Transvaginal Posterior Levatorplasty and Perineoplasty for female Primary Stress Urinary Incontinence: 12-month follow-up and technical presentation

The levator ani (LA) plays key roles in maintaining continence during sudden increase of intraabodominal pressure. To date, there has been no reports on the treatment of female stress urinary incontinence (SUI) by repairing the LA. We aimed to investigate the feasibility of transvaginal posterior levatorplasty combined with perineoplasty (TPLP) for women with primary stress urinary incontinence and demonstrate the surgical technique with step-by-step procedures. A total of 47 patients were prospectively enrolled in this study with a mean age of 43.6 years. Mean operative time was 78.7minites. Median estimated intraoperative blood loss was 80.2 ml. Objective cure and subjective cure rates were 87.2% and 91.5%, respectively. Compared with baseline, scores of quality of life，symptom severity and sexual function improved after surgery. Meanwhile, mobility of the urethra and bladder neck and areas of levator hiatus were decreased after surgery. There was no major adverse event, except mild coitus pain was reported in 15.4% (6/39) patients at the initial several times of intercourse after resuming sexual activity. In conclusions，this study shows that TPLP appears to be an effective surgical method for selected women with primary stress urinary incontinence.