A new surgical approach for the correction of female stress urinary incontinence.

A new surgical approach for the correction of female urinary stress incontinence has been devised. The retropubic space is entered through a dome-shaped incision in front of the urethral meatus in the anterior vaginal vestibule. The incision does not extend beyond the lower edge of the symphysis pubis. With the tip of the hemostat or scissors the incision is opened longitudinally, and the lower legs of the incision are opened and freed up from the bulbocavernosus muscles. The bleeders are controlled. The layers of the genitourinary diaphragm are opened beginning from behind the symphysis pubis and the retropubic cavity is exposed. Then, the vesical neck and urethra are sutured to the back of the symphysis pubis in the midline. With this procedure there is no abdominal incision. The vesical neck and urethra are well exposed. The back of the symphysis pubis can be visualized with the patient in an exaggerated Trendelenburg position. All except 1 patient were cured. Hospitalization and postoperative recovery times were markedly reduced. The procedure affords easy access for drainage of the retropubic space. A new avenue is provided for insertion of an artificial sphincter to achieve urinary continence and for vesical neck colposuspension.