Intraurethral-intravesical cough-pressure spike differences in 267 patients surgically cured of genuine stress incontinence of urine.

Cough-pressure spike differences between the urethra and bladder were compared before and after surgery that cured genuine stress incontinence in 267 women. In 97.4% of 151 patients cured by a fascia lata sling procedure, the urethralvesical cough-pressure transmission ratio was greater than 100%, and in no case was it less than 100%. In 46.6% of 116 patients cured by anterior colporrhaphy, the cough-pressure transmission ratio was greater than 100%, and in 20.7% of the 116 patients, the transmission ratio was less than 100%. The 24 women in the latter group were cured by a sufficient increase in resting intraurethral pressure (to augment the maximal intraurethral closure pressure with stress) to maintain continence with increased intra-abdominal pressure. We believe that urethral kinking at the instant of increased intra-abdominal pressure with stress produced the greater than 100% cough-pressure transmission ratio seen in 201 (75.3%) of the 267 patients cured of genuine stress incontinence.