Transvaginal therapy of genuine stress incontinence.

Two minimally invasive techniques for treatment of genuine stress incontinence, a transvaginal retropubic urethropexy and a transvaginal sling, using Cooper's ligament as the anchoring structure, are reported along with the early results. These surgeries can be done easily in conjunction with vaginal reconstructive procedures. Twenty-seven women were operated on between October 1998 and September 1999. Seventeen women underwent the transvaginal retropubic urethropexy for genuine stress incontinence, whereas 10 women underwent the transvaginal sling for genuine stress incontinence with maximal urethral closure pressures less than 20 cm H(2)O. Postoperative urodynamics were done routinely at 4 months. Subjective follow-up was by routine postoperative visits or telephone survey. The mean follow-up of the retropubic urethropexy group was 6.5 months (range 1 to 12). Of these 17 women, 16 (94%) had no stress incontinence. Seven of 14 patients (50%) resolved their urge incontinence also. The mean follow-up of the transvaginal sling group was 2.8 months (range 1 to 4.5). Of the 10 patients in this group, 7 (70%) were cured of their stress incontinence. One patient in each group underwent only the anti-incontinence procedure without concomitant vaginal reconstructive procedures; both of these women were dry. Additional follow-up is required to see if these minimally invasive techniques produce successful results in the long term.