Repair Of Incontinence Research Articles

Electrophysiologic and manometric assessment of failed postanal repair for anorectal incontinence.

The reason for failure to improve fecal incontinence after postanal repair in idiopathic (neurogenic) anorectal incontinence is unknown. The authors have studied 20 patients whose anorectal continence was not improved after Parks' postanal repair. Anorectal manometry, single fiber EMG of the external anal sphincter muscle, and measurements of the pudendal nerve terminal motor latency were studied before and nine months after postanal repair. All 20 patients had evidence of reinnervation within the external anal sphincter muscle before operation; 17 had a raised pudendal nerve terminal motor latency and all 20 had low resting voluntary contraction anal canal pressures. No significant differences were found between the resting, voluntary contraction anal canal pressures and single fiber EMG fiber density values before or after postanal repair. However, a significant increase in the pudendal nerve terminal motor latency was found after postanal repair (P less than 0.001) using a student's paired t test. These results suggest that, in patients who are not rendered continent by postanal repair, a continuing neuropathic process takes place.

Urethral pressure profile at pubococcygeal repair for stress incontinence.

The influence of pubococcygeal repair on the urethral pressure profile as well as the cure rate, technical operative results and side-effects have been studied in 16 severely stress-incontinent patients. The patients were followed during the first postoperative year in order to detect the possible long-term effects of devascularization, denervation and scarring on the urethral tone. Examination, using simultaneous urethrocystometry with recording of the urethral pressure profile at rest was undertaken preoperatively, 3 months postoperatively and one year postoperatively. Urethral functional length was not affected by the surgery. Urethral closure pressure was slightly reduced 3 months postoperatively and did not recover completely within the first postoperative year. Such a reduction in urethral pressure probably reflects damage to the urethral tissue due to devascularization and denervation. Its main clinical importance concerns cases of severe stress incontinence with a very low initial closure pressure in the urethra. Here, vaginal surgery may jeopardize that success of an otherwise technically irreproachably performed operation. On the whole, pubococcygeal repair is effective in achieving continence, although the side-effects call for careful selection of patients.

Pressure transmission to the pre-urethral space in stress incontinence.

Pressure transmission from the abdomen to the pre-urethral space has been studied in stress- incontinent women and in some women following pubococcygeal repair for stress incontinence. Pressure was recorded at different levels of the pre-urethral space and simultaneously in the bladder. Simultaneous measurements inside and outside the urethra at different levels above the external urethral meatus showed that an intra-abdominal pressure rise was transmitted via the pre-urethral space to the urethra. Pressure was transmitted almost in full to the surroundings of the lower-most part of the bladder, but outside the functional urethra, transmission was successively more defective along the urethra towards the external meatus. Therefore, a short functional length and a distal maximal pressure plateau in the urethra, as in stress incontinence, is a disadvantage. Pressure losses amount to 1/3 or more. Pressure transmission could be improved to "supranormal" values by establishing firm support for the urethra, thereby allowing a minimum of rotational descent with stress and providing good counterpressure.

Treatment of stress incontinence by the Marshall-Marchetti-Krantz procedure

Retropubic vesicourethral suspension in primary and secondary stress incontinence results in a high percentage of cures, and frequently is indicated as the initial procedure for repair of stress incontinence.

The repair of anorectal incontinence following operation for fistula.

The repair of anorectal incontinence following operation for fistula.