Bladder neck suspension for stress urinary incontinence: How does it work?

The objective of this study was to compare urethral resistance as determine d in pressure-flow studies before and after Burch retropubic urethropexy. U rethral resistance was retrospectively determined from pressure-flow studie s in 178 patients before and 1 year after Burch retropubic urethropexy. Res ults of cotton swab tests, pressure transmission to the proximal urethra, a nd urethral functional length were also recorded. Results were analyzed sta tistically using the two-tailed paired t-test. Voiding studies in 176 patie nts were analyzed before and after Burch retropubic urethropexy. Mean ureth ral resistance increased significantly over preoperative values after succe ssful surgery, from 0.051 to 0.099. The mean urethral resistance in patient s in whom surgery failed to cure stress incontinence was unchanged from the preoperative value of 0.041. There was no direct correlation between stabi lizing the bladder base, as evaluated by the cotton swab test, and cure of stress incontinence. When successful in curing genuine stress urinary incon tinence, the Burch retropubic urethropexy increases urethral resistance. Cr eating bladder neck support without affecting urethral resistance does not, by itself, restore continence. (C) 1999 Wiiey-Liss, Inc.