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Suburethral duplication of the vaginal wall — An original operation for urinary stress incontinence in women

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Abstract

The ideal surgery for urinary stress incontinence should be represented by operations producing increases in urethral closure pressure only when the intra-abdominal pressure is elevated. Guided by this principle the author proposes an original vaginal operation creating a suburethral duplication of the anterior vaginal wall, together with Halban's fascia, located under the proximal urethra just below the bladder neck. Over this supportive duplication the urethra is compressed during its dorsocaudal physiologic displacements. The technical details and indications of the procedure are fully described. In the period from 1974 to 1991, at the Department of Obstetrics and Gynecology, Medical Faculty, Skopje, 481 operations were performed. In this series, 74 patients had pre- and postoperative urodynamic evaluations. At 2 years 93.3% were continent without demonstrable obstruction. The simple technique and the use of autologous tissue, together with the lack of major complications and low recurrence rate, are the best advocates for the surgical procedure.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Medical Faculty, Vodnjanska 17, 91000, Skopje, Republic of Macedonia

    M. B. Lazarevski

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  1. M. B. Lazarevski
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Editorial Comment: This article presents a vaginal approach to the correction of stress incontinence which utilizes the well known principle of differential support of the urethrovesical junction rather than the bladder. A suburethral bar is created using the vaginal wall. Urodynamic studies were done pre- and postoperatively on 71 patients, who were followed for 2 years. These studies demonstrated a 93.3% success rate, using the absence of urine loss with a full bladder during stress as the criterion for cure. Urethral closure pressure was also found to be increased. This is the same technique as proposed Goebell in 1910 and Ingleman-Sundberg in 1947, who utilized other structures to create a differential resistance between the proximal urethra and the base of the bladder. This is an interesting procedure and will wait for others to validate its success.

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Lazarevski, M.B. Suburethral duplication of the vaginal wall — An original operation for urinary stress incontinence in women. Int Urogynecol J 6, 73–79 (1995). https://doi.org/10.1007/BF01962575

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  • DOI: https://doi.org/10.1007/BF01962575

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