At least 20% of menopausal women suffer from urinary
stress incontinence and the surgery often fails to cure it although more than
200 surgical procedures have been employed for this purpose. Actually, the
short term results are good, but over the time the success rate declines.
Above all the minimally invasive needle suspension procedures (Pereyra, modified
Pereyra, Stamey, Raz, Gittes) exhibit a 5-year cure rate of only 40%. On the
contrary, the Burch colposuspension, which is considered the “gold standard”,
takes a long term cure rate of about 80-85%, but it requires a laparotomic
approach. Recently this operation has been performed by laparoscopy, but it
does not appear equally effective as the laparotomic one. Therefore, it seems
very difficult in the urogynaecology field to couple the effectiveness of
a procedure with its mini-invasivity. In recent years, a new option has been
developed for the treatment of genuine stress incontinence, the Tension-free
Vaginal Tape (TVT), which implies the implantation of a prolene tape around
the mid-urethra with a minimally invasive technique. The success rate reported
by the TVT is about 90% and one can aspects that the aim of efficacy and minimally
invasive surgery has been achieved by this way. However, this method carries
the risk of injuries to bladder and vessels (5% and 15% respectively). Therefore,
we developed a new technique for the placement of the tension-free vaginal
tape that avoids these risks retaining its benefits.
