The Stamey endoscopic bladder neck suspension: a clinical and urodynamic investigation, including actuarial follow-up over four years.

OBJECTIVE

To assess a modified Stamey endoscopic bladder neck suspension as a management for genuine stress incontinence in women unsuitable for colposuspension because of vaginal narrowing or inefficient voiding.

DESIGN

Uncontrolled observational study.

SETTING

Regional university gynaecological urology unit.

SUBJECTS

A hundred women, median age 58 years, with genuine stress incontinence confirmed by urodynamic investigation; 65 had had previous surgery for the same problem.

TREATMENT

A Stamey procedure with monofilament nylon and short buffers of silastic tubing at each anchor site.

MAIN OUTCOME MEASURES

Urodynamic reassessment 3 months after surgery and clinical follow-up for up to 4 years, using life table methods. The median follow-up was 27 months.

RESULTS

At 3 months the objective cure rate was 83%. Subjectively the cure rates at 4 years were 53% in patients under 65 years of age and 76% in those who were older. Overall mean bladder capacity decreased from 506 to 458 ml after surgery (P less than 0.05) and, in those who were cured, mean peak flow rate fell from 25.5 to 19.6 ml/s (P less than 0.05). The urethral functional length and the pressure transmission in the proximal three quarters were increased by successful surgery (P less than 0.01) but the resting urethral profile, voiding pressure and the frequency of detrusor instability were unchanged.

CONCLUSIONS

This modification of the Stamey operation has an important role in the management of elderly patients those with previous unsuccessful operations, and those with inefficient voiding pre-operatively.