Selection of the primary operative procedure for stress urinary incontinence.

Four hundred twenty-one women were treated by an initial operative procedure for stress urinary incontinence. The patients were divided into three groups on the basis of the degree of relaxation of the anterior vaginal wall on clinical examination. Patients classified as grade O treated by vesicourethral suspension had a 98% success rate at 2 years. Similar patients treated by vaginal operation had only a 48% success rate at 2 years. In grades I and II either the vesicourethral suspension or the vaginal operations resulted in success rates in the 85% to 90% range. Chain cystourethrograms were obtained in 171 patients, but they were not predictive of success or failure for the vaginal operations. Improved results may be obtained by individualizing the choice of the operative procedure based on the anatomic findings with the vaginal procedures used for those patients with significant anterior vaginal wall relaxation.