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2.
Zhonghua Wei Chang Wai Ke Za Zhi ; 23(12): 1131-1134, 2020 Dec 25.
Artigo em Chinês | MEDLINE | ID: mdl-33353264

RESUMO

The significant increase in the incidence of benign anal diseases is related to the fast-paced life style, the change of dietary structure, the increase of work pressure and social psychological factors. Surgery is one of the most important treatments for benign anal diseases, while perioperative defecation management is closely related to the efficacy of surgery. In current clinical practice, there is no consensus on the management of perioperative defecation for benign anal diseases. Hence a discussion was held by the Professional Committee of Colorectal Diseases of Chinese Society of Integrated Chinese and Western Medicine, concerning the causes of perioperative defecation difficulties in perioperative anal benign diseases, the importance and specific strategy of defecation management. A consensus was consequently formed, aiming to provide a guideline for the clinical practice.


Assuntos
Doenças do Ânus , Defecação , Canal Anal/fisiopatologia , Canal Anal/cirurgia , Doenças do Ânus/fisiopatologia , Doenças do Ânus/cirurgia , China , Consenso , Humanos , Assistência Perioperatória , Período Perioperatório
3.
PLoS One ; 15(9): e0228761, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32991595

RESUMO

There is a need for a lower cost manometry system for assessing anorectal function in primary and secondary care settings. We developed an index finger-based system (termed "digital manometry") and tested it in healthy volunteers, patients with chronic constipation, and fecal incontinence. Anorectal pressures were measured in 16 participants with the digital manometry system and a 23-channel high-resolution anorectal manometry system. The results were compared using a Bland-Altman analysis at rest as well as during maximum squeeze and simulated defecation maneuvers. Myoelectric activity of the puborectalis muscle was also quantified simultaneously using the digital manometry system. The limits of agreement between the two methods were -7.1 ± 25.7 mmHg for anal sphincter resting pressure, 0.4 ± 23.0 mmHg for the anal sphincter pressure change during simulated defecation, -37.6 ± 50.9 mmHg for rectal pressure changes during simulated defecation, and -20.6 ± 172.6 mmHg for anal sphincter pressure during the maximum squeeze maneuver. The change in the puborectalis myoelectric activity was proportional to the anal sphincter pressure increment during a maximum squeeze maneuver (slope = 0.6, R2 = 0.4). Digital manometry provided a similar evaluation of anorectal pressures and puborectalis myoelectric activity at an order of magnitude less cost than high-resolution manometry, and with a similar level of patient comfort. Digital Manometry provides a simple, inexpensive, point of service means of assessing anorectal function in patients with chronic constipation and fecal incontinence.


Assuntos
Canal Anal/fisiopatologia , Constipação Intestinal/diagnóstico , Incontinência Fecal/diagnóstico , Manometria/instrumentação , Reto/fisiopatologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Constipação Intestinal/fisiopatologia , Estudos Transversais , Eletromiografia , Incontinência Fecal/fisiopatologia , Feminino , Voluntários Saudáveis , Humanos , Masculino , Manometria/economia , Manometria/métodos , Pessoa de Meia-Idade , Diafragma da Pelve/fisiopatologia , Pressão , Dispositivos Eletrônicos Vestíveis/economia
4.
BMC Womens Health ; 20(1): 131, 2020 06 22.
Artigo em Inglês | MEDLINE | ID: mdl-32571291

