Our changing strategies on bladder neck suspension operations.

With currently changing strategies, we retrospectively reviewed our operative results in female stress incontinence to find a suitable solution to correct both urethral hypermobility and intrinsic sphincter dysfunction with reasonable success rates. No Incision Bladder Neck Suspension (NIBNS), Modified Four Corner Bladder Neck Suspension (MFCBNS) and in situ vaginal wall sling operation with bone fixation were performed on 24, 26, 25 patients from 1992 to 1994, 1994 to 1996, 1996 to 1998, respectively, with pre- and postoperative evaluations and success rate determinations. Cure rates for NIBNS operations were 90.47, 72.2 and 50 per cent after 6 months, 2 years and 5 years, respectively. For MFCBNS operations cure rates were 96 and 75 per cent after 6 months and 2 years; for in situ vaginal wall sling by bone fixation the rates were 100 per cent in primary cases and 80 per cent in secondary cases after one year of follow-up. After two years the cure rate was 88.8 per cent in primary cases. By fixation and elevation of the urethrovesical junction and by external compression from under the urethra, in situ vaginal wall sling by bone fixation offers a better solution to urethral hypermobility and intrinsic sphincter dysfunction for urinary stress incontinence.