A 25-year experience with 519 anterior colporrhaphy procedures.

A 25-year experience with 519 anterior colporrhaphies was reviewed to assess the results in treating genuine and mixed stress urinary incontinence, the incidence of new urinary incontinence following prolapse surgery, the incidence of new detrusor instability after incontinence and prolapse surgery, and the morbidity associated with anterior colporrhaphy. The cure rate in treating genuine stress incontinence in 194 patients was increased from 75 to 94% when a Kelly-Kennedy-type technique was modified to include a vaginal retropubic urethropexy. The surgical cure in treating mixed incontinence was unsatisfactory (64%) in unselected cases but good (84%) in selected cases. Previous incontinence surgery, especially more than one procedure, significantly reduced the cure rate for genuine stress incontinence. The incidence of new incontinence after prolapse surgery in one subgroup of patients was 11%, indicating the need for measures to minimize this possibility at prolapse surgery. The incidence of new detrusor instability after surgery was 6% (higher after incontinence surgery than after prolapse surgery). The incidence of significant morbidity, excluding incontinence, was minimal (1%) among the 519 anterior colporrhaphies.