[Effect of various operations for incontinence on the dynamics and topography of the bladder and bladder neck]

Abstract

245 women who underwent surgery for stress urinary incontinence between 1982 and 1989 were tested urodynamically before and after surgery; lateral colpocystograms were obtained in 118 patients. 116 women underwent colpoperineoplasty, 59 Burch colposuspension, and 70 Stamey/Raz endoscopic suspension of the bladder neck. 72% of the patients were continent after the Burch operation, 70% after the Stamey/Raz procedure, and 54% after colpoperineoplasty. In patients with severe stress incontinence, the Burch and Stamey/Raz procedures were effective significantly more often than colpoperineoplasty (73% and 66% vs 37%). In patients with a hypotonic urethra, the Burch procedure was successful significantly more often than the other two operations (88% v. 62% and 47%). Colpoperineoplasty and the Stamey/Raz procedure both significantly decreased the urethral closure pressure (UCP) at rest while significantly improving the UCP under stress, the depression quotient, the pressure transmission factor. Urodynamic criteria of the urethral stress profiles differed significantly between continent and incontinent women. Colpocystography showed that the Burch and Stamey/Raz operations moved the vesicourethral junction well above the lower margin of the symphysis while colpoperineoplasty moved it to the lower margin. The angle beta was significantly smaller after Burch and Stamey/Raz operations than after colpoperineoplasty. There was no difference in any of the parameters between women with or without micturition complaints.