Modified Stamey procedure for bladder neck suspension.

Abstract

A review of 76 patients who underwent endoscopic bladder neck suspension (EBNS) for stress incontinence is presented. Pre-operative video-urodynamic studies in 71 patients demonstrated stable stress incontinence in 61 (86%). There was a history of previous pelvic surgery in 52 patients (68%). Surgery was performed by trainee urologists in 35 cases (46%). The overall complication rate was 46%, of which 17% were per-operative and did not influence the outcome of surgery. Infection occurred in 16% and necessitated removal of the suture buffers in 9%. Follow-up ranged from 7 to 30 months (mean 18.3). Complete resolution of stress incontinence or a marked improvement in symptoms was seen in 86% of cases. Patients with no history of previous pelvic surgery were all either cured or improved by the procedure. Of the 52 patients who had undergone previous pelvic surgery, 42 (80%) were either cured or improved. All of the 10 failures were in this group. There was no difference between complication or success rates achieved by consultants or urologists in training. It was concluded that EBNS is the treatment of choice in patients with primary stress incontinence and it is an effective procedure in patients who have undergone previous unsuccessful surgery for stress incontinence.