TRANSVAGINAL BLADDER NECK SUSPENSION TO COOPERS LIGAMENT - A MODIFIEDPEREYRA PROCEDURE

We describe a modified Pereyra procedure with fixation of the bladder neck to Cooper's ligament. The anterolateral attachments of the paraur ethral tissue to the inferior pubic ramus are exposed through a vagina l incision. Sutures are placed in the detached endopelvic fascia toget her with vaginal wall without epithelium and passed suprapubically thr ough small ipsilateral skin and fascial incisions made slightly latera l to and at the level of the pubic symphysis, allowing visualization o f Cooper's ligament. The sutures are passed through Cooper's ligament and tied to suspend the bladder neck. All ten women in whom we have do ne this operation have been subjectively cured of stress incontinence. Five have had long-term urodynamic follow-up. Four of these were dry by objective criteria, after a mean follow-up time of 18 months (range 15-23). The other patient was subjectively dry but had urodynamic evi dence of recurrent stress incontinence.