The results of the operative treatment of 425 women with severe stress incontinence grade II and grade III according to Ingelman-Sundberg are reported. The following types of operation were used: diaphragmaplasty (DP), urethrovesicosuspension Marshall-Marchetti-Krauz (MK), lyoduraslings (LDS), and puborectalisplasty of Franz-Ingelman-Sundberg (PRP). The choice of the operative method and the evaluation of the results of the operation were done by history, clinical examination and radiological examination. The urodynamic investigation with a microtransducer which we used since 1977 prior and after each operation for stress incontinence does have little influence on the choice of the operation. The value of urodynamic studies on a quantitative evaluation of the type of operation is at present doubtful. Our definitive evaluation of the result of the operation was done not earlier than one year following the operation in a prospective stress incontinence clinic. Because of our individual treatment plan from the onset by different methods 89% of the 425 patients were cured or markedly improved.

Basing on our experience with 39 patients with severe urge incontinence (in one-quarter of the cases pure urge incontinence, in one-half of the cases mixed incontinence and in a further quarter of the cases neurogenic bladder disorders) a supervised programme (mictiogram) and a well-tried therapy (especially in the Anglo-Saxon countries) consisting of the triad hospitalisation/bladder training/medication therapy are presented. After an average hospitalisation period of 14 days, we were able to achieve a symptom-free state in 94% of the patients. Cure was achieved on a long-term basis in 76%. Failure of conservative therapy was due especially to severe neurogenic bladder disorders, followed by urethral obstructive insufficiency that cannot be influenced. The superimposed psychic cause of urge incontinence that should not be underestimated and often presents as a transference of unresolved emotional needs (51% of our group are psychologically unstable), is discussed. With these facts in mind, our therapy concept is translated into reality. Hospitalisation brings about a change in surroundings, making the supervision of bladder training and adjustment to medication easier, thus supplying the basis for patient compliance and success of follow-up therapy subsequent to hospitalisation and discharge from hospital.

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