Urodynamic Evaluation of Female Stress Urinary Incontinence

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Abstract
To understand further the urodynamics of female stress urinary incontinence 6 patients were studied before and after anterior vesicopexy. The evaluation included uroflowmetry, cystometry, urethral pressure profilometry, anatomical urethral length measurement with the subject in the supine and standing positions, demonstration of stress incontinence and cystourethroscopy. These procedures, except cystometry and cystourethroscopy, were repeated 7 days and 4-6 wk postoperatively in most patients. All patients had short preoperative functional urethral lenghts and standing anatomical lengths and all were lengthened after the anterior vesicopexy. The urinary flow rates demonstrated decreased peak and average flow rates 1 wk postoperatively but complete recovery 4-6 wk later. The importance of urethral length in the pathophysiology of female stress urinary incontinence was reaffirmed and, by demonstrating decreased flow rates in the immediate postoperative period, draws attention to the need for careful observation of voiding after catheter removal to avoid bladder decompensation. The marked improvement observed in the 4-6 wk postoperative period reveals that anterior vesicopexy does not obstruct the urethra since no tissue posterior to the urethra is used. These urodynamic studies have proved to be valuable adjuncts in the evaluation of female stress incontinence.