Preperitoneální laparoskopickáretropubická kolposuspenze v léčbě stresovéinkontinence: Mesh & Tacker technika

Preperitoneal Laparoscopic RetropubicColposuspension in the Treatment of StressIncontinence: Mesh & Tacker Technique

The Burch procedure has enjoyed in the last decade a favourable status among open surgicalrepairs for stress urinary incontinence. In the last few years this technique was adapted forendoscopic aplication. This results in decreased recovery time and diminished postoperativepatients discomfort. This endoscopic procedure was further simplified by means of extraperitone-al approach and through the use of Mesh & Tacker technique. This enables a high quality durablecolposuspension in significantly shortened operational time.Objective: Evaluation of preliminary results and experiences of the abovementioned new laparos-copic extraperitoneal approach in the treatment of stress incontinence.Setting: Department of Gynaecology and minimally invasive surgery Na Homolce Hospital.Design: Prospective pilot study.Methods: The patients with stress incontinence proven clinically and by means of urodynamicinvestigation (cystometry, stress profilometry and uroflowmetry) were included in the study. TheRetzius space was dissected laparoscopically via preperitoneal distention balloon (PDB, OriginMedsystems). Colpofixation to Coopers ligaments was achieved by means of Mesh & Tacker tech-nique, e.g. polypropylen Mesh and aplicator of helicose spirals (Origin Medsystems).Results: In this pilot study of initial 8 patients we may conclude that the abovementioned methodis promising. Of note is shortened operational time (35 min), easy performance without necessityof laparoscopic endosuturing and minimal tissue damage. The small amount of patients and shortfollow up period would not allow definite conclusions but all the patients are sofar fully conti-nent.

Key words:
stress incontinence, Burch, laparoscopy, preperitoneal and transperitoneal approach,Mesh & Tacker