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Stress Urinary Incontinence

Department of Surgery, Section of Urology and Department of Gynecology at Yale University School of Medicine. New Haven, Connecticut.

Stress urinary incontinence (SUI) was studied in 125 women who were subjected to simultaneous urodynamic and radiologic evaluation. This included cystometry, urethral pressure profiles, measurement of effective urethral length, estimation of urethral mobility, and alterations in the urethrovesical angles during stress. The most common abnormality was a hypermobility of the proximal urethra with loss of its intraabdominal position during stress, associated with changes in the urethrovesical angle. Fixation of the posterior urethra, loss of effective urethral length, low resting urethral pressure, and true neurovesical dysfunction were also found in some of the patients. Uninhibited bladder contractions were found in 22% of cases, but in most instances they were the result of SUI and ceased after surgical repair. Anterior urethropexy was the treatment of choice for hypermobility with a Type II urethrovesical angle. Anterior colporrhaphy was performed for those with hypermobility and a Type I angle. Fascial sling procedure is advocated for patients with low urethral pressures, as there is a high incidence of failure following other procedures. Postoperative measurement of urethral pressure showed that there was no change after anterior urethropexy but that there was a significant increase after anterior colporrhaphy and sling procedures. Nine of 114 patients subjected to operation were not initially cured of their incontinence. Two were cured by a subsequent fascial sling procedure and 4 others responded to estrogen or sympathomimetic agents for a true failure rate of 2.6% in a follow-up period of 1 to 4 years. It is advocated that women with urinary incontinence should undergo a urodynamic and radiologic evaluation to define the pathophysiology of the condition to enable the appropriate treatment to be selected.

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