Stamey Score Research Articles

Clinical score predictive of abdominal leak point pressure (ALPP)

ObjectiveThe aim of this study was to perform a score predictive of ALPP <60 cm H2O from clinical factors in women with stress urinary incontinence (SUI). Study designWe performed a descriptive and observational study of women referred for a urodynamic study for stress urinary incontinence. Patients were divided into three groups: ALPP: >90 cm H2O, between 60 and 90 cm H2O and <60 cm H2O. A logistic regression study was performed in order to complete clinical predictors of ALPP < 60 cm H2O. Variables that were significant in the multivariate analysis were included in the score. ResultsWe studied 158 patients: 65 presented ALPP > 90 cm H2O, 64 between 60–90 cm H2O and 29 <60 cm H2O. In the multivariate analysis, were presented as independent predictors of ALPP < 60 cm H2O, the presence of a fixed urethra (p 0.01), empty bladder test positive (p 0.02) and presence of symptoms grade III in the classification of Stamey (p 0.03). The accuracy of the test was: score 0, 42%; score 1, 58%; score 2, 81%. Receiver Operating Characteristic (ROC) analysis for the overall cutoff points revealed an area under the curve of 0,75. ConclusionsPresence of a fixed urethra, positive empty bladder test and patients with a high degree of SUI symptoms according to the Stamey score are independent clinical predictors of intrinsic sphincter deficiency. This score could represent a useful clinical tool to predict the presence of ALPP <60 cm H2O based on clinical parameters.

Predictors of sexual function in women with stress urinary incontinence

To assess female sexual function (SF) in different grades of urodynamic stress urinary incontinence (SUI), with/without pelvic organ prolapse (POP); to investigate associations between clinical data and pelvic organ prolapse/urinary incontinence sexual questionnaire (PISQ) scores. A cross-sectional study was conducted in sexually active women (130 with SUI and 126 controls). Stamey score and POP quantification (POP-Q) were used. Urogynecological examinations were performed; all participants completed PISQ. Multivariable linear regression was used to identify negative SF predictors. SF was lower in the study group (P < 0.001), in moderate (P < 0.001), and severe SUI (P < 0.02) versus controls, in each particular domain and total PISQ-score (total score: 83.8 ± 14.8, 80.8 ± 14.5, 84.5 ± 11.1 vs 95.7 ± 10.3, respectively). Women with mild SUI had better SF in physical and partner-related domains compared to moderate SUI (33.6 ± 6.1 vs 30.7 ± 6.4, P < 0.02; 18.8 ± 2.9 vs 17.3 ± 3.3, P = 0.02, respectively). Age correlated with PISQ-scores in behavioral/emotive (r = -0.24, P = 0.006), and partner-related domains (r = -0.28, P = 0.002), and total PISQ-score (r = -0.2, P = 0.02); menopausal status with partner-related domain (r = -0.32, P = 0.000) and total PISQ-score (r = -0.19, P = 0.029); menopause duration with physical domain (r = 0.17, P = 0.045); SUI stage only with PISQ scores in physical domain (r = -0.22, P = 0.014). No correlations were found between BMI, parity, number of vaginal deliveries, POP-Q stages, with PISQ results. Age in the SUI group and controls (β = -0.18, P < 0.05) and BMI in controls (β = -0.26, P < 0.01) were independent predictors of impaired SF. Different SF predictors were found in SUI women and controls. Impaired SF was confirmed in SUI women compared to controls, with more severe SUI corresponding to lower SF.

A Randomized, Controlled Clinical Trial of a Novel Intravesical Pressure Attenuation Device for the Treatment of Stress Urinary Incontinence

