[Extraperitoneal laparoscopic urethropexy]

The present article describes a procedure for bladder neck suspension. The peritoneum is detached using a technique that we previously described. A 1.5 cm suprapubic incision is performed. The fascia is incised and a sound is introduced to dissect the retropubic space. A balloon tipped catheter is introduced into the Retzius space and inflated with saline to release the peritoneum. A blunt trocar is inserted, the optics is introduced and a Stamey needle is used to pass a no. 1 nylon suture to fix the vagina to the rectus fascia. The maneuver is repeated on the other side. The sutures are then tied independently on each side under visual control, without tension and ensuring adequate elevation of the bladder neck. This technique requires only one port, allows direct visualization of the bladder neck and avoids all the risks of an intraperitoneal approach. In conclusion, we believe this technique has all the advantages of an open procedure, but using a minimally invasive approach, and may well become the treatment of choice in urinary stress incontinence.