Abstract
A new operative technique combining retropublic colpourethropexy with transabdominal internal anterior and/or internal posterior repair for the treatment of genuine stress incontinence (GSI) and genital prolapse is described in 75 cases. The overall success rate in correcting GSI was 92.0%, with a 94.8% success rate in the primary surgical group (n=58) and an 82.4% in the secondary group (n=17). Average follow-up has been 1.31 years (range 6 weeks–6 years). There was a 3.4% incidence of residual prolapse. Nine patients also underwent concomitant colpourethropexy. Overall surgical complications include febrile morbidity 4/75 (5.3%), wound infection 1/75 (1.3%), deep vein thrombosis 1/75 (1.3%) and partial ureteric obstruction 1/75 (1.3%). There were no statistically significant changes in multichannel urodynamic studies preoperatively and at 1 year following surgery. Onethird (2/6) of the GSI failures had low MUCP (<20 cm H2O) prior to surgery and continued so at 1 year follow-up.
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References
Hodgkinson CP. Stress urinary incontinence.Am J Obstet Gynecol 1970; 108:1141–1168
Bergmanm A, Ballard CA, Koonings PP. Comparison of three different surgical procedures for genuine stress incontinence: prospective randomized study.Am J Obstet Gynecol 1989; 160:1102–1106
Sand PK, Bowen LW, Panganiban R, Ostergard DR. The low pressure urethra as a factor in failed retropubic urethropexy.Obstet Gynecol 1987; 69:399–402
Bowen LW, Sand PK, Ostergard DR. Unsuccessful Burch retropublic urethropexy: a case-controlled urodynamic study.Am J Obstet Gynecol 1989; 160:452–458
Horbach NS, Blanco JS, Ostergard DR, Bent AE, Cornella JL. A suburethral sling procedure with polytetrafluoroethylene for the treatment of genuine stress incontinence in patients with low urethral closure pressure.Obstet Gynecol 1988; 71:648–652
Baker KR, Drutz HP. Retropubic colpourethropexy: clinical and urodynamic evaluation of 289 cases.Int Urogynecol J (in press)
Macer GA. Transabdominal repair of cystocele, a 20 year experience, compared with the traditional vaginal approach.Am J Obstet Gynecol 1978; 131:203–207
Abrams P, Blaivas JG, Stanton SL, Anderson JT. The standardization of teminology of lower urinary tract function.Int Urogynecol J 1990; 1:45–58
Green TH Jr. Urinry stress incontinence: differential diagnosis, pathophysiology and management.Am J Obstet Gynecol 1975; 122:368–400
Green TH Jr. Urinary stress incontinence: pathophysiology, diagnosis and classifications. In: Buchsbaum HS, Schmidt SB, eds. Gynecologic and Obstetric Urology. Philadelphia, WB Saunders, 1978: 162–188
Langer R, Ron-El R, Neuman M, Herman A, Bukovsky I and Caspi E. The value of simultaneous hysterectomy during Burch colposuspension for urinary stress incontinence.Obstet Gynecol 1988; 72:866–869
Burch JC. Cooper's ligament urethrovesical suspension for stress incontinence.Am J Obstet Gynecol 1968; 100:764–774
Baker KR, Drutz HP, Stern HS, Deutsch A. Combining colposacropexy and ripstein procedures for combined vaginal vault and rectal prolapse: with or without retropubic colpourethropexy for stress urinary incontinence.Int Urogynecol J (1990) 1:228–232
Drutz HP, Cha L. Massive genital and vaginal vault prolapse treated by abdominal vaginal sacropexy with use of Marlex mesh: review of the literature.Am J Obstet Gynecol 1987; 156:387–392
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EDITORIAL COMMENT: Genital prolapse is often present in patients who have GSI. If an operation is performed to correct the GSI, and those areas of weakness in the pelvic support system that are contributing to the genital prolapse are not treated, the genital prolapse will become more severe. In the operation which has been described, the colpopexy sutures will correct any cystourethrocele, and the removal of the wedge of tissue from the anterior superior vaginal wall will correct the cystocele. The removal of the wedge of tissue from the posterior superior vaginal wall will reduce the redundancy of the posterior vaginal fornix, but a culdeplasty of the Moschcowitz or Halban type is recommended to treat or prevent an enterocele and to place the vaginal apex in the hollow of the sacrum. Any coexistent rectocele must always be treated vaginally. If it is not treated, it will appear to be more advanced following elevation of the anterior vaginal wall by retropubic urethropexy and the anterior repair which has been recommended.
Genital prolapse is best treated by a vaginal approach. When one must une an abdominal approach, ancillary procedures such as the authors have described should be considered. A ‘bulbous’ upper vagina is ideal for childbearing but if the apical support system and vaginal wall is weakened it is predisposed to prolapse. If the surgeon, in operating for genital prolapse, which involves the upper vagina, will taper the vaginal apex and support it by obliteration of the cul-desac and shortening and reattachment of the uterosacralcardinal complex, postoperative prolapse will be less likely to recur.
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Drutz, H.P., Baker, K.R. & Lemieux, M.C. Retropublic colpourethropexy with transabdominal anterior and/or posterior repair for the treatment of genuine stress urinary incontinence and genital prolapse. Int Urogynecol J 2, 201–207 (1991). https://doi.org/10.1007/BF01923385
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DOI: https://doi.org/10.1007/BF01923385