The purpose of this retrospective study was to evaluate the importance of different preoperative estimates and postoperative complications on the outcome of the Burch colposuspension with respect to urinary continence. During the period 1980-1988 243 women were operated upon with the Burch colposuspension for stress incontinence or mixed incontinence. The patient records have been analysed with respect to preoperative assessments and postoperative complications. 236 patients were alive at the follow-up, median 6 years after operation, and 232 (98%) answered a postal questionnaire about their present urinary symptoms. According to the postal questionnaire the overall cure-rate was 63 per cent, another 27 per cent were improved. Prognostic factors for an unsuccessful outcome of the operation were previous urinary incontinence surgery, postoperative febrile morbidity, and immediate voiding difficulties (stranguria and difficulties emptying the urinary bladder). At the follow-up the voiding difficulties were still significantly more often seen in patients not cured from incontinence than among women cured by the colposuspension. Among the patients with recurrent incontinence we also found a significantly higher rate of lower urinary tract infections ( > 3 UTI per year). The continence rate was found to be almost constant between the second and tenth year postoperatively. No significant differences in preoperatively measured maximal urethral closure pressure and functional urethral length were found between cured and not cured patients. Although not significant, the cure-rate showed a tendency to decrease with age at the operation, both in the short-term result as well as the long-term result.

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Using tritium-labelled oxytocin with a high specific activity, the halflife in the blood and the urinary excretion of intravenously injected oxytocin were followed in the female. The following groups of patients were studied: normally menstruating women during different phases of the menstrual cycle, women using a combination of gestagenic and oestrogenic hormones for oral contraception, and pregnant women in the first and second trimester. The pregnant women were admitted to the hospital for legal abortion in the 10th–20th week of gestation. In the proliferative phase, t½ was 272 seconds (n = 14), in the secretory phase 221 seconds (n = 5), and in women using oral contraceptives 199 seconds (n = 10). In pregnant women during the first trimester, t½ was 178 seconds (n = 6). The corresponding value in women examined during the 14th–17th weeks and during the 18th–20th weeks of gestation was 295 seconds (n = 6) and 282 seconds (n = 6), respectively. T½ was also determined within 24 h of abortion in patients in the second trimester, where the abortion was induced by intra-amniotic instillation of 50% glucose. In all cases a decrease in t½ was found. The decrease was most marked in women during the 18th–20th weeks of gestation. Altogether 25–50% of the radioactivity injected was recovered in the urine from pregnant women within 3 h of the injection. Thin-layer chromatography of the urine did not reveal the presence of any intact oxytocin. The results demonstrate that the disappearance of oxytocin from the blood seems to be influenced by the sex hormones. Thus, an oestrogendominated stage shows a lower disappearance rate, whereas gestagens produce the reverse effect. The pronounced decrease in t½ in pregnant women immediately after abortion might be due to a change to a more progesterone-dominated stage induced by the death of the foetus, or by an alteration in the affinity of oxytocin to the myometrium.

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In a prospective randomized study spontaneous and oxytocin induced labor "for convenience" have been compared with respect to uterine activity, duration of labor, the condition of the fetus and the newborn infant. The study consists of 84 normal patients, of whom 43 were induced at full term by amniotomy and oxytocin infusion using the Cardiff Infusion System Mark II; 41 patients served as controls. No difference in maternal age, number of previous pregnancies and pelvic score one week before the day of delivery were found between the groups. The following parameters were calculated: duration of labor, uterine activity, amount of bleeding in the third stage of labor, number of early and late decelerations as well as number of episodes of bradycardia in the CTG-recordings, birth weight, Apgar score one and five minutes post-delivery and blood gases in mother and child 60 seconds after delivery. No significant differences between the two groups were found. It is concluded that there are no increased risks to mother or fetus compared to normal labor provided that there is cephalic presentation and normal pregnancy, careful selection with respect to the length of pregnancy and the condition of the cervix and that the Cardiff infusion system is used with intrauterine pressure recording and continuous fetal heart monitoring.

We failed to find any clinical or defecographic characteristic which could predict the development of surgery-demanding genital prolapse following colposuspension. The colposuspension seemed to accelerate the deterioration of the pelvic floor. However, only a minority of the patients developed symptomatic genital prolapse demanding corrective surgery. We suggest that only women with symptomatic prolapse should be considered for concomitant corrective surgery at the time of the colposuspension.

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