Isolated Stress Urinary Incontinence Research Articles

The effect of the distance between mesh and the urethra on sexual function in patients who underwent transobturator tape

To evaluate the effect of mesh-urethra distance on sexual function in continent patients who underwent transobturator tape (TOT) surgery due to isolated stress urinary incontinence (SUI). Continent patients who had undergone TOT surgery for SUI were eligible. Objective treatment for SUI was defined as the absence of urine leakage during a stress test. Translabial perineal ultrasound was performed six months after surgery. The successful surgical group was split into two subgroups based on the distance from the posterior of the urethra at the bladder neck to the nearest proximal edge of the tape: <5 mm and >5 mm. In addition to these, band percentile, the descent of bladder neck and urethra length measured by perineal ultrasound, pubo-urethral distance, urethral thickness, detrusor thickness, cystocele descent, rectal descent, and uterine descent were evaluated. Preoperative and postoperative results of the standardized and internationally valid incontinence questionnaires Incontinence Questionnaire Urinary Incontinence Short Form and Female Sexual Function Index (FSFI) were compared between groups. Eighty-two patients were included. The postoperative FSFI scores for the >5 mm group were significantly lower than those of the <5 mm group, including the postoperative FSFI average, all subscales except lubrication, and average change scores due to the operation (p<0.001). There was no statistically significant relationship between the percentile occupied and postoperative FSFI score (p=0.553), and the FSFI preoperative-postoperative difference was not significant (p=0.905). Sexual functions are more affected in patients with a mesh-urethra distance >5 mm as measured by perineal ultrasound.

Tension-Free Vaginal Tape Failure After Robotic Sacrocolpopexy and Tension-Free Vaginal Tape for Concomitant Prolapse and Stress Incontinence.

Evidence of surgical cure with tension free vaginal tape (TVT) is robust for isolated stress urinary incontinence, but rigorous studies investigating combined prolapse and incontinence are lacking. Our study measured cure of stress incontinence in concomitant robotic sacrocolpopexy and retropubic sling (TVT). We hypothesized a higher rate of objective failure as measured by the cough stress test (CST) compared to failures reported in recent randomized trials of TVT in patients without prolapse (aggregate 8% failure). Prospective cohort of patients with stress incontinence and prolapse, scheduled for robotic sacrocolpopexy and TVT. Outcomes assessed at 12 months: CST (primary aim), Patient Global Impression of Improvement (PGI-I), Pelvic Floor Distress Inventory, and the Sandvik questionnaire. Sixty-six of 77 subjects (86%) completed follow-up. Average age was 65 years, 96% were white, with mean body mass index of 28.1 kg/m2. Mean parity was 2.7, 50% had a previous hysterectomy. Mean leading edge of prolapse was +2.3 cm. All patients underwent the planned surgery; additionally, 50% underwent hysterectomy and 38% posterior colporrhaphy.The TVT failure (+CST) was 19.7% (95% confidence interval, 11.3%-31.7%; P < 0.001 compared to 8%). Neither preoperative disease severity, nor preoperative prolapse stage affected risk of failure of TVT. Eighty-three percent of the subjects were happy or very happy (PGI-I). However, those with a positive CST (failure) had significantly less satisfaction on PGI-I, UDI-6, and Pelvic Floor Distress Inventory-20. In this population with advanced prolapse, cure of stress urinary incontinence by TVT in setting of robotic sacrocolpopexy is lower compared to published trials where prolapse is absent. Women are less satisfied when the postoperative CST is positive.

