Influence of pubococcygeal repair on urethral closure pressure at stress

Stress incontinence is cured or improved by surgical treatment but the immediate reason is obscure. Simultaneous urethrocystometry with urethral pressure profile recording at rest pre- and postoperatively has shown that the urethral pressure remains fairly unchanged by the operation. Similar measurements, but during stress, have been performed in eight women with stress incontinence before and after pubococcygeal repair with interest focussed on changes in pressure transmission from abdomen to urethra. We have found that the reason for cure is a greatly improved pressure transmission, probably depending on the firm support beneath the urethra postoperatively. Rotational descent is prevented and the "floor" beneath the urethra responds with good counterpressure at stress. The pressure transmission was as good at one year as at one month after surgery, pointing to a lasting result.