Treatment of recurrent urinary incontinence.

This method of elevating the vesical neck with two permanent nylon sutures is effective for correcting primary or recurrent stress urinary incontinence and even total urinary incontinence in over 90% of patients. The cystoscope guides placement of the nylon sutures, and the buttress supports the tissues to achieve precise functional closure of the bladder neck. The technique causes less blood loss and postoperative morbidity than many other operations because open pelvic surgery is avoided. There is less pain, and the patient can be discharged with supra-public urinary drainage on the second or third postoperative day if desirable. The procedure can be performed easily by a single surgeon in less than an hour in uncomplicated patients and is no more difficult in obese women than in thin women. It is particularly well adapted for patients who have failed other procedures for stress urinary incontinence and those with previous pelvic fracture, pelvic irradiation, or trauma. Simultaneous repair of significant rectoceles or substantial cystoceles can be performed through the same operative field, and hysterectomy is not required for achievement of adequate endoscopic suspension of the bladder neck.