Introital ultrasound of the lower genital tract before and after colposuspension: a 4-year objective follow-up.

OBJECTIVE: To assess the topography of the bladder neck by introital ultrasound before and after open colposuspension. METHODS: Three hundred and ten women with urodynamically proven stress urinary incontinence were included in this long-term study to investigate the position and function of the bladder neck at rest and during straining. Height (H), distance (D), and urethrovesical angle of the bladder neck (beta) were measured by means of preoperative and postoperative introital ultrasound. Women were followed up; 152 of them (49%) completed 48 months of follow-up. RESULTS: At the 6-month follow-up examination, 90.0% of the women were continent (279/310), 3.5% (11/310) showed voiding difficulties, 3.5% (11/310) had urgency, and 1.6% (5/310) had developed de novo urge incontinence. At the 48-month follow-up, 76.8% of the patients were still continent. All postoperative measurements yielded significantly lower values for angle beta at rest and during straining compared with the preoperative results (P < 0.0001). The median linear movement of the bladder neck during straining decreased from 18.0 mm before surgery to 6.4 mm at the 48-month follow-up (P < 0.0001). The median level of ventrocranial elevation of the vesicourethral junction was 14.3 mm immediately after surgery, 9.9 mm after 6 months and 6.6 mm after 48 months. The degree of surgical bladder-neck elevation was associated with postoperative urgency/de novo urge incontinence (P < 0.0001) and voiding difficulty (P < 0.0001). CONCLUSIONS: The colposuspension procedure reduces angle beta at rest and during straining, restricts linear movement with straining, and elevates the bladder neck. Perioperative introital ultrasound improves understanding of this surgical procedure and might help to prevent postoperative complications.     

Ultrasound imaging of paravaginal defects in women with stress incontinence before and after paravaginal defect repair.

OBJECTIVE: The aim of our study was to analyze whether transabdominal and introital sonography can identify paravaginal defects and to determine changes that occur following paravaginal defect repair and Burch colposuspension. METHODS: Twenty women with genuine stress incontinence took part in this prospective study. The mobility of the bladder neck was assessed transperineally with a curved array probe following instillation of 300 mL saline. The same probe was used transabdominally to determine the presence of paravaginal defects. Introital examination using a transvaginal probe was then performed to determine the presence of paravaginal defects. The same measurements were performed following Burch colposuspension and paravaginal defect repair. RESULTS: There were significant differences in bladder neck position and mobility before and after surgical intervention. In 18 women before surgery, transabdominal ultrasound identified unilateral or bilateral paravaginal defects. Eight unilateral defects were found on the right side but only two were found on the left side. In eight women, the defect was bilateral. The introital approach obtained similar results apart from in two patients with a bilateral defect in whom it indicated a unilateral right defect. Between the first and second weeks following the operation transabdominal ultrasound found no paravaginal defects in 16 women and introital ultrasound found no paravaginal defects in 18 women. We were unable to visualize the region of the paravaginal defect in two women using transabdominal ultrasound because the abdominal wall was edematous after surgery. Five to 6 weeks after the operation, our results were confirmed by abdominal and introital ultrasound in all cases. No paravaginal defects were found in any of the patients after paravaginal defect repair. CONCLUSION: Our clinical study suggests that ultrasound scanning should be performed to confirm the presence of paravaginal defects and that paravaginal defect repair may be added to Burch colposuspension for the treatment of genuine stress incontinence, as an operation to correct cystourethrocele and the posterior urethrovesical angle.     

Assessment of female urinary incontinence by introital sonography

By the use of a vaginal sector scanner, placed to the vaginal introitus (introital sonography), we studied the static and dynamic function of the urethrovesical region in patients with genuine stress incontinence and detrusor instability. Patients with genuine stress incontinence (n = 25) revealed either an increase of the retrovesical angle or the angle of inclination associated with a descent of the bladder neck during coughing. Opening of the bladder neck during cystometry, showing an increase of the detrusor pressure, was observed in patients with motor urge incontinence (n = 10). Application of the technique is recommended in patients with stress incontinence undergoing surgery for objective intraoperative assessment of successful reformation of the urethrovesical junction, irrespective of the surgical procedure. Compared with radiologic techniques, introital sonography has many advantages with no radiation exposure and with minimal inconvenience to the patient.     

Sonographic evaluation of anatomic results after the pubovaginal sling procedure for stress urinary incontinence.

