Clinical and roentgenographic evaluation of endoscopic suspension of the vesical neck for urinary incontinence

Forty four consecutive patients, (women, aged 37 to 88 yr), without residual urine or infection, were operated upon for urinary stress incontinence by endoscopic suspension of the vesical neck. All patients had preoperative and postoperative lateral view cystograms which showed after operation substantial upward and forward elevation of the urethrovesical junction as measured by the posterior urethrovesical angle, the angle of urethral inclination, and elevation of the base of the bladder. Despite a significant history of an urgency component to their incontinence in many patients, as well as 44 previous operations in 22 of the patients, a carefully performed cystometrogram and cholinergic sensitivity test were nor helpful in detecting abnormalities of the detrusor muscle. 41 Patients were cured, and in 3 others, the condition was not cured, the failure group. The lateral view cystogram was the most diagnostic test in that 2 in the failure group did not show preoperatively the roentgenographic hallmark of stress urinary incontinence.