Preliminary results of muscle cuff cervicoplasty in the ewe for the treatment of urinary incontinence.

Abstract

Muscle cuff cervicoplasty consists of dissecting a strip of the superior slip of the levator ani muscle, by sectioning it flush with the symphysis pubis, and applying it like a cuff around the urethra below the bladder neck. We conducted a preliminary study in 12 ewes, including preoperative urodynamic assessment, intravenous urography with retrograde cystography on day 15, and another urodynamic assessment 1 and 3 months after the operation. Two animals died, but the other 10 animals were able to be evaluated. An increase in the urethral functional length with an infracervical plateau was revealed on all postoperative urethral profiles. Only transrectal electrostimulation, performed on the last 5 ewes, demonstrated an elevation of the closure pressure by 5-10 cm H2O. At sacrifice of the animals at 4 months, in situ stimulation of the muscle strip induced muscle contraction in 7 of 10 cases. Histological examination demonstrated persistence of muscle fibers in the cuff, despite the presence of marked fibrosis. The preliminary results are encouraging: urinary continence was improved with a minimal risk of retention, and cervicoplasty appears to retain its contractile activity, suggesting the possibility of a long-term sphincteric and proprioceptive action. This technique could be proposed in women suffering from urinary stress incontinence with sphincter hypoactivity.