RESUMO

BACKGROUND: Aim of the study was to estimate the prevalence of postpartum anal incontinence among women who delivered vaginally, and to assess the extent to which obstetric injuries to the anal sphincters are missed. METHODS: All women (both primiparous and multiparous) who delivered vaginally and received any kind of sutures in the perineal area at Innlandet Hospital Trust Elverum in Norway between January 1, 2015 and June 30, 2016 were invited to answer a questionnaire on St. Mark's incontinence score and to participate in a clinical examination of the pelvic floor including endoanal sonography. RESULTS: In total 52,3% (n = 207) of the 396 invited women participated in the study. Mean St. Mark's score was 1.8 points (95% CI 1.4 to 2.1) at examination 14 months (mean) postpartum, and none of the participants suffered from weekly fecal leakage. Fecal urgency affected 11.7% (95% CI 7.1 to 16.3) of the participants, and 8.7% (95%CI 5.1 to 12.8) had weekly involuntary leakage of flatus. Nine women (9.3%, 95% CI 4.1 to 15.5) had a previously undetected third degree obstetric anal sphincter injury. CONCLUSION: The prevalence of anal incontinence among women who have delivered vaginally and received sutures due to 1st and 2nd degree perineal lacerations is low. Some obstetric anal sphincter injuries remain unrecognized at the time of delivery, but the symptoms of anal incontinence due to these injuries are in the lower half of the St. Mark's incontinence score. Women with persistent symptoms like fecal urgency or leakage of gas and/or feces should be referred to evaluation by a colorectal surgeon in order to achieve optimal treatment.


Assuntos
Canal Anal/lesões , Parto Obstétrico/estatística & dados numéricos , Episiotomia/efeitos adversos , Incontinência Fecal/epidemiologia , Lacerações/epidemiologia , Períneo/lesões , Adulto , Canal Anal/fisiopatologia , Estudos Transversais , Parto Obstétrico/métodos , Episiotomia/estatística & dados numéricos , Incontinência Fecal/etiologia , Feminino , Humanos , Noruega/epidemiologia , Complicações do Trabalho de Parto/epidemiologia , Períneo/fisiopatologia , Gravidez , Prevalência , Qualidade de Vida
5.
Anticancer Res ; 40(4): 2199-2208, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32234915

RESUMO

BACKGROUND/AIM: To date, there is no clear understanding whether preoperative long-course chemoradiotherapy combined with surgery for rectal cancer is detrimental to anorectal function. The purpose of this study was to clarify the influence of preoperative chemoradiotherapy and surgery for middle and lower rectal cancer on postoperative anorectal function. PATIENTS AND METHODS: Data of 113 patients with middle or lower rectal cancer treated with preoperative chemoradiotherapy plus surgery or surgery alone between January 2013 and December 2016 were analyzed. A total of 84 and 29 patients underwent low anterior resection and intersphincteric resection, respectively. In patients with T3 or deeper and with any N stage cancer below peritoneal reflection, surgery plus lateral lymph node dissection or preoperative radiation (total: 50.4 Gy/28 fractions) to the pelvis with chemoradiotherapy plus surgery was treated. Anorectal function was assessed prior to treatment and 6 and 12 months postoperatively. Specifically, maximum resting pressure and maximum squeezing pressures were measured. The Wexner score was recorded prior to treatment and 12 months postoperatively. RESULTS: maximum resting pressure and maximum squeezing pressure decreased post-surgery in both groups. Maximum resting pressure and maximum squeezing pressure at 12 months and the Wexner score at 12 months post-surgery were comparable among patients treated with chemoradiotherapy plus surgery and those treated with surgery alone. CONCLUSION: Preoperative chemoradiotherapy did not clearly impair postoperative anorectal function in patients who underwent low anterior resection and intersphincteric resection.


Assuntos
Canal Anal/fisiopatologia , Neoplasias Retais/cirurgia , Neoplasias Retais/terapia , Reto/fisiopatologia , Idoso , Canal Anal/patologia , Canal Anal/cirurgia , Quimiorradioterapia/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Terapia Neoadjuvante/métodos , Avaliação de Resultados em Cuidados de Saúde/métodos , Avaliação de Resultados em Cuidados de Saúde/estatística & dados numéricos , Período Pré-Operatório , Reto/patologia , Reto/cirurgia
6.
Neurourol Urodyn ; 39(4): 1129-1136, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32163639

