[Effect of stress incontinence surgery on urodynamic parameters. 2. Are various surgical methods comparable?]

This study examines the pre- and postoperative clinical data of 215 women operated on during 1983-87 at the University Hospital of Freiburg for stress incontinence. The following procedures were used: Anterior colporrhaphy (n = 27), anterior colporrhaphy in combination with a ventral levator plasty (n = 61), sling procedure with the Lyodura sling (n = 44), and a colposuspension within the total abdominal concept (n = 83). All the procedures, with the exception of anterior colporrhaphy, were followed by a decrease in maximum urethral pressure. The functional urethral length was not changed by any of the methods. Colposuspension showed a marked postoperative improvement of urethral stress profile parameters in the proximal and midurethra, the sling had a steep, unphysiological increase of pressure transmission ratio in the proximal urethra. The vaginal methods did not improve pressure transmission to the proximal section of the urethra, their effect was only measurable in the mid section. The urodynamic effects of different types of surgery were very individual, a fact which may be helpful in the selection of the surgical approach.