Pleated colposuspension: Our modification of Burch colposuspension

Introduction:Burch colposuspension is a standard treatment for stress urinary incontinence. However, it is associated with recurrence and urinary retention. We describe a modification of this technique to overcome these problems and evaluate the results in comparison with the standard procedure.Materials and Methods:A total of 145 patients with isolated stress urinary incontinence (SUI), underwent either our modified pleated colposuspension (PC); n = 97) or standard Burch colposuspension (BC) (n = 48). Description of PC: Three No. 0 non-absorbable sutures were placed in the side-to-side manner at the mid-urethral level with 0.5-1.0 cm distance between them using double bites and were passed through the Cooper's ligament. The patients were followed-up every 6 months for SUI and genital prolapse evaluation. Successful surgery was defined as (1) No self-reported SUI symptoms, (2) Negative Marshall's coughing test (MT), (3) No retreatment for SUI, (4) Absence of urodynamic SUI. In addition, failure was defined as the occurrence of urinary retention, use of catheter on 6-week visit, maximum flow rate >15 ml/s, flow time <60 s, or residual urine <100 ml. Data was compared using Student's paired test and Mantel-Haenzel's χ2 test. P > 0.05 was considered significant.Results:The mean follow-up after surgery for PC was 102.4 months and for BC was 103.6 months. At last follow-up, data suggesting failure (Stress score ≥7, urge score ≥7, Pad test with weight < 15 g/day and positive MT during lithotomic/upright position) were more frequent in BC group (P > 0.05; P > 0.0; P > 0.01; P > 0.05; P > 0.05, respectively). The incidence of recurrent SUI was 5.2% after PC and almost triple (14.6%) after BC. Residual urine <100 ml and weak stream were more frequent in the BC group (P > 0.05; P > 0.01, respectively). Detrusor over-activity on urodynamic studies, Flow time <60 s, urethral pressure profilometry positive for obstruction had a higher incidence in BC group (P > 0.01; P > 0.001; P > 0.01, respectively).Conclusion:Our modified pleated colposuspension showed improved outcomes when compared with standard Burch colposuspension.

TRANSOBSTURATOR TAPE (TOT) PROCEDURE: THE IPOH EXPERIENCE

The use of transobturator tape (TOT) for the treatment of stress urinary incontinence (SUI) has gained popularity since it was introduced in 2001. Only few studies have reported that TOT is superior in safety and efficacy when compared to tension free vaginal tape (TVT). This case-series study was conducted to investigate the safety and efficacy of the TOT procedure in patients at Ipoh Hospital. A cross sectional study on patients who underwent TOT procedures from Jan 2006 to Jun 2008 was conducted. Patients were followed-up 1 month, 3 month, 12 month and annually thereafter. Data were retrieved from patients' records based on the standard pre-operative assessment sheet and follow up record. Interviews were then made via telecommunication to assess the patients' progression and satisfaction using a validated questionnaire. Fifty-two subjects (n=52) were recruited. The mean age was 54.2 ' 10.6 years with the median follow up time of 19 months. Majority of cases (n=46; 88.5%) had concomitant pelvic organ prolapse (POP), while only 2 (3.8%) had an isolated stress urinary incontinence (SUI). Pre-operatively, only 16 patients (30.8%) were diagnosed with mixed urinary incontinence (MUI) and 24 patients (46.2%) had over active bladder symptoms (OAB) which include increased frequency and urgency. The objective cure rate for SUI was 42 (80.7%), 3 (5.8%) failed while 7 (13.5%) improved. Complications were limited to minor conditions and was only observed in four patients: one case (1.9%) of acute urinary retention, three (5.7%) had prolonged indwelling catheter more than 3 days and one (1.9%) each for mesh erosion, hematoma, urinary tract infection (UTI) and wound infection. Cure rate for MUI, frequency and urgency were 37.4%, 70.8% and 54.2% respectively. De novo urgency was noted in three (n=3: 5.7%) cases while (n=3: 5.7%) required revision of the tape. Forty-nine women (n=49: 94.2%) were satisfied with the procedure. TOT procedures significantly improve OAB symptoms with high patient's acceptance rate and no serious operative complication.

Rectal distension: The effect on bladder function

To assess how rectal distension affects urodynamics parameters and diagnosis. Thirty women underwent filling cystometry with a rectal balloon inserted and filled with 150 ml of normal saline and repeated without the balloon distended. The volume at which first desire, strong desire and bladder capacity were reported by the women was recorded as well as urodynamics diagnosis. Women were randomized, using the closed envelope method, into having the rectal balloon distended during the first or during the second filling phase. Women with any bowel disease, history of bleeding per rectum were excluded, or women with any contraindication to undergoing urodynamics, or insertion of a device per rectum. All women of a reproductive age underwent pregnancy test and excluded if found to be pregnant. Thirty patients were recruited, 16 reported mixed urinary incontinence (53%), 5 (17%) had isolated overactive bladder (OAB) symptoms and 9 (30%) reported isolated stress urinary incontinence. Patients with distended rectum had statistically significant lower bladder volumes at which first (46% reduction) and strong desire (33% reduction) was felt and reduced maximum bladder capacity (26% reduction) when compared to the rectum being undistended. In four patients (13%) with a history of OAB a diagnosis of detrusor overactivity was found with the rectum was distended but not when the rectum was empty. Rectal distension alters bladder sensation and in some cases urodynamics diagnosis.