RESUMO

AIMS: The primary aim of this study was to assess the relationship between a strong desire to void (SDV) and rectal sensory function in patients with multiple sclerosis (PwMS) and anorectal disorders. The secondary aim was to identify clinical, urodynamic or manometric factors associated with greater rectal sensory function impairment in this population. METHODS: Thirty PwMS (mean age 49.2 ± 10.9 years) with anorectal disorders (constipation and/or fecal incontinence) participated in this observational study. Rectal sensory parameters during anorectal manometry were recorded at a strong desire to void and after urination (PV, post-void). The primary outcome was the desire to defecate volume. Secondary outcomes were first perception and maximum tolerated threshold volumes, presence and modulation of recto-anal inhibitory reflex. RESULTS: The mean desire to defecate volume was 125 ± 59 mL at SDV and 104 ± 64 mL at PV (P < .001). The mean maximum tolerated volume was 167 ± 61 mL at SDV vs 141 ± 64 mL after urination (P = .01). The other parameters were not different between SVD and PV conditions. No predictive factors for greater impairment of rectal sensory function were identified. CONCLUSION: This study suggests a relationship between bladder sensation and thus bladder capacity, and rectal sensory function in PwMS and with anorectal disorders.


Assuntos
Defecação/fisiologia , Incontinência Fecal/fisiopatologia , Esclerose Múltipla/fisiopatologia , Bexiga Urinária/fisiopatologia , Micção/fisiologia , Adulto , Idoso , Canal Anal/fisiopatologia , Constipação Intestinal/fisiopatologia , Feminino , Humanos , Masculino , Manometria , Pessoa de Meia-Idade , Reto/fisiopatologia , Sensação/fisiologia , Urodinâmica/fisiologia
7.
G Chir ; 41(1): 118-125, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32038023

RESUMO

AIM: The pathogenesis of hemorrhoids involves vascular congestion, fragmentation of supporting tissues and, in many cases, increased resting anal pressure. A new ointment (Hemolen®) has been devised to control hemorrhoids symptoms acting on all the pathophysiologic mechanisms involved. METHODS: Pilot study on patients with grade I-III hemorrhoids. The ointment was applied twice daily for 30 days and follow-up visits were scheduled 7 days (T1), 14 days (T2) and 30 days (T3) after recruitment (T0). Signs and symptoms (bleeding, discomfort, itching, edema, thrombosis, congestion, inflammation, pain) were evaluated at each visit using dedicated scores and VAS scale. Resting anal pressure was measured at time T0, 1 hour after the first application and at T1. Use of painkiller was recorded. RESULTS: 48 patients (25 females; mean age 47±15.8 years) were enrolled; 52.1% of them had II degree hemorrhoids and 27.1% had III degree hemorrhoids. The severity scores significantly dropped from T0 to each scheduled visit and a significant reduction of resting anal pressure was observed from T0 to 1 hour after application (z=13.5; p<0.001) and from T0 to T1 (z=6; p<0.001). The comparison of the resting pressure among whole time series showed a significant reduction (Fr=124.4; p=<0.001). Use of pain-killers decreased significantly from T0 to T1 (p<0.001) and from T1 to T2 (p=0.001). CONCLUSION: The new ointment tested in the present study is safe and effective for the management of hemorrhoid symptoms in the early stages hemorrhoids, during the acute phases and in patients with more severe hemorrhoids awaiting surgery. Prospective, randomized controlled trials are needed to confirm these encouraging results.


Assuntos
Hemorroidas/tratamento farmacológico , Canal Anal/efeitos dos fármacos , Canal Anal/fisiopatologia , Analgésicos/administração & dosagem , Esquema de Medicação , Feminino , Hemorroidas/classificação , Hemorroidas/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Pomadas/administração & dosagem , Projetos Piloto , Pressão , Índice de Gravidade de Doença , Avaliação de Sintomas
8.
Rev Col Bras Cir ; 46(6): e20192361, 2020.
Artigo em Português, Inglês | MEDLINE | ID: mdl-32022113

RESUMO

OBJECTIVE: to identify predictors of low anterior resection syndrome (LARS) that can contribute to its early diagnosis and treatment. METHODS: we conducted a retrospective cohort study of patients undergoing anterior resection of the rectum between 2007 and 2017 in the Coloproctology Service of the Federal University of Parana Clinics Hospital. We performed Receiver Operating Characteristic Curve (ROC) analysis to identify LARS predictive factors. RESULTS: we included 64 patients with complete data. The men's age was 60.1±11.4 years and 37.10% were male. Twenty patients (32.26%) had LARS. The most reported symptoms were incomplete evacuation (60%) and urgency (55%). In the univariate analysis, the distance from the anastomosis to the anal margin (p<0.001), neoadjuvant therapy (p=0.0014) and ileostomy at the time of resection (p=0.0023) were predictive of LARS. The ROC curve analysis showed a 6.5cm cut-off distance from the anastomosis to the anal margin as a predictor of LARS. CONCLUSION: distance between the anastomosis and the anal margin, neoadjuvant therapy history and preparation of stoma are conditions that can help predict the development of LARS. Guidance and involvement in patient education, as well as early management, can potentially reduce the impact of these symptoms on patients' quality of life.


