The Use of the Flexible Ureteroscope in the Stamey Urethropexy (original) (raw)
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Urodynamic Evaluation after Endoscopic Modified Bladder Neck Suspension
Urologia Internationalis, 1999
A total of 45 simplified double-needle bladder neck suspensions for genuine stress incontinence were clinically and urodynamically evaluated pre-and postoperatively. After a mean follow-up of 26 months, the subjective cure rate was 82.2% and the objective cure rate was 86.6%. Comparison of the pre-and postoperative urodynamic parameters showed a significant change in the maximum urethral closure pressure, functional urethral length, bladder capacity and maximum urine flow rate but no significant alteration in maximum detrusor pressure and first sensation during bladder filling. In summary, the modified bladder neck suspension effectively restores normal urethral function urodynamically.
Bladder neck suspension for stress urinary incontinence: How does it work?
Neurourology and Urodynamics, 1999
The objective of this study was to compare urethral resistance as determined in pressureflow studies before and after Burch retropubic urethropexy. Urethral resistance was retrospectively determined from pressure-flow studies in 178 patients before and 1 year after Burch retropubic urethropexy. Results of cotton swab tests, pressure transmission to the proximal urethra, and urethral functional length were also recorded. Results were analyzed statistically using the two-tailed paired t-test. Voiding studies in 176 patients were analyzed before and after Burch retropubic urethropexy. Mean urethral resistance increased significantly over preoperative values after successful surgery, from 0.051 to 0.099. The mean urethral resistance in patients in whom surgery failed to cure stress incontinence was unchanged from the preoperative value of 0.041. There was no direct correlation between stabilizing the bladder base, as evaluated by the cotton swab test, and cure of stress incontinence. When successful in curing genuine stress urinary incontinence, the Burch retropubic urethropexy increases urethral resistance. Creating bladder neck support without affecting urethral resistance does not, by itself, restore continence. Neurourol. Urodynam. 18: 623-627, 1999.
Delayed reaction to the Dacron buttress used in Stamey bladder neck suspension
International Urology and Nephrology, 2006
Stamey bladder neck suspension is thought to be an excellent procedure for stress urinary incontinence in selected groups of patients. However we must not ignore the complications of this procedure. We report a case of a patient who developed a delayed reaction with bladder wall erosion to the Dacron buttress used in Stamey urethropexy 19 years before. She was presented with pelvic pain and persisting irritative bladder symptoms. The treatment of choice was cystoscopic removal of suture and buttress. Tissue intolerance is a common problem with the use of different kinds of biomaterials in incontinence surgery. Careful cystourethroscopy is essential for early diagnosis and treatment if pain, infections and severe irritative symptoms occur postoperatively.
International Urogynecology Journal, 2006
We analyzed the objective and subjective long-term outcomes of women who underwent needle suspension of the bladder neck 11 to 16 years previously. A total of 132 women underwent a needle suspension procedure at our institution between 1986 and 1991. In a retrospective cohort study, 63 of these women were evaluated by clinical examination, urodynamic testing, cough stress test, and standardized personal interview. Objective continence was defined as no loss of urine either during cystometry or during coughing with the bladder filled to 300 ml. The objective continence rate was 56% (25/45) and the subjective continence rate was 41% (26/63). With regard to patient satisfaction, only 38% (24/63) of the studied patients considered themselves completely cured, and an additional 30% (19/63) improved. The objective and subjective long-term results of needle suspension of the bladder neck are modest. Long-term complications such as urinary retention and overactive bladder syndrome are rare.
The clinical and urodynamic effects of the tension free bladder neck sling procedure
International Urogynecology Journal, 2004
This study evaluated the clinical and urodynamic findings before and after tension-free bladder neck sling (TBS) procedure with Prolene tape. We enrolled 32 women who underwent TBS for genuine stress incontinence without intrinsic sphincter deficiency or severe uterovaginal prolapse. All subjects received 1-h pad test, Q-tip test, multichannel urodynamic testing, introital ultrasonography, and the Bristol Female Lower Urinary Tract Symptoms Questionnaires before and 1 year after surgery. Of the 32 subjects 27 were cured of stress incontinence, two improved, and three failed. The incidence of irritative symptoms and incomplete bladder emptying were significantly lower after surgery. The mean urethral straining angle showed a significant decrease from 73.8° preoperatively to 30.1° postoperatively. At rest the postsurgical position of the bladder neck (BN) was localized more cranially. During straining both ventral and caudal mobility of the BN decreased significantly following TBS, causing a more cranial and dorsal position of the BN. Urodynamic parameters including functional urethral length, maximal urethral closure pressure, and pressure transmission ratio showed significant increases after surgery. TBS could decrease the hypermobility of the BN and restore the BN support to prevent urinary leakage during straining, instead of urethral obstruction. The subjective and objective cure rate of stress incontinence is 84%, similar to those results reported after retropubic urethropexy and tension-free vaginal tape procedure. It is also worth emphasizing that no postoperative urinary retention occurred, although the limited number of cases makes it hard to confirm the significance of findings over the retention rate of tension-free vaginal tape.
