The clinical and urodynamic effects of anterior vaginal repair and Burch colposuspension.

The clinical and urodynamic effects of anterior vaginal repair and Burch colposuspension for correction of stress urinary incontinence were assessed in a prospective study. Ninety women undergoing surgery for the first time because of genuine stress incontinence were studied. A full clinical examination including simultaneous urethrocystometry according to a standardized methodology with the patients in the supine, sitting, and standing positions was performed preoperatively, 3 months postoperatively, and again 1 to 2 years later. Clinical follow-up continued for 5 to 7 years. Neither surgical anterior vaginal repair nor Burch colposuspension affected the resting variables of the urethral sphincter mechanism. After Burch colposuspension the transmitted intraabdominal pressure to the urethra significantly increased in all recording positions in all women who were successfully treated. After successful anterior colporrhaphy, the increase in pressure transmission from the abdomen to the urethra was less prominent and was only present in the sitting and standing positions. The postural changes in the urethral pressure profile characteristic of stress urinary incontinence were still present even after successful restoration of continence. The impact of successful surgery for stress incontinence is the enhancement of transmission of the intraabdominal pressure rise to the proximal urethra. This is achieved primarily by anatomic alterations rather than by altering urethral sphincter function. Burch colposuspension was more effective for the correction of genuine stress incontinence than was anterior vaginal repair.