Abstract: The incision-free pubovaginal suspension due to Gittes and Loughlin is improved by simultaneous gas obturation and visual monitoring using a suprapubic endoscope, inserted with the aid of a urethral trocar. It is further improved by simultaneous manipulation of the urethra, bladder and other tissues by the trocar, to optimize alignment for the Gittes procedures. The trocar, and procedure for its use, are refinements of the present inventor's earlier apparatuses and procedures for suprapubic cystostomy with endoscopy, and for gas obturation.

Abstract: An inflatable elongate pessary fits into and longitudinally distends the patient's vagina and with it the urethra. An indentation near the proximal end of the pessary receives the patient's servix so that the pessary can extend into and distend the most proximal region behind the cervix. Preferably a lateral enlargement near the distal end of the pessary aids in supporting the pessary above the levator ani sling. The pessary moves the bladder neck and the proximal portion of the urethra toward normal positions above the abdominal wall. The pessary includes a flexible airtight chamber, and a valve and fitting that are operable from outside the vagina while the pessary is inside. The fitting is accessible from the outside for attachment of a source of compressed gas, while the pessary is in the vagina.

Abstract: A tube is passed through the urethra into the bladder (indicated by liquid flow from the bladder to the distal end of the tube) and then withdrawn slightly so that its proximal end is within the urethra (indicated by flow cessation). The tube is anchored in that position by sliding a hygroscopic bougie up the outside of the tube and just inside the urethral meatus, and then spraying the bougie with water to expand it against the urethral wall. A proximal enlargement in the tube also aids anchoring.A conical sheath is used to expand the meatus, to aid in inserting the tube and bougie. The patient holds a handle on the sheath to facilitate access to the meatus.With the tube anchored, the patient undergoes stress of the type which produces the incontinence to be diagnosed, and the diagnostician observes the timing of liquid discharge from the urethra through the tube, relative to stress incidence. From this relative timing the type of incontinence is inferred.