Advertisement

Stamey Endoscopic Bladder Neck Suspension

  • P. Abrams
  • S. D. Yande
Part of the Clinical Practice in Urology book series (PRACTICE UROLOG)

Abstract

A plethora of surgical techniques has been designed for the treatment of stress incontinence. Uro-gynaecologists favour operations that seek to reposition the bladder neck and proximal urethra within the abdominal cavity. The theoretical basis of repositioning operations is the intraabdominal position of the proximal urethra. The intra-abdominal proximal urethra acts as a “flutter valve”. Although there are large alterations in intravesical pressure during straining and coughing (pressures rising up to 200–300 cmH20) we are protected from leakage. The increased intravesical pressure will try to force open the bladder neck. In a flutter valve mechanism an equal and opposite pressure attempts to maintain lateral compression on the urethra, negating the intravesical force attempting to open it. Stress urethral pressure profilometry shows how these increases in intravesical pressure are matched by equal transmission of intra-abdominal pressure to the proximal urethra (Fig. 14.1, “Post-op” trace). It has been disputed whether the intra-abdominal position of the proximal urethra is the only mechanism preventing stress incontinence. Several workers have suggested that there is also a pelvic floor reflex contraction that is important in maintaining continence (Heidler et al. 1979).

Keywords

Pelvic Floor Bladder Neck Stress Incontinence Rectus Sheath Urologic Surgery 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

Reference

  1. Chilton CP, Turner-Warwick R (1981) The relationship of the distal urethral sphincter to the pelvic floor musculature. Communication to the annual meeting of the British Association of Urological Surgeons, London, July 1981Google Scholar
  2. Heidler H, Wölk H, Jonas U (1979) Urethral closure mechanism under stress conditions. Eur Urol 5: 110–112PubMedGoogle Scholar
  3. Mundy AR (1983) A trial comparing the Stamey bladder neck suspension with colposuspension for the treatment of stress incontinence. Br J Urol 55: 687–690PubMedCrossRefGoogle Scholar
  4. Stamey TA (1973) Endoscopic suspension of the vesical neck for urinary incontinence. Surg Gynecol Obstet 136: 547PubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1988

Authors and Affiliations

  • P. Abrams
  • S. D. Yande

There are no affiliations available

Personalised recommendations