title: Stress urinary incontinence after delayed primary closure of genitourinary fistula: a technique for surgical management.
abstract: OBJECTIVE
  Our purpose was to evaluate the anatomic pathology of severe incontinence after fistula closure and assess a surgical technique for correction of this problem.
  
  
  METHODS
  Twenty-two women with severe urinary incontinence after fistula closure were recruited, and clinical and urodynamic assessment was performed. A technique combining retropubic urethrolysis, pubovaginal sling, and omental graft was performed in women with genuine stress incontinence (GSI), and continence outcome was assessed at 4 weeks and 14 months.
  
  
  RESULTS
  On urodynamic assessment, 9 (41%) had severe GSI with normal compliance, 3 (14%) GSI and poor compliance, 9 (41%) GSI and detrusor instability, and 1 (4%) voiding dysfunction with overflow incontinence. Nine women (41%) with pure GSI underwent continence surgery. Continence outcomes were 78% at 4 weeks and 67% at 14 months.
  
  
  CONCLUSIONS
  The anatomic pathology of GSI after fistula surgery is complex. The surgical technique described is promising with low morbidity and improved continence rates at 4 weeks and 14 months compared with previous techniques.
authors.affiliation: Department of Urogynaecology, Mercy Hospital for Women, Melbourne, Australia.
authors.forename: Marcus P
authors.initials: MP
authors.lastname: Carey
authors.forename: Judith T
authors.initials: JT
authors.lastname: Goh
authors.forename: Michelle M
authors.initials: MM
authors.lastname: Fynes
authors.forename: Christine J
authors.initials: CJ
authors.lastname: Murray
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006801:Humans; D008875:Middle Aged; D016896:Treatment Outcome; D001747:Urinary Bladder Fistula / Q000601:surgery*; D014550:Urinary Incontinence, Stress / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology / Q000601:surgery*; D014563:Urodynamics; D013519:Urogenital Surgical Procedures / Q000009:adverse effects*; D013520:Urologic Surgical Procedures; D014624:Vaginal Fistula / Q000601:surgery*