In this clinical trial we evaluated the efficacy, safety and tolerability of a novel pressure attenuation device for the reduction or elimination of female stress urinary incontinence using a prospective, randomized, single-blind, multicenter design. A total of 166 female patients with stress urinary incontinence were randomized 2:1 to treatment with an intravesical pressure attenuation device (112) or sham procedure (54). In the treatment arm the device was replaced every 90 days and in the sham arm device replacement was simulated every 90 days. The primary outcome measure was Stamey score improvement of 1 or more at 6 months. An additional outcome measure evaluated at 6 months was a composite score combining data from a provocative pad test and patient impression of symptom improvement. In the treatment arm 40.9% of women achieved the primary end point, compared to only 22.4% in the sham arm (p=0.046 in per protocol analysis). In an intent to treat analysis, 28.6% of women in the treatment arm reached the primary end point vs 22.2% of women in the sham arm (p=0.455). 50.8% of women in the treatment arm reached the composite end point compared to 16.3% of women in the control arm (p<0.001, intent to treat analysis). Three-day voiding diaries revealed a mean reduction in total daily leakage events after 6 months from 4.4 per day to 2.5 per day (43.2%) in the treatment group vs 5.4 per day to 4.1 per day (24.1% reduction) in the control group (p<0.001). Minimally invasive treatment for female stress urinary incontinence with a first-generation intravesical pressure attenuation device was safe and effective when evaluated by a composite end point. For those patients that can tolerate the device, the concept of pressure attenuation as a therapy for stress urinary incontinence is valid and feasible. Further modifications are anticipated for this device potentially resulting in improved outcomes.

Five Years Follow-Up of Adjustable Continence Therapy (ACT) in the Treatment of Recurrent Female SUI

Purpose/Objective: The primary objective of this FDA study is to evaluate the safety and efficacy of the ACT device (Adjustable Continence Therapy) in the treatment of female recurrent Stress Urinary Incontinence (SUI). The secondary objective is to evaluate the difficulty of placement and aspects of device adjustability. Materials and Methods: The Adjustable Continence Therapy (ACT) system (Uromedica, Inc., Plymouth, MN) consists of two silicone balloons providing urethral coaption and bladder neck support. Each balloon is attached to a titanium port buried in the labia allowing for post-operative adjustment of volume. Females with recurrent SUI with or without urethral hypermobility were evaluated at baseline and follow-up periods of 6 weeks, 3, 6, 9, 12 months and annually thereafter including urinalysis, a 3-day voiding diary, provocative pad weight test, direct visual stress test, Stamey score and validated questionnaires to assess severity of incontinence, voiding dysfunction, sexual function and quality of life. Results: During a 5 years period (2002-2007), 162 patients were implanted (mean age 67.6, range 31 - 94 years). Of these 162 patients 142, 90, 80, 56 and 31 patients completed the 1, 2, 3, 4 and 5 years follow-up respectively. One hundred and thirty five (83%) had failed at least one surgery for incontinence and 44% had failed 2 or more procedures prior to ACT implantation. Difficulty of ACT placement was rated mild in 62%, moderate in 30% and severe in 9%. Improvement in Stamey score of >1 grade was achieved in 75% (107/142) at 1 year, 76% (68/90) at 2 years, 86% (62/78) at 3 years, 93% (50/54) at 4 years and 83% (25/30) at 5 years. Dry rate (provocative pad weight 2 gms) was 51%, 62% , 76%, 76% and 76% at 1 through 5 years, and >50% improvement was achieved in 83%, 86%, 86%, 90% and 93%,respectively. IQoL improved from 37 at baseline to 71, 71, 75, 77 and 74 during the study, and optimal continence was achieved with a mean of 4 adjustments, and mean balloon volumes of 4.0 ml (1.0 - 11.5 ml). Complications including bladder perforation, erosion, migration, pain and urinary retention were reported in 25% (38/155) at 12 months, and 9% (10/109), 3% (3/91) , 6% (5/79) and 4% (3/69) respectively, and of these, the majority were mild to moderate. At 5 years, 33 patients had undergone permanent explants of both devices, 48 were lost to follow-up and 6 had died of unrelated causes. Conclusions: Five years data suggest that ACT is, a safe and effective, minimally invasive treatment for recurrent SUI, which is easy to place and adjust to optimize urinary control without impairing bladder emptying.

Monoprosthesis for anterior vaginal prolapse and stress urinary incontinence: midterm results of an international multicentre prospective study

Stress urinary incontinence (SUI) can occur simultaneously with anterior vaginal prolapse (AVP) in up to 30% of patients. We studied a monoprosthesis that combines prepubic and transobturator arms for simultaneous treatment of AVP and SUI. One hundred four women with AVP underwent surgical treatment using a monoprosthesis (NAZCA TC). POP-Q was used for anatomical evaluation. Functional results were evaluated by quality of life questionnaires, stress test and Stamey score. Patients were evaluated at 1, 3, 6 and 12 months postoperatively. There were significant and sustained improvements in points Aa, Ba and C. Positive stress test was observed in 29.8% preoperatively and decreased to 1.9% after 12 months. There was no significant impact in sexual symptoms. Mesh exposure was noted in 5.7% of patients. Monoprosthesis with combined prepubic and transobturator arms presented high success rates for AVP repair and simultaneous SUI treatment. It has also been shown to be safe and appears to preserve sexual function.

