Laparoscopic retropubic cystourethropexy

To evaluate the efficacy of laparoscopic retropubic urethrovesical suspension.

Retrospective review of charts of 62 women over a follow-up period ranging from 8 to 30 months.

A suburban hospital in a major metropolitan area.

Sixty-two women, age 34 to 69 years, gravidity 0 to 8, and parity 0 to 7, with gynecologic abnormalities requiring surgical intervention and with pure genuine urinary stress incontinence.

Each patient underwent a Burch or Marshall-Marchetti-Krantz procedure, modified to be performed at laparoscopy.

Success was measured subjectively and objectively. Subjective success, determined by the lack of need to wear pads, was 100%. Objective success was assessed using several criteria: comparison of preoperative and postoperative symptom diaries; questionnaires; urine characteristics by straight catheter (office dipstick for nitrate, leukocyte estrace, bacteria, and white cell blood count, if suspicious urine culture and sensitivity); postvoid residual volume (<100 ml was considered complete); urethrovesical junction angle as determined by catheter or Q-Tip placement (upward, downward, or straight); bladder support; and negative standing stress test. All women reported satisfactory relief of symptoms, with subjective and objective improvement. None have noted urinary leakage during activities similar to those preoperatively associated with this condition.

To date, the outcomes have been acceptable, although the limited numbers and relatively short follow-up prohibit any definitive conclusions.