***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: Abstract Objectives : To describe the impact of surgery for stress incontinence on the severity of symptoms , other mental and physical symptoms , and overall health . To describe the incidence of postoperative complications . Design : Prospect i ve cohort study ; question naires completed by patients before and 3 , 6 , and 12 months after surgery . Question naires completed by surgeons both before and after surgery . Setting : 18 hospitals in the North Thames region . Subjects : 442 women treated surgically for stress incontinence between January 1993 and June 1994 . 367 women returned the 3 month question naire ; 364 returned the 6  month question  naire ; and 359 returned the 12 month question  naire . 49 surgeons provided perioperative information on 285 of the 442 women and postoperative information on 278 . Main outcome measures : Stress incontinence symptom severity index , other urinary symptoms , bowel function , mental health , complications , global measures . Results : Most women ( 288 ; 87 % ) reported an improvement in the severity of their stress incontinence , though only 92 ( 28 % ) were cured ( continent ) . These improvements persisted for at least 12 months . The likelihood of improvement was similar regardless of whether urodynamic pressure studies had been conducted before surgery . Following surgery , women were less likely to suffer from urinary frequency , nocturia , postvoid fullness , dysuria , and urgency . While mental health improved for 194 ( 71 % ) , a quarter of women reported deterioration . Only 37 ( 10 % ) were satisfied with postoperative pain control . A third experienced one or more complications while in hospital , most commonly difficulty urinating . This problem affected 1 in 11 women after discharge . A year after surgery two thirds of women reported feeling better ( 251 ; 72 % ) , that the outcome met or exceeded their expectations ( 230 ; 66 % ) , and that they would recommend the operation to a friend in a similar situation ( 239 ; 68 % ) . Surgeons tended to be more optimistic about the effects of surgery ; they were satisfied with the outcome in 176 ( 85 % ) cases and would again treat 245 ( 94 % ) of the women as they had done previously . Conclusions : Although surgery reduces the severity of stress incontinence it is not as effective as current textbooks suggest . Women considering surgery should be provided with more accurate information on the likelihood of an improvement in symptoms and the occurrence of complications , including postoperative pain . Urgency and urge incontinence should not be considered contraindications to surgery . The need for urodynamic assessment before surgery should be reappraised . Key messages Although surgery improves stress incontinence in most women ( 87 % ) , only 28 % are continent one year later The need for preoperative urodynamic testing should be reappraised Urgency and urge incontinence should not be considered contraindications to surgery Women considering surgery should receive more accurate information on the probability of an improvement in symptoms and possible complications There is a need for a rigorous , pragmatic , r and omised trial of surgery for stress Fifty consecutive female patients with genuine urinary stress incontinence were r and omized either to surgery or to a pelvic floor training program . The operative procedure was chosen according to the type of bladder suspension defect on micturition cystourethrography . The training program was given 5 times in weekly lessons and the patients were guided by trained physiotherapists . Surgery was superior to the pelvic floor training program both subjectively and objective ly . However , a significant improvement was found following the training program . Forty-two percent were satisfied with the outcome of the training and did not want operation . We find physiotherapist-guided pelvic floor exercise a realistic alternative to surgery in patients with mild degrees of stress incontinence . Also patients with residual symptoms after surgery are c and i date s for pelvic floor training One hundred seven consecutive patients with clinical and urodynamic findings of genuine stress incontinence not previously treated were prospect ively allocated in a r and omized manner to one of three surgical procedures : anterior colporrhaphy , revised Pereyra procedure , or Burch retropubic urethropexy . R and omization included the surgical procedure and choice of surgeon ( one of the three authors ) . Clinical and urodynamic evaluations were repeated at 3 months and 1 year after surgery . Differences in cure rates among the three procedures at the 3-month postoperative evaluation were insignificant ( 82 % , 84 % , and 92 % for the anterior colporrhaphy , Pereyra , and Burch respectively ) but became statistically significant at the 1 year