VESICA(R) PERCUTANEOUS BLADDER NECK STABILIZATION

The Vesica (R) percutaneous bladder neck stabilization (PBNS) represen ts a minimally invasive surgical procedure for the treatment of stress incontinence caused by hypermobility of the proximal urethra and blad der neck. Since the initial description of the procedure, technique an d instrumentation modifications have added to the reproducibility of t his operation. Three specific modifications have been incorporated: st rong attachment of the stabilization suture to the pubic bone utilizin g a bone anchor; incorporation of a full-thickness broad segment of ti ssue including the endopelvic, pubocervical, and subvaginal fascia as well as vaginal wall in a Z suture; and loose resuspension of the prox imal urethra to stabilize the continence mechanism. Cystoscopic verifi cation of suture location precludes bladder entry or distal suture pla cement. This procedure has been utilized in 71 women with an overall c ure rate (no stress incontinence) of 94% at follow-up of 12 months. On e retropubic abscess required drainage, and a second patient required excision of a skin sinus tract caused by an infected bone anchor. Urin ary retention longer than 3 weeks has not been encountered. Overall mo rbidity has been minimal. Long-term follow-up of continence status and other procedure-related complications is ongoing. The PBNS provides c ontinence results and complication rates equivalent to those of other retropubic and transvaginal procedures using a minimally invasive outp atient technique.