ABSTRACT

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.