Urethral pressure profile at pubococcygeal repair for stress incontinence

The influence of pubococcygeal repair on the urethral pressure profile as well as the cure rate, technical operative results and side-effects have been studied in 16 severely stress-incontinent patients. The patients were followed during the first postoperative year in order to detect the possible long-term effects of devascularization, denervation and scarring on the urethral tone. Examination, using simultaneous urethrocystometry with recording of the urethral pressure profile at rest was undertaken preoperatively, 3 months postoperatively and one year postoperatively. Urethral functional length was not affected by the surgery. Urethral closure pressure was slightly reduced 3 months postoperatively and did not recover completely within the first postoperative year. Such a reduction in urethral pressure probably reflects damage to the urethral tissue due to devascularization and denervation. Its main clinical importance concerns cases of severe stress incontinence with a very low initial closure pressure in the urethra. Here, vaginal surgery may jeopardize that success of an otherwise technically irreproachably performed operation. On the whole, pubococcygeal repair is effective in achieving continence, although the side-effects call for careful selection of patients.