Recurrent stress incontinence

Abstract

The results of urethrocystography in 193 patients with urodynamically and clinically confirmed recurrent incontinence were analyzed. Severe displacement of the vesical cervix and the proximal section of the urethra predisposes the patient to recurrent stress incontinence. The roentgenological findings (difference of over 30 mm in the distance between the vesical cervix and the ischium, outflow of contrast medium next to the catheter under stress with differential values between 20 and 40 mm, angle of inclination of the proximal urethra of over 45 degrees) are significantly more frequent in cases of recurrent stress incontinence than in cases of first occurrence (132 patients). Of the 193 patients 164 (84%) had previously undergone a vaginal operation. In 60% of these 164 patients the difference in the distance between the vesical cervix and the ischium was 30 mm or more under "resting" stress, and in a further 19% it was between 26 and 30 mm, often with outflow of contrast medium during "pressing". Stress incontinence has a damaging effect on the supporting apparatus of the urethra and the bladder, and also on the ureter and the kidneys. Ureteral drainage disorders and chronic pyelonephritis are the changes most commonly diagnosed in roentgenograms. No statistically significant differences between recurrent and first-time stress incontinence were found. Urethrocystographic findings facilitate selection of the surgical procedure. It appears possible to reduce the frequency of recurrence if preoperative roentgenological findings are taken into account.