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The aim of this study was to determine the quantitative and qualitative effects of patient position on coughing and Valsalva leak-point pressure in women with genunie stress incontinence. Thirty-seven patients with genuine stress incontinence and 4 with mixed incontinence underwent multichannel urodynamics using a standardized protocol. Leak-point pressures were performed using 8 Fr microtip catheters placed in the bladder and vagina at a bladder volume of 250 ml in the supine, semirecumbent and standing positions. Urethral pressure profilometry was performed in the semirecumbent position at a bladder volume of 250 ml. The mean (range) age, and median (range) gravidity, parity, body mass index (BMI), and mean (range) Q-tip deflection angle were 61 years (36-80), 3 (1-8), 3 (1-6), 26 (22-30) and 55.8 degrees (25 degrees-80 degrees), respectively. The mean (+/- standard deviation) Valsalva leak-point pressures in the supine, semirecumbent and standing positions were 82 +/- 23, 73 +/- 24 and 63 +/- 22 cmH2O, respectively (P<0.001). The mean (+/- standard deviation) cough leak-point pressures also decreased as the patients were moved from the supine (98 +/- 29 cmH2O) to the semirecumbent (88 +/- 24 cmH2O) and standing positions (77 +/- 24 cmH2O) (P<0.001). The correlation between leak-point pressure and maximum urethral closure pressure was statistically significant and was dependent upon patient position and the provocative maneuver used.

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The purpose of this study was to evaluate the feasibility, safety and efficacy of performing the Burch urethropexy (BU) and the abdominal paravaginal repair (APR) through a 1.5-2.5 in suprapubic incision. A prospective clinical study was undertaken by four urogynecologists. Seventy-three patients, each with a urodynamic and clinical diagnosis of genuine stress incontinence, underwent a BU procedure, with 33 of the 73 having concomitant APR through the same incision. The duration of surgery and any complications were recorded. Postoperative outcome tests included subjective incontinence questionnaire, cough stress testing, pad testing, measurement of residual volumes, and analgesia requirements. The BU procedure was accomplished in 72 of 73 patients, with 1 requiring conversion to a 5 in incision. The mean operative time was 64.6 +/-21.9 (SD) min. Intraoperatively, 1 patient was noted to have a suture in the bladder. All patient having only a BU (40) went home on the day of surgery or the first postoperative day, and all patients with BU and APR went home within 2 days. All but 1 patient met the criteria for catheter removal within 7 days, with 1 patient suffering obstructive voiding. At a mean follow-up of 9 months, cough stress test and questionnaire demonstrated complete cure in 70 of 72 patients tested. Pad testing confirmed cure in all of the 46 patients who consented to the test. We conclude that the standard Burch procedure and paravaginal repair can be accomplished safely and with excellent short-term efficacy through a 1.5-2.5 in incision.