THE STAMEY ENDOSCOPIC BLADDER NECK SUSPENSION - A CLINICAL AND URODYNAMIC INVESTIGATION, INCLUDING ACTUARIAL FOLLOW-UP OVER 4 YEARS

Objective - To assess a modified Stamey endoscopic bladder neck suspension as a management for genuine stress incontinence in women unsuitable for colposuspension because of vaginal narrowing or inefficient voiding. Design-Uncontrolled observational study. Setting - Regional university gynaecological urology unit. Subjects - A hundred women, median age 58 years, with genuine stress incontinence confirmed by urodynamic investigation; 65 had had previous surgery for the same problem. Treatment - A Stamey procedure with monofilament nylon and short buffers of silastic tubing at each anchor site. Main outcome measures - Urodynamic reassessment 3 months after surgery and clinical follow-up for up to 4 years, using life table methods. The median follow-up was 27 months. Results - At 3 months the objective cure rate was 83%. Subjectively the cure rates at 4 years were 53% in patients under 65 years of age and 76% in those who were older. Overall mean bladder capacity decreased from 506 to 458 ml after surgery (P < 0.05) and, in those who were cured, mean peak flow rate fell from 25.5 to 19.6 ml/s (P < 0.05). The urethral functional length and the pressure transmission in the proximal three quarters were increased by successful surgery (P < 0.01) but the resting urethral profile, voiding pressure and the frequency of detrusor instability were unchanged. Conclusions - This modification of the Stamey operation has an important role in the management of elderly patients those with previous unsuccessful operations, and those with inefficient voiding pre-operatively.