Assuntos
Canal Anal/fisiopatologia , Neoplasias Retais/diagnóstico , Reto/fisiopatologia , Canal Anal/cirurgia , Anastomose Cirúrgica , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Neoplasias Retais/etiologia , Neoplasias Retais/cirurgia , Reto/cirurgia , Fatores de Risco , Estomas Cirúrgicos
9.
Surg Today ; 50(8): 889-894, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32052183

RESUMO

PURPOSE: The aim of this study was to evaluate the clinical outcomes and postoperative anorectal function in the patients with high/intermediate imperforate anus (HIA/IIA) treated in our institution. In addition, we report our novel procedure, laparoscopically assisted anorectoplasty with anterior perineal incision (LAARP-API), which allows direct approach to the anterior edge of the puborectal sling and muscle complex, and is useful for the creation of a pulling-through route for the rectal pouch. METHODS: From 1976 to 2016, 22 patients with HIA and 43 patients with IIA underwent sacroperineal/sacroabdominoperineal pull-through anorectoplasty (SP/SAP), Potts procedure (Potts), SP with API (SP-API) or LAARP-API. Clinical data and anorectal function of those patients were retrospectively evaluated using the Japanese clinical score. RESULTS: Of the 22 cases of HIA, 15 were treated by SAP, 2 were SP and 5 were LAARP-API. Of the 43 cases of IIA, one was treated by SAP, 31 were SP, two were Potts and nine were SP-API. The mean score of anorectal function of HIA/IIA both increased with age. In IIA, the score after SP-API was significantly higher than the score after SP. CONCLUSION: Long-term outcomes of our anorectoplasty for HIA/IIA are good with excellent anorectal function score.


Assuntos
Canal Anal/cirurgia , Anus Imperfurado/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Recuperação de Função Fisiológica , Reto/cirurgia , Adolescente , Adulto , Canal Anal/fisiopatologia , Anus Imperfurado/fisiopatologia , Criança , Feminino , Humanos , Masculino , Reto/fisiopatologia , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
10.
Neurourol Urodyn ; 39(2): 732-737, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31899809

RESUMO

AIM: We aimed to explore the utility of the Multiple Array Probe Leiden (MAPLe) device to assess pelvic floor muscle activity in men with lower urinary tract symptoms (LUTS). METHODS: This was an observational cohort study performed at the urology outpatient department of a large teaching hospital in the Netherlands between April and October 2018. We recruited male patients referred for the assessment of LUTS, without a history of prostate surgery, if they had an International Prostate Symptom Score greater than or equal to 8. The MAPLe device was then used to assess the puborectalis, pubococcygeus, iliococcygeus, urogenital diaphragm, and the internal and external anal sphincters during three tasks: a rest period (1 minute), five maximum voluntary contractions (held for 3 seconds each), and three maximal endurance contractions (held for 15 seconds each). RESULTS: In total, 57 patients were included, 5 of which had diabetes mellitus. Muscle activity at rest was significantly lower than during either contraction task and did not differ between the muscle groups. By contrast, the external anal sphincter had significantly less activity than any other muscle group during the endurance task, and the internal anal sphincter and puborectalis had significantly less activity during the maximum voluntary contraction task. No association was found between pelvic floor muscle activity and LUTS severity during any task. CONCLUSION: Pelvic floor muscle activity and LUTS severity appear to be unrelated, but this does not completely exclude the possibility of muscle involvement in the development or experience of symptoms. Further research is needed.


