Pubourethral supports in perspective: modified pereyra procedure for urinary incontinence

Area of Science:

• Urology
• Pelvic Floor Surgery
• Female Incontinence

Background:

• Anatomic stress urinary incontinence (SUI) in women often necessitates surgical intervention.
• Failures in traditional urethral suspensory procedures are frequently linked to suture pull-out.
• Suture pull-out is associated with attenuation of the endopelvic fascia near the urethrovesical junction.

Purpose of the Study:

• To investigate a modified surgical approach to enhance the success rate of anti-incontinence surgery.
• To determine if reinforcing the endopelvic fascia can prevent suture pull-out and improve outcomes for anatomic SUI.
• To evaluate the long-term efficacy of a modified Pereyra procedure for treating SUI.

Main Methods:

• A modified Pereyra procedure was performed on 54 women with primary anatomic SUI.
• The technique involved detaching and enfolding the endopelvic fascia to thicken it.
• Suspensory sutures were secured to both the enfolded fascia and the stronger posterior pubourethral ligaments.

Main Results:

• The modified procedure demonstrated a high success rate in treating anatomic SUI.
• 94.5% of patients experienced complete cure or marked improvement.
• These positive outcomes were sustained over a 4 to 6-year follow-up period.

Conclusions:

• Thickening the endopelvic fascia by enfolding it significantly enhances resistance to suture pull-out.
• The modified Pereyra procedure, reinforcing fascial support, offers a durable solution for anatomic SUI.
• This surgical modification presents a highly effective treatment option for women with stress urinary incontinence.