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Preliminary report: Modification of the needle urethropexy in the management of stress incontinence

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Abstract

The management of stress urinary incontinence continues to be a perplexing problem for the gynecologist. The needle urethropexy procedures have undergone extensive revision with modifications of Pereyra, Stamey, Gittes, and Raz. In 16 patients with severe pelvic floor relaxation a modified needle urethropexy was performed along with vaginal surgery for correction of prolapse. Two small suprapubic incisions are made. No vaginal incision is required. The Pereyra needle is passed twice on each side of the urethra from the rectus fascia through the full thickness of the vaginal mucosa at the level of the urethrovesical junction. A 5-mm Mersilene strip is used in the suspension. At 2 months vaginal mucosa has epithelialized over the strips in all patients. There were 5 objective failures, but 4 of these patients were subjective cures. Two patients developed vesical instability. One patient postoperatively was unable to void, and 4 months later the sutures were cut. Only 1 patient developed suture rejection 11 months after surgery.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Wayne State University, Hutzel Hospital, 4707 St Antoine Boulevard, 48201, Detroit, Michigan, USA

    D. A. Richardson

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  1. D. A. Richardson
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Editorial Comment: The ideal operation for stress incontinence should be simple, safe, inexpensive, well-tolerated, effective, and, if necessary, easily repeatable. The needle suspension techniques were developed and are now being regularly modified to come closer to this ideal. This paper addresses the medical success rates encountered by other authors using other modifications and suggests that the procedure may be further simplified by the use of two Mersilene mesh loops. The authors report preliminary optimistic results. Longer follow-up of a larger group of patients will be required to confirm their findings.

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Richardson, D.A. Preliminary report: Modification of the needle urethropexy in the management of stress incontinence. Int Urogynecol J 2, 123–126 (1991). https://doi.org/10.1007/BF01997420

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  • DOI: https://doi.org/10.1007/BF01997420

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