A urodynamic appraisal of success and failure after retropubic urethropexy

Fifty patients were evaluated with microtransducer urodynamic evaluation before and three months after retropubic urethropexy. Despite a 92% subjective success rate (46 of 50 patients), 13 patients (26%) were found to be surgical failures on postoperative urodynamic evaluation. Prior incontinence surgery (28 patients) was not a statistically significant risk factor except in those with prior Marshall-Marchetti-Krantz procedures; they were found to be at increased risk of failure (67%) (P less than .001). Prior hysterectomy had no effect on surgical outcome. Functional length in the sitting position was augmented by 4.3 mm (P less than .01) after the modified Burch procedure. However, there was no significant change in closure pressure. Patients who failed incontinence surgery had significantly lower preoperative closure pressures (P less than .005) and functional lengths (P less than .025). Urethral pressure profiles may be used to identify those patients with low-pressure, short urethras; they are at increased risk of surgical failure.