| Objectives:Female stress urinary incontinence(SUI) , which affects the patients' quality of life, is not uncommon in the practice of urology and gynecology. It is statistically estimated that about 50 percent of women suffer SUI in their life. According to literature, the operations that correct SUI are classified into 4 categories, that is, anterior vaginal repair, retropubic bladder neck suspension, transvaginal bladder neck suspension and vaginal slings. Others are their derivatives. TVT is the most common alternative procedure for SUI up to now. Though it's simple to perform, the TVT procedure, which requires special instrumentation and its expensive price, as well as the complication of vaginal erosion, makes it prohibitive in many parts of the world, especially in China. So, it is necessary to exploit an inexpensive alternative procedure with a higher cure rate and a lower incidence of long-term side-effects. Pedicled rectalis muscle flap bladder neck suspension, which is simple to perform, may be available.Materials and Methods:1. Surgical technique: Under the epidural anaesthesia, a lower median incision was made. A 2.0~2.5 12~15cm, inferiorly pedicled rectalis muscle flap with its relative anterior sheath was prepared after the separation or division of all layers of tissues. Through the mobilized urethrovaginal space, from the left side, the flap waspulled out from the opposite side and fixed to the distal segment of the rectalis muscle, forming a muscle loop, which elevated the urethra. 2. Forty patients who underwent this procedure were regarded as the research group. The anatomic and functional urethral length, the posterior urethrovesical angle, the maximal urethral pressure and the maximal urethral closure pressure of each were collected before and after operation. 3. Twenty-eight SUI patients (followed up) treated with Burch operation by Peking union hospital was regarded as the control group. The cure rates of the two groups 3 months and 1 year after operation were collected . 4. Statiscal analysis: SPSS10.0 was used to analyze the data. Results were expressed by x s. a =0.05 wasregarded as the level of test. Paired-sample t test and x 2 test were used to analyze the data. There is a statistical significance when P<0.05.Results:1. In the research group, the anatomic urethral length and the posterior urethrovesical angle of the 40 patients before operation were 2.46 0.23cm and 138.2 5.3皉espectively, while the relative values after operation were 5.33 0.31cm and 102.1 4.8 respectively. The difference of the paired values was statistically significant. Urodynamics was done in 20 patients. Before operation, the functional urethral length, the maximal urethral pressure and the maximal urethral closure pressure were 2.09 0.42cm, 41.88 4.94cmH2O and 42.33 4.80cmH2O respectively, while the relative values after operation were 3.55 0.52cm, 64.04 5.35cmH2O and 58.68 5.52cmH2O respectively. There was a statistically significant difference between each paired data. 2. The difference of the cure rates 3 months after operation between the research group and the control group was not significant. One year after operation, however, the cure rate of the former was 97.5%, which was higher than that(92.8%) of the latter. The difference between them was statistically significant.Conclusions:1. The posterior urethrovesical angle returns to normal after operation. The urethral length, the maximal urethral pressure and the maximal urethral closurepressure are prolonged or increased.2. The cure rate of this procedure 1 year after operation is higher statistically than that of Burch operation, which means that there may be a long-term cure rate.3. The mechanisms of contra-SUI of this operation are: to elevate the urethra, correcting the inferioposterior translocation, returning posterior urethrovesical angle to normal; to increase the supporting of the periurethra, prolonging the length of urethra; to improve the coaptation of urethral wall, enhancing the closure of ur...
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