MiniArc™ : étude prospective et suivi à un an d’une série de 72 patientes

To evaluate the results at 1 year of a mini invasive sub urethral sling, not requiring no more a single incision.Prospective study of 72 patients with isolated stress urinary incontinence. The procedures were performed on an outpatient under local anesthesia. Pain was assessed using the visual analogue scale. All patients were checked at 2 months and 1 year of intervention.Stress urinary incontinence for 58 patients, 14 for mixed incontinence and sphincter deficiency for five. As per procedure, the average pain was 3.7/10, at the end of the intervention, 0.5/10. Peroperative complications were: one episode involving bleeding over 100ml, one vasovagal episode, and one procedure failure. At 2 months follow-up, the authors recorded: de novo urge incontinence (n=2), de novo dysuria (n=1), sling exposure (n=1), urinary infection (n=1) and noticeable side ties (n=4). Control at 1 year, another patient filed an eviction of the anchor of the tape with Stall thereof. Two patients reported having moderate pain. The objective results at 1 year of 68 patients were 69.1% cured, 20.6% improved and 10.3% failed. Three patients were re-operated and two of them are cured.The results of this simplified tape are worse than those of classic sub-urethral tape; however, no comparative study has been completed and the specific indications of these techniques are not specified.

TVT Secur™ : de plus en plus minimal invasif. Étude préliminaire prospective sur 110 cas

To present a new minimal invasive suburethral tape device derivative of the classic TVT, to describe the technique of laying, to evaluate complications and results to short term.Prospective multicentric study of 110 patients presenting a stress urinary incontinence and benefiting from the laying of TVT Secur without associated operation. The tape is identical to that old-fashioned retropubic and obturator TVT, smaller, laying in "U" or in "hammock" without orifice of exit, to avoid complications due to crossed spaces of the other techniques. The device and the technique of laying are described by authors. The originality of the TVT Secur resides in the mechanism of insertion of the tape to a metallic divice. All patients have been controlled at two months and complications with notably pains (quotation VAS) as well as objective results have been reported.Pure and isolated stress urinary incontinence for 71 patients, mixed incontinence for 39 and sphincter deficient for 23. Preoperative urgency for 49 patients and dysuria for 10 of them. The method "hammock" has been used in 85.5% of cases. The type of anaesthesia has been pure local for 69.1% (0 to 98.8% for the different centers) with an average operative time of 8'30". Under local anaesthesia, the average per operative pain was quoted 2.8/10, and 0.7 at the end of intervention. Peroperative complications have revealed a wound of bladder, a vaginal wound and four bleeding of more than 100ml. In immediate continuations a total retention yielding to 24h and 13 postmicturition residual between 100 and 200ml have been mentioned. At two months, authors have observed the following: de novo urgency in 19.6%, de novo dysuria in 13.2%, one tape exposition, one granuloma, one urinary infection and seven perceptible lateral cords without pain. Thirteen patients have signalled to have had moderated pains on a duration of four to 30 days. Early objective results are globally 70.4% of dry patients (83% for pure isolated SUI, 72.2% for SUI with deficient sphincter, 50% for mixed incontinence). The pure local anaesthesia was recommended by 98% of patients.The diminution of complications ahead not to be made to the detriment of results, it is necessary to envisage multicentric studies with standardized modifications. The indications of this new device will have to be defined.

Incontinencia urinaria de esfuerzo asociada a obstrucción del tracto urinario inferior en el cistocele

