Transvaginal bladder neck suspension to Cooper's ligament: a modified Pereyra procedure

We describe a modified Pereyra procedure with fixation of the bladder neck to Cooper's ligament. The anterolateral attachments of the paraurethral tissue to the inferior pubic ramus are exposed through a vaginal incision. Sutures are placed in the detached endopelvic fascia together with vaginal wall without epithelium and passed suprapubically through small ipsilateral skin and fascial incisions made slightly lateral to and at the level of the pubic symphysis, allowing visualization of Cooper's ligament. The sutures are passed through Cooper's ligament and tied to suspend the bladder neck. All ten women in whom we have done this operation have been subjectively cured of stress incontinence. Five have had long-term urodynamic follow-up. Four of these were dry by objective criteria, after a mean follow-up time of 18 months (range 15-23). The other patient was subjectively dry but had urodynamic evidence of recurrent stress incontinence.