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Position and Mobility of the Urethrovesical Junction in Continent and in Stress Incontinent Women Before and After Successful Surgery
Author(s) -
Carey Marcus P.,
Dwyer Peter L.
Publication year - 1991
Publication title -
australian and new zealand journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.734
H-Index - 65
eISSN - 1479-828X
pISSN - 0004-8666
DOI - 10.1111/j.1479-828x.1991.tb02799.x
Subject(s) - medicine , position (finance) , stress incontinence , urology , surgery , urinary incontinence , economics , finance
EDITORIAL COMMENT: This paper has a nice discussion regarding the anatomical supports of the upper urethra and how the position of the urethrovesical junction influences urinary continence during acute episodes of raised intraabdominal pressure. Because of the importance of urinary incontinence in the female the urethrovesical junction has been the site of a wider range of surgical manoeuvres than any other part of the genitourinary tract. This paper will not settle the debate but it reexamines the theories and will interest many readers. The principles of the Burch and Stamey operations are also discussed and explanation provided of why surgery may fail to cure stress incontinence of urine. Summary: The position of the urethrovesical junction and its movement with straining was assessed using lateral chain cystourethrography in 9 continent women and 27 women with genuine stress incontinence before and after continence surgery. The women with genuine stress incontinence had a significantly lower urethrovesical junction related to the symphysis pubis which descended more with straining than the continent women. Surgery was successful in 25 of the 27 women. Following both successful Burch colposuspension and Stamey operation the urethrovesical junction was significantly higher, closer to the symphysis and less mobile. The position of the urethrovesical junction was significantly higher following the Burch colposuspension than Stamey operation and was similar to the continent control group. Overelevation of the urethrovesical junction can be avoided at the time of Burch colposuspension by not tying the suspension sutures with excessive tension but leaving a free space of 2–4 cm between the vaginal wall below and the iliopectineal ligament above. The posterior urethrovesical angle was similar in continent and incontinent women but was significantly narrower following successful surgery.