Outcome of colposuspension in patients with stress urinary incontinence and abnormal cystometry.

OBJECTIVE

To analyze the prognostic value of preoperative cystometric alterations in the outcome of women undergoing colposuspension for stress incontinence.

PATIENTS AND

METHODS

Over a 5 year period, 220 women were operated on for stress urinary incontinence using the Burch or Marshall colposuspension techniques. An abnormal cystometry was found pre-operatively in 44 (20%), which was associated with urge incontinence in 11 (25%). Cystometric abnormalities comprised 3 subgroups: detrusor instability (DI), low bladder compliance (LBC) and small detrusor contractions (SDC). Women with an abnormal cystometry had responded partially to anticholinergic therapy. Detailed postoperative questioning was undertaken to differentiate stress from urge incontinence, as well as storage symptoms. Results of patients with cystometric abnormalities were compared to an age-matched group of 44 patients with a stable bladder on the preoperative study.

RESULTS

Bladder compliance was statistically lower in the preoperative CMG of patients with abnormal cystometry (p < 0.005). Groups were followed for a mean of 39 (abnormal CMG) and 36 months (stable bladder), respectively. The presence of the aforementioned cystometric alterations was not associated with lower cure rates of the stress incontinence. However, the group with DI referred more postoperative storage symptoms. "De novo" DI was found in 20% of patients with a previously stable bladder who referred storage symptoms postoperatively.

CONCLUSIONS

Small detrusor contractions are not a contraindication for colposuspension. Patients with DI and low bladder compliance who also have stress incontinence showed more storage symptoms on postoperative evaluation.