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Objective To investigate the role of altered innervation of the urethral sphincter in the genesis of genuine Design Prospective observational study.Setting Tertiary referral centre urodynamics unit.Subjects Sixty-eight women, 33 with urodynamically proven pure genuine stress incontinence and 35Interventions Concentric needle electrornyography of the urethral striated sphincter. Main outcome measuresThe means of motor unit potential duration, number of changes in polarity and the amplitude of individual motor unit potentials were compared between the two groups. ResultsThere was no statistically significant difference in motor unit potential duration (P = 0.87) or in the number of changes in polarity (P = 0.85). There was a trend towards a higher amplitude of motor unit potentials in the control group (P = 0-07). ConclusionsOur findings suggest that denervation and re-innervation of the striated urethral sphincter following trauma to the pelvic floor, such as that occurring during childbirth, is not a major aetiological factor in the development of genuine stress incontinence.

Controversy remains over which tests are necessary in the routine evaluation of women with lower urinary tract dysfunction. Is cystometry alone sufficient, or is a more detailed investigation such as videocystourethrography justified? Two hundred consecutive new patients attending for urodynamic assessment were reviewed. In fifteen (7.5%) patients the correct diagnosis was made only on videocystourethrography . We therefore suggest that videocystourethrography should continue to be used as the routine investigation of female lower urinary tract dysfunction.

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