postoperative evaluation ( cure rates of 65 % , 72 % , and 91 % for the anterior colporrhaphy , Pereyra , and Burch respectively , p less than 0.05 ) . In our h and s the Burch procedure stabilized the urethrovesical junction and prevented its descent during straining ( evaluated by a postoperative Q-tip test ) more effectively than either the Pereyra or anterior colporrhaphy . No procedure result ed in severe postoperative voiding difficulties . The present prospect i ve r and omized study demonstrates that in our h and s the abdominal retropubic operation for genuine stress incontinence in patients not previously operated on results in a higher cure rate when compared with anterior colporrhaphy or Pereyra procedure Forty-five women with stress incontinence ( mean age 50 years ) scheduled for surgical treatment r and omized either to retropubic urethrocystopexy or to pubococcygeal repair were prospect ively studied . Fifty healthy women were used as a reference group . No difference emerged concerning the outcome for these two surgical techniques in terms of success rate . Consequently , the subjects were treated as one group . The aim of the study was to test for predictive factors of the outcome of surgical treatment . Age of the patient , duration of stress incontinence , parity , personality , psychological and social factors were investigated . The outcome of surgical treatment was estimated both subjectively and objective ly ( pad test ) . The women were classified as cured or improved/failure . There was an 80 % concordance between subjective and objective methods . In the stress incontinent women who were improved/failure one year after surgery , a high degree of neuroticism , low degree of extraversion , high degree of somatic anxiety , psychic anxiety , psychasthenia and suspicion was observed compared to the cured women . Furthermore , the improved/failure women had a lower level of social integration , in terms of loneliness compared to the cured women . Our findings point to the need of psychosocial support and care in addition to the medical treatment . According to a stepwise logistic regression analysis three variables have been found of importance as predictors of the outcome of the surgical treatment : duration of stress incontinence , neuroticism and age of patient The aim of the present study was to evaluate subjective and objective methods used for the investigation of stress urinary incontinence ( SUI ) and to compare the outcome of two different surgical techniques regarding cure rate , postoperative nursing , bladder drainage and postoperative pain relief . The study included 45 women with SUI , r and omized either to retropubic urethrocystopexy ( n = 30 ) or pubococcygeal repair ( n = 15 ) . The assessment included medical history , gynaecological examination , urine analysis and culture , residual urine , pad test , frequency-continence charts , water urethrocystoscopy , continence test , and cystometry with micturition analysis .  Moreover ,  Beck 's Depression Inventory and the Eysenck Personality Inventory  were used before surgery . One year after surgery no significant difference in subjective cure rate was found between the two surgical methods ( 73 % vs. 80 % , respectively ) . According to pad tests , 67 % of the women in the urethrocystopexy group and 47 % in the pubococcygeal repair group had ceased to leak urine . The bladder volume increased significantly in both groups . Sixty-three per cent of the women in the urethrocystopexy and 33 % in the pubococcygeal repair group experienced severe to very severe postoperative pain . In these groups , significantly more dysphoric women were found as compared with the group of women with less postoperative pain . Furthermore , the women with more severe pain scored higher on the neuroticism scale . These findings indicate the importance of personality factors in the treatment and nursing women with SUI OBJECTIVES To measure the effect on voiding pressure and flow rate of three different operations for stress urinary incontinence . METHODS In a previous study of cure rates , 289 women with genuine stress incontinence and genital prolapse were prospect ively allocated in a r and omized manner to one of three procedures : the Burch retropubic urethropexy , anterior repair , or the modified Pereyra procedure . In the current derivative study , we retrospectively evaluated the urodynamic indicators of voiding dysfunction in the original subjects preoperatively and at the 1-year postoperative follow-up visit . RESULTS One hundred thirty-two charts were available for review . One year after surgery , pressure and flow during voiding were altered to more obstructive levels with the suspension procedures ( Burch and modified Pereyra ) . The proportion of patients with obstructive and equivocal voiding patterns after the suspension procedures was significantly greater