Urodynamic and ultrasonographic evaluation after continence surgery.

Abstract

Our objective was to evaluate urodynamic and ultrasonographic findings after continence surgery. The study consisted of three groups of women according to the surgery performed: group I (Burch colposuspension) with 12 patients; group II (Kelly-Kennedy plication) with 10 patients; and group III (Gittes surgery) with 9 patients. Urodynamic study was done preoperatively and after surgery (on the 7th and 30th postoperative days, and at least 6 months after surgery) and ultrasonography of the bladder neck was performed to evaluate its position in relation to the inferior edge of the pubic symphysis and its mobility, both preoperatively and after surgery (30th postoperative day). All patients remained continent. We observed an increase in the first desire to void and maximum cystometric capacity after 6 months in groups I and II, respectively. There was no change in the urethral closure pressure profile in the three groups. Elevation of the bladder neck and decrease of its mobility were found by ultrasonography. Urinary continence after surgery is not the result of alterations in the urethral closure pressure profile, but rather of an elevation in the bladder neck and limitation of its mobility, which probably improves the abdominal pressure transmission rate to the proximal urethra.