Long-term Results of the Gittes Procedure for Treatment of Stress Urinary Incontinence / 대한비뇨기과학회지

PURPOSE: We evaluated the long-term outcome of the Gittes procedure for treatment of stress urinary incontinence. MATERIALS AND METHODS: A total of 84 women had Gittes bladder neck suspension carried out for the treatment of anatomic stress urinary incontinence. Long term (mean 51.4 months) results were evaluated using a questionnaire. RESULTS: Of the 58 patients assessed, 25 (43.1%) reported cure of stress urinary incontinence, 19 (32.8%) reported improvement, 12 (20.7%) were the same and 2 (3.4%) were worse after Gittes bladder neck suspension. Thirty-seven (63.8%) replied 'satisfactory' for the Gittes bladder neck suspension. Overall success rate was estimated as 62.1%. Depending on follow-up periods success rate was declined with time and by 5 years the success rate was 67.2%. CONCLUSIONS: Although the Gittes procedure was quick and easy to perform and was well tolerated with minimal complications, long term follow-up study of Gittes bladder neck suspension showed a declining success rate with time. Therefore it may not be a satisfactory procedure for the management of anatomic stress urinary incontinece in women.

Percutaneous Bladder Neck Suspension using Bone Anchors for the Treatment of Stress Urinary Incontinence / 대한비뇨기과학회지

PURPOSE: We investigated the technical feasibility and clinical results of percutaneous bladder neck suspension(PBNS) using bone anchors(Vesica) which represents a minimally invasive surgical procedure for the treatment of stress urinary incontinence caused by hypermobility of the proximal urethra and bladder neck. MATERIALS AND METHODS: Among women who underwent PBNS using bone anchors for type I or type II stress urinary incontinence, 22 women were followed for at least postoperative 9 months. A miniature bone anchor was used. On each side the suture was attached to the pubocervical fascia and the vaginal wall via a broad ?Z-stitch?. Postoperative voiding status was evaluated during office follow-up visits and telephone surveys. RESULTS: Mean operation time was 32 minutes. Mean hospital stay was 0.9 days. Mean follow-up was 13 months(9 to 18 months). In the 22 patients, the procedure was successful in 18 cases(82%), with 11(50%) of the patients completely dry and 7(32%) significantly improved. Preoperative urgency was present in 10 patients(45%). Postoperative resolution rate of urgency was 60%(6 of 10 patients). In 4 cases(18%), de novo urgency was documented. Removal of the bone anchor and suture was necessary in only one patient, because of persistent vaginal infection. Other complications were transient urinary retention in 3 patients(14%), prolonged suprapubic discomfort in 1 patient(4.5%) and incidental bladder perforation in 1 patient(4.5%). Major complications such as chronic urinary retention, osteitis pubis were not noted. CONCLUSIONS: The use of this bone anchoring technique and preservation of the endopelvic fascia appears to enhance the success rate without increasing the risk to the patient and, as minimally invasive procedures, reduce the surgery time and the length of hospitalization. However, the suspension sutures of PBNS may pull through the paraurethral tissue because there is no paravesical scar formation as in open procedures. Therefore we conclude that modifications of the suspension technique should be required for the improvement of long-term results.

Assessment of Success Rates of the Raz b1adder Neck Suspension Using Questionnaire Based Outcomes Analysis in Patients with Stress Urinary Incontinence / 대한비뇨기과학회지

PURPOSE: We reviewed surgical results in a group of women after Raz bladder neck suspension using questionnaire based outcomes analysis. MATERIALS AND METHOD: Of 71 patients who underwent Raz bladder neck suspension 55 had completed the questionnaire. Interviewees mean age was 54 years(range: 41-72 years) and mean observation time was 26.2 months(range: 3-77 months). RESULTS: According to outcomes analysis 39 patients(70.9%) were cured, 4(7.2%) improved, 11(20%) same and 1(1.8%) became worse. Overall improvement was found to be 43 patients(78.2%). 40(72.7%) patients replied 'satisfactory' for the Raz bladder neck suspension. Overall 'success rate' was estimated as 74.5%. No significant statistical correlation was found between success rate of Raz bladder neck suspension and various factors such as patients age, urge incontinence or follow up length. Of the 55 patients 7(12.7%) reported daily pad use. CONCLUSIONS: With these questionnaire based outcome analysis there was an overall success rate of 74.5%. We strongly emphasize the need for standardized questionnaire based outcome analyses for the evaluation of incontience surgery.

