الفهرس 
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Abstract
Stress urinary incontinence (SUI) is a devastating condition that affects 15 - 35% of female, in the general population (Jae et al.,2004).
Genuine stress incontinence is defined as the involuntary loss of urine when the intravesical pressure exceeds the maximum urethral closure pressure in the absence of detrosor activity. Genuine SUI is the commonest cause of incontinence in women, demonstrable in 40-60% of those investigated (Abrams et al., 2005).
Surgical techniques for stress urinary incontinence have evolved over the last 150 years. The pressure transmission theory, proposed that re-positioning of the bladder neck and proximal urethra in a high intra-pelvic position allowed equal pressure transmission to the bladder and proximal urethra, and results in stress continence. In the 1960s and 1970s surgical success was widely attributed to this passive mechanical effect (Bauer et al 2011).
Subsequently it became apparent that maintenance of stress continence was not a purely passive process. Studies examined the effect of continence surgery on midurethral function and urethral anatomy. Commence was found to be dependent on efficient pressure transmission during rise in intra-abdominal pressure to the proximal three-quarters of the functional urethral length (Sassani and Aboseif 2009).
This randomized controlled trial had been conducted at El - Minya Maternity and Pediatric university hospital started at September 2007 to February 2010.
The study consists 60 patient whose were randomly divided into three groups each group contains 20 patients who subjected to 3 types of surgical procedures for genuine stress incontinence as follow:
1-The 1st group was subjected to trans-obturator vaginal tape operation (Inside – out technique ).
2-The 2nd group was subjected to Burch colposuspension operation.
3-The 3rd group was subjected to Kelly’s plication operation.
All patients were evaluated pre-operatively by history, physical examination, routine pre-operative laboratory investigations including, urine analysis, culture and sensitivity if needed, abdomino-pelvic ultrasound with estimation of post-voiding residual urine and urodynamic investigations in the form of uroflowmetry, cystormetry with assessment of valsalva leak point pressure ,abdominal leak point pressure and pressure flow study.