[Urethral pressure profile in sling operations for stress incontinence]

Abdominovaginal sling procedures are one of the operative methods for treating urinary stress incontinence in women. They are used especially in incontinence associated with severe pelvic floor weakness. By suspending the vesicourethral junction to the anterior abdominal wall by help of a dural or fascial sling, the bladder neck and proximal urethra are restored to their original anatomical position. Changes in intraabdominal pressure are transmitted equally to both bladder and urethra. One of the difficulties during the course of the operation is to maintain proper tension to the sling while suturing it to the rectus sheath. If the sling is placed to loosely, therapeutic failure may result; on the other hand, overtightening of the sling can lead to delayed voiding and retention of urine. With this problem in mind, urethral pressure recordings were performed during the course of 14 abdominovaginal sling operations. Significant changes concerning the functional urethral profile length, the maximum urethral pressure, and especially the shape of the urethral closure pressure profile could be demonstrated following the main operative steps.