Recurrent stress incontinence of urine: preoperative assessment and surgical management.

Surgical correction of stress incontinence in the female remains a complex and distressing problem. Just as there is no single etiologic factor present in all patients with stress incontinence, so ther is no single uniformly corrective operative procedure, as attested by the continued reports of new operative techniques or malfunctions of old procedures. Every therapeutic effort for stress incontinence, whether by means of medication, exercise, plication, suspension, sling, or some combination of these, effectively increases urethral resistance by tightening the musculofasical planes and supporting the urethra. Regrettably, none of these methods can be 100% effective. The patient who does not have good urethral smooth muscle, qualitatively and quantitatively, will remain incontinent. Regardless of its length, caliber, angle, or axis, a fixed, fibrotic, noncontractile urethra will not provide urinary control. I prefer to use the Marshall-Marchetti-Krantz procedure in patients who had previous operatons and have persistent or recurrent incontinence.