Urodynamic changes in voiding after anti-incontinence surgery: An insight into the mechanism of cure

Objectives. To measure the effect on voiding pressure and flow rate of thre e different operations for stress urinary incontinence. Methods. In a previous study of cure rates, 289 women with genuine stress i ncontinence and genital prolapse were prospectively allocated in a randomiz ed manner to one of three procedures: the Burch retropubic urethropexy, ant erior repair, or the modified Pereyra procedure. In the current derivative study, we retrospectively evaluated the urodynamic indicators of voiding dy sfunction in the original subjects preoperatively and at the 1-year postope rative follow-up visit. Results. One hundred thirty-two charts were available for review. One year after surgery, pressure and flow during voiding were altered to more obstru ctive levels with the suspension procedures (Burch and modified Pereyra). T he proportion of patients with obstructive and equivocal voiding patterns a fter the suspension procedures was significantly greater than after anterio r repair. Conclusions. This post hoc comparison of randomized data shows a difference in postoperative voiding indexes between suspension procedures and anterio r colporrhaphy. Successful bladder neck suspension depends on altering the pressure and flow during voiding to more obstructive levels. Suspension pro cedures alter the voiding pressure and flow toward obstruction to a greater extent than anterior repair.