Sphincteroplasty

Sphincteroplasty is a surgical procedure to repair or reconstruct a damaged sphincter muscle to restore continence. The term most often refers to repair of the external anal sphincter to treat fecal incontinence, but it can also describe surgery aimed at the urethral sphincter to improve urinary continence.

Anal sphincteroplasty is indicated for fecal incontinence due to a defect of the external anal sphincter, typically from obstetric trauma or pelvic injury, when a discrete defect is evident and rectal sensation is preserved. The procedure is most successful in well-selected patients.

Two main approaches are end-to-end sphincteroplasty and overlapping sphincteroplasty. End-to-end repair reapproximates the torn ends; overlapping sphincteroplasty mobilizes and overlaps the ends to increase circumference. Both are performed through a perineal incision under anesthesia, with careful dissection and layered suturing using absorbable material.

Urethral sphincteroplasty may be used to treat intrinsic urethral sphincter deficiency contributing to stress urinary incontinence, especially after prostate surgery or in women with weakened sphincter function. Techniques include mobilization and cuffing around the urethra, sometimes combined with other continence procedures.

Outcomes vary. Many patients notice meaningful improvement, particularly with defined defects, but durability ranges and decline over time can occur, especially with ongoing neuropathy or aging.

Risks include infection, bleeding, wound problems, fistula, persistent incontinence, urinary retention, and stricture.

Recovery involves wound care, stool softeners, and activity modification, with follow-up to assess continence and healing. Alternatives include bulking agents, pelvic floor therapy, sacral neuromodulation, or urinary or anal sphincter devices.