[Functional risks in the surgical therapy of urinary incontinence and prolapse (author's transl)]

In addition to the known surgical risks in the treatment of incontinence or prolapse there exists a functional risk inherent in the surgical methods, which can even cause a deterioration in the functional condition if the surgical aim is not achieved. The vaginal bladderneck sutures are only worth as much as the tissues they hold together. The surgical treatment of certain cases of prolapse can eliminate the stopcock mechanism of the urethra and lead to the manifestation of a preoperatively-existent incontinence. With the sling operations success depends, among other factors, on the degree of restraint and the correct placement of the sling. The outcome of hysterectomy is endangered by failure to recognize a coexistent prolapse or enterocoele. With Ward's manipulation, high peritonization and adequate treatment of the overextened posterior vaginal vault, the involved functional risks can be minimized. Typical examples are mentioned in the text. Particular emphasis is placed on the necessity of exact knowledge of the circumstances threatending the functional success and their recognition by means of wick-urethrocystocolporectography. For the maintenance of a good doctor-patient relationship, the patient may receive prior to surgery an understandable explanation of the limitations of the methods used in achieving a functional cure.