Suburethral duplication of the vaginal wall — An original operation for urinary stress incontinence in women

Abstract

Abstract:The ideal surgery for urinary stress incontinence should be represented by operations producing increases in urethral closure pressure only when the intra-abdominal pressure is elevated. Guided by this principle the author proposes an original vaginal operation creating a suburethral duplication of the anterior vaginal wall, together with Halban's fascia, located under the proximal urethra just below the bladder neck. Over this supportive duplication the urethra is compressed during its dorsocaudal physiologic displacements. The technical details and indications of the procedure are fully described. In the period from 1974 to 1991, at the Department of Obstetrics and Gynecology, Medical Faculty, Skopje, 481 operations were performed. In this series, 74 patients had pre-and postoperative urodynamic evaluations. At 2 years 93.3 % were continent without demonstrable obstruction. The simple technique and the use of autologous tissue, together with the lack of major complications and low recurrence rate, are the best advocates for the surgical procedure.

Outcome Assessment of the Marshall Coughing Test during Cervix Reposition Maneuver in Women with Urinary Stress Incontinence with/without Genital Prolapse

“…This is the reason why we strongly recommend CRM in preoperative evaluation of patients with stage II GP. In cases with USI and GP stage II, we always combined the vaginal hysterectomy with the anti-stress procedure: Lazarevski's suburethral vaginal duplication [ 21 ]. In these group of patients, the deteriorating process of pubourethral ligaments, due to downward GP forces, is already finished, but the cystocele is large enough to have an overall impact over the above-mentioned forces and mask USI in lithotomic/upright position.…”