ENDOSCOPIC SUSPENSION OF THE BLADDER NECK - CLINICAL, URODYNAMIC AND RADIOLOGIC RESULTS

70 women were evaluated clinically and urodynamically both before and, on average 16 (12-48) months after undergoing endoscopic suspension of the bladder neck, following Stamey, for genuine stress urinary incontinence. The average age of the patients at surgery was 52 (35-85) years; the average parity was 3 (0-10). Preoperative and postoperative lateral colpocystograms were performed on 48 patients. 40 patients had marked descent of the pelvic organs; 30 patients had previously undergone vaginal hysterectomy and anterior colporrhaphia. Overall, 70 % of the patients were postoperatively clinically and urodynamically continent at follow-up; however, only 44 % of the patients with a preoperative urethra closure pressure (UCP) < 20 cm H2O were continent. The functional urethral length was unchanged but the point of maximum closure pressure was shifted to the proximal third of the urethra. The UCP at rest decreased significantly (p = 0.0277). Radiologically, the bladder neck was elevated further and the angle-beta decreased more in the patients continent after surgery, than in those who remained incontinent. These data suggest that the Stamey operation is effective in selected patients with stress incontinence, but not in patients with a low UCP at rest.