The Efficacy of Anterior Colporrhaphy (Beck Technique) for the Treatment of Stress Urinary Incontinence
Drs. William S. Alford+#, K. Whittington, Kay Kennedy, Michael Hopkins
Aultman Health Foundation
Canton, Ohio

Objective: Anterior colporaphy alone for stress incontinence has been reported with widely varying results.  We report our experience in a highly selective patient population using the Beck technique. 
Materials and Methods: Patients with genuine stress incontinence and a VLPP of 100 cm/H₂O or greater without any evidence of detrussor instability were treated by this technique.  The leak point pressure was determined by inserting a small caliber 8F catheter with a micro transducer into the bladder.  The patient underwent valsalva maneuvers after the bladder was filled to a volume of 150 mL of saline.  The lowest intravesical pressure that produced gross urine leakage was recorded. The procedure was performed in a standard fashion using a box stitch. Assessment of post-procedural urinary continence was ascertained by patient history and a pad test over twenty minutes at the six-week postoperative visit and yearly examinations.
Results: A total of 15 patients were treated by this technique from 1993 to 2001.  The average age was 51.1 years (range 36-72) and the median parity was 2.92 (range 1-5). Nine (60%) were menopausal, and all were on HRT.  Only one had a prior anti-incontinence (Intact sling that had to be removed) surgery.  BMI was 26.25 (range 20-44).  Tobacco use was 26%.  Concurrent surgical procedures TVH ten (66%), TVH/Posterior repair 6 (40%) and posterior repair 3 (20%).  There were no surgical complications and no patients had prolonged urinary retention.  Thirteen patients (86.6%) were continent at a mean follow-up of 43 months, and a range of 6-112 months.  Two patients who were not completely continent reported significant improvement. These two patients developed incontinence at 30 and 100 months.
Conclusions: Anterior colporaphy utilizing the Beck technique provides satisfactory results for highly selective patients.  This selection may help explain the widely varied success rates of anterior colporaphy.
Key Words: Anterior colporaphy, Beck technique