Stress incontinence. Why and how operations work

We still remain uncertain of the precise mode of cure produced by many continence procedures. In achieving a cure, some operations produce unacceptable side effects of urge incontinence and voiding difficulty. True comparison of results of different procedures cannot be made until both subjective and objective results are presented, the criteria for patient entry are documented, and randomized studies using matched patients as far as possible (taking into account factors such as the patient's age, parity, and past history of bladder neck operations) are carried out. A follow-up for at least 2 years and preferably 5 years is necessary. As more than one factor may act to cause urethral sphincter incompetence, operations must be selective, and bearing that in mind, a schematic approach is needed to match the operation with the pathophysiology or anatomic lesion responsible for incontinence.