The association of stress urinary incontinence secondary to urethral hypermobility and lower urinary tract obstruction in the same patient with cystocele is rare, and even represents a contradiction. The objective of our work is to treat to define the characteristics that identify this entity, in comparison with isolated stress urinary incontinence or lower urinary tract obstruction in patients with cystocele. We performed a retrospective study in 1168 cases of cystocele in which urodynamic studies were performed. All patients underwent history and neurological and uro-gynecologycal physical examination. The urodynamic study included uroflowmetry, cystomanometry, voiding pressure/flow tests and voiding cystourethrograms. All data were collected in an Excel 2000 database and statistical analysis was performed with the SPSS software. A- General data: 25 cases qualified for the study in group I (isolated stress urinary incontinence with urethral hypermobility); 24 cases in group II (lower urinary tract obstruction); and 14 cases in group III (astress urinary incontinence associated with lower urinary tract obstruction). The proportion of each group in the whole group of cystoceles corresponded to a 4/1/0.05 ratio respectively. Mean age was 58.4 years for group I, 68.2 for group II and 71.2 for group III. A Statistically significant lower age was demonstrated for group I (p < 0.0005). B- The symptom "sensation of vaginal lump" was less frequent in group I (32%). A significant difference was demonstrated (p = 0.02). C- Group I showed a lower increase of daily voiding frequency (32%), p = 0.02. D- Group I showed less night-time voiding frequency (1 episode)(p < 0.04). E- Urinary incontinence with cough was less frequent in group 1 (84%) (p = 0.0004). F- Group I had more bladder capacity (243.6 ml) (p < 0.05).G- Group I showed less urethral resistances (URA = 37.9 cm H2O) (p = 0.01). H- W80-W20 was higher in group I: 1.3 W/m2 (p < 0.05). I- The symptom "sensation of vaginal lump appeared more often in group II (70.8%) (p = 0.02). J- Radiological degree of cystocele was greater in group II1 (1.7) (p < 0.05). K- Detrusor hyperactivity was more frequent in group III (64.3%) (p = 0.00009). L- No significant differences were found between groups II-III when comparing type of obstruction. The group of isolated stress urinary incontinence (group I) is characterized by a younger age, less frequency of sensation of vaginal lump, less daily frequency and nocturia, and urodynamic data of greater bladder capacity, lower urethral resistance and normal detrusor contractility. The group of isolated lower urinary tract obstruction (group II) could be characterized by a more frequent sensation of vaginal lump and increase of the radiological cystocele. The group of stress urinary incontinence associated with lower urinary tract obstruction had a higher percentage of cases of detrusor hyperactivity. All these data might enable a proper identification of different risk elements in the groups.

Soutènement sous-urétral par la voie obturatrice pour la cure chirurgicale de l’incontinence urinaire d’effort féminine: dehors en dedans (Monarc®) versus dedans en dehors (TVT-O®)

The originally described outside-in procedure for the trans-obturator route was later turned inside-out. We wanted to demonstrate the safety of the two techniques through personal and published experience. Non-randomized, prospective, observational, open-label, longitudinal study of 100 female patients (50 TVT-O and 50 Monarc). All the female patients presented with isolated stress urinary incontinence. Only 4 patients presented with mixed incontinence in the Monarc (MON) group. Sphincter incompetence was observed 4 times in the MON group and 3 times in the TVT-O group. All the patients underwent surgery under assisted local anesthesia in a day-hospital setting. Only those patients presenting with patent established urinary incontinence, corrected by the TVT test, underwent surgery. Post-operative control was conducted at 3 months and 1 year. The duration of hospitalization was 10 h for 48 patients in the MON group and 49 in the TVTO group. The only per-operative complication was a vaginal perforation in the lateral angle of the vagina for a MON patient. Early post-operative complications were observed in the MON group: 3 cases of urinary tract infection, 1 of transient urine retention, 3 of pain in the thighs spontaneously resolving within 4 days and 1 of permanent pain in one leg at time 1 year, which remained bearable. For the TVTO group the post-operative complications consisted in: 1 case of urinary tract infection, 1 of transient retention and 4 of pain in the thigh. No hematoma was reported in either group. Among the late complications, the de novo symptoms included 1 case of imperious urges to urinate in the TVTO group and objective dysuria in 2 cases in the MON group vs. 7 in the TVTO group. There was no statistically significant between-group difference in the complications. No tape exposure was observed. Overall, the recovery rate was 90% at 1 year for MON vs. 94% for TVTO (p = NS) with 2 cases of recurrence between 3 months and 1 year in that series. Mixed incontinence was corrected at time point 1 year in 75% of cases for MON, with 1 case of recurrence in the year. For the patients presenting with sphincter incompetence, competence was maintained at 3 months and 1 year in all cases in the MON group. The 3 TVT-O were cured at 3 months, but 2 recurrences were observed at 1 year. All patients, except one, were satisfied at time point 1 year and those who had sexual relations (54%) did not report any disorder at time point 1 year. The cadaveric studies by advocates of the outside-in technique show a vascular and nervous risk which has received little attention in terms of complications in the literature. Post-operative leg pain is encountered with both techniques and usually is transient. Our experience, like that reported in the literature, shows that the two trans-obturator access routes are equally safe. The clinical results would appear to be equivalent, in terms of recovery, to the rates obtained with retropubic TVT.

