Correlation of Chain Cystourethrographic Findings with Grade of Incontinence and Duration of Postoperative Voiding Difficulty in Genuine Stress Incontinence(GSI)

Kim, Young Tae; Kwon, Chil Hun

Abstract

For recent 3 years, l8 GSI patients were followed for more than 6 months after surgical treatment with Raz procedure. Posterior urethrovesical angle(PUVA), urethral inclination angle (UIA), and bladder neck descent below the upper border of symphysis pubis(BN) on voiding chain cystourethrogram were measured preoperatively and postoperatively with respect to the grade of preoperative incontinence and postoperative period of voiding difficulty. UIA and BN in Stamey grade II group(N=9) were 57+/-14.6 degrees and 5.4+/-l.1cm, which were significantly higher than 39+/-7.6 degrees and 4.3+/-0.9cm in Stamey grade I group(N= 9) (P <0.05). Normal values of PUVA and UIA were defined as 90-l00 and 0-45. Depending on the duration of postoperative voiding difficulty, mean values of postoperative PUVA and UIA were normal(90+/-18.9' and 8+/-16.9') in the 1st week group(N=9), but lower than normal values(ie, overcorrected) in l-2 week group( 64+/-2l.3 and -l0+/-8.9 ) and in over 2 week group( 50+/-l0.0' and -11+/-2.2' ). Duration of postoperative voiding difficulty was 3.5+/-1.6 days in properly corrected Green type I group(N=6) and 8.3+/-l.2 days in properly corrected Green type II group(N=3), but it was much longer in overcorrected groups. From the above results, it is inferred that chain cystourethrography can be used as a useful means to predict the duration of postoperative voiding difficulty in GSI patients and prolonged postoperative voiding difficulty can be prevented by taking care not to overcorrect the bladder neck during Raz procedure.