title: Long-term evaluation of the Gittes procedure for urinary stress incontinence.
abstract: OBJECTIVE
  We evaluate the long-term outcome of the Gittes procedure for urinary stress incontinence.
  
  
  METHODS
  A total of 87 women with proved genuine stress incontinence were treated with the Gittes procedure. The same urologist performed 95 consecutive operations during an 8-year period. Patients were evaluated by a postal questionnaire.
  
  
  RESULTS
  Of the patients 52 (60%) (55 operations) responded to the questionnaire. Mean and median followup were 53 and 46 months, respectively (range 24 to 103). Twelve patients (23.1%) reported complete absence of postoperative urinary incontinence and were considered cured, 14 (26.9%) were significantly improved and a total of 30 (57.7%) benefited from the operation. The short-term results were initially encouraging but by 2 years only 20 patients were completely continent (38.5% cured). Of the 40 patients who were not cured 32 (80.0%) experienced incontinence within 2 years postoperatively. There were 26 who had complained of frequency and/or urgency preoperatively. There was a statistically significant subjective failure rate in this group (p = 0.007).
  
  
  CONCLUSIONS
  The Gittes procedure is simple and has minimal complications. Although it provides continence in the early weeks and months following surgery, the long-term cure rate is disappointing, with most failures occurring within 2 years of surgery. Preoperative irritative symptoms, even when multichannel cystometry did not reveal instability, were associated with a poor subjective outcome. Our results suggest that the Gittes procedure is not satisfactory for the management of genuine stress incontinence in women.
authors.affiliation: Department of Urology, Northwick Park and St. Mark's Hospital, London, United Kingdom.
authors.forename: J J
authors.initials: JJ
authors.lastname: Elkabir
authors.forename: A D
authors.initials: AD
authors.lastname: Mee
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D013514:Surgical Procedures, Operative / Q000379:methods; D013997:Time Factors; D014550:Urinary Incontinence, Stress / Q000601:surgery*