Foreign Body Induced Bladder Stone After Bladder Neck Suspension: A Case Report / 대한비뇨기과학회지

Bladder stone formation may be associated with the intravesical foreign body. Frequency of bladder foreign body in female is less than male. We present a case of bladder stone formation for nylon suture materials in a 47-year-old female patient who has been treated by bladder neck suspension for stress incontinence. Patient was successfully treated by surgical removal of suture materials without recurrence of stress incontinence.

Comparison of Extraperitoneal Laparoscopic Burch versus Open Burch and Raz`s Suspension for Female Genuine Stress Urinary Incontinence / 대한비뇨기과학회지

The purpose of this study was to determine the feasibility of treating female stress incontinence with a extraperitoneal laparoscopic Burch. We compared the operative data of laparoscopic Burch, open Burch and Raz`s suspension and we introduced our technique, hybrid of the laparoscopic Burch and Gittes` procedure which avoids traditional intracorporeal suturing entirely. Twenty patients underwent a laparoscopic Burch were compared with 15 open Burch and 21 Raz`s suspension during the same time period for anatomical stress incontinence. We did not use the application of balloon dissection and intracorporeal suturing but extracorporeal knot tying. The results showed that laparoscopic Burch operation could shorten the Foley catheter removal day and hospital day compared to other methods. There were no significant differences in operation time and the complications. Laparoscopic Burch operation offers a less invasive approach to surgical correction of stress urinary incontinence and a rapid return to normal activities. Further clinical assessment is necessary to evaluate the long-term feasibility.

Extracorporeal Ligation Using Self-Made Knot Pusher in Laparoscopic Bladder Neck Suspension for Female Stress Urinary Incontinence / 대한비뇨기과학회지

PURPOSE: Extracorporeal ligation using knot pusher enables one to tie surgical knots easily. However, commercialized knot pusher can not prevent the leakage of gas along the working port during procedure. So, we made knot pusher by ourselves which has a thick diameter enough to prevent leakage of CO2 gas and evaluated the usefulness of self-made knot pusher. MATERIALS AND METHODS: Between May 1995 and May 1996, 28 women with anatomic SUI underwent laparoscopic BNS at our department. Of the total, 10 patients underwent laparoscopic BNS using commercialized knot pusher with a diameter of 3 mm (thin knot pusher group); whereas 18 underwent operation using self-made knot pusher with a diameter of 5 mm (thick knot pusher group). Laparoscopic BNS was done by extraperitoneal approach in all cases. RESULTS: Patient`s characteristics of the 2 groups were similar. 25 of patients were exhibited grade 1 or 2 of incontinence at physical examinations, 10 in thin knot pusher group and 15 of 18 patients in thick knot pusher group. Urethral hypermobility (mean 52 degree) were observed in all cases by the Q-tip test. VLPP was far above 60 cmH2O at 150 ml filling in all cases. Mean operation time was 185 min in thin knot pusher group and 95min in thick knot pusher group. Post operative blood transfusion was needed in 2 cases (1 case for each group). Urethral catheter were removed 25 hours after the operations and return to normal voiding were possible in 27-29 hours without intergroup difference. Mean duration of hospital stay was 3 days in both group. Amount of residual urine at discharge was less than 100 cc in 28 cases (9 in thin knot pusher group and 19 in thick knot pusher group). Complication included 1 case recurrent urinary incontinence in thin knot pusher group, 1 case of voiding difficulty for each group (which were improved by medication and dean intermittent catheterization), 2 cases of frequency for each group (improved by medication), and 1 case of bleeding in thin knot pusher group(managed by laparoscopic coagulation and hematoma removal). 27 patients were completely dry at followup of 2-12 months following surgery. Only one patient with thin knot pusher group are still wet. CONCLUSIONS: It was evident from this study that tying of knot using knot pusher thick enough to seal the lumen of working port prevented leakage of gas and therefore, shortened the total operation time.

