Pubourethral supports in perspective: modified pereyra procedure for urinary incontinence

The present study supports the thesis that failures in urethral suspensory-type operations in women with anatomic stress urinary incontinence often are caused by pull-out of suspensory sutures attached to attenuated endopelvic fascia around the urethrovesical junction. Thickening of this fascia helps impede suture pull-out. Such thickening is facilitated by detaching the fascia from the pubis to enfold it. Freeing the fascia from the inferior pubis exposes the posterior pubourethral ligaments to direct view. Binding the much stronger posterior pubourethral ligaments and enfolded fascia together with the suspensory sutures provides maximum resistance to suture pull-out. Of 54 women treated with this modified Pereyra procedure as a primary operation for anatomic stress urinary incontinence, 94.5% showed complete cure or marked improvement 4 to 6 years postoperatively.