Lawrence R. Wharton

The Goebell-Stoeckel operation for universal cases of urinary incontinence

Abstract The Goebell-Stoeckel fascia lata strap operation for stress incontinence of urine has been used for 30 years. This is a review of eight cases from our practice using this operation for problems of total urinary incontinence secondary to congenital defects and complications of vaginal surgery. The Goebell-Fragenheim-Stoeckel 1–3 operation was first described in 1917. In the original operation, strips of fascia lata were not used for the strap. In later modifications of the procedure, a strip of fascia lata and a small transverse suprapubic incision were employed. The basic principle of the operation is having a supporting structure beneath the urethrovesicle junction that slightly elevates the urethra in this area upon downward or caudad movement of the bladder. Such movement occurs in all Valsalva maneuvers such as coughing, sneezing, laughing, lifting heavy objects, and many body movements. During these movements, the intravesical pressure is raised. If the intraurethral pressure is lower than the intravesical pressure, at that particular moment, urine in the bladder moves to the lower pressure area in the urethra and drains to the outside. The strap procedure, by supporting the suburethral tissue and the urethral vesical angle, probably increases the intraurethral pressure to a level greater than the intravesical pressure preventing urinary incontinence associated with Valsalva maneuvers but the pressure is not elevated to such a level as to retard urinary drainage during detrusor muscle contraction for voluntary voiding. If the above physiologic explanation is true for stress incontinence, how can the Goebell-Stoeckel strap procedure be explained for total incontinence, particularly secondary to congenital defects such as total bladder exstrophy and epispadias? A physiologic explanation of the success of the strap operation in congenital defects cannot be given. This physiologic explanation remains to be answered. However, the clinical results achieved in these eight cases deserve further study. Consideration of this operation may be warranted in these severe cases of incontinence.