Stamey Endoscopic Bladder Neck Suspension

Abstract

A plethora of surgical techniques has been designed for the treatment of stress incontinence. Uro-gynaecologists favour operations that seek to reposition the bladder neck and proximal urethra within the abdominal cavity. The theoretical basis of repositioning operations is the intraabdominal position of the proximal urethra. The intra-abdominal proximal urethra acts as a “flutter valve”. Although there are large alterations in intravesical pressure during straining and coughing (pressures rising up to 200–300 cmH₂0) we are protected from leakage. The increased intravesical pressure will try to force open the bladder neck. In a flutter valve mechanism an equal and opposite pressure attempts to maintain lateral compression on the urethra, negating the intravesical force attempting to open it. Stress urethral pressure profilometry shows how these increases in intravesical pressure are matched by equal transmission of intra-abdominal pressure to the proximal urethra (Fig. 14.1, “Post-op” trace). It has been disputed whether the intra-abdominal position of the proximal urethra is the only mechanism preventing stress incontinence. Several workers have suggested that there is also a pelvic floor reflex contraction that is important in maintaining continence (Heidler et al. 1979).