Percutaneous Bladder Neck Stabilization for Stress Urinary Incontinence in Women: The Technique, Risks, Benefits.
Recent reviews have noted failures of transvaginal surgical procedures designed to cure stress urinary incontinence in women. Modifications continue to be applied to improve the transvaginal approach, including anchoring the supporting sutures to the pelvic bones and reducing the transvaginal dissection to prevent further prolapse. This article reports the outcomes of 2 procedures: a bone-anchoring technique with preservation of the endopelvic fascia in transvaginal suspension surgery for incontinence caused by urethral hypermobility, and a modified sling procedure for incontinence caused by intrinsic sphincteric deficiency. Results of the bone-anchor suspension showed an 81.7% cure rate in 71 patients who were followed for at least 3 years. Findings of the in situ sling procedure with bone anchoring showed a 97.5% cure rate in 40 patients who were followed for at least 2 years. The use of this bone-anchoring technique with preservation of the endopelvic fascia and the use of the modified sling technique appear to enhance the success rate without increasing the risk to the patient. As minimally invasive procedures, they also reduce surgical time and length of hospitalization, thus lowering costs.
Appell
RA
Department of Urology at the Cleveland Clinic Foundation, Ohio.