Laparoscopic needle colposuspension for genuine stress incontinence.

Abstract

Laparoscopic needle colposuspension offers a minimally invasive endosurgical treatment of genuine stress incontinence. With the patient in the low lithotomy position, three lower abdominal ports are inserted. Bilateral incisions are made in the peritoneum, and the retropubic space is dissected, leaving the urachus intact. A suprapubic incision is made down to rectus fascia only and a Stamey needle inserted into the retropubic space and passed into the vagina under vision. Using No. 1 Ethibond, a double bite of the vaginal wall is taken and the suture pulled into the suprapubic incision. The suture is tied over a silicone button with no slack and no tension. Seven women have been treated by this method, with all having control of their stress incontinence in the short term. The mean operative time was 112 minutes. The catheter was removed on the first postoperative day in six women and on the second day in one woman, with no voiding difficulties. The mean time to discharge was 3.3 days for all except one woman, who had a perforation of the bladder and remained for 12 days. The advantages of the laparoscopic approach are that it allows dissection of the retropubic space, direct examination of the bladder, and observation of the bladder neck during tying of the sutures, allowing them to be tied with no slack and no tension. As a consequence, there is a minimization of the duration of catheterization, voiding difficulties, hospital stay, and postoperative discomfort, with avoidance of scarring of the vaginal wall and urethra.