COMPARISON OF TRANSVAGINAL VERSUS LAPAROSCOPIC BLADDER NECK SUSPENSION FOR STRESS URINARY-INCONTINENCE

Objectives. The purpose of this retrospective review was to determine the feasibility of treating anatomic female stress urinary incontinenc e (SUI) with a retropubic laparoscopic bladder neck suspension. Also, we compared the clinical course and results of the transvaginal bladde r neck suspension (VBNS; Raz) and laparoscopic bladder neck suspension (LBNS) among a group of patients of similar age and American Society of Anesthesiologists rating. Methods. Nineteen patients undergoing a r etropubic LENS (E.M.M.) were compared with 23 patients undergoing a Ra z VBNS (C.G.K.) operated on during the same time period for anatomic S UI. All patients were assessed for their age, preoperative bladder cap acity, preoperative postvoid residual, operative time, estimated blood loss, length of hospital stay, postoperative analgesia requirement, t ime required to resume a normal voiding pattern, complications, and re currence rate of the SUI. Results. The operative time for the LBNS is longer than the VBNS (124 versus 44 minutes). The LBNS patients requir ed significantly less postoperative parenteral analgesia (6.3 versus 1 5.6 mg morphine sulfate), and a shorter time to resume a normal voidin g pattern (0.6 versus 13 days) compared with the VBNS patients. The ov erall success rate of the two procedures was similar at 3 months, 6 mo nths, and 12 months of follow-up. Conclusions. Retropubic LBNS is a te chnically feasible surgical procedure for patients with anatomic SUI. Compared with the VBNS, the LBNS is associated with minimal postoperat ive discomfort, no need for suprapubic urinary diversion, and a rapid return to normal activities. The short-term success rate of the LBNS a ppears to be similar to that for the VBNS.