| Popis: |
Modifications of classical vesico-urethral suspension, according to Marshall-Marchetti-Krantz, are in widespread use among numerous operations for urinary incontinence, on account of their mild direct effect on both the urethra and bladder neck region. However, dysuria and dyspareunia may be quite frequent consequences later on because of retrosymphysial adhesions and rigid fixation of the vagina. We have, therefore, adopted an approach by which the advantages of mobile sling suspension are combined with indirect elevation of the urethrovesical junction, in that the vagina is fixed to strips obtained from the aponeurosis of the abdominal wall or from lyophilised dura mater. Fascial origin and dura anchorage in the abdominal wall are conducive to achieving a pronounced ventrocranial pull, and involvement of the rectus musculature in bridle action was found to add to the elevation effect in stress situations. A detailed account is given of the surgical technique. The method is contra-indicated or at least not fully sufficient only in cases of severe pelvic floor insufficiency or descensus of the vagina. Twenty-eight women have undergone this operation, within one year, with 20 of them (71 per cent) being relieved from complaints and five (18 per cent) substantively improved. Stress quotient and transmission factor are favourably affected, in terms of urodynamics, while ventral urethrovesical fixation is improved, in terms of radiography. Postoperative uroflow parameters have stayed normal. Problems of co-habitation did not occur. The small number of cases and lack of long-time results, therefore, cannot prevent the authors from recommending the technique for verification by re-use. |
