The coexistence of intrinsic sphincter deficiency with type II stress incontinence

Purpose: We investigate the coexistence of intrinsic sphincter deficiency a nd urethral hypermobility with type II stress incontinence and moderate cys tocele. Materials and Methods: Abdominal leak point pressure measurements were perf ormed during cystometric evaluation with Valsalva's maneuvers in 50 consecu tive women 33 to 73 years old (mean age 48.8) diagnosed with urethral hyper mobility and moderate cystocele on pelvic examination and cotton swab test. Patients with unstable detrusor contractions or urgency with detrusor hypo compliance were excluded from the study. Results: Of the 50 women 36 (72%) had pure urethral hypermobility, and 14 ( 28%) were diagnosed with intrinsic sphincteric deficiency and hypermobility (mixed incontinence group), including 6 (42.8%) who had undergone previous surgery. No predisposing factor responsible for intrinsic sphincteric defi ciency was noted in 8 mixed incontinence group patients (57.2%). Conclusions: The high rate of intrinsic sphincteric deficiency in patients with urethral hypermobility indicates that the incidence with stress incont inence may be greater than previously believed, and may influence the appar ently higher failure rates after bladder neck suspension. We believe that l eak point pressure measurements are not necessary with sling procedures whi ch correct urethral hypermobility and intrinsic sphincter deficiency but ar e required if bladder neck suspension is planned.