1865 URINARY SYMPTOMS IN YOUNG WOMEN: COMPARING ORAL CONTRACEPTIVE PILL(OCP) USERS AND NON-USERS

Improvement in Stamey score of 1 grade was achieved in 75.4% (107/142) at 1 year, in 75.6% (68/90) at 2 years, in 84.9% (62/73) at 3 years and in 92.9% (39/42) at 4 years. Dry rate (PPWT 2 gms) was 51%, 62% and 74%, and 77% and 50% improved rate was 80%, 86%, 83% and 89% at 1, 2, 3 and 4 years, respectively. IQoL increased from 36.8 (SD 23.1) at baseline compared to 70.0 (SD 25.5), 71.7, 74.1 and 80.6 at 1, 2, 3 and 4 years. Optimal continence was achieved with a mean of 3 adjustments. Mean balloon volumes were 3.9 ml (1.0–11.5 ml). Device or procedure related complications (bladder perforation, port or balloon erosion, balloon migration, port or balloon related discomfort, intermittent urinary retention) were reported in 25% (39/ 156) of subjects at the end of 12 months, 19% (22/116) through year 2, 11.1% (10/90) through year 3 and 13.2% (3/22) through year 4. Of these, the majority were considered to be mild in severity. At 4 years 29 patients had undergone permanent explants of both devices, 43 were lost to follow up and 6 had died of unrelated causes. CONCLUSIONS: Four year data suggest ACT is a simple, safe and minimally invasive effective treatment for recurrent female SUI.

Treatment of moderate to severe female stress urinary incontinence with the adjustable continence therapy (ACT) device after failed surgical repair

Treatment of recurrent stress incontinence after a failed surgical procedure is more complicated, and repeat surgeries have higher rates of complications and limited efficacy. We determined the technical feasibility, efficacy, adjustability, and safety of adjustable continence therapy device for treatment of moderate to severe recurrent urinary incontinence after failed surgical procedure. Female patients with moderate to severe recurrent stress urinary incontinence who had at least one prior surgical procedure for incontinence were enrolled. All patients underwent percutaneous placement of adjustable continence therapy (ACT) device (Uromedica, Plymouth, Minnesota). Baseline and regular follow-up tests to determine subjective and objective improvement were performed. A total of 89 patients have undergone implantation with 1-3 years of follow-up. Data are available on 77 patients at 1 year. Of the patients, 47% were dry at 1 year and 92% improved after 1-year follow-up. Stamey score improved from 2.25 to 0.94 at 1 year (P < 0.001). IQOL questionnaire scores improved from 33.9 to 71.6 at 1 year (P < 0.001). UDI scores reduced from 60.7 to 33.3 (P < 0.001) at 1 year. IIQ scores reduced from 57.0 to 21.6 (P < 0.001) at 1 year. Diary incontinence episodes per day improved from 8.1 to 3.9 (P < 0.001) at 1 year. Diary pads used per day improved from 4.3 to 1.9 (P < 0.001). Explantation was required in 21.7% of patients. The ACT device is an effective, simple, safe, and minimally invasive treatment for moderate to severe recurrent female stress urinary incontinence after failed surgical treatment.

Salvage Spiral Sling Techniques: Alternatives to Manage Disabling Recurrent Urinary Incontinence in Females

