Genuine stress urinary incontinence with low urethral pressure. Five-year follow-up after the Ball-Burch procedure.

OBJECTIVE

To evaluate long-term results of the Ball-Burch procedure in women with genuine stress incontinence (GSI), low urethral pressure type.

STUDY DESIGN

Sixty women with a clinical and urodynamic diagnosis of GSI, low urethral pressure type, underwent the Ball-Burch procedure between May 1987 and February 1988. They were evaluated preoperatively and one and five years after surgery. The urogynecologic workup consisted of a history, physical examination, urine culture, neurologic examination, urethrocystoscopy, cotton swab test, urethrocystometry, urethral profilometry and uroflowmetry. Forty-eight women were available at the one-year follow-up, and 32 of the 48 (66.7%) were available after five years; the mean age at the time of surgery was 58.7 years and mean parity, 2. Twenty-seven women were premenopausal and 33 postmenopausal; at the five-year follow-up all but 2 were postmenopausal. All postmenopausal women received estrogen replacement therapy prior to urodynamic evaluation. Cure was defined as absence of loss of urine by history (subjective) and during urodynamic evaluation (objective). The t test and paired t test were used for statistical analysis.

RESULTS

Forty-two of 48 women (87.5%) were cured after one year, and 27 of 32 (84%) were cured after five. There was a statistically significant difference between the preoperative and five-year follow-up values for the swab test, maximum urethral closure pressure and pressure transmission ratio at the proximal and mid urethra. Twenty-six of 29 patients with a negative swab test at the one-year follow-up were cured after five years, resulting in a predictive value of 89% for cure after a negative test.

CONCLUSION

In our series the Ball-Burch procedure was an effective surgical treatment for patients with GSI and low urethral pressure. The swab test, when negative one year after surgery, was predictive of a successful long-term outcome.