[The importance of an additional retropubic urethroply by the pereyra or the Marshall-Marchetti-Krantz method in the primary operative treatment of stress incontinence involving rotational descent of the urethra (author's transl)].

Between 1971 and 1974, 270 patients underwent a hysterectomy and anterior colporrhaphy for severe stress incontinence of Type Green II with loss of the posterior urethrovesical angle and rotational descent of the urethra. All these patients had an additional retropubic urethropoly either of the Pereyra of Marshall-Marchetti type or an additional sling operation. 176 patients were followed up. The total series showed a cure rate of 57%, an improvement rate of 28% and persistent or recurrent incontinence in 14.3% of the cases. The importance of pre-operative diagnosis by cystometry and sphincterometry is stressed. An irritable bladder is emphasized as a contraindication to an operation for stress incontinence. The conclusion is reached that the primary stress incontinence operation is the most decisive and the most likely to succeed. Operations for recurrent stress incontinence show a much lower cure rate. Since the anterior colporrhaphy according to Stoeckel or Kelly is not capable of curing severe forms of stress incontinence with rotational descent of the urethra, our results show that an additional retropubic urethropoly is desirable and justified in these cases.