Extraperitoneal laparoscopic colposuspension for genuine urinary stress incontinence

Abstract

To evaluate endoscopic colposuspension with extraperitoneal and direct entry into the space of Retzius. Prospective case series (Canadian Task Force classification II-1). University of Texas Health Science Center and unaffiliated private practice, San Antonio, Texas. Seventy women with genuine urinary stress incontinence. The space of Retzius was entered directly through a 1.5-cm incision about 2 inches above the symphysis pubis. Three cannulas were inserted at the suprapubic area to access extraperitoneum. Permanent sutures were introduced into the space of Retzius, and with a 5-mm needle holder a double bite was taken into paravaginal fascia on either side. Cooper's ligaments were identified and the needle was passed through the ligaments medial to obturator vessels. To secure sutures, we used a simple surgical knot followed by square knots with either extracorporeal or intracorporeal method. Paravaginal fascia was pulled toward Cooper's ligaments to produce a zero-degree Q-Tip angle in the urethra. Of 70 women, 64 (91.4%) were clinically continent after surgery. Average duration of follow-up so far is 15.9 months. Twenty-nine patients were managed as short-stay admissions, and average length of hospital stay for women who had only colposuspension was 14 hours. Two cases were converted to laparotomy, and two patients had endoscopic repair of bladder perforation. Extraperitoneal laparoscopic Burch colposuspension produced direct access to the space of Retzius with satisfactory visualization and acceptable outcome. It may be performed as a short-stay procedure in selected patients.