Laparoscopic Burch Colposuspension and Overlapping Sphincteroplasty for Double Incontinence

OBJECTIVES: 1. To assess the effectiveness of laparoscopic Burch and overlapping sphincteroplasty in treating uri-nary 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 uni-lateral neuropathy can significantly impair surgical outcomes.