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Abdominoperineal Urethral Suspension: A Report of 20 Cases
Author(s) -
Browne David S.,
Frazer Malcolm I.
Publication year - 1990
Publication title -
australian and new zealand journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.734
H-Index - 65
eISSN - 1479-828X
pISSN - 0004-8666
DOI - 10.1111/j.1479-828x.1990.tb02032.x
Subject(s) - medicine , popularity , stress incontinence , general surgery , surgery , abdominoperineal resection , urinary incontinence , psychology , cancer , social psychology , colorectal cancer
EDITORIAL COMMENT: We accepted this paper for publication because we consider Zacharin's operation does not enjoy the popularity it deserves ‐ it is also ironical that this operation and the anatomy of the pubourethral ligament as described by Zacharin, and on which the technique is based, has been acknowledged in overseas journals (Obstet Gynecol Surv 1989; 44:833) but not our own. Zacharin uses abdominoperineal urethral suspension exclusively for patients with recurrent stress incontinence but he, unlike the authors of this paper, does not advocate its use as a primary procedure when there is uterovaginal prolapse. Most of the 335 patients Zacharin has operated on in the past 20 years for the relief of stress incontinence have had previous surgery, although there were a few without prolapse who had not (personal communication to the editor). Zacharin reported an 85% overall cure rate for his operation after long‐term follow‐up in a series of 194 women treated during the 15 years, 1965–1980 (Obstet Gynecol 1983; 62: 644–654). During the past 15 years Zacharin has been invited to perform his abdominoperineal urethral suspension procedure in university centres in the United States, Canada. Europe, the United Kingdom, Africa and Asia. The editorial board is unaware of any other Australian gynaecologist who is repeatedly asked to demonstrate a surgical procedure abroad ‐ it seems appropriate that the technique be reexamined by all gynaecologists who treat patients for stress incontinence when it recurs after primary surgery. Summary: Twenty patients adjudged to require surgical management of genuine stress incontinence underwent the abdomino‐perineal urethral suspension procedure between May, 1989 and February, 1990. Short‐term subjective follow‐up revealed a 94% cure and improved rate in 19 patients in whom the operation was completed. There was a striking absence of postoperative voiding morbidity. We believe this somewhat neglected procedure is worthy of further objective study and comparison with the more popular methods of surgical management of genuine stress incontinence.