The risk of developing urinary stress-incontinence after vaginal repair in continent women. A clinical and urodynamic follow-up study.

A study was performed to find out how often continent women develop urinary stress-incontinence after a Manchester operation for genito-urinary prolapse, and to ascertain whether factors in the selection of patients, or steps in the surgical procedure are responsible for producing stress-incontinence postoperatively. Seventy-three of 102 consecutive patients were continent before operation. Sixteen of the 73 women (22%) became stress incontinent. Advanced age increased the risk of developing urinary stress-incontinence. Twenty-five per cent of the women more than 60 years old developed stress-incontinence, but only 1 of 13 below the age of 60. Preoperative urethral closure pressure was significantly lower in those developing urinary stress-incontinence, and closure pressure was further reduced by surgery in this group, significantly more than in the women remaining continent. Surgery significantly reduced the pressure transmission ratio in the patients who developed urinary stress-incontinence, and less in the continent ones. The preoperative pressure transmission ratio, however, was not related to the risk of developing urinary stress-incontinence after the operation. The urodynamic examinations pre- and postoperatively demonstrated important changes in the urodynamic parameters produced by the Manchester procedure, but did not prove useful in determining which patients will develop urinary stress-incontinence.