Failure to predict and attempts to explain urinary stress incontinence following vaginal repair in continent women by using a modified lateral urethrocystography

Of continent women undergoing the Manchester procedure for genito-urinary prolapse, about 25% develop urinary stress-incontinence. In order to study whether this is due to pre-existing anatomical factors or to the surgical procedure itself, a prospective study was set up. Fifty-eight continent women operated on for genito-urinary prolapse, underwent urethrocystography prior to and 3 months following surgery. Sixteen of the 58 (28%) developed stress-incontinence following the operation. Radiological parameters preoperatively were of little help in distinguishing the patients developing incontinence from those remaining continent. The stress-incontinence following a Manchester procedure for genital prolapse seems to depend on two surgical factors: an insufficient elevation of the bladder- neck and a radical reduction of the cystocele. A parameter combining the two factors: the percentage reduction of the cystocele minus the percentage elevation of the bladder- neck, was significantly lower in women remaining continent than in those who developed stress-incontinence.