[Bladder suspension by retropubic endoscopy. Techniques and preliminary results (24 cases)].

The authors propose an original technical based on the concept of bladder neck support by a sling (Goebell-Stoeckel) to treat urinary stress incontinence, without cystocele, in young women. The technical modifications concern: the incision: retropubic endoscopy facilitated by a dissection balloon and combined with a short vaginal incision. The use of synthetic material for the sling: expanded polytetrafluoroethylene (Gore-Tex) attached to Cooper's ligaments by a suture tied extracorporeally. The long-term objective is to achieve results comparable to those of open surgery with a lower morbidity. From 1992 to 1994, 24 patients were treated according to this technique by the same operator. The mean age was 48 years. In every case, this operation constituted the first procedure for incontinence, and only one patient had a history of previous pelvic surgery (Caesarean section). Incontinence was classified as stage 3 according to the Ingelmann Sundberg classification in 46% of cases. 35% of patients present uninhibited contractions, and 35% presented urethral hypotonia. Two intraoperative complications and immediate postoperative complications were only minor. The mean operating time was 2 hours 45 minutes. With experience, it gradually decreased, as did the hospital stay, which was an average of 4.3 days. With a short mean follow-up (1 year 7 days), the results were good in 71% of cases, satisfactory in 8% of cases (1 case of urgency, 1 case of persistent retention), with a failure in 5 cases (21%); 1 case of true incontinence confirmed by clinical examination and 4 cases of minor incontinence during occasional violent effort.