Laparoscopic Burch colposuspension and overlapping sphincteroplasty for double incontinence.

OBJECTIVES

1. To assess the effectiveness of laparoscopic Burch and overlapping sphincteroplasty in treating urinary and fecal incontinence. 2. To determine the importance of unilateral pudendal neuropathy in fecal incontinence.

METHOD

Forty-six women with proven genuine stress incontinence and anal sphincter tears were treated with a laparoscopic Burch colposuspension. Patients with detrusor instability, intrinsic sphincter dysfunction, idiopathic fecal incontinence, and prior anal surgery were excluded. Objective postoperative testing for urinary continence included a cough stress test and bladder neck ultrasound, with repeat urodynamic studies if either test was positive. Fecal incontinence was graded with a clinical scoring index. The anal evaluation included sonography, sigmoidoscopy, manometry, and pudendal nerve terminal motor latency. Patients were divided into 2 groups. Group I (n = 34) had no neuropathy, and Group II (n = 12) had unilateral neuropathy.

RESULTS

At 1-year follow-up, 40 patients (89%) were objectively dry, but 3 (7%) had recurrent genuine stress incontinence, and 2 (4%) had detrusor instability. Fecal incontinence cure rate was 82% in Group I and 58% in Group II. Group I had greater improvement in anal physiology studies than did Group II. Sphincter breakdown was the most common cause of recurrent fecal incontinence in Group I, but 4 of 5 patients with persistent incontinence in Group II had intact sphincters.

DISCUSSION

Burch colposuspension is effective in treating genuine stress incontinence. Anal sphincteroplasty is effective in treating fecal incontinence due to obstetrical tears in the absence of pudendal neuropathy. Even unilateral neuropathy can significantly impair surgical outcomes.