Intraoperative endoscopic evaluation of suprapubic urethropexy.
In a preliminary study of 32 women with stress urinary incontinence, a modification was added to the standard suprapubic urethropexy to decrease the incidence of postoperative urinary retention. Immediately before the elevating sutures are tied, a urethroscope is inserted into the midurethra and the bladder neck is visualized while the sutures are being tied with just enough tension to close the bladder neck. This resulted in a 100 per cent continence rate at twenty-four months and an average catheter time of 6.2 days, with 69 per cent of the patients voiding easily on the fourth postoperative day. This has resulted in a significant improvement over the length of catheter time when the urethroscope is not used, and additionally provides good experience and immediate feedback in a teaching situation for accuracy of suture placement and adequacy of bladder neck closure.