Urethro-plasty, a Novel Operation based on a New Concept

Urethro-plasty, a Novel Operation based on a New Concept, for the Treatment of Stress Urinary Incontinence, SUI, Detrusor Instability, D.I., and Mixed-type of Urinary Incontinence. Introduction: Urethro-plasty, a vaginal operation for surgical management of SUI, DI and Mixed-type of urinary incontinence is innovated, depending on, a new concept. SUI is a sequel of a weak, defective internal urethral sphincter, the defect is mostly due to traumatic rupture of its wall. The internal sphincter is a collagenous tissue cylinder that extends from the bladder neck down to the perineal membrane. Urethro-plasty, depends on identifying the defect, (rupture), in the wall of the sphincter, and mending the torn wall by simple interrupted sutures, urethro-raphy; and fortifying the sphincter further by fixing longitudinally a rectangular piece of vagina on the mended wall. In addition, it is an autologus source of collagen, and it separates the fortified repaired sphincter from the overlying repaired vagina. Thus the sphincter restores its integrity, and strength to resist sudden increases of pressure. Aim of the study: Evaluating the results of this new operation, is done by assessing the patients soon after surgery and for up to 12months following surgery. Study design: Urethro-plasty operation is done to cases with SUI, DI, and Mixed-type of urinary incontinence. The cases are followed up for continence up to 12months after the operation. Results: Urethro-plasty had been done for 84 patients; success rate was 92.8%; 78 patients gained continence. There was improvement in 4 patients; a rate of (4.8%).Failure was recorded in 2 women; a rate of 2. 4%. No post-operative troubles were recorded. Conclusion: By mending the torn posterior wall of the internal urethral sphincter, Urethro-raphy; and fortifying it further by fixing longitudinally a vaginal graft, Urethro-plasty, the integrity and strength of the sphincter are restored. The sphincter, thus regains its ability to resist sudden increases of intra abdominal pressure. There were no relevant postoperative complications. Table of contents: Introduction >Objectives >Patients & Methods >Pre-operative Assessment >Postoperative care >Postoperative evaluation >Results Discussion Figures and Table Introduction Stress Urinary Incontinence, Detrusor Instability, and Mixed-type of Urinary Incontinence, though widely spread with nasty effects on the quality of life (QOL) of many women, its pathogenesis has not been well understood nor universally accepted. Furthermore, its surgical treatment has a wide spectrum of different types of operations, (1-13)