Mechanism of continence after endoscopic bladder neck suspension

The aim of this study was to understand the mechanism of continence after endoscopic bladder neck suspension (Stamey procedure). Forty-two patients with primary genuine stress incontinence who underwent the Stamey procedure were enrolled. Preoperative and postoperative investigations included detailed histories, urinalysis, physical examination, 1-hour pad tests, urodynamic studies, and perineal ultrasound urethrocystography. The results were evaluated 2 years after operations. The Wilcoxon paired signed-rank test was used for statistical analysis. Twenty (47.6%) patients were completely cured, 12 (28.6%) patients showed significant improvement, and 10 (23.8%) had recurrence of incontinence. The complication rate was 19%. Urodynamic data showed significant increases in maximal stress urethral closure pressure and proximal urethral transmission ratios. Perineal ultrasound urethrocystography and Q-tip tests showed significant anatomic corrections in bladder neck descent. This report demonstrates that the mechanism of continence after endoscopic bladder neck suspension depends on repositioning the bladder neck above the pelvic diaphragm, with subsequent improvements in pressure transmission ratios.