Position and Mobility of the Urethrovesical Junction in Continent and in Stress Incontinent Women Before and After Successful Surgery

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Abstract
The position of the urethrovesical junction and its movement with straining was assessed using lateral chain cystourethrography in 9 continent women and 27 women with genuine stress incontinence before and after continence surgery. The women with genuine stress incontinence had a significantly lower urethrovesical junction related to the symphysis pubis which descended more with straining than the continent women. Surgery was successful in 25 of the 27 women. Following both successful Burch colposuspension and Stamey operation the urethrovesical junction was significantly higher, closer to the symphysis and less mobile. The position of the urethrovesical junction was significantly higher following the Burch colposuspension than Stamey operation and was similar to the continent control group. Overelevation of the urethrovesical junction can be avoided at the time of Burch colposuspension by not tying the suspension sutures with excessive tension but leaving a free space of 2-4 cm between the vaginal wall below and the iliopectineal ligament above. The posterior urethrovesical angle was similar in continent and incontinent women but was significantly narrower following successful surgery.