The levator ani is approximated between the rectum and vaginal.
(4) The vagina is closed transversely or in a sagittal plane different from that
of the rectal canal; the vaginal mucosal layer is inverted into the vaginal wall; an
2-18. OPERATIONS FOR URINARY STRESS INCONTINENCE
(1) This operation involves the repair of the fascial supports and
pubococcygeal muscle surrounding the urethra and the bladder neck. It is done through
either a vaginal or an abdominal approach.
(2) Normal micturition (urination) depends on a finely coordinated group of
voluntary and involuntary movements. As a result of volitional impulses, voiding may be
inhibited or stopped by contraction of the perineal and periurethral musculofascial
(3) The type of operation selected depends on the severity of stress
incontinence, the extent of the lesion causing it, the patient's ability to use the
anatomical mechanism for voluntary inhibition of urination, and the operations that have
already been performed for correcting it. Stages of stress incontinence are classified in
relation to frequency and degree of incontinence, the presence of other diseases, and
the function of the pubococcygeus muscle (levator ani).
(4) The aim of any operation for urinary stress incontinence is to improve
the performance of a dislodged or exhausted bladder neck. The surgeon endeavors to
restore or reconstruct the supporting structures, the operation thereby resulting in the
effective closure of the bladder neck.
(5) Previous pelvic operations may have resulted in scarring and distortion,
with displacement of the bladder neck to an unfavorable position for proper functioning.
Conditions such as uterine prolapse, cystocele, urethrocele, cystourethrocele, or
urogenital fistulas following therapy may be associated with stress incontinence.
b. Operative Procedure--Vaginal Approach.
(1) A Foley catheter is passed into the bladder. The posterior vaginal wall is
retracted, and an incision is made through the anterior vaginal wall down to the urethra
(2) The vaginal wall is dissected from the bladder and urethra; the neck of
the bladder is sutured together with fine chromic gut. The wound is closed, as
described for vaginal repair.