Females with recurrent stress urinary incontinence after anti-incontinence surgery represent a therapeutic challenge. In our experience and that of others standard sling procedures have occasionally failed to correct these problems. We determined the effectiveness of various spiral sling techniques used in these cases to manage pipe stem urethras in which conventional slings had failed. Between January 2007 and July 2008 we evaluated 30 female patients with persistent stress urinary incontinence after multiple failed anti-incontinence procedures. Preoperative and postoperative evaluation consisted of history, physical examination, number of pads, Stamey score and quality of life questionnaires. We followed 28 patients a minimum of 15 months (range 15 to 18). Mean patient age was 60 years (range 36 to 84). At presentation patients had undergone a mean of 3.5 prior vaginal procedures (range 1 to 6) and used a mean of 7 pads daily (range 3 to 12). Of the patients 21 received a synthetic spiral sling, 5 received an autologous spiral sling (rectus fascia in 3 and fascia lata in 2) and 3 received a lateral spiral sling. Mean pad use decreased to 0.9 daily (range 0 to 2, p<0.05). Postoperative mean Stamey score decreased from 2.6 to 0.3 (p<0.05). Complications included unilateral vesical perforation in 3 patients with a contralateral lateral spiral sling. The overall success rate was 72%. Salvage spiral sling techniques are a satisfactory alternative treatment for refractory stress urinary incontinence. When synthetic material cannot be used, autologous tissue can provide similar results. When the bladder is perforated unilaterally, a lateral spiral sling can be used on the contralateral side.

V171 SALVAGE SPIRAL SLING TECHNIQUES: ALTERNATIVES FOR THE MANAGEMENT OF DISABLING RECURRENT URINARY INCONTINENCE IN FEMALES

You have accessJournal of UrologyFemale Voiding Dysfunction (Pelvic Reconstruction & Incontinence)1 Apr 2010V171 SALVAGE SPIRAL SLING TECHNIQUES: ALTERNATIVES FOR THE MANAGEMENT OF DISABLING RECURRENT URINARY INCONTINENCE IN FEMALES Alejandro R. Rodriguez, Tariq Hakki, Jorge Caso, Raul Ordorica, and Jorge Lockhart Alejandro R. RodriguezAlejandro R. Rodriguez More articles by this author , Tariq HakkiTariq Hakki More articles by this author , Jorge CasoJorge Caso More articles by this author , Raul OrdoricaRaul Ordorica More articles by this author , and Jorge LockhartJorge Lockhart More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.226AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Females with recurrent stress urinary incontinence (SUI) following anti-incontinence surgery represent a therapeutic challenge. In our experience and that of others, standard sling procedures have failed to consistently correct these problems. In this video we are presenting a variety of spiral sling techniques that were used in these situations. METHODS Between January 2007 and July 2008, 30 female patients with persistent SUI following multiple failed anti-incontinence procedures were evaluated. The main indication for placement of a spiral sling included one or both of the following: 1.Failed previous anti-incontinence procedures with at least one prior sling placement and 2.ISD incontinence without concomitant urethral mobility. Preoperative evaluation included medical history, quality of life questionnaire, physical examination, urinalysis and culture, a Stamey score, cystoscopy, and video urodynamic assessment. The technique starts with a midline incision performed in the anterior vaginal wall approximately 1 cm away from the urethral meatus and carried down to the proximal urethra. The surgical procedure requires a circumferential dissection of the proximal urethra prior to sling placement. All the slings measured 1 x 16 cm. All the synthetic spiral slings (SSS) were polypropylene mesh with a zero polyglactin suture applied at each end. Slings were wrapped around the urethra to provide 360 degrees of compression prior to securing without tension. Patients were followed with number of pads, Stamey score, and quality of life questionnaires. RESULTS Twenty-nine patients were followed for a minimum of 15 months (15-18 months). Mean age was 60 years (36-84 years). At presentation, the mean number of prior vaginal procedures and pads used was 3.5 (1-6) and 7 (3-12), respectively. 21 had a synthetic spiral sling (SSS), 5 had an autologous spiral sling (AUSS)(3 rectus fascia and 2 fascia lata), and 3 underwent a lateral spiral sling (LSS). Mean daily pad use decreased to 0.9 (0-2) (p<0.05). Postoperative mean Stamey score decreased from 2.6 to 0.3 (p<0.05). Complications included 3 unilateral vesical perforations, in which the contralateral LSS was used. Overall success rate was 72%. CONCLUSIONS Salvage spiral sling techniques represent a satisfactory alternative for the treatment of refractory urinary incontinence. When synthetic material can not be used, autologous tissue can provide similar results. When the bladder is unilaterally perforated an LSS can be used on the contralateral side. Tampa, FL© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e69 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Alejandro R. Rodriguez More articles by this author Tariq Hakki More articles by this author Jorge Caso More articles by this author Raul Ordorica More articles by this author Jorge Lockhart More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Oral Poster 20

