The female bladder and urethra before and after correction for stress incontinence

The selection of twelve patients with urinary stress incontinence forms the basis of this study. Simple vesicourethral suspension as described by Marshall and his co-workers was the procedure used to correct their complaint. An evaluation of the clinical and anatomical findings observed before correction, particularly with the aid of cystography, showed that failure of the pelvic floor, especially of the levator ani, to support the vesical sphincter mechanism was most frequently associated with loss of urinary control. Cystography postoperatively revealed the striking degree of elevation of the bladder and its outlet effected by the operation. It further demonstrated that the procedure fixes the urethra to the posterior surface of the symphysis without distortion. Although suprapubic vesicourethral suspension is not meant to supplant the standard vaginal operations for the relief of stress incontinence, some of the advantages are enumerated. It is indicated, as a result of this study, that the mechanism of the operation's success lies in the fact that it restores a relatively firm point of attachment to the sphincter mechanism of the vesical neck, a major requirement for the normal function of any sphincter.