The Transvaginal Bladder Neck Suspension by Raz for Stress Urinary Incontinence: A Review of 106 Cases

Rha, Koon Ro; Mah, Sang Yol

Abstract

From January, 1990 to December, 1995, 106 patients received transvaginal bladder neck suspension by Raz. Follow up periods ranged from 3 months to 5 years, and mean age of patients was 52.2 years. Severity of incontinence were grade 1 in 22, grade II in 83, and grade III in 1 patient. After minimum of 3 months follow up, 87 (82.1%) patients were completely cured and 14 (13.2%) patients reported minimal leaking, the final success rate being 95.3% (101/106). Degree of posterior urethral angle and grades of incontinence(classified either by Blaivas or Green) were not significant factors in predicting outcome. Grade of incontinence, preoperative irritative voiding symptoms, previous incontinence surgery, age, and menopause were not correlated with success. However the history of hysterectomy and overweight were related with lower success rate. Mean hospital stay was 6.1 days, and 50 (47.2%) patients performed intermittent catheterization at discharge but later all resumed normal voiding. Among 34 patients with urgency preoperatively 25 (73.5%) improved after operation, and de novo urgency was found in 11 (16.2%). Complications including urinary tract infection blood loss requiring transfusion were seen in one patient respectively, but no case of peritonitis, bladder perforation, and wound perforation was seen. Success rate of Raz operation is more than 90%, which was higher than other types of bladder suspension. Raz colpo-suspension can place bladder neck traction sutures accurately without causing obstruction or significant morbidity, therefore should be recommended as a premier mode of surgical treatment in patients with stress urinary incontinence.