Why Marshall-Marchetti operation works . . . or does not

Vesicourethral suspension operations fail (1) when preoperative evaluation is insuffcient, leading to improper selection of patients; and (2) for technical reasons when anatomy is uncorrected (suture malplacement, suture breakage, and failure to release adhesions) or when anatomy is corrected (periurethral fibrosis, fistula, stone or granuloma formation on nonabsorbable suture, and overcorrection). Vesicourethral suspension operations work by changing urethrotrigonal anatomy, creating a new equilibrium of forces acting on the bladder neck and urethra.