Assuntos
Sintomas do Trato Urinário Inferior/fisiopatologia , Músculo Esquelético/fisiopatologia , Diafragma da Pelve/fisiopatologia , Idoso , Idoso de 80 Anos ou mais , Canal Anal/fisiopatologia , Estudos de Coortes , Diabetes Mellitus/fisiopatologia , Diafragma/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Resistência Física , Próstata/cirurgia
11.
Surg Today ; 50(5): 516-524, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-31797125

RESUMO

PURPOSE: Very low anterior resection (VLAR) is performed widely, but some patients are left with fecal incontinence (FI), which compromises their quality of life (QOL) severely. This study sought to identify the predictive factors of postoperative FI after VLAR, which remain unclear. METHODS: We evaluated the anorectal manometry data of patients who underwent VLAR to identify the risk factors for postoperative FI among the various clinicopathological factors and manometric characteristics. FI and QOL were analyzed using the Wexner score and EORTC QLQ-C30, respectively. RESULTS: The subjects of this study were 40 patients who underwent VLAR for low rectal cancer between April, 2015 and May, 2018. There were 11 (27%) patients in the major-FI group and 29 (73%) in the minor-FI group. Multivariate analysis revealed that low preoperative incremental maximum squeeze pressure (iMSP) was an independent risk factor for postoperative major-FI. Postoperative QOL tended to be worse in the major-FI group. CONCLUSIONS: Preoperative low iMSP increases the risk of major-FI and impaired QOL after VLAR. This highlights the importance of performing preoperative anorectal manometry to evaluate the patient's anal function as well as to select the most appropriate operative procedure and early multifaceted treatment such as medication, rehabilitation, and biofeedback for postoperative FI.


Assuntos
Canal Anal/fisiopatologia , Incontinência Fecal , Complicações Pós-Operatórias , Pressão , Neoplasias Retais/fisiopatologia , Neoplasias Retais/cirurgia , Reto/fisiopatologia , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Incontinência Fecal/epidemiologia , Manometria , Complicações Pós-Operatórias/epidemiologia , Valor Preditivo dos Testes , Período Pré-Operatório , Fatores de Risco
12.
Neurourol Urodyn ; 39(1): 447-454, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31770467

RESUMO

BACKGROUND: Anal acoustic reflectometry (AAR) is a technique for measuring the physiological profile of the anal canal, primarily the internal anal sphincter. Evaluation of a new continuous method, recently developed for the urethra, would enable its future application for investigation of rectal reflexes. METHODS: Patients aged 18 and over with fecal incontinence (FI) were included. Stepwise AAR parameters were compared with continuous opening pressure (Op, cmH2 O), opening elastance (Oe, cmH2 O/mm2 ), closing pressure (Cp, cmH2 O), closing elastance (Ce, cmH2 O/mm2 ), hysteresis (Hys, [%]), squeeze opening pressure (SqOp, cmH2 O), and squeeze opening elastance (SqOe, cmH2 O/mm2 ). Vaizey incontinence and Manchester Health Questionnaire scores were also collected. RESULTS: Thirty-two patients, 26 females were analyzed. Median age: 60 (range, 32-75). Median AAR parameters of Op (37.50 vs 35.15, P = .031), Oe (1.31 vs 0.84, P < .0001), Ce (1.11 vs 0.88, P < .0001), Hys (37.75 vs 19.04, P < .0001), and SqOe (1.27 vs 1.06, P = .005) were significantly higher with the continuous method. Cp (22.70 vs 27.22, P = .003) is lower and SqOp (96.87 vs 59.47, P = .71) not significantly different. The continuous technique had superior repeatability between cycles for all AAR parameters except Oe, which was equivalent and continuous SqOp had a stronger negative correlation with Vaizey score than stepwise (-0.46, P = .009 vs -0.37, P = .038). CONCLUSIONS: The differences seen between the two techniques are likely to be related to the rate of stretch. The continuous technique appears to represent a more physiological measurement of anal sphincter function than the stepwise technique particularly in the assessment of voluntary squeeze function.


