The use of the supra-pubic fibrous complex in isthmic hysteropexies

This study forwards a new surgical approach we have performed in the treatment of genital prolapse, associated or not with stress urinary incontinence. The study used 150 patients with genital prolapse and stress urinary incontinence in various stages, and lasted from 1985 until 2001. Four-five threads of silk were passed through the uterine muscle in the isthmus area, just below the bladder-uterus recess, and fastened to the supra-pubic ligament complex. Although the mechanical basis for this surgical approach is not entirely clear, no relapse, incident or post-surgery complications (bladder voiding problems, enteroceles, detrusor instability, urethra or bladder bottom lesions, incomplete urinary retention or clearance, hematoma or abscess of the Retzius space) were noted in any of the studied cases. The suspension of the uterine isthmus on to the supra-symphyseal fibrous complex leads to an increase in urethral closure pressure during the occasional increase of intra-abdominal pressure (cough, laughter, spontaneous movements, walking), the results being superior to the other methods used for treating genital prolapse.