Study No. 11: Ligamentous repair using the Tissue Fixation System confirms a causal link between damaged suspensory ligaments and urinary and fecal incontinence

Abstract: AIM. The aims of this study were: 1. To test the efficacy of a less invasive method (TFS) for tape implantation in patients with vaginal prolapse, urinary and fecal incontinence; 2. To test the contribution of ATFP/cardinal and their attached fascia (cystocoele repair), if any, to causation of fecal incontinence. PATIENTS AND METHODS. Eighty-one patients, mean age 60.1, mean weight 69 kg (43-112 kg), mean 2.0previous pelvic operations, underwent 154 site specific operations in the 3 zones of the vagina as primary procedures using the Tissue Fixation System (TFS). The site of operation(s) was determined by reference to a pictorial diagnostic algorithm: pubourethral ligaments, n=43; ATFP, cardinal ligaments, (cystocoele) n = 39; uterosacral ligaments (apical prolapse), n = 72. The patients were assessed with a 24 hour urinary diary, structured questionnaire, transperineal ultrasound, urodynamics, cough stress test, and 24 hour pad test, pre and post-operatively at mean 12months (6-18 months). RESULTS. Symptom improvement was as follows: fecal incontinence (n = 33) 88%, stress incontinence (n = 43) 89%,urgency and nocturia (n = 50) 80%. CONCLUSIONS. Both urinary and fecal incontinence (FI) symptoms were simultaneously cured, indicating a causal link. Repair of ATFP and cardinal ligament defects (cystocoele) did not produce a significantly higher cure rate for FI to that achieved by repairing just the anterior and/or posterior suspensory ligaments in studies No 9 & 10, indicating perhaps, the primacy of anterior and/or posterior suspensory ligaments in FI control.