A urodynamic evaluation of the effects of abdominal urethrocystopexy and vaginal sling urethroplasty in women with stress incontinence

Henriksson, L.; Ulmsten, U.

American Journal of Obstetrics and Gynecology 131(1): 77-82


ISSN/ISBN: 0002-9378
PMID: 565593
DOI: 10.1016/0002-9378(78)90478-7
Accession: 004642631

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The effect of vaginal sling urethroplasty according to Zoedler and abdominal urethrocystopexy according to Marshall-Marchetti-Krantz on the intravesical and intraurethral pressures and on the functional urethral length was evaluated in 30 women with stress incontinence. The recordings were made by a specially designed microtransducer technique, allowing accurate determination of the above, related parameters. Before operation, all patients reported incontinence and this was objectively confirmed with pressure recordings, since the urethral closure pressure decreased to 0 or below 0 in conjunction with leakage of urine. After the operations, all 30 patients reported continence, which was objectively confirmed by positive urethral closure pressures. When the pre- and post-operative recordings were compared, minimal changes (within 3 mmHg and 2 mm) had occurred in the resting urethral and bladder pressures and in the functional length of the urethra. A sophisticated hydrodynamic investigation was performed, in which the patients coughed repeatedly during recording of the urethral closure pressure within all parts of the urethra, i.e., urethral cough pressure profile. Preoperative negative cough pressure profiles became positive after operation. The results support the theory given by Enhoerning that successful surgical treatment of stress urinary incontinence in women was primarily due to fixation or relocation of the proximal part of the urethra into the intra-abdominal pressure sphere. The 2 different surgical procedures seem to be equivalent in treatment of typical stress incontinent patients.