Colpovesical neck suspension for the correction of female stress urinary incontinence.

A new surgical approach for the correction of female urinary stress incontinence has been devised. The retropubic space is entered through a dome-shaped incision in the vaginal vestibule. The bulbocavernosus muscles are separated from the urethra and the layers of the genitourinary diaphragm are opened beginning behind the symphysis pubis. The retropubic cavity is exposed and the junction of the vesical neck and vagina is identified. Double helical bites with 2-zero polypropylene sutures are taken from each side of the junction. The 2 ends of the sutures are brought ventrally with a suture carrier through a small incision just above the symphysis pubis in the midline and tied. This procedure moves the bladder neck forward and upward to the desired level by observing movement of the bladder neck through the vestibule. Of 20 patients treated 17 are fully continent and 3 remain much improved after 2 years.