Trans-obturator urethral sling for the surgical correction of female stress urinary incontinence: Outside-in (Monarc ®) versus inside-out (TVT-O ®) : Are the two ways reassuring?

Introduction In 2001, the trans-obturator route was proposed for the surgical positioning of tape with a view to avoiding the retropubic space and its disadvantages. The route, originally described outside-in by Delorme was presented inside-out by de Leval. Since then, anatomical discussions have attempted to prove that one technique is safer than the other. Objective Demonstrating the safety of the two techniques through personal and published experience. Material and methods Non-randomized, prospective, observational, open-label, longitudinal study of 100 female patients (50 tension-free vaginal tape (TVT)-O ® and 50 Monarc ®). All the female patients presented with isolated stress urinary incontinence. Only four patients presented with mixed incontinence in the Monarc (MON) group. Sphincter incompetence was observed four times in the MON group and three times in the TVT-O group. Almost all the patients were undergoing their first procedure. All the patients underwent surgery under assisted local anesthesia in a day-hospital setting. All the patients underwent a full gynecological examination and a urodynamic assessment. Only those patients presenting with patent established urinary incontinence, corrected by the TVT test, underwent surgery. Post-operative control was conducted at 3 months and 1 year when a physical examination and urodynamic assessment were implemented. Results All the patients underwent control up to time point 12 months. The duration of hospitalization was 10 h for 48 patients in the MON group and 49 in the TVT-O group. The duration of hospitalization was 24 h for one patient in each group and 4 days for one patient in the TVT-O group due to transient urine retention. The only per-operative complication was a vaginal perforation in the lateral angle of the vagina for a MON patient. Tape repositioning was necessary. Early post-operative complications were observed in the MON group: three cases of urinary tract infection, one of transient urine retention, three of pain in the thighs spontaneously resolving within 4 days and one of permanent pain in one leg at time 1 year, which remained bearable. For the TVT-O group the post-operative complications consisted in: one case of urinary tract infection, one of transient retention and four of pain in the thigh. No hematoma was reported in either group. Amongst the late complications, the de novo symptoms included one case of imperious urges to urinate in the TVT-O group and objective dysuria in two cases in the MON group versus seven in the TVT-O group. There was no statistically significant between-group difference in the complications. No tape exposure was observed. Overall, the recovery rate was 90% at 1 year for MON versus 94% for TVT-O ( p = NS) with two cases of recurrence between 3 months and 1 year in that series. Mixed incontinence was corrected at time point 1 year in 75% of cases for MON, with one case of recurrence in the year. For the patients presenting with sphincter incompetence, competence was maintained at 3 months and 1 year in all cases in the MON group. The three TVT-O were cured at 3 months, but two recurrences were observed at 1 year. Almost all the patients were satisfied or very satisfied at time point 1 year and those who had sexual relations (54%) did not report any disorder at time point 1 year. Discussion The outside-in technique necessitates more marked peri-urethral dissection and vesical complications are possible. The cadaveric studies by the outside-in partisans show a vascular and nervous risk, which has little reflection in terms of complications in the literature. Post-operative leg pains are encountered with both techniques and are usually only transient. All the studies of the two routes report a recovery rate of over 90% for pure stress incontinence. Conclusion The author's experience, like that reported in the literature, shows that the two trans-obturator access routes are equally safe and do not require per-operative cystoscopic control. The clinical results would appear to be equivalent, in terms of recovery, to the rates obtained with retropubic TVT. Attempting to find anatomical or etiological arguments in order to prove one technique superior to the other appears somewhat parochial.

