Abdominal surgical procedure to correct stress incontinence.

Figure 45-6. Abdominal surgical procedure to correct stress incontinence. A: Anterior vaginal wall has been mobilized. Two sutures have been placed on either side and far lateral from the midline. Distal sutures are opposite the midurethra. Proximal sutures are at the end of the vesicourethral junction. Sutures are attached to Cooper's ligament. B: Cross-section shows urethra free in the retropubic space, with anterior vaginal wall lifting and supporting it. C and D: Urethra is compressed and strangulated against pubic bone when vaginal sutures are applied close to the urethra and then fixed to the pubic symphysis.