Urodynamic assessment and chain cystogram in women with stress urinary incontinence. Clinical significance of detrusor instability.

A retrospective analysis of 51 women presenting with stress urinary incontinence was performed. Preoperative assessment protocol consisted of a careful history and physical examination, urinalysis and culture, cystoscopy, urodynamic study, beaded-chain cystogram, and intravenous pyelogram (IVP). All patients in the study were subjected to the Marshall-Marchetti-Krantz vesicourethral suspension procedure. The overall incidence of detrusor instability was 38.8 per cent. Surgical success rate was 92.5 per cent. Identification of detrusor instability was considered not to be a deterrent to surgery, nor a prognosticator of surgical failure. The chain cystogram was believed to be of little value in cases that had undergone previous surgical corrective attempts. Urodynamic studies were felt helpful in patients presenting with mixed symptom patterns, as well as in patients previously operated on for stress urinary incontinence. The preoperative IVP was not found to be a cost-effective study.