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Objectives The tension-free vaginal tape (TVT) insertion technique generally does not take into account individual urethral length. In this study we investigated whether preoperative sonographic measurement of individual urethral length allows for reliable TVT positioning under the midurethra, which is a critical segment for the continence mechanism. Methods Urethral length was measured by preoperative introital ultrasonography in 102 consecutive female patients with stress urinary incontinence. TVT procedures were performed as recommended by the manufacturer. The suburethral incisions were initiated at one-third of the sonographically measured urethral length. TVT position and tape–urethra distance were followed up 6 months postoperatively. Results At 6-month examination of the 102 study participants, 93.1% were cured and 6.9% showed improved continence. TVTs were found in the target range of 50–70% of the urethral length in 88.2% of the cohort. Women with the TVT in the 50–70% urethral length range and a 3–5-mm tape–longitudinal smooth muscle distance had a greater likelihood of being cured without complications (P < 0.001). Conclusions Preoperative sonographic measurement of urethral length, combined with the one-third rule, may aid in reliable midurethral TVT positioning. Copyright © 2012 ISUOG. Published by John Wiley & Sons, Ltd.

Aims To report the conclusions of the Think Tank on mechanisms of incontinence and surgical cure in female and male SUI: surgical research initiatives during the ICI-RS meeting in 2010. Methods The sub-group considered five areas for future research in stress urinary incontinence (SUI); (i) epidemiology and public health efforts in SUI, (ii) the basic sciences examining the physiology and pathophysiology of the continence mechanism, (iii) diagnostic techniques and clinical assessment of SUI, (iv) the future of treatment and surgical cure, and (v) the separate issue of male SUI. Results Roadblocks to progress were identified for each of the five directions. Conclusions Future research directions are suggested for each of these areas. Neurourol. Urodynam. 30:704–707, 2011. © 2011 Wiley-Liss, Inc.

Transrectal sonography of the bladder and urethra was performed to investigate urethral conditions in 296 women (191 with stress urinary incontinence, 78 with frequency-urgency syndrome, and 27 who were asymptomatic). Patients with stress urinary incontinence showed larger pubovesical angle during both resting and straining states than those with either frequency-urgency syndrome or those who were asymptomatic. Pubovesical length did not vary among the three groups of women. Five types of stress urinary incontinence were classified according to the four findings of transrectal sonography: hypermobility of the bladder neck, bladder neck incompetence, urethral sphincteric incompetence, and the presence of a cystocele. Of the patients with frequency-urgency syndrome, 55.1% showed bladder neck incompetence, whereas only 29.6% of the asymptomatic women did. Of the patients with frequency-urgency syndrome, nine had urethral sphincteric incompetence and one had a cystocele. none of the asymptomatic women had any of these disorders. However, the presence of bladder neck incompetence did not correlate well with the presence of clinical symptoms. Transrectal sonography could not differentiate symptoms caused by the bladder from those caused by the urethra. Although a large overlapping of pubovesical angle size was noted among the groups of women, the angle was largest in those with stress urinary incontinence, second largest in those with frequency-urgency syndrome, and smallest in those who were asymptomatic. These findings held true during both resting and straining. Bladder neck incompetence was often associated with a weak extrinsic continence mechanism, as was demonstrated by pubovesical angle changes in both frequency-urgency syndrome patients and asymptomatic women. Urethral sphincteric incompetence was not present in asymptomatic women but could be found in 12.8% of those with frequency-urgency syndrome.

We present our experience with a modified technique for constructing a continent ileal reservoir, using the terminal ileum in a pre-peritoneal position. The ureters were implanted using the Le Duc-Camey technique; the Benchekroun valve was used as a continence mechanism. This technique was used in 18 patients and its advantages and complications are discussed.