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Objective: To determine the utility of the urethral plug in the management of female stress urinary incontinence., Methods: A prospective clinical study was conducted in 20 female patients with stress urinary incontinence in order to evaluate the efficacy of a new urethral plug. The mean age was 59.6 +/- 6.2 years (range 40-66). The study design included 3 visits (4 weeks). The results were considered "positive" when urinary incontinence decreased and the patient referred a subjective sensation of improvement, and "negative" if otherwise., Results: Positive results were demonstrated in 8 patients (40%). Ten patients (50%) refused to continue, mainly due to urinary tract infection in 7 cases (35%), difficulties in plug use (loss of plugs, anomalous urethral anatomy, cystocele,...) in 6 cases (30%) and urethral mucosa irritation in one case (5%). No plug migrated into the bladder. The initial urinary incontinence grade in the positive cases were: minor in 4 (50%), mild in 2 (25%) and severe in 2 (25%). We found no statistical relationship between the urinary incontinence grade and clinical results. The patients used a median of 5 plugs per day. Of the 10 patients who completed the study, 5 (50%) refused to continue using the plug and 5 (50%) decided to continue using the plug in combination with electrostimulation and/or pelvic floor exercises., Conclusions: The use of the urethral plug in the management of female stress urinary incontinence is not an alternative to surgical treatment or pelvic floor rehabilitation. However, it could be useful for patients who are unwilling or unfit for surgery. Finally, the urethral plug is an alternative to the use of collecting systems or devices in female stress urinary incontinence.

Objectives: To evaluate the clinical and urodynamic data of a multicenter study on female urinary stress incontinence undergoing surgical repair with the Ramírez simplified urethropexy., Methods: Clinical, urodynamic and videocystographic data were analyzed in a multicenter series of 340 female patients with urinary stress incontinence (mean age 51.7 +/- 9.7 years) before and after the Ramírez urethropexy technique (mean follow-up 21.7 months)., Results: Post surgical urinary continence was 78.4%. Cystocele repair was demonstrated in 57.7%. Urge incontinence decreased in 17.1%. Daytime frequency statistically significantly decreased in 19%. Urinary obstructive symptoms increased in 19.3%. Bladder instability significantly decreased posturethropexy. Peak urinary flow rate and mean urinary flow rate diminished in 65% and 59%, respectively. Postvoiding residual urine increased significantly. No statistical correlation between posturethropexy continence and videocystographic bladder neck morphology was observed., Conclusions: The clinical and urodynamic data obtained in our series indicate that the Ramírez urethropexy technique, a simple and fast procedure, may be considered an alternative treatment in female urinary stress incontinence.

Objective: To assess the changes in urethral pressure measurement after vaginal electrostimulation for the treatment of genuine urinary stress incontinence., Methods: A clinical study, cystometry and urethral pressure profile were conducted on 15 female patients with urinary stress incontinence., Results: The clinical results showed that electrostimulation was effective in 60% of the patients. The maximum urethral pressure and the functional urethral length increased after electrostimulation (from 47.72 +/- 16.47 cm H2O to 58.27 +/- 14.09 cm H2O, and from 3.9 +/- 1.56 cm to 5.25 +/- 1.69 cm, respectively). There was no relationship between the clinical improvement and the increment of both parameters. However, the increase of the maximum urethral pressure was higher in patients with improvement of incontinence (from 42.5 +/- 3.53 cm H2O to 49.65 +/- 11.26 cm H2O)., Conclusions: Electrostimulation increases both the maximum urethral pressure and the functional urethral length. However, there is no relationship between these parameters and the effects of electrostimulation on urinary incontinence.

