TRAITEMENT DE L'INCONTINENCE URINAIRE D'EFFORT PAR SUSPENSION TRANSVAGINALE DU COL VESICAL. PROCEDE DE PEYREYRA-RAZ

Results are reported of the use of the technique of suspension of paravaginal tissue from either side of the neck of the bladder to treat female stress incontinence. Conducted almost exclusively through the vaginal route, an inversed incision in U allows dissection of the total retropubic space and pre-urethral bladder neck adhesions from any previous surgery, and the passage of a solidly implanted non-absorbable thread from one side of the bladder neck to the other in the paravaginal tissue. A short suprapubic incision involving skin and subcutaneous tissue is made down to the aponeurosis alone. A special long needle is then passed from above downwards from the lateral extremity of the suprapubic incision to the vaginal incision and the two ends of the non-absorbable thread clamped. One of the advantages of the retropubic dissection is the guidance of this needle without the risk of perforation of the bladder or urethra. The ends of the thread are brought from the vaginal incision to the lateral angles of the hypogastric wound and tied together or over a small square of Tevlon. The tension of the thread is such that it will just allow ascension of the posterior lip of the neck. This ascension, as well as the absence of any vesico-urethral perforation, and the permeability of the ureteral meatuses is verified by endoscopy. The very wide safety margin inherent in this procedure is shown by the 96% of perfect results in patients not previously operated upon, and the 94% of successes in those operated upon previously on one or several occasions without practically any complications. These findings suggest that this technique should occupy a place of choice in the treatment of urinary stress incontinence in women.