Gynäkologie und Geburtshilfe
Offener Zugang

Abstrakt

Surgical Treatment of Urgency Urinary Incontinence, OAB (Wet), Mixed Urinary Incontinence, and Total Incontinence by Cervicosacropexy or Vaginosacropexy

Sebastian Ludwig, Martin Stumm, Elke Neumann, Ingrid Becker and Wolfram Jäger

We previously developed a standardized surgical method to replace the uterosacral-ligaments in patients with genital prolapse. These cervicosacropexy (CESA) or vaginosacropexy (VASA) operations were effective in treating genital prolapse and urinary incontinence. In this study, we investigated the effects of these operations in combination with a transobturator tape (TOT) 8/4 procedure for the treatment of urgency urinary incontinence (UUI), overactive bladder (OAB), mixed urinary incontinence (MUI), and total incontinence (TI) in patients without symptomatic prolapse. Material and Methods: Patients with UUI, OAB, MUI, and TI were eligible for the study and an informed consent was obtained. Patients with genital prolapse POP-Q stage>I were excluded. The USLs in all the patients were replaced by standardized polyvinylidene fluoride structures by CESA/VASA. If patients remained incontinent, they received a TOT 8/4. Main outcome analysis was performed 4 months after the previous surgery. Data were analyzed retrospectively. Results: 133 patients were operated by CESA (n=57) or VASA (n=76). Subsequently, continence was reestablished in 57 patients (43%). The respective continence rates ranged from 27% (CI [5-49%]) in patients with TI to 73% (CI [54-92%]) in patients with UUI. After 75 patients received an additional TOT 8/4, the overall continence rates were 33% and 86% for patients with TI and those with UUI, respectively. Conclusion: The results of this study strongly support the hypothesis that urinary continence is based on the anatomical changes of the different levels of the holding apparatus of the bladder. The bilateral suspension of level I by CESA/VASA cured 66%-72% of the patients with UUI and OAB. In patients with MUI, an additional repair of level III by a TOT 8/4 was necessary to achieve a cure rate of 76%. Only patients with TI demonstrated a success rate of 33% after the suspension of the levels I and III indicating an additional problem of level II.