OBJECTIVE: To investigate the anatomic changes after the pubovaginal sling procedure in women with stress urinary incontinence by transrectal sonography METHODS: This study enrolled 56 women with varying types of stress urinary incontinence who were treated with the pubovaginal sling procedure using self-fashioned polypropylene mesh. The suburethral sling was fixed without tension and was placed at the position between the bladder neck and the proximal urethra. The patients were investigated preoperatively and postoperatively by transrectal sonography of the bladder and urethra. RESULTS: At a median follow-up of 24 months (range, 6-39 months), 48 patients (85.7%) were cured, 6 (10.7%) had improved, and 2 (3.6%) had treatment failures. Transrectal sonography revealed a well-suspended bladder neck and proximal urethra in all patients who were cured. As measured by changes of the axis of the pubovesical ligament, the position of the bladder neck was elevated by a mean of 29.6 +/- 21.5 degrees in the resting condition and 47.4 +/- 27.7 degrees in the straining condition. An incompetent bladder neck and proximal urethra were noted in 8 patients who had stress urinary incontinence after surgery. The incidence of opening of the bladder neck was 84.6% in 13 patients with de novo urgency or urge incontinence, whereas only 2 (4.7%) of 43 patients who did not have postoperative urgency had opening of the neck (P = .000). CONCLUSION: Transrectal sonography provides useful information about anatomic changes after the pubovaginal sling procedure. Bladder neck incompetence after surgery was closely related to postoperative urgency or urge incontinence.     

Role of bladder neck mobility and urethral closure pressure in predicting outcome of tension-free vaginal tape (TVT) procedure.

OBJECTIVE: To investigate how urethral mobility and urethral closure pressure affect the outcome of tension-free vaginal tape (TVT) insertion for stress incontinence. METHODS: A total of 191 consecutive women with genuine stress urinary incontinence with or without intrinsic sphincter deficiency were evaluated prospectively with multichannel urodynamics, 24-h voiding diaries, clinical stress tests and introital ultrasound measurements preoperatively and 6 months after surgery. Additional introital ultrasound examinations were performed immediately after the operation, at 12 months and annually thereafter. 177/191 patients had completed a 36-month follow-up at the time of writing. Urethral mobility was described as linear dorsocaudal movement (LDM), with hypermobility being defined as LDM > 15 mm on sonography. Intrinsic sphincter deficiency was defined by a maximum urethral closure pressure (MUCP) of <20 cm H(2)O. RESULTS: The overall cure rate at the 36-month follow-up was 89.5% (Kaplan-Meier estimator), with secondary cure (within 6 months of surgery) in 10.5% of these patients. The operation failed in 4.2% of the women and recurrence was seen in 6.3% of the cases. Bladder neck mobility was significantly reduced at the 6-month follow-up (P < 0.001). Compared with primary cure, therapeutic failure and secondary cure were associated with a significantly lower postoperative bladder neck mobility (P < 0.05). Postoperative hypermobility reduced the risk of therapeutic failure. In addition, women with therapeutic failure or secondary cure had a significantly lower MUCP than did those with primary cure (P < 0.01). CONCLUSION: The effectiveness of the TVT sling appears to depend on adequate postoperative urethral mobility and urethral closure pressure.     

Dynamic morphological changes in the anterior vaginal wall before and after laparoscopic Burch colposuspension in primary urodynamic stress incontinence.

OBJECTIVE: To evaluate dynamic morphological changes in the anterior vaginal wall in primary urodynamic stress incontinence before and after laparoscopic Burch colposuspension and to explore the related effects on urethral and voiding functions. METHODS: Ultrasound cystourethrography and urodynamic study were performed in 112 patients with primary urodynamic stress incontinence before and 3 months after laparoscopic Burch colposuspension. Ultrasound assessment included measurement of the bladder neck positions at rest and during straining, the bladder wall thickness at the dome and trigone, and observation of the motion of the bladder neck in addition to the development of cystocele on Valsalva maneuver. On ultrasonography, a cystocele was defined as prolapse or descent of the bladder base below the bladder neck at rest, on Valsalva, or both. RESULTS: After laparoscopic Burch colposuspension, ultrasound cystourethrography revealed significant differences in the bladder neck position at rest and during stress (preoperative median 93 degrees vs. postoperative 70 degrees at rest and preoperative 160 degrees vs. postoperative 81 degrees during stress, P < 0.001, respectively) and rotational angle (preoperative median 58 degrees vs. postoperative 10 degrees , P < 0.001). A laparoscopic Burch operation corrected 50% (5/10) of the preoperative cystoceles. However, a residual cystocele developed postoperatively in 29% (30/102) of the women who did not have one previously. Postoperative ultrasonographic and urodynamic studies did not reveal any differences between those women with or without postoperative cystocele except for the residual urine volume, detrusor opening pressure, and straining and rotational angles of the bladder neck (P < 0.001, 0.032, 0.010 and < 0.001, respectively). CONCLUSIONS: Laparoscopic Burch colposuspension may correct a pre-existing cystocele, but in other patients a cystocele may persist or be disclosed. After laparoscopic Burch operation a persistent cystocele is not associated with urethral compression or voiding impairment.     

