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

Kim, Dong Won; Uh, Ong Sun; Yoo, Tag Keun

Abstract

PURPOSE: We retrospectively evaluated the 45 patients who underwent the original Raz procedure and anterior vaginal wall sling(AVWS) operation for stress urinary incontinence(SUI) with or without cystocele.
MATERIALS AND METHODS
Transvaginal bladder neck suspension was performed in 14 patients, 4-corner bladder and bladder neck suspension in 16 patients, anterior vaginal wall sling in 14 patients, and 6-corner suspension in one patient. Of 16 patients who underwent 4-corner operation, 11 had grade 2 cystocele, and 5 had grade 3 cystocele.
RESULTS
Mean age was 49 years and mean parity was 2.7. Duration of symptom was 58.5 months in average. Patients with grade l was 27%(12), grade ll was 69%(31) and grade lll was 4%(2). Mean operation times were 92. 1minutes in Raz bladder neck suspension, 90.9minutes in 4-corner bladder and bladder neck suspension, and 76.2minutes in anterior vaginal wall sling. The duration of follow up was 20 months in average. Urinary incontinence was completely disappeared in 40 patients(91%), and significantly improved in 3 patients(7%), but one patient(2%) underwent Raz BNS was recurred. Complications include a case of severe bleeding requiring intraoperative transfusion, 2 cases of prolonged retention, 2 cases of do novo urgency and 2 cases of persistent weak urinary stream.
CONCLUSIONS
Our midterm result for Raz BNS and 4-corner operation was good(96.7%) and short term result for AVWS was excellent(100%). We think that original Raz BNS may be used in patients with mild SUI without ISD. And, long term follow-up for AVWS operation is required to determine persistence of the good results in patients with moderate to severe SUI.