Original scientific paper

SURGICAL TREATMENT OF STRESS URINARY INCONTINENCE, FECAL INCONTINENCE AND VAGINAL PROLAPSE BY A NOVEL OPERATION »URETHRO-ANO-VAGINOPLASTY«

Abdel Karim M. El Hemaly orcid.org/0000-0002-5576-8987 ; Faculty of medicine, Al Azhar University, 3 emad el din kamel street, Nasr City, Cairo, Egypt
Laila A. Mousa ; Faculty of medicine, Al Azhar University, 3 emad el din kamel street, Nasr City, Cairo, Egypt
Ibrahim M. Kandil ; Faculty of medicine, Al Azhar University, 3 emad el din kamel street, Nasr City, Cairo, Egypt
Fatma S. El Sokkary ; Faculty of medicine, Al Azhar University, 3 emad el din kamel street, Nasr City, Cairo, Egypt
Ahmad G. Serour ; Faculty of medicine, Al Azhar University, 3 emad el din kamel street, Nasr City, Cairo, Egypt
Hossam Hussein ; Faculty of medicine, Al Azhar University, 3 emad el din kamel street, Nasr City, Cairo, Egypt

Abstract

We put forward a novel concept explaining the mechanism of micturition and the factors that control urinary continence. Also, we describe the mechanism of defecation and the factors that control stool continence and prevent fecal incontinence. A weak internal urethral sphincter (IUS) will not withstand sudden rise of intra-abdominal pressure and urine will leak. The weakness of the IUS is mostly due to traumatic rupture of its wall as a result of the huge vaginal distension that happens during prolonged, difficult and multiple frequent labors. So, surgical correction is by exposing that rupture and mending its walls. Also the marked vaginal distension which occurs in labor will cause lacerations in the internal anal sphincter (IAS) which is intimately related to the posterior vaginal wall. The torn weak IAS will cause fecal incontinence (FI). Exposing the torn IAS and mending the torn walls will restore the sphincter strength and fecal continence. Vaginal prolapse occurs as a result of vaginal wall weakness, redundancy and flabbiness subsequent to its marked stretching of its walls during vaginal deliveries. Overlapping the vaginal flaps both in the anterior and posterior vaginal wall, such repair will strengthen the vaginal walls, as if we put a collagenous mesh but instead this is an autologus collagenous mesh. We innovated an operation called »urethro-ano-vagino-plasty« to surgically treat urinary incontinence, fecal incontinence and and vaginal prolapse. Objectives. To describe this novel operation, and assess its results for a follow up period of 24 months. Methods. 134 patients with SUI and FI were assessed. Urethro-ano-vaginoplasty was done, and the results were assessed immediately and for 24 months follow up. Results. 121 (90.3%) gained urinary and fecal continence and remained continent in the follow up period. Conclusion. The internal anal sphincter (IAS) is a collageno-muscular tissue cylinder that surrounds the anal canal innervated by alpha-sympathetic nerve supply from the hypogastric nerves. It is surrounded in its lower part by the EAS which is a striated muscle innervated by the pudendal nerve. Its damage during childbirth causes fecal incontinence and mending the torn walls restores fecal continence.

Keywords

urethro-ano-vaginoplasty; internal urethral sphincter; internal anal sphincter; fecal incontinence; stress urinary incontinence

Hrčak ID:

69732

URI

https://hrcak.srce.hr/69732

Publication date:

1.9.2010.

Article data in other languages: croatian

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