[Urinary incontinence in women, without urodynamic studies].

From a series of 212 cases of urinary stress incontinence in women, the author analyses the results of 41 operations by retro-pubic vaginal fixation and 110 operations by aponeurotic support of the bladder neck. From this second group of 110 operations, 100 cases were reviewed with 93 successes, 3 improvements and 4 failures. The results obtained after one year were definitive. The author stresses the importance of the pre-operative assessment of the clinical signs and symptoms. Out of 90 cases of pure stress incontinence, with no other associated disturbance of micturition, there was a 95,5% success rate. 16,6% of cases had post-operative retention which was easily treated by simple measures. However, out of the 10 cases of mixed stress incontinence, with associated symptoms of urinary urgency, the results were favorable in only 70%. The author believes that urodynamic studies have a certain role in the investigation of the cause for a failed operation. They may even be useful in the investigation of the urodynamics of the vesicosphincteric apparatus of the woman with stress incontinence associated with other disturbances of micturition. However, clinically pure urinary stress incontinence does not require urodynamic investigation and can be corrected by lifting up the anterior vaginal wall (Bonney's manoeuvre). According to the author, the aponeurotic sling is the best way of treating these patients. The results are better when there is not a simultaneous cure of cystocele. Retro-pubic vaginal fixation is only used in cases of minor, discrete stress incontinence in elderly women and to complete surgery for prolapse.