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Summary Ninety‐five patients complaining of urinary incontinence, 58 of whom had been subjected to previous unsuccessful surgery, were investigated by means of flow studies and voiding cine‐urethrocystography with simultaneous pressure recordings. Patients suffering from neurological lesions or fistulae were excluded from this study. It was found that urinary stress incontinence could result from weakness of the internal urethral sphincter, detrusor instability, urethral narrowing, or any combination of these three. Clinical symptoms and signs alone did not provide an accurate diagnosis. A rational plan of treatment, based on full investigation is outlined and attention is especially drawn to the treatment by internal urethrotomy ofincontinence due to urethral narrowing which may occur as a sequel to gynaecological surgery.

A prospective study has been carried out over six years to determine whether or not assisted delivery before full dilatation of the cervix is a safe alternative to Caesarean section. Malmstrom's vacuum extractor was employed to accelerate the first stage of labour in 86 patients. This was successful in 82 patients, 39 being delivered with the ventouse alone, and 43 with the additional aid of forceps. In 4 patients vaginal 1077

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