Introital and transvaginal ultrasound as the main tool in the assessment of urogenital and pelvic floor dysfunction: an imaging panel and practical approach.

This article reviews the different applications of ultrasound in benign urogynecological diseases. The findings presented here were obtained by introital and transvaginal ultrasound, both of which can be performed with the same equipment (5-7-MHz sector transducer, emission angle of at least 90 degrees; for introital sonography, the transducer is placed over the external urethral orifice with the transducer axis corresponding to the body axis). Female voiding dysfunction, including urge symptoms, recurrent urinary tract infections and urinary incontinence, may occur secondary to morphological and topographical changes of the urogenital organs. Findings such as urethral diverticula, periurethral masses, funneling of the urethra and distension cystoceles are identified by introital ultrasound. Transvaginal ultrasound enables the detection of pathologies of the bladder and uterus including its appendages. Ultrasound as part of the diagnostic work-up of stress urinary incontinence and genitourinary prolapse allows for the morphological and dynamic assessment of the lower urinary tract. It is possible, for example, to classify sonographically identified changes of the endopelvic fascia as lateral (distraction cystocele, funneling of the urethra) and central (pulsation cystocele) defects as well as to determine the reactivity of the pelvic floor muscles. Ultrasound has replaced radiography in yielding information on the abnormal morphology of the urogenital organs, which should be taken into account in planning the treatment of urogynecological conditions.     

Ultrasound imaging of the lower urinary system in women after Burch colposuspension.

OBJECTIVE: Most of the relevant surgical procedures employed in the management of genuine stress urinary incontinence (GSI) involve the technique of bladder neck elevation. The appropriate level of suspension is an important (but frequently overlooked) consideration as the clinical consequences of over-correction of the posterior angle are voiding dysfunction and urgency symptoms. The aim of our study was to compare ultrasound characteristics in women with GSI with those of women before and after Burch colposuspension. The findings of our study should have implications for GSI management. DESIGN: Prospective randomized clinical study at the Department of Obstetrics and Gynecology, Charles University, Prague, Czech Republic. SETTING: Department of Obstetrics and Gynecology, Charles University, Prague, Czech Republic. METHODS: Seventy women with previously untreated GSI (preoperative group) and 52 women (42 of whom had been in the preoperative group) who were studied 3-12 months after receiving Burch colposuspension (postoperative group) took part in the study. The standard transperineal and introital ultrasound scans were performed. The mobility of the bladder neck was assessed transperineally with a curved array probe after instillation of 300 mL of saline. The bladder was then evacuated and the thickness of the urinary bladder wall in the sagittal plane in defined regions (base, vertex and anterior wall) was measured. RESULTS: We found significant differences in bladder neck position, mobility, and in bladder wall thickness. Where symptoms of urgency occurred, the average bladder wall thickness was > 5 mm, the gamma angle < 40 degrees, and lower bladder neck mobility was evident. CONCLUSION: These findings supported our hypothesis that signs of urgency follow over-elevation of the bladder neck. These results helped us significantly to refine our GSI management.     

Translabial ultrasonography in the assessment of urethral diameter and intrinsic urethral sphincter deficiency.

