Long-term subjective results of Marshall-Marchetti-Krantz procedure

Stress urinary incontinence: current understanding

Many new concepts were introduced in epidemiology, a etiopathology and treatment of stress urinary incontinence. This review gives a short account of these concepts and compares the results of commonly used treatment options with new ones recently introduced.

Ten-year results of Marshall Marchetti Krantz and anterior colporraphy procedures

OBJECTIVE

To evaluate subjective results of Marshall Marchetti Krantz (MMK) and anterior colporraphy (AC) procedures.

STUDY DESIGN

Patients who had operations for genuine stress incontinence 10 years ago were surveyed regarding their current incontinence status. Results of both procedures were evaluated and compared.

RESULTS

Fourteen of 28 patients in the MMK group and 21 of 67 patients in the AC group were evaluated at 10 years, the cure rates were found to be 64% and 38%, respectively.

CONCLUSION

We conclude that the success rate of both procedures declines over time. The anterior colporraphy procedure appears to have a lower success rate than MMK, although this was not found to be statistically significant.

Laparoscopic bladder neck suspension fails the test of time

PURPOSE

Initial reports on laparoscopic bladder neck suspension have suggested success rates similar to those of traditional bladder neck suspension. We compare long-term success rates of laparoscopic and transvaginal Raz bladder neck suspension.

MATERIALS AND METHODS

A total of 100 patients with anatomical stress urinary incontinence underwent extraperitoneal laparoscopic bladder neck suspension with securing of the endopelvic fascia to Cooper's ligament (58, laparoscopy group) or transvaginal Raz bladder neck suspension (42, transvaginal group). Patients were evaluated by chart review and telephone questionnaire to determine whether they had urinary incontinence.

RESULTS

The 2 groups were similar in terms of age, mean body mass index, preoperative bladder capacity and post-void residual. Mean followup was 45 months (range 14 to 71) in 50 laparoscopy group (86%) and 59 months (range 35 to 72) in 29 transvaginal group (70%) patients. Only 15 of 50 laparoscopy group (30%) and 10 of 29 transvaginal group (35%) patients were completely continent at followup. There was no statistically significant difference in the success rates for the 2 groups. Mean time to failure for both groups was 18 to 24 months.

CONCLUSIONS

With long-term followup laparoscopic bladder neck suspension demonstrated poor success rates similar to other minimally invasive surgical therapies for stress urinary incontinence. Any new surgical technique for treatment of stress urinary incontinence should have a mean followup of more than 2 years to determine true clinical efficacy.

Comparison of the anterior colporrhaphy procedure and the Marshall-Marchetti-Krantz operation in the treatment of stress urinary incontinence among women

OBJECTIVE

To compare retrospectively the efficacy of the anterior colporrhaphy procedure (AC) and the Marshall-Marchetti-Krantz operation (MMK) in the treatment of stress urinary incontinence (SUI).

METHODS

A retrospective analysis through a review of the medical records of Japanese women with stress urinary incontinence who were surgically treated at Kyushu University Hospital from 1980 through 1996. A questionnaire regarding the current status of urinary incontinence was sent to all patients.

RESULTS

A total of 103 patients could be evaluated, 77 of whom had undergone an AC, and 26 of whom had undergone an MMK. Postoperative complications were more common in the AC group (p < 0.05). There were no significant differences between the 2 groups in terms of the duration of hospital stay or postoperative catheterization. The long-term subjective cure rates of the ACs and the MMKs were 55% and 58%, respectively.

CONCLUSIONS

The AC and the MMK were equally effective in treating stress urinary incontinence, and both showed decreased long-term subjective cure rates. The recurrence rate did not differ between the AC and the MMK. The AC had more postoperative complications and shorter recurrence intervals.