Urinary incontinence procedures performed at a military teaching hospital.

PURPOSE: This study provides follow-up of primary modified Pereyra needle urethropexy procedures performed with permanent suture by residents at a military teaching hospital.

METHOD: Review of all resident-performed primary Pereyra urethropexy procedures performed at Keesler Medical Center (KMC) from December 1990 through April 1994.

RESULTS

The results from 34 primary Pereyra needle urethropexy procedures, with 24 patients less than 2 years from surgery and mean follow-up of 19.5 months, demonstrated that 21/24 had improvement in their incontinence. This gives an 88% success rate at less than 2 years. We had 10 patients more than 2 years from surgery, with mean follow-up of 38 months, and 6/10 with continence. The overall success rate was 27/34 (79%). We noted that on preoperative evaluation, 5/7 failures were found to have urethral closing pressures of < 20 cm H2O (8-18). One of the late failures was found to have had no cystometrics performed and no demonstrable stress urinary incontinence. Her procedure was termed "prophylactic." Removing 6/7 failures for incomplete evaluation or use of less appropriate procedure, we find 27/28 patients (96%) with successful results. The presence of low urethral pressure (< 20 cm H2O) was a significant factor in the failures regardless of timing (< 2 years vs. > 2 years) (p < 0.04). There was no difference in parity, estrogen use, urgency component, age, socioeconomic status, associated operative procedures, postoperative infection, or complications noted between successful and unsuccessful Pereyra urethropexy as a primary method of genuine stress incontinence surgery.

CONCLUSION

The primary Pereyra needle urethropexy had an overall success rate of 79% (27/34). Allowing for properly evaluated and treated patients, we find 96%(27/28) success. It appears that the primary modified Pereyra vaginal urethropexy with permanent suture is an easily taught and superior method of primary surgical treatment of stress urinary incontinence in a military training program.