OBJECTIVE: The purpose of this study was to determine the role of translabial ultrasonography in the investigation of intrinsic urethral sphincter deficiency (ISD), assessing bladder neck hypermobility and urethral diameter in continent and incontinent patients. METHODS: A case-control study evaluated 94 women with the diagnosis of urinary incontinence and 96 continent women. Both groups underwent translabial ultrasonography to assess bladder neck hypermobility by means of the x-y coordinate system and urethral diameter. The study was performed at Hospital de Clínicas de Porto Alegre. RESULTS: Women with urinary stress incontinence showed significantly greater bladder neck descent than continent women and women with urge and mixed incontinence (P = .05). Women with ISD showed significantly larger urethral diameters than control subjects and incontinent women without ISD (P = .05). Of women with urinary incontinence, 78.7% had descent of greater than 10 mm, and 91.7% of the women with ISD had urethral diameters of greater than 6 mm. A urethral diameter of greater than 6 mm showed sensitivity of 91.7% and specificity of 75.6% for ISD. CONCLUSIONS: Translabial ultra-sonography has an important role in the assessment of women with urinary stress incontinence and intrinsic urethral sphincter deficiency.     

Visibility of the polypropylene tape after tension-free vaginal tape (TVT) procedure in women with stress urinary incontinence: comparison of introital ultrasound and magnetic resonance imaging in vitro and in vivo.

OBJECTIVE: To determine whether introital sonography and magnetic resonance imaging (MRI) after TVT (tension-free vaginal tape) insertion can depict the polypropylene tape, and thus be used for patient follow-up. METHODS: The study comprised an experimental part, which investigated in-vitro visualization of the polypropylene tape in a model (phantom), and a clinical part, in which 20 women (mean age, 53.4 years) with clinically and urodynamically proven stress urinary incontinence without prolapse were investigated by introital ultrasound and MRI before and 13 months after the TVT procedure. RESULTS: In the phantom, the polypropylene tape was depicted with a low signal intensity by MRI and as a highly echogenic structure by ultrasound. In the clinical study, introital ultrasound in a mediosagittal orientation depicted the vaginal tape in all patients: it was located under either the midurethra (n = 16) or the lower urethra (n = 4), and in either the muscular coat of the urethra (n = 8) or in the urethrovaginal space (n = 12), the tape was either flat (n = 6) or curled up (n = 14), and there was no retropubic visualization of the tape. Overall, depiction by MRI was limited, and was poorer in comparison with ultrasound, especially when the tape had a sub- or paraurethral location. Retropubically, however, MRI identified the tape near the periosteum of the pubic bone (55% of cases), in the retropubic space (37.5% of cases), or near the bladder wall (7.5% of cases). CONCLUSION: Sonography is recommended for evaluation of the suburethral and paraurethral tape portions, while MRI is suitable for retropubic evaluation after the TVT procedure.     

Ultrasound imaging of the lower urinary tract after successful tension-free vaginal tape (TVT) procedure.

OBJECTIVES: To evaluate changes in the mobility of the whole urethra, in the proximal urethra (funneling) and in the thickness of the urinary bladder wall, after a successful tension-free vaginal tape (TVT) procedure. METHODS: This prospective longitudinal study included 52 women with urodynamically confirmed stress urinary incontinence who had undergone a successful TVT procedure. Ultrasound examination was performed before the TVT procedure and at a median of 3 (range, 3-6) months after surgery. For all women, the changes to the urethra and urinary bladder induced by surgery were examined. For three mobility groups (low, intermediate and high urethral mobility before surgery) we compared the changes induced by the operation and the typical position and mobility of the tape. RESULTS: The position of the urethra at rest was not influenced by surgery. The operation significantly decreased the mobility of all parts of the urethra during Valsalva. The absolute changes of the vector of the urethral movement differed according to the mobility group (average decrease, 6 mm; decrease for women with low, intermediate and high mobility, respectively, 2-3 mm, 4-6 mm and 9 mm). The change in relative mobility was the same in all groups. The operation decreased funneling (width and depth) during maximal Valsalva. After surgery there was an increase in the thickness of the bladder wall (by 0.64 and 0.73 mm, respectively, at the anterior part and trigone). CONCLUSIONS: A successful TVT procedure did not influence the position of the urethra at rest but significantly decreased the mobility of the urethra during Valsalva and also decreased funneling at maximal Valsalva.     

Surgical therapy of female urinary incontinence

Within the past years, surgical concepts for treating females with urinary incontinence have greatly changed. The spectrum of indications is becoming increasingly narrower. All possible conservative treatment modalities must first be attempted. Should the incontinence still continue to evoke social or hygienic problems, stress incontinence is usually treated with the minimally invasive TVT procedure (Tension-free Vaginal Tape), and in special cases, a modern modification of colposuspension is undertaken. Based on a success rate and specific complications, it is now known which slings and colposuspension techniques should no longer be used. Vaginal reconstructive surgery for pelvic organ prolapse, such as anterior and posterior repair and sacrospinous colpopexy are now obsolete for treating incontinence. Likewise discussed are operative procedures for rare forms of female incontinence and for urge incontinence, resistant to therapy.     