OBJECTIVES: Evaluate the safety and efficacy of the ACT® device for the treatment of recurrent SUI. Secondary objectives included procedural technical difficulty and device adjustability. MATERIALS AND METHODS: Management of stress urinary incontinence (SUI) associated with intrinsic sphincter deficiency (ISD) can be challenging after prior failed therapies. The Uromedica ACT® system is a novel device under FDA investigation that provides bulk at the bladder neck with adjustable silicone balloons for urethral coaptation and bladder neck support. Each balloon is attached to a titanium port allowing for post-operative titration of the balloons for maximal efficacy. A small incision between the labia majora and minora at the level of the urethral allows for passage of a trocar under fluoroscopic guidance to the bladder neck. The device is delivered and the balloon filled with 1.5 cc dilute contrast. The injection port for balloon adjustment is placed into a subcutaneous pouch in the labia majora. Balloon adjustments begin 6 weeks post-operatively, as needed. The study population involves female patients with recurrent SUI with urethral hypermobility (UHM) and/or intrinsic sphincter deficiency (ISD). Testing was performed at baseline, then postop 6 wks, 3, 6, 9, 12 months, and annually thereafter, and included urinalysis, a 3-day diary, provocative pad weight test (PPWT), direct visual stress test (DVST), Stamey score, physical exam and validated questionnaires (UDI-6, IIQ-7, IQoL). RESULTS: : 162 patients were implanted to date, with 142, 84 and 57 patients completing at least 1, 2, and 3 years follow-up, respectively. Mean age is 67.4 yrs (range 31–94 yrs). 83% (N = 135) had at least one previous anti-incontinence procedure, with 42.6% experiencing 2 or more failed procedures. Difficulty of ACT® surgery was rated as mild, moderate, or severe in 62%, 29%, and 9% of procedures, respectively. Improvement in Stamey score was >1 in 75.4% (107/142), in 75.0% (63/84) and in 83.9% (47/56) at 1, 2 and 3 yrs, respectively. Mean PPWT decreased from 48.9, 44.3 and 44.5 grams at baseline to 11.8, 8.9 and 8.4 grams at 1, 2 and 3 yrs, respectively (P < 0.001). Dry rate was 50.8%, 63.0% and 71.4%, and >50% improved rate was 79.7%, 88.7% and 83.3% at 1, 2 and 3 yrs, respectively. Validated questionnaires noted significant improvements at 1, 2 and 3 yrs (P < 0.001). Mean number of balloon volume adjustments through the study period to achieve maximum continence was 2.9 (0–15). Device or procedure related complications (bladder perforation, port or balloon erosion, balloon migration, port or balloon related pain/discomfort, intermittent urinary retention) were reported in 25% (39/156) of subjects at the end of 12 months, 18.6% (21/113) through year 2, and 13.7% (10/73) through year 3. Of these, the majority (54%) were considered to be mild in severity. CONCLUSION: 3-year data suggest the Uromedica ACT® system can be an effective, simple, minimally-invasive and safe treatment for recurrent female SUI.

ProACT™ for Stress Urinary Incontinence after Radical Prostatectomy

Introduction: Stress urinary incontinence is a bothersome complication of radical prostatectomy. Surgical treatment consists of the artificial urinary sphincter (AUS), the male sling and bulk injections. This study presents the results of the first series of implantations of ProACT^TM in the Netherlands. Materials and Methods: A non-validated questionnaire was sent to 29 male patients implanted with ProACT to determine Stamey score, pad count and questions about quality of life and satisfaction. Complications, revisions and explantations were registered. Results: Mean follow-up was 41 months. Based on Stamey score four patients are continent at the end and nine patients according to the pad count. The average pad count decreased significantly. Remarkable was the high rate of dislocations and revisions and patients’ satisfaction. Conclusions: ProACT is a less invasive treatment compared to the AUS. However, the procedure is associated with a substantial revision and explantation rate. ProACT can be part of a so-called step-up approach before opting for a more invasive treatment.