than after anterior repair . CONCLUSIONS This post hoc comparison of r and omized data shows a difference in postoperative voiding indexes between suspension procedures and anterior colporrhaphy . Successful bladder neck suspension depends on altering the pressure and flow during voiding to more obstructive levels . Suspension procedures alter the voiding pressure and flow toward obstruction to a greater extent than anterior repair Objective To determine the sensitivity and specificity of several urodynamic testing methods in the diagnosis of genuine stress urinary incontinence ( GSI ) . Methods One hundred eight consecutive patients were evaluated prospect ively by history and physical examination , cough stress test , and single and multichannel urodynamics . Sensitivities and specificities in detecting genuine stress incontinence were calculated for : a positive cough stress test with a negative cystometrogram , equalization throughout a cough urethral pressure profile , a positive stress leak-point pressure determination , observed urine loss with cough during multichannel urodynamics , and a pressure transmission ratio of less than 90 % for each third of the urethra . Results Sixty-five patients ( 60 % ) were found to have GSI .  Observed urine loss with cough during multichannel studies was 91 % sensitive and 100 % specific . A positive stress leak-point pressure determination had a 78 % sensitivity and was 100 % specific . A positive cough stress test with a negative cystometrogram was 77 % sensitive and 100 % specific . Pressure equalization throughout the length of the urethra during a cough urethral pressure profile was 49 % sensitive and 98 % specific . A pressure transmission ratio of less than 90 % in the distal , middle , and proximal urethra had sensitivities and specificities of 54 and 79 % , 51 and 65 % , and 45 and 58 % , respectively . A pressure transmission ratio of less than 90 % along the entire length of the urethra was 22 % sensitive and 93 % specific . Conclusion Observed urine loss with cough during multichannel urodynamics was the best examination for diagnosing GSI in our population OBJECTIVE In a r and omized trial , we compared the success of Burch retropubic urethropexy to the modified anterior colporrhaphy for the treatment of genuine stress urinary incontinence . METHODS Thirty-five patients with stress incontinence were r and omly assigned to undergo Burch retropubic urethropexy or modified anterior colporrhaphy .  Subjects had preoperative and 1-year postoperative physical examinations , multichannel urodynamic testing , 20-minute pad test , and subjective grading of incontinence severity with question naires . Data were evaluated using Fisher exact test , Wilcoxon two- sample test , logistic regression analysis , and analysis of variance . RESULTS Objective cure 1 year postoperatively was significantly greater for the women treated by Burch retropubic urethropexy than by modified anterior colporrhaphy ( 16 of 18 [ 89 % ] versus five of 16 [ 31 % ] , relative risk .15 , 95 % confidence interval .04 , .59 ) . Patients ' subjective ratings of incontinence severity 1 year after surgical treatment were significantly lower in women who had Burch retropubic urethropexy . CONCLUSION Burch retropubic urethropexy yields a significantly superior objective cure for genuine stress urinary incontinence than the modified anterior colporrhaphy in a r and omized trial OBJECTIVE Our purpose was to compare two antiincontinence procedures in patients with severe genitourinary prolapse and coexisting clinical or potential stress incontinence . STUDY DESIGN In addition to cystopexy , 109 patients with a urethrocystocele of grade 2 or more and a positive stress test result with prolapse reduction received posterior pubourethral ligament plication or Pereyra suspension . RESULTS Of 55 patients undergoing posterior pubourethral ligament plication , 15 were clinical ly and 40 potentially incontinent ; the same figures were 21 and 33 , respectively , among 54 patients undergoing the Pereyra procedure . Follow-up was for 3 to 9 years . Subjective ( 60 % vs 71 % , p = 0.72 ) and objective ( 27 % vs 57 % , p = 0.14 ) cure rates were not statistically different among patients who were clinical ly incontinent ( posterior pubourethral ligament plication vs Pereyra suspension ) . Among potentially incontinent patients , subjective ( 8 
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The performance of anterior repair  in comparison with needle suspension appeared similar but clinical ly important differences could not be confidently ruled out .
These findings held irrespective of the co-existence of prolapse ( pelvic relaxation ) .
REVIEW ER 'S CONCLUSIONS There were not enough data to allow comparison of  anterior vaginal repair  with physical therapy or needle suspension for primary urinary stress incontinence in women .