A six-year experience with paravaginal defect repair for stress urinary incontinence.

One hundred forty-nine consecutive patients who had surgery from May 1890 through December 1986 were evaluated to assess the functional and anatomic results of the paravaginal defect repair for stress urinary incontinence. All patients had their preoperative assessment, operative procedure, and postoperative follow-up managed by the authors. Twelve percent of the patients had one or more previous surgical procedures for urinary incontinence. Sixteen percent of the patients had the preoperative diagnosis of urinary incontinence with mixed components of true stress incontinence and detrusor instability. Postoperatively, 6% of all patients developed evidence of cuff prolapse; 5% had an enterocele. In none of those patients did the defect prolapse to the hymen. Five percent of the patients had postoperative evidence of a persistent cystocele, all of which were smaller than they had been preoperatively. An assessment of the anatomic results of the repair demonstrates that meticulous attention must be paid to the proper repair of the paravesical defect, to support of the vaginal cuff, and to management of the cul-de-sac of Douglas to minimize postoperative anatomic defects. Ninety-seven percent of patients had excellent functional results with no postoperative complaints of stress urinary incontinence.