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Volume : 41 Issue : 2 Year : 2022
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pelviperineology. 2022; 41(2): 91-97 | DOI: 10.34057/PPj.2022.41.02.2022-3-3

The effect of apical tensioning and suburethral support on stress and urgency urinary incontinence

Wolfram JÄGER1, Andre PAEFFGEN1, Anne HAGEMEIER2, Elke NEUMANN1, Sebestian LUDWIG1, Peter MALLMANN1
1Department of Obstetrics and Gynecology, Division of Urogynecology and Pelvic Reconstructive Surgery, University Hospital of Cologne, Cologne, Germany, 2Institute of Medical Statistics and Computational Biology (IMSB), University Hospital of Cologne, Cologne, Germany

Objectives: In the present study, we evaluated the effect of apical suspension of the vagina on urinary incontinence by replacing both uterosacral ligaments with polyvinylidene-fluoride (PVDF) structures. Materials and Methods: All patients had stress and urgency urinary incontinence (mixed urinary incontinence). These PVDF-structures were sutured to the cervical stump (after supracervical hysterectomy) or to the vaginal vault according to the standardized cervicosacropexy (CESA) or vaginosacropexy (VASA) technique. The length of PVDF-structures in patients who underwent CESA and VASA was 8.8 cm and 9.3 cm, respectively. Results: In total 39% and 33% of the patients who underwent CESA or VASA became continent, respectively. Stress-related and urgency symptoms disappeared in all patients. The number of patients who became continent with these suspensions decreased with the increasing age, particularly in those aged >60 years. The age-dependent decrease in continence rates was significant among patients who underwent CESA. The percentage of patients in the <60-years and >60-years-of-age groups who became continent after CESA was 50% and 26%, respectively (p=0.002). In patients who underwent VASA, the respective continence rates were 41.5% (<60-years-of-age group) and 28.9% (>60-years-of-age group) (p=0.100). Conclusion: Patients who still exhibited mixed urinary incontinent were then offered a transobturator tape (TOT) procedure, following which the continence rates ranged between 40.4% and 43.3%. Patients with mixed urinary incontinence are usually treated with different medical methods, which provide a limited success rate. The results of our study demonstrated that a bilateral apical fixation of the vaginal apex either alone or in combination with a suburethral TOT procedure was effective in treating and restoring urinary continence in 56% and 87% of patients aged >60 and <60 years, respectively.


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JÄGER W, PAEFFGEN A, HAGEMEIER A, NEUMANN E, LUDWIG S, MALLMANN P. The effect of apical tensioning and suburethral support on stress and urgency urinary incontinence. 2022; 41(2): 91-97

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