The Journal of Urology, 2000
Purpose: We evaluated the long-term results of percutaneous needle suspension using bone anchor devices for treating stress urinary incontinence in women. Materials and Methods: We retrospectively evaluated the long-term results of percutaneous bladder neck needle suspension performed at our institution. None of the women had undergone any anti-incontinence surgery before percutaneous needle suspension. A telephone survey was done for all available patients. Subjective cure was defined as no evidence of incontinence, significant improvement as 0 to 1 protective pad soaked daily and patient satisfaction with incontinence level, and failure as more than 1 pad used daily, lack of patient satisfaction or a secondary procedure required to treat stress urinary incontinence. In cases considered failures a detailed video urodynamic study was performed when possible before any secondary procedure. Results: In 1996 and 1997, 49 patients underwent percutaneous needle bladder neck suspension with bone anchors, of whom 42 (86%) were available for telephone interview. Mean patient age was 57 years (range 31 to 77) and mean followup was 29 months (range 16 to 52). As defined, subjective outcome in the 42 women was cure in 2 (5%), significant improvement in 5 (12%) and failure in 35 (83%). Of the 35 patients with treatment failure who did not undergo a secondary procedure 25 were asked to present for video urodynamics and 18 were evaluated. Urodynamics revealed demonstrable urinary incontinence, urethral hypermobility in 16 (88%), intrinsic sphincter deficiency in 1 (6%) and detrusor instability in 1 (6%). In 2 cases x-ray revealed that a bone anchor had dislodged and migrated into the pelvis. Serious osteomyelitis at the bone anchor site in 1 case required surgical débridement and 6 weeks of intravenous antibiotics. Conclusions: Percutaneous needle suspension is associated with poor long-term results in women with stress urinary incontinence. Other procedures should be considered.
The triangular vaginal patch sling for stress urinary incontinence and hypermobile urethra
American Journal of Obstetrics and Gynecology, 1997
We describe an alternative sling procedure that permits concomitant correction of urethral hypermobility and urinary incontinence through a single surgical exposure. STUDY DESIGN: Fifteen women with severe urinary stress incontinence and urethral hypermobility underwent a sling procedure by creation of a simple triangular patch from the anterior vaginal wall. RESULTS: The mean operative time for the vaginal sling procedure was 38 minutes (range 29 to 65 minutes) in addition to other operations. The mean postoperative hospital stay was 7.7 days (range 5 to 13 days) and all patients were routinely discharged with an indwelling Foley catheter. Spontaneous micturition occurred in 12 patients after a mean period of 25 days (range 13 to 36 days). In three cases long-term catheterization was necessary. By subjective and objective evaluations, all the patients were cured of their stress incontinence. CONCLUSION: The triangular vaginal patch with the single sutures on each side provides an alternative approach for bladder neck stabilization that may permit a more anatomic suspension of a hypermobile urethra. (Am J Obstet Gynecol 1997;177:1426-31 .) Key words: Gynecologic surgery, stress urinary incontinence, sling, urethral hypermobility, Gore-Tex suture Different sling procedures have been described for patients with urinary incontinence that is the result of severe sphincter incompetence, t The preoperative evaluation includes assessment of multiple factors. Urodynamics are necessary to evaluate the filling and voiding phase of the bladder and to exclude the presence of detrusor hyperreflexia. Urethral profilometry identifies patients with short urethral functional length or cases of low urethral closure pressure, predisposing to operative failure after traditional retropubic urethropexy. 2 Cystourethrography may demonstrate severe incontinence with the bladder neck and urethra open both at rest and with stress. In these cases the leakage of urine is evident with minimal increase in abdominal pressures during a Valsalva maneuver and leak pressures are <30 cm H20. ~ Careful study and thoughtful consideration of the anatomic defects requiring operative repair are necessary for the successful therapy of massive and multiple forms of pelvic herniations. Hawksworth and Roux 4 are of the opinion that the most successful surgical means of supporting the vesicourethral junction are "sling" proce-