[Urethrovesical suspension with autologous fascia tissue by the purely vaginal approach--the short-arm sling operation].

Sling operations are a last result following failures of routine vaginal surgery for stress incontinence. The present paper describes a new operative treatment of stress incontinence by using pre-existing urethral fixing ligaments. The complex reunion of these ligaments after their preparation results in a sling formation with autologous tissue. The ligaments are 1-2 cm long from their origin. The urethra is directly under the insertion of the ligaments. Their presence in all cases permits the treatment of incontinence of all types and degrees with a reliable fixation of the urethra to the symphysis. The regional anatomy must be well observed in all cases. Plication of the remaining vesico-vaginal septum eliminates the always present vaginal descent. The numerous advantages over all other sling operations of this short arm sling operation are described in detail. Only the incorporation of endopelvic fascia into the carrying structures is a reliable indication for postoperative continence. The ideal nutrition of the fixating ligaments permits full activity four weeks after the operation and integration into the working life. Among the 332 cases of stress incontinence which were cured by this method no true recurrence was observed. A few patients had stress incontinence under extreme stress and were considered as failures. The short arm sling operation shows its advantages by reliable long term results, the pure vaginal approach without costly foreign materials and the lack of infection are other advantages.