Transvaginal incisionless bladder neck suspension. A simplified technique for female genuine stress incontinence

Purpose of the present study is to evaluate the efficacy of a modified Gittes procedure in the management of Type I and Type II stress urinary incontinence of the female.

Thirty-two female patients with urodynamically proven Type I and Type II stress urinary incontinence had been subjected to transvaginal incisionless bladder neck suspension (modified Gittes procedure) from September 1991 to June 1996. Their mean age was 55.2 (32-78) years. The preoperative evaluation included provocative video-urodynamics and occasional profilometry to exclude Type III stress incontinence in certain cases. The procedure described by Gittes was performed with the modification of approaching the rectus fascia through two small suprapubic incisions instead of the percutaneous original Gittes puncture.

The mean follow-up was 41 (10-66) months. Two of our patients had been lost from follow-up and were excluded from analysis. Of the remaining 30 patients, 26 (86.7%) are clinically continent. Six of them (20%) developed de novo postoperative urgency and/or urge incontinence due to bladder instability not present preoperatively. All six of them successfully managed with oral oxybutynin chloride. One diabetic patient was unable to void spontaneously and had to use the technique of clean intermittent self-catheterization (CISC) to evacuate her bladder. Of the remaining 4 (13.3%) incontinent patients, one was subjected to insertion of an artificial urinary sphincter (AUS) and one to a Burch colposuspension, both successfully. There were no major peri- or postoperative complications, with the exception of one patient with recurrent cystitis, who was treated with long-term chemoprophylaxis.

The modified Gittes bladder neck suspension is a simple and effective procedure, with no major complications and thus a good alternative to abdominal approaches.