Uroflowmetry has a good specificity, a high negative predictive value, and a good diagnostic capacity such as to make it useful as the first diagnostic approach in urogynaecologic patients.

ISD is related to the presence of a more severe clinical picture and case history, but the most significant independent variables are the VLPP and MUCP.

INTRODUCTION AND OBJECTIVE:The relationship between bladder outlet obstruction (BOO) due to benign prostate hyperplasia and sexual dysfunction is of considerable current interest. The influence of surgical treatment of BOO on sexual dysfunction is uncertain and available evidence is conflicting. Transurethral resection of the prostate (TURP) is known to cause retrograde ejaculation, but its effect on erectile function is still discussed controversially. In our study we prospectively investigated the influence of TURP on erectile and ejaculatory function.METHODS: The presented data have been collected by the 'Outcome Association', a quality control instrument in the Swiss healthcare system. From January 2000 to August 2003 1190 patients scheduled for TURPin 10 hospitals in the Canton Zurich were prospectively assessed. A questionnaire including the sexual function domain of the Danish prostatic symptom score (DAN-PSS-Sex) and a question on general sexual activity was mailed out to the patients prior to their hospitalization as well as 4 months after surgery. DAN-PSS-Sex scores before and after TURP were compared using Wilcoxon signed ranks test (level of significance p<0.05).RESULTS: Preoperatively questionnaires of 839 patients were returned and deemed evaluable. Mean patient age was 69 years (range 43 to 91 years). 228 patients (27%) stated that they were still sexually active. Postoperatively 405 questionnaires were returned and evaluable for analysis. Therein I 06 patients (26%) declared that they were sexually active. In patients with 2 evaluable questionnaires the mean erectile function score increased (worsened) insignificantly from 0.853 to 0.911 (p=0.2). When this score was multiplied with the respective bother score, however, an almost significant decrease from 1.774 to 1.553 (p=0.05) resulted. Mean ejaculatory function scores increased from 1.063 to 2.239 (p

A prospective analysis of 166 women with genuine stress incontinence was performed comparing Valsalva leak-point pressure (VLPP) and maximum urethral closure pressure (MUCP) with age, previous urogynecologic surgery and/or hysterectomy, poor urethral mobility, weight, menopause and vaginal deliveries, to find correlations with intrinsic sphincter deficiency (ISD). Cut-off value for VLPP were 60 cmH2O and for MUCP 30 cmH2O. MUCP < or = 30 cmH2O identifies a group of patients with more severe incontinence, a shorter urethral functional length (UFL) (P = 0.02), more previous urogynecologic operations and the menopause (P = 0.004 and P = 0.000), and older age (P = 0.000). VLPP < or = 60 cmH2O identifies a group of patients with more severe incontinence, a shorter UFL (P = 0.005), more previous urogynecologic surgery (P=0.006) and poorer urethral mobility (P = 0.004). As these two tests measure different components of urethral functions we can hypothesize that they detect different pathogenic processes contributing to ISD. When one or both tests is abnormal incontinence is more severe and the incidence of poor prognostic factors is increased.

Forty women with stress incontinence, intrinsic sphincter deficiency (ISD), associated or not with urethral hypermobility, a Valsalva leak point pressure (VLLP)<60 cmH(2)0 and a maximum urethral closure pressure<30 cmH(2)0 underwent in situ vaginal wall sling. The main modification to the technique was the use of two small Marlex meshes placed at the lateral edges of the sling. Outcome was assessed by pad use, surgical results and patients' satisfaction. Data of 39/40 patients were analyzed after a minimum follow-up of 1 year. After surgery 30/39 patients were completely dry (no pads), stress incontinence disappeared in 22/39, and 30/39 patients were satisfied with outcome. Reasons for dissatisfaction included recurrence of stress incontinence in three, infections in one and urge incontinence in five. Overall results are good given this category of patients. The vaginal wall sling can be recommended for patients with ISD because the results are promising, it corrects urethral hypermobility and, in our experience, it does not cause obstruction if correctly performed.