Stress urinary incontinence is defined as the involuntary loss of small amounts of urine during coughing, laughing, and other activities that increase intra-abdominal pressure4. Over the years, many different techniques have been proposed to correct this problem. Retropubic colposuspension (Burch Procedure) via laparotomy is the treatment of choice for genuine stress urinary incontinence5, 6 with cure rate of 70% to 80% 5,8. However this procedure has disadvantages such as laparotomy, poor visibility in the retropubic space, more blood loss due dissection of the space of Retzius5 and mobilization of the bladder, prolonged operating time and hospital stay and patient discomfort9.
Laparoscopy has evolved as an alternative technique that permits placement of suspension sutures under direct vision. Vancaille and Schuessler10 first described the transperitoneal laparoscopic approach for the correction of stress urinary incontinence using a modified Marshall-Marchetti-Krantz (MMK) technique. Polascik5, in 1994 reported a technique using a laparoscopic modification of the Burch procedure. These versions, however, require the procedure to be done transperitoneally, with the associated risks of viscus injury, uncontained bleeding, peritonitis, adhesion formation, hypercarbia and hypothermia
11, 12. Further, such an approach requires multiple trocar puncture sites for the placement of the laparoscope and laparoscopic instruments. The transperitoneal laparoscopic approach also requires the use of laparoscopic suturing techniques, which have a steep learning curve and prolong the operative time.
Raboy13 first described the extraperitoneal endoscopic vesicourethral suspension for the treatment of stress urinary incontinence and has given excellent short-term results. Afterwards Knapp14 used the laparoscopic retroperitoneal needle suspension urethropexy to provide excellent bladder neck mobilization with the use of an extraperitoneal balloon dissector. This technique uses a single extracorporeal laparoscopic puncture site and the suture placement in the fascia overlying the pubic tubercle to provide a firm anchor. Our approach use the suture in the strong periosteal support (Cooper’s ligament). The bladder is mobilized, and the Cooper’s ligament is dissected exclusively by the optica. This technique uses a single extraperitoneal laparoscopic puncture site with no vaginal or abdominal fascial incision. Postoperative pain is minimal. Five patients have been completely continent, and a single patient reports mild, but improved stress incontinence.