Experience of Transvaginal Bladder Neck Suspension by Raz and Vaginal Wall Sling Operation for Female Stress Urinary Incontinence and Coexisting Cystocele

Joo, Kwan Joeng; Lee, Jeong Gu

Abstract

Transvaginal bladder neck suspension(TVBNS) by Raz is an acceptable procedure for the treatment of stress urinary incontinence(SUI) with high cure rate, operative simplicity, short hospitalization and little morbidity. We had treated 89 patients of stress urinary incontinence with or without cystocele. Age of the patients ranged from 28 to 78 years(mean 47.7) and mean parity was 2.9. According to the symptom grading by Stamey, Grade 1 was 18.0%(16), Grade II was 79.8%(71) and Grade III was 2. 2%(2). Coexisting cystocele were 8 cases. TVBNS by Raz were undertaken for the 82 patients of Grade I and II SUI and also with coexisting Grade 1 cystocele, 4-corner bladder neck suspension were undertaken for the 3 patients of SUI with coexisting Grade II cystocele, and TVBNS with cystocele repair were undertaken for the 2 patients of SU with coexisting Grade III cystocele. For the 2 patients of total incontinence, vaginal wall sling operation were undertaken. Mean operation time for the cases treated by Raz procedures was 56.3+/-12.3 min.; whereas it was 98.3+/-25.3 min. for the cases with coexisting cystocele. Intra or post-operation blood transfusion was performed in 7 cases. Mean duration of hospital stay after Raz procedures were 4.5+/-0.9 days and 7.3+/-1.9 days for the treated by cystocele repair. Mean interval for returning to normal voiding after operation were 11.9+/-3.0 days after Raz procedures and 22.3+/-4.3 days after the correction of coexisting cystocele. Residual urine at discharge was less than 100 ml in 54 cases(60.7%). After the mean followup of 3.5 months, urinary incontinence was disappeared completely in 83 cases(93.3%). For the 2 cases of total incontinence, symptoms were disappeared completely after the vaginal wall sling operation. Complications included persistent voiding difficulty in 3 patients(improved after suspension take down in 2 cases and following up in 1 case), recurrence of urinary incontinence in 3 cases(which was disappeared by periurethral injection of collagen in 2 cases), frequency in 16 cases(improved by medication), bladder stone in 1 case(treated by cystolithorapaxy), and dyspareunia in 1 case. Conclusively, it could be suggested that the Raz procedures and vaginal wall sling operation are reliable techniques or the treatment of SUI and cystocele with little morbidity and high cure rate.