Conservative and surgical therapy of urinary incontinence and bladder complaints in the man

Treatment of incontinence and bladder complaints in the male should be directed to the cause whenever possible. Frequently, however, only symptomatic therapy is possible. Urge incontinence or overactive bladder due to obstruction should primarily be treated by eliminating the obstruction. Medical and surgical treatment methods are available for benign prostatic hyperplasia, bladder neck hypertrophy and prostatic cancer. In contrast, bladder neck sclerosis and uretheral strictures can only be treated surgically. Anticholinergics are primarily indicated if urge symptoms/incontinence persist after obstruction has been relieved or if urge incontinence occurs without obstruction. Seldom, in special cases injection of Botulinustoxin A or augmentation of the bladder may be indicated. Another possible cause of urge symptoms is urinary tract infection. This should be adequately treated according to resistance studies and the cause of the infection determined. In cases of overflow incontinence the infravesicle obstruction must be sought and treated. If limited detrusor contractability is the cause of overflow incontinence and the bladder cannot be emptied through pressmicturition, parasympathicometics may be of help. By insufficient effect, the procedure of intermittent self-catheterization must be taught. If this is not possible, the last resort is placement of a transuretheral or percutaneous catheter for continuous drainage. Stress incontinence is a rare complication in men, usually following prostatic surgery. It can be treated conservatively with pelvic floor training and alpha-adrenergic receptor agonists and if necessary surgically with submucosal collagen or silicon injections in the sphincter area or implantation of a sphincter prosthesis. Supravesicular urinary diversion is occasionally necessary after conservative and less invasive surgical measures have been exhausted and symptomatic suffering persists. Neurogenic disturbances in bladder capacity and/or emptying can be treated conservatively, medically, surgically or a combination of these depending upon the site of the lesion and the resulting urodynamic patterns.     

Laparoscopic single-port Burch colposuspension with an extraperitoneal approach and standard instruments for stress urinary incontinence: Early results from a series of 15 patients

Abstract

Objective:We aimed to investigate the use of single-port laparoscopy in a series of patients undergoing Burch colposuspension with an extraperitoneal approach as an alternative treatment for scarless surgery in stress urinary incontinence. Material and methods: From September 2010 to May 2011 we performed single-port extraperitoneal laparoscopic Burch colposuspension for stress incontinence in 15 patients. Fifteen women who were diagnosed with urodynamic stress incontinence were included in the study. Demographic and clinical data, intraoperative findings, and postoperative course were recorded. Results:The mean age was 45,80 ± 9,91 years (range: 38–70 years). The mean body mass index was 25,67 ± 4.06 kg/m2 (range: 22.23–35.38 kg/m²). The mean operation time and mean blood loss were 40.80 ± 5.94 minutes (range: 30–50 minutes) and 30.67 ± 11.00 cc (range: 10–50 cc), respectively. The single-port laparoscopic operations were technically completed successfully without placement of additional trocars and there were no complications. The cure and improvement rates following laparoscopic Burch colposuspension via single port were 73.3 % and 20 % respectively. Conclusion: Single-port laparoscopic Burch can be an alternative treatment for scarless surgery in stress incontinence. Single-incision laparoscopic Burch colposuspension can offer suitable, effective and safe treatment in women with stress incontinence.     

Ultrasound imaging of the pelvic floor. Part I: two-dimensional aspects.

Ultrasound imaging is rapidly replacing radiological methods in the investigation of pelvic floor disorders. Transrectal, transvaginal/introital and transperineal/translabial methods are being employed, with the latter probably the most widespread due to ease of use and availability of equipment. Position and mobility of the bladder neck, bladder wall thickness, pelvic floor muscle activity and uterovaginal prolapse can be quantified, and color Doppler may be used to document stress urinary incontinence. Ultrasound imaging has simplified audit activities and enhanced our understanding of the effects of incontinence and prolapse surgery, such as the new synthetic suburethral slings. In recent years, imaging methods have contributed significantly to our understanding of the traumatic effects of childbirth on the pelvic floor. Finally, the assessment of pelvic floor biomechanics may have implications for clinical obstetrics and ultimately for the prevention of delivery-related pelvic floor trauma.     

