Effectiveness of modified six corner suspension in patients with paravaginal defect and stress urinary incontinence

Abstract

The purpose of our study was to evaluate the effectiveness of a modified six-corner suspension in patients with a paravaginal defect and stress urinary incontinence (SUI) by observing changes in the POP (pelvic organ prolapse) stage, substage, and the cure rates in SUI. Forty-two women patients who had a paravaginal defect and stress urinary incontinence were treated by a modified six-corner suspension at the urogynecology clinic, Yonsei University Medical Center between January 1999 and March 2000. Each patient underwent a complete physical examination and a standardized urogynecologic interview that asked about age, hormone replacement, parity, urinary symptoms and previous gynecologic surgery. From the 42 patients who had the operation, 30 patients with 1-year follow-up made up the study group. Changes from stage III ( n = 18, 60%) of the group to stage I ( n = 6, 33.3%) or stage 0 ( n = 12, 66.6%) were observed 3 months after surgery, and no further changes were observed up to 1 year after surgery, except in one case. Changes from stage IV ( n = 12) to stage 0 ( n = 3, 25%) or stage I ( n = 6, 50%) or stage II ( n = 6, 50%) were observed 3 months after surgery, but no further change was observed up to 1 year later. Changes from substage Aa (+2, +3) to -3 ( n = 27, 90%) and from substage Ba (+2,+3,+4,+5,+6,+7) to -3 ( n = 27, 90%) were observed 3 months after surgery. No further changes were observed up to 1 year. The average length of the genital hiatus was initially 4.95 cm and 2.5 cm 3 months after surgery. Little change (2.6 cm) was observed up to 1 year later. When the patients were assessed clinically by urodynamics and physical examination, none had urinary leakage symptoms up to 1 year after the operation. All patients had excellent functional results and no postoperative complaints of stress urinary incontinence. We observed that a modified six-corner suspension was surprisingly effective in patients having a paravaginal defect and a stress urinary incontinence.