Urinary incontinence procedures performed at a military teaching hospital.

PURPOSE: This study provides follow-up of primary modified Pereyra needle urethropexy procedures performed with permanent suture by residents at a military teaching hospital. METHOD: Review of all resident-performed primary Pereyra urethropexy procedures performed at Keesler Medical Center (KMC) from December 1990 through April 1994. RESULTS: The results from 34 primary Pereyra needle urethropexy procedures, with 24 patients less than 2 years from surgery and mean follow-up of 19.5 months, demonstrated that 21/24 had improvement in their incontinence. This gives an 88% success rate at less than 2 years. We had 10 patients more than 2 years from surgery, with mean follow-up of 38 months, and 6/10 with continence. The overall success rate was 27/34 (79%). We noted that on preoperative evaluation, 5/7 failures were found to have urethral closing pressures of < 20 cm H2O (8-18). One of the late failures was found to have had no cystometrics performed and no demonstrable stress urinary incontinence. Her procedure was termed "prophylactic." Removing 6/7 failures for incomplete evaluation or use of less appropriate procedure, we find 27/28 patients (96%) with successful results. The presence of low urethral pressure (< 20 cm H2O) was a significant factor in the failures regardless of timing (< 2 years vs. > 2 years) (p < 0.04). There was no difference in parity, estrogen use, urgency component, age, socioeconomic status, associated operative procedures, postoperative infection, or complications noted between successful and unsuccessful Pereyra urethropexy as a primary method of genuine stress incontinence surgery. CONCLUSION: The primary Pereyra needle urethropexy had an overall success rate of 79% (27/34). Allowing for properly evaluated and treated patients, we find 96%(27/28) success. It appears that the primary modified Pereyra vaginal urethropexy with permanent suture is an easily taught and superior method of primary surgical treatment of stress urinary incontinence in a military training program.