Treatment of stress urinary incontinence due to paravaginal fascial defect.

This study supports the thesis that the physical findings of pelvic relaxation, such as cystourethrocele, are the results of isolated defects in the pelvic fascia rather than the results of generalized stretching or attenuation of the supporting structures. The most frequently encountered defect resulting in cystourethrocele with stress urinary incontinence was a paravaginal break in the pubocervical segment of the endopelvic fascia between the lateral edge of the vagina and the pelvic sidewall. The operative approach to this paravaginal defect is described. The overall results in 233 procedures performed by 2 separate groups are analyzed. Functionally satisfactory results were obtained in over 95% of patients with 2 to 8 years of follow-up. The use of an indwelling urethral catheter was found to be unnecessary, and all patients experienced a rapid return of normal bladder function. The average length of the postoperative hospital stay was 5 days.