Four-Corner Bladder and Urethral Retropubic Suspension Versus Anterior Colporrhaphy in the Correction of Stress Urinary Incontinence With Urethrocystocele 3-4. Randomized Clinical Trial

In this study we compared, in a prospective randomized trial, the results, in terms of anatomic and functional correction, of two procedures for Stress urinary incontinence (SUI) with cystocele 3-4: four-corner retropubic correction versus anterior repair with medial duplication of the pubocervical fascia and pubourethral ligaments plication. From June 1996 through April 2000, 80 patients affected by SUI type 1 and 2 according to Blaivas with urethrocystocele of 3 or 4 degrees according to the halfway system were randomly assigned to one of the following treatments (randomization 2:1): -1. Anterior colporrhaphy according to Nichols (52 women); -2. Four-corner bladder and urethral retropubic suspension according to Raz (28 women). The follow-up time of patients varied from 280 to 1670 days. The SUI relapse occurred in 26.9% of patients who underwent Nichols’ technique, against the 14.3% found in the other group, with a statistically significant difference (p<0.01). By contrast, the anatomic correction of vaginal profile did not result significantly different in the two groups analyzed. We concluded that the four-corner procedure is more successful in terms of incontinence cure.