Urodynamic evaluation of female incontinence.

Several diseases of the female bladder are accompanied by stress incontinence or some other form of incontinence. By using micturition cystourethrography, visualizing the bladder in lateral views, with simultaneous recording of micturition pressure and flow, a distinction may be made between the individual diseases, as they often exhibit characteristic radiological configurations and urodynamic patterns. It is also possible, by comparing with measurements in control material, to decide the best physiological method of abolishing the incontinence. This method of examination has proved particularly suitable in cases with a history of unsuccessful operation for incontinence. Stress incontinence has been found to be associated mainly with descent of the bladder, a reduced urethral resistance, and cystoceles; it also occurs as a sequel to radical operations on the true pelvis and in a number of neurological diseases. In practically all cases it has been possible to abolish incontinence by the following surgical plan: descent of the bladder to be treated by colpoperineoplasty, reduced urethral resistance and incontinence following radical hysterectomy or extirpation of the rectum by colposuspension, and cystoceles by reduction of the cystocele and colpoperineoplasty.