Severe anatomical and functional defects and failure or rejection of conservative treatment are clear indications for surgical repair of sphincter incompetence. Adequate pretherapeutical diagnostic work-up should rule out other reasons for incontinence and additional pathology and allow adequate selection of the surgical technique. Prospective randomized studies as well as meta-analyses enable us to recognize suitable procedures; for primary surgery colposuspension and tension-free vaginal tapes (TVT), and in selected cases traditional slings can be recommended, whereas vaginal repairs, needle suspensions and the different injectables should not be encouraged for primary cases.

: Severe anatomical and functional defects and failure or rejection of conservative treatment are clear indications for surgical repair of sphincter incompetence. Adequate pretherapeutical diagnostic work-up should rule out other reasons for incontinence and additional pathology and allow adequate selection of the surgical technique. Prospective randomized studies as well as meta-analyses enable us to recognize suitable procedures; for primary surgery colposuspension and tension-free vaginal tapes (TVT), and in selected cases traditional slings can be recommended, whereas vaginal repairs, needle suspensions and the different injectables should not be encouraged for primary cases.

Unwillkürlicher Urinabgang und Descensusvorgänge des inneren Genitale sind Probleme, mit denen der Frauenarzt häufig konfrontiert wird. Beide Zustände beziehen ihren Krankheitswert ausschließlich aus den durch sie verursachten Beschwerden (z.B. Wundsein bei Harninkontinenz, Ulcusbildung bzw. Kohabitationsbeschwerden durch Descensus) und/oder durch soziale Beeinträchtigung. Leitline jeder Behandlungsindikation ist deshalb der indivisuelle Leidensdruck.

We performed 82 operations for stage II or stage III urinary incontinence between January 1974 and August 1977. These patients were followed up after operation and examined by lateral urethrocystography. Significant morphological changes could be found in all four types of operations. There were no positive correlations between outcome of operation and alterations in the angles β and β (Green). However, elevation and ventral dislocation of the apex of the angle β seemed to be of importance in succesful surgery for urinary incontinence.

In 100 women urethrocystometric investigations were carried out with the microtransducer method. The women were of different height and the examinations were done at different states of bladder filling. The interpretation of the resting and stress pressure profiles of the urethra were done according to well defined parameters. The profiles were studied in continent and in continent women regarding their diagnostic value. From the results guidelines for the quantitative and qualitative evaluation of stress incontinence were derived, discussed and conclusions for treatment are outlined.