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40 women (average age 65 years) who underwent vaginal hysterectomy and colpoperineoplasty for total prolapse of the uterus with (26) or without Stamey's procedure (14), were tested urodynamically before and 14 months after surgery. 6/14 (43%) women were clinically and urodynamically continent after vaginal hysterectomy and anterior and posterior repair, compared to 20/24 (83%) after an additional Stamey's procedure. The pressure transmission ratio was significantly improved after both procedures (p = 0.05). These results indicate that anatomic correction does not suffice to correct latent stress urinary incontinence in patients with uterovaginal prolapse. Endoscopic suspension of the bladder neck seems to be a successful method in these cases. The transmission ratio was improved by both operative procedures. The results show, that colpoperineoplasty alone cannot correct stress incontinence in patients with total prolapse of the uterus. In such cases Stamey's procedure is a successful method.

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.

Sixty-six patients who underwent radical abdominal hysterectomy between 1971 and 1985 for stage Ib-IIb cervical cancer underwent urodynamic studies 1-15 years after surgery. None of the patients had received radiotherapy. Surgical specimens were processed as serial giant sections permitting measurement of the resected parametrial and paravaginal tissue. In 1984 parametrial resection was extended to the pelvic wall by the use of hemoclips. Impaired bladder sensation, bacteriuria, and residual urine were significantly more common among the patients who had more radical surgery, as were reduced flow rates and abnormal bladder compliance.