Factors influencing the outcome of a no incision endoscopic urethropexy.

A urethropexy without incision has been used in 108 women with a minimum of one year follow-up evaluation. Most of the patients (81 percent) experienced postoperative urinary retention, with the mean period of retention being 22 days. The cure rate was 81.5 percent. The technique was successful in women with grade I stress urinary incontinence (97 percent), but not as effective in women with high grade stress incontinence (45.5 percent in women with grade III stress urinary incontinence). The success rate, therefore, correlated significantly with the grade of incontinence (p less than 0.001). It is noteworthy that there were no failures in 36 women who were premenopausal and the cure rate of 72 percent in the postmenopausal group represented a significant reduction (p less than 0.001). The approach without incision is often effective in patients who have failed previous anti-incontinence procedures, with a cure rate of 82 percent in 22 women in this category, but most patients with a successful outcome in the more complex instances of stress urinary incontinence were also noted to be premenopausal. These data suggest that the success of the repair is dependent on the strength and integrity of the vaginal mucosa. When using the no incision technique, it is advisable to avoid the use of foreign body material in the suprapubic stab sites because of the high incidence of infection and tender nodules.