EDITORIAL COMMENT: This study compares three groups of patients: normal controls; patients referred for evaluation of genuine stress incontinence; and patients with recurrent stress incontinence. The authors compare the cough urethral pressure profile parameters of functional length, maximum urethral closure pressure, and pressure transmission ratios. Patients in the referral (non-recurrent) group were subdivided according to whether historical, clinical, or urodynamic parameters were positive. The patients with recurrent incontinence were subdivided according to the severity of their incontinence, as described by Ingelman-Sundberg [3]. These authors found an increasing decay of urethral pressure profile parameters as the severity of incontinence increased, whether in the previously nonoperated or recurrent groups, when compared with controls. The authors make a point of suggesting that retropubic surgery is indicated in their group 3 patients, who demonstrated positive findings in historical, clinical, and urodynamic studies, including Iowurethral pressures, and recommend either a Marshall-Marchetti-Krantz or Ball-Burch [9] procedure. Low urethral pressure patients were not prominent in this study (only 4 patients). Recent evidence seems to indicate that a suburethral sling procedure is to be preferred in these patients.
clinical examination for GSUI (group 2); and positive history, clinical examination, and cough urethral pressure profile for GSUI (group 3). When compared with a group of 30 normal women (control group) the values for the urethral functional length (FL) and the maximum urethral closure pressure (MCUP) decreased progressively from group 1 to group 3. The pressure transmission ratio (PTR) was signficantly lower only in group 3.
Tonometric values calculated for a group of 25 patients with GSUI recurring afterprevious surgical correction (group 4) were found to be comparable with group 3. These patients with recurrent GSUI had a FL decreased to 70% and a MCUP decreased to 48% of the normal values. The PTR was maintained at a normal value of 97% in patients with degree I recurrence, but was decreased to 68 % in patients with degree H-Ill recurrence having the most severe impairment of the periurethral environment.