Ultrasound diagnosis of intra-urethral tension-free vaginal tape (TVT) position as a cause of postoperative voiding dysfunction and retropubic pain.

Intra-urethral Prolene tape erosion is a rare postoperative complication of tension-free vaginal tape (TVT) plasty. In cases reported in the literature, intra-urethral tape positioning has been diagnosed by urethroscopy as late as 3-12 months after the procedure. Introital ultrasound using a vaginal sector scanner allows for the non-invasive assessment of the position of the Prolene tape in relation to the urethra. Postoperative introital ultrasound might shorten the interval between surgery and the time of diagnosis of an intra-urethrally placed tape and thus significantly shorten the duration of symptoms. We present a patient with urethral pain syndrome and dysuria following TVT plasty. In this case, introital ultrasound was not performed until 8 months after surgery, when it demonstrated intra-urethral Prolene tape positioning as the cause of the patient's complaints. All symptoms disappeared after surgical removal of the intra-urethrally placed parts of the tape. The patient is continent, suggesting that the remaining para-urethral portions of the Prolene tape depicted sonographically ensured adequate stabilization of the mid-urethra in this case. The case report emphasizes the role of introital ultrasound in assessing Prolene tape position relative to the urethra on sagittal and transverse angulated views in the postoperative diagnostic evaluation of functional disturbances occurring after TVT plasty.     

超声剪切波弹性成像联合灰阶超声评估首次分娩产后压力性尿失禁膀胱颈变化

目的:研究超声剪切波弹力成像(Shear wave elastography,SWE)联合灰阶超声评估首次分娩产后压力性尿失禁(Stress urinary incontinence,SUI)患者膀胱颈变化.方法:选取我院2017年1月—2020年1月间收治的136例初产妇为研究对象,根据其产后是否出现SUI,将其分为...     

A clinical overview of the treatment of post-prostatectomy incontinence

This article discusses benign prostatic hyperplasia, which may be treated by a transurethral resection of prostate and prostate cancer which in turn may be treated by a radical prostatectomy. During both operations the bladder neck sphincter is damaged and continence relies on a competent external urethral sphincter. After surgery men may suffer from stress urinary incontinence, urge urinary incontinence and erectile dysfunction. Men undergoing prostatectomy would benefit from pre- and post-prostatectomy pelvic floor exercises including advice on how and when to perform them. Pelvic floor exercises can significantly help men with urinary incontinence and erectile dysfunction.     

乙状结肠膀胱扩大术治疗神经源性急迫性尿失禁的临床研究

目的探讨乙状结肠膀胱扩大术治疗顽固性神经源性急迫性尿失禁伴便秘的疗效。方法 16例患者经尿动力学检查为急迫性尿失禁,且术前均未发现肾积水和膀胱输尿管返流,行乙状结肠膀胱扩大术。结果术后随访3～24个月,均未见肾积水、膀胱输尿管返流和生化异常,便秘症状明显好转。所有患者能利用腹压辅助自行排尿及基本控尿,残余尿量10～40ml。结论乙状结肠膀胱扩大术治疗神经源性急迫性尿失禁能增加膀胱容量,降低膀胱压力,实现自主排尿;还能缓解便秘。     

Perineal bladder neck ultrasound: appearances before and after continence surgery.

An objective method of quantifying suture tension during bladder neck elevation for genuine stress incontinence has long been sought. Perineal ultrasonography has been used to measure bladder neck position and excursion in continent and incontinent women. This study used perineal ultrasound findings to determine surgical positioning of the bladder neck and predict outcome. Eighteen asymptomatic controls and 72 women with genuine stress incontinence were studied before and after continence surgery. Perineal ultrasonography was used to plot bladder neck position at rest and on maximum Valsalva maneuver on an x, y co-ordinate system to allow comparison between groups. Logistic regression analysis was then performed to derive an equation for the likelihood of continence. In both pre-and postoperative analysis, the best correlation with continence was achieved with the use of the patient's age and the distance of the bladder neck resting position measured along the x-axis. An equation was derived to give the probability of continence. The equation is easily calculated using a pocket calculator. The distance of the bladder neck along the x-axis is under the direct control of the surgeon, so the patient's age can be put into the equation and the distance along the x-axis most likely to make the patient continent can be calculated. This can be done during surgery to provide an objective method for evaluating suture tension.