Suspension Suture Materials and Suture Carrier in Modified Gittes Bladder Neck Suspension / 대한비뇨기과학회지

We reviewed 42 cases (mean age 48.3+/-7.6 years, range 30 to 63 years) who underwent the modified Gittes bladder neck suspension for female stress urinary incontinence between January 1990 and May 1995 to evaluate the efficacy of two different suspension suture materials and new suspension suture carrier. At first we used the No. 1-0 Prolene as suspension suture in 24 cases (group I) and secondly No. 1-0 Ethibond in 18 cases (group II) with Ostycut bone biopsy needle (Angiomed) as suture carrier Following results were obtained. 1. The patient's ages ranged from 30 to 63 years (mean age 48.3+/-7.6 years), and most patients were multiparous with an average of 3.3+/-1.2 deliveries and we classified the patients according to Blaivas classification and there was statistically no difference of variables in both groups except the parity. 2. The mean values of operative time, postoperative days on catheter, and postoperative hospitalization were 65.5+/-11.4 minutes, 6.9+/-1.6 days, 7.3+/-1.4 days respectively. 3. The postoperative complications were transient urinary retention 8 cases (21.1%), vaginitis or cystitis 5 cases (11.9%), wound bleeding 1 case (2.4%) and deviation of urinary steam 1 case (2.4%). 4. The success rate was 83.3% in the group I, 94.4% in group II with minimum followup of 12 months (mean 24.6+/-5.0 months) but the latter wasn't significantly higher than the former statistically. The overall success rate was 88.1%. 5. The Ostycut bone biopsy needle as suspension suture carrier was simple and safe in the bladder neck suspension treatment. With above results, we recommend the No. 1-0 Ethibond as suspension suture material rather than the Prolene in bladder neck suspension and Ostycut bone biopsy needle as suspension suture carrier.

Laparoscopic extraperitoneal bladder neck suspension (LEBNS) for stress urinary incontinence

Seventy-nine patients of bladder neck suspension using an extraperitoneal variation of laparoscopic surgery were performed for the treatment of stress urinary incontinence. Using a balloon dissector the anterior vesical pelvic space is secured. The bladder neck suspension similar to the Burch operation was performed through a laparoscopic procedure. Symptoms of patients were assessed preoperatively and at one and six months following surgery. Operative times and complications were also evaluated. Success rate was 89.8% at six months. Complications such as bladder perforations were observed. Laparoscopic extraperitoneal bladder neck suspension-(LEBNS) is a viable option to the conventional methods of suspension, it has definite cosmetic advantages, is devoid of intraperitoneal dissection and adhesion, and has a comparable success rate.

Experience of the Raz procedure for stress urinary incontinence / 대한비뇨기과학회지

Bladder neck suspension to replace the bladder neck and proximal urethra into a high fixed retropubic position is paramount in the surgical treatment of genuine stress incontinence. Thirteen patients with grade II stress incontinence and one patient with grade III one underwent the Raz bladder neck suspension. All patients had no previous anti-incontinence operation. radiation therapy and pelvic trauma. Thirteen patients(93%) were cured and one patient(7%) improved with mean Follow-up period of 26 months. One failure case was due to insufficient suspension toward high retropubic position. The complications were not significant except temporary urinary retention of 2 to 9 days. The Raz bladder neck suspension providing good mobilization of paraurethral tissues is considerable way to the treatment of all types of genuine stress incontinence except those secondary to urethral intrinsic damage.

Early experience of "no-incision" bladder neck suspension of urinary stress incontinence / 대한비뇨기과학회지

Female urinary stress incontinence is not an uncommon surgical problem. Seventeen women with genuine stress incontinence underwent bladder neck suspension according to Gittes' procedure. The mean follow-up period was 9.8 months (3-19 months). Fourteen patients (82%) were cured and three (18%) significantly improved. The complications were not serious and the incidence was low. The 'no-incision' pubovaginal suspension is quick (mean operation time: 53 min), easy to perform and has a short hospital stay (mean : 6.5 days). While longer follow-up is required, our early experience suggests that this operation merits further evaluation in patients with grade I and grade II stress incontinence.