[Urethro-cervico-cystopexy using aponeurotic colposuspension: an original technic in the treatment of stress urinary incontinence. Apropos of 32 long-term reviewed cases]. / L'uréthro-cervico-cystopexie par colposuspension aponévrotique: une technique originale dans le traitement de l'incontinence d'urine à l'effort. A propos de 32 cas revus à long terme.

ABSTRACT

This is an original technique for the treatment of isolated urinary stress incontinence without associated cystocele, designed to obtain a good result, stable in the long term, which avoids dysuria and phenomena of bladder irritation (frequency, urgency) inherent to suspension cervicopexy. It consists of a Gobell-Stoeckel operation, modified at two points retrocervical dissection exclusively via a retropubic incision and fixation of a band of aponeurosis to the vagina before fixing it to Cooper's ligament to prevent compression of the posterior lip of the bladder neck. Thirty two patients with a mean age of 56 years (range 41-83 years) were operated by this technique between 1986 and 1991. Sixteen of the 32 patients (50%) had a history of previous pelvic surgery 14 hysterectomies, 4 cures of urinary stress incontinence, 4 cures of cystocele. Stress incontinence was associated with urgency in 25% of cases. Five patients developed 7 minor early complications 3 benign parietal complications, 4 cases of transient urinary retention. The mean duration of indwelling catheterisation was 4 days (range 2-6 days) and the mean length of hospital stay was 8 days (range 6-20 days). The mean follow-up was 32 months (range 12-70 months). Perfect continence was achieved in 91% of cases. 69% of patients obtained an excellent result (normal continence, no dysuria, no urgency), 19% obtained a moderate result (normal continence, but slight dysuria and/or urgency) and 12% obtained a poor result (2 cases of urge incontinence, 1 case of late incontinence secondary to a neurological lesion and 1 case of permanent incomplete retention requiring endoscopic section of the strip of aponeurosis). On the basis of these good long-term results, the authors propose this technique for the treatment of urinary stress incontinence in postmenopausal and/or previously operated women.