[Marshall-Marchetti-Khrantz operation for stress incontinence. 100 cases (author's transl)]

Abstract

The authors report a series of 100 cases of stress incontinence of urine in the woman, treated by Marshall-Marchetti-Khrantz operation. In reoperations for urinary incontinence which has already been treated surgically, the authors deliberately opened the bladder in order to clearly visualise the bladder neck and trigone and hence insert the juxta-cervico-urethral sutures in the best possible position. It is of interest to note the severity of Retzius haematomas (even though rare: 3 cases) and the risk of transfixion of the excretory system by a suture which leads to the development of bladder lithiasis. It is above all of interest to note the absence of prolonged dysuria. Results were excellent and may be viewed in three main areas: 1) Patients undergoing their first operation: 76 cases, 70 successes, i.e. 92.2%. 2) Patients undergoing reoperation: 16 cases, 13 successes, i.e. 82%. 3) Finally, neurological bladders: 8 cases with 4 failures. The authors draw the conclusion that neurological bladder with urinary incontinence is a poor indication for incontinence surgery. By contrast, the results of primary or secondary operations appear to be good and they are encouraged to continue. Failures of this operation are due either to an inappropriate indication or essentially to technical errors leading to the breaking away of vaginal fixation: Retzius haematoma, Retzius abscess, the use of absorbale sutures and finally late breakdown. It must nevertheless be noted that deteriorations occurred up to the 2nd postoperative year. In the literature, the authors found reports of non-negligeable deterioration occurring late in a certain number of published series.