Comparison of three different surgical procedures for genuine stress incontinence: Prospective randomized study

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      One hundred seven consecutive patients with clinical and urodynamic findings of genuine stress incontinence not previously treated were prospectively allocated in a randomized manner to one of three surgical procedures: anterior colporrhaphy, revised Pereyra procedure, or Burch retropubic urethropexy. Randomization included the surgical procedure and choice of surgeon (one of the three authors). Clinical and urodynamic evaluations were repeated at 3 months and 1 year after surgery. Differences in cure rates among the three procedures at the 3-month postoperative evaluation were insignificant (82%, 84%, and 92% for the anterior colporrhaphy, Pereyra, and Burch respectively) but became statistically significant at the 1 year postoperative evaluation (cure rates of 65%, 72%, and 91% for the anterior colporrhaphy, Pereyra, and Burch respectively, p < 0.05). In our hands the Burch procedure stabilized the urethrovesical junction and prevented its descent during straining (evaluated by a postoperative Q-tip test) more effectively than either the Pereyra or anterior colporrhaphy. No procedure resulted in severe postoperative voiding difficulties. The present prospective randomized study demonstrates that in our hands the abdominal retropubic operation for genuine stress incontinence in patients not previously operated on results in a higher cure rate when compared with anterior colporrhaphy or Pereyra procedure. (Am J Obstet Gynecol 1989;160:1102-6.)

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        • Beck RP
        • McCormick S
        Treatment of urinary stress incontinence with anterior colporrhaphy.
        Obstet Gynecol. 1982; 59: 269
        • Pereyra Al
        • Lebberz TB
        • Growdon WA
        • Powers JA
        Pubourethral support in perspective: modified Pereyra procedure for urinary incontinence.
        Obstet Gynecol. 1982; 59: 643
        • Stamey TA
        Endoscopic suspension of the vesical neck..
        in: Stanton SL Tanagho EA Surgery of female incontinence. Springer-Verlag, Berlin1980: 77-91
        • Burch JC
        Cooper's ligament urethrovesical suspension for stress incontinence.
        Amt J OBSTET GYNECOL. 1968; 100: 764
        • Parnell JP
        • Marshall VF
        • Vaughan ED
        Primary management of urinary stress incontinence by the MarshallMarchetti-Krantz vesicourethropexy.
        J Urol. 1982; 127: 679
        • Riggs JA
        Retropubic cystourethropexy: a review of two operative procedures with long term follow-up.
        Obstet Gynecol. 1986; 68: 98
        • Bhatia NN
        • Bergman A
        Modified Burch versus Pereyra retropubic urethropexy for stress urinary incontinence.
        Obstet Gynecol. 1985; 66: 255
        • Green DF
        • McGuire EJ
        • Lytton B
        A comparison of endoscopic suspension of the vesical neck versus anterior urethropexy for the treatment of stress urinary incontinence.
        J Urol. 1986; 136: 1205
        • Mundy AR
        A trial comparing the Stamey bladder neck suspension procedure with colposuspension for the treatment of stress incontinence.
        Br J Urol. 1983; 55: 687
        • Van Geelen JM
        • Theeuwes AGM
        • Eskes TB
        • Martin CB
        The clinical and urodynamic effect of anterior vaginal repair and Burch colposuspension.
        Am j OBSTET GYNECOt. 1988; 159: 137
        • Stanton SL
        • Cardozo LD
        A comparison of vaginal and suprapubic surgery in the correction of incontinence due to urethral sphincter imcompetence.
        Br J Urol. 1979; 51: 497
        • Bradley WE
        Urologic oriented neurologic examination..
        in: Ostergard DR Gynecologic urology and urodynamic. Williams & Wilkins, Baltimore1985: 63-68
        • Bhatia NN
        • Bergman A
        Urodynamic appraisal of vaginal versus rectal pressure recording as indication of intra abdominal pressure changes.
        Urology. 1986; 27: 482
        • Bates P
        • Bradley WE
        • Glen E
        • et al.
        The standardization of terminology of lower urinary tract functions.
        J Urol. 1979; 121: 551
        • Diem K
        Random numbers..
        in: Scientific tables. Ciba-Geigy Pharmaceutical, Ardley, New York1962: 131
        • Tanagho EA
        Colpocystourethropexy: the way we do it.
        J Urol. 1976; 116: 751
        • Bergman A
        • Matthews L
        • Ballard CA
        • Roy S
        Suprapubic versus transurethral bladder drainage after surgery for stress urinary incontinence..
        Obstet Gynecol. 1987; 69: 546
        • Sand PK
        • Bowen LW
        • Pangamiban R
        • Ostergard DR
        The low pressure urethra as a factor in failed retropubic urethropexy.
        Obstet Gynecol. 1987; 69: 399
        • Beck RP
        • McCormick S
        • Nordstrom L
        Intraurethralintravesical cough pressure spike difference in 267 patients surgically cured of genuine stress incontinence of urine.
        Obstet Gynecol. 1988; 72: 302
        • Hertogs K
        • Stanton SL
        Mechanism of urinary continence after colposuspension: barrier studies.
        Br J Obstet Gynecol. 1985; 92: 1184
        • Sand PK
        • Bowen LW
        • Ostergard DR
        • Nakaniski AM
        Hysterectomy and prior incontinence surgery as risk factors for failed retropubic cystourethropexy.
        .1 Reprod Med. 1988; 33: 171
        • Hilton P
        • Stanton SL
        Urethral pressure measured by micro-transducer: the results in symptom-free women and those with genuine stress incontinence.
        Br j Obstet Gynecol. 1983; 90: 919
        • Stanton SL
        • Cardozo L
        • Williams JE
        • et al.
        Clinical and urodynamic features of failed incontinence surgery in the female.
        Obstet Gynecol. 1978; 51: 515
        • Beck RP
        • McCormick FS
        • Nordstrom L
        The fascia lata sling procedure for treating recurrent genuine stress incontinence of urine.
        Obstet Gynecol. 1988; 72: 699
        • Leach GE
        • Yip CM
        • Donovan BJ
        Mechanism of continence after modified Pereyra bladder neck suspension.
        Urology. 1987; 29: 328