GENUINE STRESS URINARY-INCONTINENCE WITH LOW URETHRAL PRESSURE - 5-YEAR FOLLOW-UP AFTER THE BALL-BURCH PROCEDURE

OBJECTIVE: To evaluate long-term results of the Ball-Burch procedure i n women with genuine stress incontinence (GSI), low urethral pressure type. STUDY DESIGN: Sixty women with a clinical and urodynamic diagnos is of GSI, low urethral pressure type, underwent the Ball-Burch proced ure between May 1987 and February 1988. They were evaluated preoperati vely and one and five years after surgery. The urogynecologic workup c onsisted of a history, physical examination, urine culture, neurologic examination, urethrocystoscopy, cotton swab test, urethrocystometry, urethral profilometry and uroflowmetry. Forty-eight women were availab le at the one-year follow-up, and 32 of the 48 (66.7%) were available after five years; the mean age at the time of surgery was 58.7 years a nd mean parity, 2. Twenty-seven women were premenopausal and 33 postme nopausal; at the five-year follow-up all but 2 were postmenopausal. Al l postmenopausal women received estrogen replacement therapy prior to urodynamic evaluation. Cure was defined as absence of loss of urine by history (subjective) and during urodynamic evaluation (objective). Th e t test and paired t test were used for statistical analysis. RESULTS : Forty-two of 48 women (87.5%) were cured after one year, and 27 of 3 2 (84%) weve cured after five. There was a statistically significant d iffer ence between the preoperative and five-year follow-up values for the swab test, maximum urethral closure pressure and pressure transmi ssion ratio at the proximal and mid urethra. Twenty-six of 29 patients with a negative swab test at the one-year follow-up were ctiued after five years, resulting in a predictive value of 89% for cure after a n egative test. CONCLUSION: In our series the Ball-Burch procedure was a n effective surgical treatment for patients with GSI and low urethral pressure. The swab test, when negative one year after surgery, tons pr edictive of a successful long-term outcome.