Objectives: To determine the utility of the urethral pressure profile and videocystography in the evaluation of stress urinary incontinence posturethropexy., Methods: A clinical, urodynamic and radiological study was conducted in 50 females who had undergone urethropexy due to stress urinary incontinence. The clinical features and urodynamic demonstration of urinary incontinence were analyzed and the type of incontinence was evaluated by videocystography and the urethral pressure profile posturethropexy., Results: The urethral pressures did not correlate with the clinical findings or urodynamic demonstration of urinary incontinence posturethropexy. A maximum urethral pressure significantly lower in patients with radiologically demonstrated type III incontinence was observed. The presence of an open bladder neck, although significantly more frequent in patients with type III urinary incontinence, showed no correlation with the demonstration of urinary incontinence. An open bladder neck was also observed in patients with type II incontinence and patients who were continent posturethropexy., Conclusions: To determine the type of urinary incontinence posturethropexy, it is necessary to utilize cystomanometry, filling videocystography and urethral pressure profile.

Objectives: To evaluate the voiding repercussions of urethropexy., Methods: We carried out a clinical and urodynamic study in 70 patients subjected to different techniques of urethropexy (Kelly, Raz, Marshall-Marchetti-Krantz, Burch and simplified Ramirez) for stress urinary incontinence. We evaluated the voiding repercussions of urethropexy., Results: There was a significant increase in the obstructive symptoms with urethropexy (29% of the patients) although there was no relationship with the variation of the urinary flow rate. It also significantly diminished the urinary flow rate (85% of the patients) and increased the postvoiding volume significantly (3.68 times the average before surgery). The increase in postvoiding volume occurred more frequently in patients with diminished urinary flow rate before urethropexy (60% of the cases). The Raz technique showed less urodynamic data of voiding disturbances., Conclusions: Urethropexy causes voiding disturbance. We believe the decrease in urinary flow rate is related to the increase in urethral resistance produced by urethropexy. In the cases with previously diminished urinary flow rate, reduction in bladder contractility is added to the former mechanism.

Objectives: To evaluate the repercussion of irritative urinary symptoms and bladder instability on the results of urethropexy for urinary stress incontinence., Methods: A clinical and urodynamic study was carried out in 70 adult women submitted to urethropexy (Kelly, Raz, Marshall-Marchetti-Krantz, Burch or simplified Ramirez technique)., Results: The urge incontinence symptom was associated with coughing incontinence is 38 (60%) of the patients submitted to urethropexy. This symptom decreased to 42% (27 patients) after urethropexy. The average score of diurnal urinary frequency was 23% less posturethropexy. The simplified Ramirez technique had the lowest diurnal urinary frequency score [1.17 +/- 1.07 (0 to 3)]. Bladder instability with urinary stress incontinence (mixed incontinence) was found in 21 (30%) patients before urethropexy. The incidence of bladder instability after urethropexy was significantly greater in this group (52%) than in the patients with isolated urinary stress incontinence (17%). However, urethropexy also corrected bladder instability in 30% of the women with mixed incontinence. The Kelly technique produced the lowest incidence of bladder instability after urethropexy (14%)., Conclusions: Urethropexy significantly decreases the irritative urinary symptoms associated with stress urinary incontinence. In some cases, bladder instability associated with stress incontinence (mixed incontinence) may disappear following urethropexy. In most cases bladder instability continues after urethropexy.

We conducted a clinical and urodynamic study in 70 patients who had undergone different urethropexy procedures for stress urinary incontinence. Urethropexy had achieved positive results in 87% of the patients. Incontinence persisted in 21% of the patients. Urethropexy significantly reduced the urge-incontinence and frequency associated with this disorder. Anterior urethropexy did not increase the incidence of poor results in the present series since no patient had intrinsic urethral involvement. The suprapubic and the combined techniques achieved the following cure rates: Marshall-Marchetti-Krantz (92%), Burch (100%), Ramírez simplified (80%), Raz (60%). The cure rate for the Kelly vaginal technique was found to be lower (57%).

We conducted a clinical, radiological and urodynamic study in 70 patients submitted to different urethropexy techniques (Kelly, Raz, Marshall-Marchetti-Krantz, Burch, simplified Ramírez) to determine the importance of the bladder neck in the treatment of urinary incontinence. Urethropexy achieved a significant increase in the percentage of patients with an open bladder neck during the filling phase. However, the opening of the bladder neck posturethropexy did not influence urinary continence.