Original Study

Experimental Study No. 9: Double incontinence, urinary and fecal, cured by surgical reinforcement of the pubourethral ligaments

  • IAN W. HOCKING

Pelviperineology 2008;27(3):110-110

AIM.

To test a previous observation that patients with double incontinence, stress urinary incontinence and fecal incontinence, may both be cured with a midurethral sling.

METHODS:

A prospective study. Between September 1999 and February 2007, using the IVS tunneller (Tyco Norwalk CT), the author performed 647 midurethral sling operations in patients with genuine stress incontinence (GSI) (n = 343), mixed stress and urge incontinence (n = 242), and double incontinence, stress and fecal (n = 62). Mean age of the patients was 63 years (range 36-86), and mean parity 3 (range 1-6). Transperineal scanning (n = 575) and urodynamics (n = 509) were performed in the majority of patients. Inclusion criteria: all patients with GSI, mixed and double incontinence. Exclusion criterion: external anal sphincter damage.

RESULTS:

Postoperative assessment was at 6 weeks, 6 months, then 12 months. GSI (n = 343); Mixed Incontinence (n = 242); fecal incontinence (n = 62). Overall cure rate for stress incontinence was 91%, for the urge component of mixed incontinence 74% , and for the fecal component of double incontinence 92%. Complications included bladder perforation 0.1%, voiding difficulty 4%, haematoma 1.7%, neourgency 3.4%, and tape erosion 1.5%.

CONCLUSION:

A competent pubourethral ligament appears to be an important component of the fecal continence mechanism, at least as concerns patients with double incontinence, who have no obvious external anal sphincter damage.

Keywords: Fecal Incontinence; Stress Incontinence; Pubourethral ligament; Midurethral sling; Integral Theory.