LAPAROSCOPIC RETROPUBIC CYSTOURETHROPEXY

Study Objective. To evaluate the efficacy of laparoscopic retropubic u rethrovesical suspension. Design. Retrospective review of charts of 62 women over a follow-up period ranging from 8 to 30 months. Setting. A suburban hospital in a major metropolitan area. Patients. Sixty-two w omen, age 34 to 69 years, gravidity 0 to 8, and parity 0 to 7, with gy necologic abnormalities requiring surgical intervention and with pure genuine urinary stress incontinence. Interventions. Each patient under went a Burch or Marshall-Marchetti-Krantz procedure, modified to be pe r formed at laparoscopy. Measurements and Main Results. Success was me asured subjectively and objectively. Subjective success, determined by the lack of need to wear pads, was 100%. Objective success was assess ed using several criteria: comparison of preoperative and postoperativ e symptom diaries; questionnaires; urine characteristics by straight c atheter (office dipstick for nitrate, leukocyte estrace, bacteria, and white cell blood count, if suspicious urine culture and sensitivity); postvoid residual volume (< 100 ml was considered complete); urethrov esical junction angle as determined by catheter or Q-Tip placement (up ward, downward, or straight); bladder support; and negative standing s tress test. All women reported satisfactory relief of symptoms, with s ubjective and objective improvement. None have noted urinary leakage d uring activities similar to those preoperatively associated with this condition. Conclusion, To date, the outcomes have been acceptable, alt hough the limited numbers and relatively short follow-up prohibit any definitive conclusions.