Stress incontinence: classification and surgical approach.

We present a modified classification for stress urinary incontinence based on the nature of vesical neck descent and the integrity of the intrinsic sphinteric mechanism. Surgical treatment was undertaken in 72 patients with this classification. With a minimum followup of 18 months there was a 94 per cent cure rate with respect to stress incontinence. However, in 14 patients significant frequency and urgency developed, which persisted for at least 6 months postoperatively. Of these patients 13 had undergone a pubovaginal sling procedure, 3 of whom had refractory symptoms, including urge incontinence, which resulted in augmentation cystoplasty in 2 and supravesical urinary diversion in 1.