Sutureless endoscopic colposuspension with fibrin sealant.

Endoscopic colposuspension by using fibrin sealant as a substitute for sutures was performed in 17 women suffering from urodynamically verified type I-II stress urinary incontinence. Two-puncture technique was used with a 10-mm trocar for optics and a 5-mm trocar for instrumentation. The two-component fibrin sealant, Tisseel (1 ml) by using special applicator device, Duploject was applied with tube on both sides of the urethrovesical area. After that the urethrovesical junction was pressed for 5 min against the retropubic periost by the surgeon's index and middle fingers placed in the vagina. The average duration of the procedure was 20 min, excluding learning curve for the first two cases. The indwelling catheter and vaginal packing were removed and all patients discharged on the first postoperative day. All but two patients experienced excellent immediate response. Of the 12 patients followed > 6 months, 10 patients were completely dry and two were markedly improved. In our experience, laparoscopic colposuspension with fibrin sealant appears to be a promising new approach in correcting stress incontinence in women.