Robotic Placement of the FENIX Continence Restoration System in a Patient with Previous Radiation to the Pelvis: A Case Report.

Fecal incontinence (FI) is a disabling problem affecting women. Conservative treatment includes dietary modification, antimotility agents, and pelvic floor physical therapy. If conservative medical management is unsuccessful, surgical intervention may be required. Surgical options include rectal sphincteroplasty, bulking agent injection, radiofrequency anal sphincter remodeling, and sacral nerve stimulation therapy. Recently, a new therapy for FI, the FENIX Continence Restoration System (Torax Medical, Inc., Shoreview, MN), has become available. The FENIX device is placed through a perineal incision; however, pelvic radiation and previous anal carcinoma are both contraindications. We report the case of a 62-year-old woman with FI after anal carcinoma. Treatment included surgery, chemotherapy, and pelvic radiation. Initially, she was treated with conservative therapy and sacral nerve stimulation, which were only partially effective. A physical examination showed perineal skin changes consistent with previous radiation, which increased the patient's risk of infection and a nonhealing wound. Therefore, a robotic approach was used to place the FENIX device and improve the patient's quality of life. Our case sets a precedent for expanding the treatment options of FI in patients with previous pelvic radiation and using a robotic approach for the placement of the FENIX device.

Electroestimulación del suelo pélvico en mujeres con incontinencia urinaria y/o síndrome de vejiga hiperactiva: una revisión sistemática / Pelvic Floor Electrostimulation in Women With Urinary Incontinence and/or Overactive Bladder Syndrome: A Systematic Review

Contexto: La electroestimulación (EE) es una de las técnicas empleadas en el tratamiento conservador de la incontinencia urinaria (IU) y/o síndrome de vejiga hiperactiva (SVH). Sin embargo, existe controversia en la literatura científica acerca de su eficacia como monoterapia. Objetivo: Evaluar la evidencia científica sobre la EE del suelo pélvico en mujeres con IU y/o SVH. Adquisición de evidencia: Se realizó una revisión sistemática de ensayos clínicos en las bases de datos PubMed, Cochrane, PEDro, Elsevier (Doyma) y EnFisPo (1980-2011). Se evaluó la calidad de los estudios y se extrajo la información de los que reunieron los criterios de inclusión establecidos. Síntesis de evidencia: Un total de 27 ensayos clínicos han sido incluidos en la revisión: 13 ensayos controlados aleatorizados, 11 ensayos aleatorizados no controlados y 3 ensayos no aleatorizados. Conclusión: La mayor parte de los ensayos clínicos concluyen que la EE es eficaz en el tratamiento de la IU y el SVH en mujeres. Sin embargo, son necesarios más estudios de buena calidad metodológica para obtener un mayor nivel de evidencia científica y conocer cuál es la modalidad, tipo y parámetros de corriente óptimas para cada tipo de IU y el SVH (AU)

Context: Electrostimulation (ES) is one of the techniques employed in conservative treatment of urinary incontinence (UI) and/or overactive bladder syndrome (OAB). Nevertheless, there is controversy in the scientific literature regarding its effectiveness as monotherapy. Objective: To evaluate the scientific evidence on ES of the pelvic floor in women with UI and with/without OAB. Evidence acquisition: A systematic review of clinical trials was carried out in the following databases: PubMed, Cochrane, PEDro, Elsevier (Doyma) and EnFisPo (1980-2011). Quality of study registries was evaluated and information was obtained from those that presented the inclusion criteria established in the review. Evidence synthesis: The 27 clinical trials were included in the review: 13 randomized controlled trials, 11 randomized non-controlled trials and 3 non-randomized trials. Conclusion: Most of the clinical trials conclude that ES is effective in the treatment of UI and OAB in women. However, better methodological quality studies are needed to obtain a higher level of scientific evidence and to know the optimal current modality, type and parameters for each type of UI and OAB (AU)

Treatments for invasive carcinoma of the cervix: what are their impacts on the pelvic floor functions?

AIMS: Describe the impact of surgery, radiotherapy and chemoradiation in the pelvic floor functions in cervical cancer patients. MATERIALS AND METHODS: A prospective study with women submitted to radical hysterectomy (RH) (n = 20), exclusive radiotherapy (RT) (n = 20) or chemoradiation (CT/RT) (n = 20) for invasive cervical cancer. Urinary, intestinal and sexual function, as well as vaginal length and pelvic floor muscle contraction were evaluated. Comparisons between groups were performed by Kruskal-Wallis and Chi-square tests (p < 0.05). RESULTS: The groups were similar in stress urinary incontinence incidence (p = 0.56), urinary urgency (p = 0.44), urge incontinence (p = 0.54), nocturia (p = 0.53), incomplete bowel emptying (p = 0.76), bowel urgency (p = 0.12) and soilage (p = 0.43). The CT/RT group presented a higher urinary frequency (p < 0.001) and diarrhea (p = 0.025). Patients in the RH group were more sexually active (p = 0.01) and experienced less dyspareunia (p = 0.021). Vaginal length was shorter in RT group (5.5 ± 1.9 cm) and CT/RT(5.3 ± 1.5 cm) than in the RH group (7.4 ± 1.1 cm) (p < 0.001). Pelvic floor muscle contraction was similar (p = 0.302). CONCLUSIONS: RT and CT/RT treatment for cervical carcinoma are more associated to sexual and intestinal dysfunctions.

Treatments for invasive carcinoma of the cervix: what are their impacts on the pelvic floor functions?

Aims: Describe the impact of surgery, radiotherapy and chemoradiation in the pelvic floor functions in cervical cancer patients. Materials and Methods: A prospective study with women submitted to radical hysterectomy (RH) (n = 20), exclusive radiotherapy (RT) (n = 20) or chemoradiation (CT/RT) (n = 20) for invasive cervical cancer. Urinary, intestinal and sexual function, as well as vaginal length and pelvic floor muscle contraction were evaluated. Comparisons between groups were performed by Kruskal-Wallis and Chi-square tests (p < 0.05). Results: The groups were similar in stress urinary incontinence incidence (p = 0.56), urinary urgency (p = 0.44), urge incontinence (p = 0.54), nocturia (p = 0.53), incomplete bowel emptying (p = 0.76), bowel urgency (p = 0.12) and soilage (p = 0.43). The CT/RT group presented a higher urinary frequency (p < 0.001) and diarrhea (p = 0.025). Patients in the RH group were more sexually active (p = 0.01) and experienced less dyspareunia (p = 0.021). Vaginal length was shorter in RT group (5.5 ± 1.9cm) and CT/RT(5.3 ± 1.5 cm) than in the RH group (7.4 ± 1.1 cm) (p < 0.001). Pelvic floor muscle contraction was similar (p = 0.302). Conclusions: RT and CT/RT treatment for cervical carcinoma are more associated to sexual and intestinal dysfunctions. .