To compare the efficacy of the Stamey endoscopic vesical neck suspension with the Marshall-Marchetti-Krantz vesicourethropexy in the correction of stress urinary incontinence, we studied retrospectively 127 consecutive patients who underwent either procedure during a defined interval at our institution. Of 95 women for whom adequate data were available 41 (group 1) underwent the Stamey and 54 (group 2) underwent the Marshall-Marchetti-Krantz procedures. Characteristics of the 2 groups were similar. A cure was obtained 21 to 118 months postoperatively in 61 per cent of the patients in group 1 and in 57 per cent in group 2. Cured and improved rates for the 2 groups were 78 and 80 per cent, respectively. Cure rates decreased with time in both groups. Complications occurred in 37.5 per cent of the patients in group 1 and in 18.5 per cent in group 2. Risk factors implicated in the pathogenesis of primary or recurrent stress urinary incontinence did not predispose to failure in either group. Adequate interpretation of our lower cure rates vis-à-vis those reported previously is hampered by the variability between series in the definition of cure and length of postoperative followup.

Experience with suprapubic closure of vesicovaginal fistulas in 42 patients considered candidates for this procedure is reviewed. Five patients required a second operation for cure and the reasons for failure are discussed. Wide exposure with tension-free closure of well vascularized flaps and the judicious interposition of pedicled omentum have produced the most encouraging results. The litigious nature of this distressing condition is lessened when primary closure is successful and supravesical diversion by ileal or colonic conduits can be avoided.

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