Laparoscopic management of female urinary incontinence.

Recent technologic developments in laparoscopic reconstructive surgery have generated an interest in the laparoscopic approach to bladder neck suspension. There have been numerous descriptions of a variety of techniques for the laparoscopic approach to bladder neck suspension. Initial reports seemed to suggest satisfactory rates of improvement in the stress urinary incontinence of these patients. Long-term follow-up has shown that although this minimally invasive approach to the management of stress urinary incontinence is associated with a short duration of urinary diversion, minimal postoperative discomfort, and a quick return to a productive life, the durability of the cure has failed the test of time. The laparoscopic bladder neck suspension in 3 and 4 years follow-up has achieved a success rate of only 30%, with a mean time to failure of 18 months. Any new surgical technique applied to the management of stress urinary incontinence must have a minimum of 2 years mean follow-up to determine its true clinical efficacy and durability.