Colpocystourethropexy: the way we do it.

In pure stress urinary incontinence the sphincteric mechanism is intact. Restoration of normal position and support to the vesicourethral segment usually re-establish normal sphincteric function. A suprapublic approach is used to gain adequate mobilization of the anteriorr vaginal wall and vesicourethral segment. Full thickness sutures applied in the anterior vaginal wall as far lateral from the urethra as possible are then tied to Cooper's ligament. Forward and upward lifting of the vesicourethral segment is achieved but the urethra is free in a wide retropubic space. Normal position with limited mobility of the sphincteric segment is attained, yet compression or obstruction of the urethra and surgical trauma to the delicate sphincteric musculature are avoided. Adsorbable sutures are used. Permanent fixation is to be achieved by the postoperative fibrosis made possible after all retropubic fat has been cleared away. This technique has been uniformly successful in virginal cases and in the great majority of the least favorable cases, after repeated failures. Adequate mobilization proper placement of sutures and prevention of compression and surgical damage are the keys to longlasting successful repair.