Anterior bladder suspension defects in the female. Radiological classification with urodynamic evaluation. Anatomically corrective operations.

Abstract

Colpo-cysto-urethrography, urodynamic and cystometric examinations were performed in 420 patients from the departments of urology and gynecology. One hundred and ninty-eight patients displayed displacement of the urethro-vesical junction in the anterior and inferior direction. Three grades of displacement were established. The mildest form, grade 1, was visible only during a cough. The intermediate form, grade 2, was present even at rest. The severest form, grade 3, involved a displacement of the anterior vaginal wall, resulting in anterior bladder descent during cough and/or micturition. Stress incontinence was a complaint in 82 per cent of the women. The pathology is shown to be laxity of the arcus tendineus fasciae pelvis, which normally exerts a pull on the bladder neck in a postero-cranial direction. In seven cases anatomically corrective operations on this ligament were performed, resulting in a normal bladder base in an anatomically correct position. The operation is complicated and not suited for routine use.