Comparison of transvaginal versus laparoscopic bladder neck suspension for stress urinary incontinence.

ABSTRACT

OBJECTIVES: The purpose of this retrospective review was to determine the feasibility of treating anatomic female stress urinary incontinence (SUI) with a retropubic laparoscopic bladder neck suspension. Also, we compared the clinical course and results of the transvaginal bladder neck suspension (VBNS; Raz) and laparoscopic bladder neck suspension (LBNS) among a group of patients of similar age and American Society of Anesthesiologists rating. METHODS: Nineteen patients undergoing a retropubic LBNS (E.M.M.) were compared with 23 patients undergoing a Raz VBNS (C.G.K.) operated on during the same time period for anatomic SUI. All patients were assessed for their age, preoperative bladder capacity, preoperative postvoid residual, operative time, estimated blood loss, length of hospital stay, postoperative analgesia requirement, time required to resume a normal voiding pattern, complications, and recurrence rate of the SUI. RESULTS: The operative time for the LBNS is longer than the VBNS (124 versus 44 minutes). The LBNS patients required significantly less postoperative parenteral analgesia (6.3 versus 15.6 mg morphine sulfate), and a shorter time to resume a normal voiding pattern (0.6 versus 13 days) compared with the VBNS patients. The overall success rate of the two procedures was similar at 3 months, 6 months, and 12 months of follow-up. CONCLUSIONS: Retropubic LBNS is a technically feasible surgical procedure for patients with anatomic SUI. Compared with the VBNS, the LBNS is associated with minimal postoperative discomfort, no need for suprapubic urinary diversion, and a rapid return to normal activities. The short-term success rate of the LBNS appears to be similar to that for the VBNS.