Rezidivrate nach Inkontinenzoperationen bei Patientinnen mit hypotoner Urethra

Abstract
In a retrospective study, 94 patients were examined after incontinence operation. We show the anamnestic, clinical and urodynamic results. Standardised questions were used for exploring the patients'' history. The loss of urine during provocation, like coughing with a filled bladder up to 300 ml. showed the clinical incontinence. The urodynamic investigations were performed with a modern computer-guided instrument. The pressure was measured by highly flexible polyurethane catheters with micro-tip pressure transducers. The examinations were made in horizontal position with 100 ml, and upright position with either 100 ml or 300 ml bladder volume. Approx. 50% of the examined patients had postoperative stress incotinence both anamnestically and urodynamically. After vaginal repair and the Marshall-Marchetti-Krantz procedure, regardless of maximal urethral closure pressure (UVDR max), the recurrence rate was doubled in comparison to Burch colposuspension. After dividing all patients into these with hypotonic and those with normotonic urethra, and recurrence rate was doubled when UVDR max was low. The comparison of vaginal repair and abdominal colposuspension in patients with hypotonic urethra showed a significantly higher recurrence rate in the first group. In a preliminary prospective study, 19 patients with hypotonic urethra prior to surgery underwent Burch colposuspension. The examinations 3-6 months later did not show any stress incontinence. The main UVDR max ascended from 28.2 to 38.2 cm H2O. The increase was statistically significant (p < 0.003). Unsatisfactory results after incontinence operations were obtained on patients with vaginal repair with hypotonic urethra. Preliminary results show, that after Burch colposuspension on patients with low maximal urethra closure pressure, a reduction of recurrence may be achieved. Therefore, it is necessary to integrate the profilometry in preoperative urodynamic diagnostics in addition to cystometry. The operation procedure should take into account the results of the maximal urethral closure pressure.