures of urinary stress incontinence, 4 cures of cystocele. Stress incontinence was associated with urgency in 25% of cases. Five patients developed 7 minor early complications: 3 benign parietal complications, 4 cases of transient urinary retention. The mean duration of indwelling catheterisation was 4 days (range: 2-6 days) and the mean length of hospital stay was 8 days (range: 6-20 days). The mean follow-up was 32 months (range: 12-70 months). Perfect continence was achieved in 91% of cases. 69% of patients obtained an excellent result (normal continence, no dysuria, no urgency), 19% obtained a moderate result (normal continence, but slight dysuria and/or urgency) and 12% obtained a poor result (2 cases of urge incontinence, 1 case of late incontinence secondary to a neurological lesion and 1 case of permanent incomplete retention requiring endoscopic section of the strip of aponeurosis). On the basis of these good long-term results, the authors propose this technique for the treatment of urinary stress incontinence in postmenopausal and/or previously operated women.
Hôpital Ambroise Paré, Clinique Urologique, Boulogne.
D
D
Beurton
E
E
Fontaine
J
J
Grall
P
P
Quentel
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002584:Cervix Uteri / Q000601:surgery*; D004210:Dissection; D000071938:Fasciotomy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008722:Methods; D008875:Middle Aged; D011183:Postoperative Complications; D011379:Prognosis; D013536:Suture Techniques; D014521:Urethra / Q000601:surgery*; D001743:Urinary Bladder / Q000601:surgery*; D014550:Urinary Incontinence, Stress / Q000601:surgery*; D014554:Urination / Q000502:physiology; D014555:Urination Disorders / Q000209:etiology; D014563:Urodynamics / Q000502:physiology; D014599:Uterus / Q000601:surgery*
L'uréthro-cervico-cystopexie par colposuspension aponévrotique: une technique originale dans le traitement de l'incontinence d'urine à l'effort. A propos de 32 cas revus à long terme.