Repeat Marshall-Marchetti procedure for recurrent stress urinary incontinence.

Thirty-six patients with recurrent stress incontinence had undergone a total of 109 previous procedures, at least one of which had been a Marshall-Marchetti-Krantz (MMK) operation. At the time of operative dissection, it was apparent that most of these patients had had an "alleged" MMK operation with no evidence of adhesion or scarring in the periurethral and vesical neck regions. With the transvesical approach, accurate assessment of the tone and quality of the bladder neck and the proximal urethra is possible. This approach also provides an opportunity to "see and feel" the effect of the properly placed periurethral and suspending suture. Thirty-two of 36 patients are continent after repeated suspension augmented by plication and bladder revision