Primary management of urinary stress incontinence by the Marshall-Marchetti-Krantz vesicourethropexy.

To evaluate clearly the Marshall-Marchetti-Krantz cystourethropexy in defined populations we did a retrospective study of 151 women who underwent the procedure as a first attempt to correct stress incontinence. Of 140 patients for whom data were available 126 (90 per cent) were cured, 12 (8.6 per cent) were improved and 2 (1.4 per cent) failed. Preoperative cystoscopy was normal in 83 women (67.5 per cent). The most common abnormality was inflammatory change (82.5 per cent). Preoperative findings failed to correlate with postoperative irritative symptoms, indicating that surgical correction of documented mechanical instability is warranted. Concurrent medical problems, such as obesity and chronic obstructive pulmonary disease, were not associated with failures. Significant complications occurred in 11.4 per cent of the patients but there were no deaths. In view of a 90 to 98 per cent success rate with long-term followup (average 45.7 months) the Marshall-Marchetti-Krantz operation should be considered the procedure of choice in cases of primary stress incontinence. In addition, comparisons with other well defined groups and with modifications of the original procedure will be facilitated.