Stress incontinence: why and how operations work.

We still remain uncertain of the precise mode of cure produced by many continence procedures. In achieving a cure, some operations produce unacceptable side-effects of urge incontinence and voiding difficulty. True comparison of results of different procedures cannot be made until both subjective and objective results are presented, the criteria for patient entry are documented, and randomized studies, using matched patients as far as possible (taking into account factors such as the patient's age, parity and past history of bladder neck operations), are carried out. A follow up for at least two years and preferably five years is necessary. Because more than one factor may act to cause USI, operations need to be selective, bearing that in mind that a schematic approach is needed to match the operation with the pathophysiology or anatomical lesion responsible for incontinence.