[Surgical therapy of recurrent stress incontinence]

We reviewed 245 patients, who underwent surgical treatment of stress urinary incontinence between 1982 and 1989. All patients underwent clinical and urodynamic assessment before and an average of 23 months after surgery (range 12-28). 159 patients had not undergone a previous incontinence operation and 86 one or more previous procedures. 42 patients with recurrent stress incontinence underwent a Burch colposuspension, 20 an anterior colporrhaphy and colpoperineoplasty, and 24 a Stamey endoscopic bladder neck suspension. All operations were successful, more frequently in patients undergoing the first surgical attempt at correction of incontinence than in those undergoing surgery for recurrent incontinence (Burch colposuspension 88% vs 69%; anterior and posterior repair 62% vs 20%; Stamey bladder neck suspension 80% vs 52%). In patients with severe stress incontinence both the Burch and Stamey procedures yielded significantly better results than anterior and posterior repair (73% and 66% vs 37%). The urethral closure pressure at rest was unchanged in patients continent after surgery, but significantly reduced in the surgical failures. Stress profile values differed significantly between patients continent after surgery and surgical failures. Also, the vesicourethral junction was elevated further in the continent than in the incontinent women.