Urogynaecology: Quality of life before and after TVT, a prospective multicentre cohort study, results from the Netherlands TVT database

To asses the long term outcome of tension-free vaginal tape procedure in women with isolated stress urinary incontinence (SUI). Prospective cohort study. Twenty-eight teaching hospitals and 13 local hospitals, with 54 gynaecologists and urologists performing the surgery. Eight hundred and nine participants. The Incontinence Impact Questionnaire (IIQ-7) and the Urogenital Distress Inventory (UDI-6) were used to measure the results of the TVT procedure (pre-operative at 2, 6, 12 and 24 months post-operative). According the recommendation of the International Continence Society (ICS), the question 'Do you experience urinary leakage during physical activity, coughing or sneezing?' was selected from the UDI to asses SUI. Incontinence Impact Questionnaire (IIQ-7) and the Urogenital Distress Inventory (UDI-6). Both IIQ and UDI mean scores decreased significantly after TVT, indicating an improvement in quality of life. Subjective improvement can improve for up to two years post-operatively. This is the largest prospective study that used these validated disease-specific questionnaires to asses the long term outcome of the TVT procedure. This study shows a statistically significant and clinically relevant long term improvement of the quality of life after a TVT for women with SUI.

OBTURATOR INFECTED HEMATOMA AND URETHRAL EROSION FOLLOWING TRANSOBTURATOR TAPE IMPLANTATION

Since the introduction of the tension-free vaginal tape (TVT) procedure as surgical treatment of female stress urinary incontinence, several tape and other minimally invasive procedures have been developed. The transobturator tape (TOT) procedure was developed to reproduce, through the obturator and puborectalis muscles, the natural suspension fascia of the urethra.1 This procedure was developed to prevent bladder perforation and is considered to be associated with a low morbidity.1 We report a case of infected hematoma and urethral erosion following the transobturator tape procedure. To our knowledge this is the first case of urethral erosion and the second case of infected hematoma reported in the literature. CASE REPORT A 43-year-old woman with a history of hypothyroidism, depression, appendectomy and uterine fibroma was referred for lateral right labia majora pain radiating to the internal face of the thigh, increased at the sitting position, associated with a purulent vaginal flow and dyspareunia. The patient had been treated 6 months earlier for isolated stress urinary incontinence by a suburethral nonwoven, nonelastic polypropylene tape placed through the obturating membrane. Symptoms appeared on postoperative day 1. Physical examination showed an anterior vaginal erosion associated with a purulent flow. Bacteriological study of the vaginal flow revealed group B streptococcus. With the patient under general anesthesia vaginal examination demonstrated a urethral erosion opposite the silicone portion of the tape. Faced with the impossibility of removing the totality of the tape, only the silicone portion was removed. The urethra was sutured, and the paraurethral spaces were abundantly washed with a mixture of povidone iodine and serum. The edges of the vaginal erosion were resected and a suprapubic catheter was placed. At 48 hours postoperatively pain persisted, and opposite the obturating hole an inflammatory, hot, painful tumefaction appeared. This abscess was evacuated and drained surgically. At the bottom of the abscess the right portion of the tape was found and easily extracted. The pain then disappeared but the vaginal flow persisted associated with recurrence of the urethrovaginal fistula. The left portion of the tape was then removed by a transobturator route and the vaginal flow disappeared. One month later urethroplasty was performed. Three months later the vagina and the urethra were cicatrized, and the patient remained continent.

Prevalence of anal incontinence in 409 patients investigated for stress urinary incontinence

A clinical questionnaire concerning anorectal symptoms and urodynamic tests was used to investigate 409 women consulting for stress urinary incontinence. To compare urodynamic data, patients were divided into three goups of women who had either stress urinary incontinence associated with incontinence for formed and/or liquid stools or with gas incontinence, or isolated stress urinary incontinence. To take in account the patients'age for data interpretation, a Mantel-Haenszel test or covariate analysis was performed. Anal incontinence was reported in 114 (28%) of the 409 women investigated. The prevalence of incontinence for gas only, for liquid, or for solid stools was 18.3, 9.3, and 1%, respectively. The duration of gas incontinence was longer than that of fecal incontinence or stress urinary incontinence. Difficult defecation was more frequently observed in patients with double incontinence than in patients with only stress urinary incontinence, and the difference was significant between patients with gas incontinence and patients with stress urinary incontinence (53% versus 37%, P = 0.03). There was no difference in the number of bowel movements per week among the three groups of patients. The number of vaginal deliveries was surprisingly lower in patients with fecal incontinence associated with urinary incontinence than in others. There was no urodynamic feature that could distinguish patients with urinary incontinence and patients with double incontinence. This study confirmed the close relationship between anal and stress urinary incontinence. Neurourol. Urodynam. 18:579–590, 1999. © 1999 Wiley-Liss, Inc.