The Adjustable Continence Therapy System for Recurrent Female Stress Urinary Incontinence: 1-Year Results of the North America Clinical Study Group

We determined the efficacy, safety, adjustability and technical feasibility of the adjustable continence therapy device (Uromedica, Plymouth, Minnesota) for the treatment of recurrent female stress urinary incontinence. Female patients with recurrent stress urinary incontinence were enrolled in the study and a defined set of exclusionary criteria were followed. Baseline and regular followup tests to determine eligibility, and to measure subjective and objective improvement were performed. A trocar was passed fluoroscopically and with digital vaginal guidance to the urethrovesical junction through small incisions between the labia majora and minora. The adjustable continence therapy device was delivered and the balloons were filled with isotonic contrast. The injection ports for balloon inflation were placed in a subcutaneous pocket in each labia majora. Device adjustments were performed percutaneously in the clinic postoperatively. An approved investigational device exemption Food and Drug Administration protocol was followed to record all adverse events. A total of 162 subjects underwent implantation with 1 year of data available on 140. Mean Stamey score improved by 1 grade or more in 76.4% (107 of 140) of subjects. Improvement in the mean incontinence quality of life questionnaire score was noted at 36.5 to 70.7 (p <0.001). Reductions in mean Urogenital Distress Inventory (60.3 to 33.4) and Incontinence Impact Questionnaire (54.4 to 23.4) scores also occurred (p <0.001). Mean provocative pad weight decreased from 49.6 to 11.2 gm (p <0.001). Of the patients 52% (67 of 130) were dry at 1 year (less than 2 gm on provocative pad weight testing) and 80% (102 of 126) were improved (greater than 50% reduction on provocative pad weight testing). Complications occurred in 24.4% (38 of 156) of patients. Explantation was required in 18.3% (28 of 153) of the patients during 1 year. In terms of the complications 96.0% were considered to be mild or moderate. The Uromedica adjustable continence therapy device is an effective, simple, safe and minimally invasive treatment for recurrent female stress urinary incontinence. It can be easily adjusted percutaneously to enhance efficacy and complications are usually easily manageable. Explantation does not preclude later repeat implantation.

Success Rate of Modified Pereyra Bladder Neck Suspension Determined by Outcomes Analysis

The reported success rates of the modified Pereyra bladder neck suspension vary from 51 to 90%. Retrospective chart review studies have reported cure rates of 77 to 90%. In contrast, a questionnaire based outcomes analysis, using a strict definition of cure, reported 51% of the patients to be cured of stress urinary incontinence after modified Pereyra bladder neck suspension. We conducted a questionnaire based outcomes analysis of the modified Pereyra bladder neck suspension at our institution. The objectives of the study were to determine the success rates of this procedure using strict criteria in an outcomes analysis format, assess the overall satisfaction of patients postoperatively and identify historical factors that may be predictive of outcome.Between September 1988 and December 1991, 151 patients underwent a modified Pereyra bladder neck suspension for urodynamically documented genuine stress urinary incontinence. Mean patient age was 56 years (range 19 to 82 years) and mean followup was 25 months (range 9 to 45). All patients had type 2 incontinence (anatomical) based on history (severity of symptoms), physical examination, and fluoroscopic assessment of the bladder neck and urethra. Preoperative pad use, and irritative and obstructive symptoms were retrospectively assessed, and a preoperative Stamey incontinence score was assigned. A standardized questionnaire was used to compare preoperative and postoperative voiding symptoms, perception of urinary control and satisfaction with the decision to undergo an operation. Followup telephone calls were made by a trained registered nurse not associated with the original procedure. Postoperative pad use also was quantified and a postoperative Stamey score was assigned.A total of 106 patients (70%) returned the questionnaires. Cure was strictly defined as no urine leakage under any circumstance. While 78% of the patients required no to minimal protection postoperatively, 50 (47%) reported cure of the stress urinary incontinence, 68 (64%) reported subjective improvement, 27 (26%) were the same and 11 (10%) were subjectively worse after modified Pereyra bladder neck suspension. Of the patients 77% were satisfied with the decision to undergo the operation. Patients subjectively worse were significantly older than those subjectively improved (66 versus 54 years, p = 0.05). Postoperative failures had significantly higher obstructive and irritative symptom scores.Questionnaire based outcomes analysis has consistently demonstrated success rates less than those reported in retrospective chart review studies. Outcomes analysis, based on patient assessment of satisfaction, may more accurately reflect the expected surgical outcome after a modified Pereyra bladder neck suspension. We emphasize the need for standardized questionnaires and outcomes analysis to evaluate patient satisfaction with surgery designed to improve quality of life.