[Operative therapy of female stress incontinence].

Abstract

Description of the fateful change of the differing operation methods for the treatment of female stress incontinence between 1979-2005. For the reason of scientific cognitions and many years of applying experience there are two logical and anatomical well-founded possibilities for the treatment of stress incontinence: 1. Elevation of the bladder neck to it's original position by a shortarm sling plasty. In doing that vaginally the ligg. urethrotendinea and the ligg. pubourethralia posteriora are connected suburethrally by a shortarm sling plasty or a double sling plasty and in this way the bladderneck is elevated to the height of the arcus tendineus fasciae pelvis. So a horizontal bladder base plate able to contract results with a retrovesical angle of about 90 %. The anatomic proof for continence. 2. Producing of the urethrovesical reflex by UST (Urethra Surrounding Tape). A polypropylene mesh with a circumference of 1,5 x 2,6 cm is fixed to the inner surface of the right and left os pubis and paraurethrally right and left too. This stable hammock causes a physiological impression of the dorsal urethra of about 2 mm. Because of that the urethrovesical reflex is set off leading to the contraction of the bladder neck and the relaxation of the detrusor vesicae muscle. This minimal invasive stress incontinence operation method brings about a subjective incontinence healing rate of 83.7 % and a clinical healing rate of 97.7 %. That means the same results like after TVT (Tension Free Vaginal Tape) or TOT (Transobturatorial Tape). In contrast to TVT or TOT there are no complications with UST.