Assuntos
Canal Anal/fisiopatologia , Doenças do Ânus/diagnóstico , Incontinência Fecal/fisiopatologia , Reflexo/fisiologia , Adulto , Idoso , Doenças do Ânus/fisiopatologia , Feminino , Humanos , Masculino , Manometria/métodos , Pessoa de Meia-Idade , Reto/fisiopatologia
13.
Am J Physiol Gastrointest Liver Physiol ; 318(1): G66-G76, 2020 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-31736339

RESUMO

Cardiac loops have been used extensively to study myocardial function. With changes in cardiac pump function, loops are shifted to the right or left. Functional luminal imaging probe (FLIP) recordings allow for loop analysis of the anal sphincter and puborectalis muscle (PRM) function. The goal was to characterize anal sphincter area-pressure/tension loop changes in fecal incontinence (FI) patients. Fourteen healthy subjects and 14 patients with FI were studied. A custom-designed FLIP was placed in the vagina and then in the anal canal, and deflated in 20-ml steps, from 90 to 30 ml. At each volume, subjects performed maximal voluntary squeezes. Area-pressure (AP) and area-tension (AT) loops were generated for each squeeze cycle. Three-dimensional ultrasound imaging of the anal sphincter and PRM were obtained to determine the relationship between anal sphincter muscle damage and loop movements. With the increase in bag volume, AP loops and AT loops shifted to the right and upward in normal subjects (both anal and vaginal). The shift to the right was greater, and the upward movement was less in FI patients. The difference in the location of AP loops and AT loops was statistically significant at volumes of 50 ml to 90 ml (P < 0.05). A similar pattern was found in the vaginal loops. There is a significant relationship between the damage to the anal sphincter and PRM, and loop location of FI patients. We propose AP and AT loops as novel ways to assess the anal sphincter and PRM function. Such loops can be generated by real-time measurement of pressure and area within the anal canal.NEW & NOTEWORTHY We describe the use of area-pressure (AP) and area-tension (AT)-loop analysis of the anal sphincters and puborectalis muscles in normal subjects and fecal incontinent patients using the functional luminal imaging probe (FLIP). There are differences in the magnitude of the displacement of the loops with increase in the FLIP bag volume between normal subjects and patients with fecal incontinence. The latter group shifts more to the right in AP and AT space.


Assuntos
Canal Anal/diagnóstico por imagem , Defecação , Incontinência Fecal/diagnóstico por imagem , Músculo Esquelético/diagnóstico por imagem , Ultrassonografia , Adulto , Idoso , Canal Anal/fisiopatologia , Estudos de Casos e Controles , Incontinência Fecal/fisiopatologia , Feminino , Humanos , Imageamento Tridimensional , Pessoa de Meia-Idade , Músculo Esquelético/fisiopatologia , Valor Preditivo dos Testes , Pressão , Fatores de Tempo , Adulto Jovem
14.
Asian J Surg ; 43(1): 265-271, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31036477

RESUMO

BACKGROUND: Rectocele is often associated with chronic constipation. Various surgical techniques have been described to repair rectoceles, but the results vary. The aim of this study was to compare the outcomes of transanal repair (TAR) and transanal repair with posterior colporrhaphy (TAR + PC). METHODS: While 44 patients underwent TAR, 49 patients underwent TAR + PC for surgical repair of rectocele. Patients were followed up 3 months post-surgery for anorectal physiological changes. From the entire cohort of patients who underwent the surgical repair, 22 patients who underwent TAR and 25 patients who underwent TAR + PC agreed to participate in the 3-year post-treatment check-up. RESULTS: Out of the 22 patients who underwent TAR, 3 patients (13.6%) scored more than 15 on the constipation scoring system (CSS), while 1 out of 25 patients who underwent TAR + PC scored more than 15 on the CSS 3 months post-treatment, which is considered as recurrence (p = 0.237). With 7 patients from the TAR group (31.8%) and 2 patients from the TAR + PC group (8.0%) showing recurrence of rectocele at 3-year post-treatment follow-up, this study found that TAR + PC had a much lower rate of recurrence than TAR. Furthermore, TAR + PC was found to be more effective than TAR in terms of rectal sensation, sensory threshold (p = 0.001), and early defecation urge (p = 0.003). CONCLUSIONS: TAR + PC can help alleviate some symptoms by restoring the rectal sensation and improving the rectovaginal septum. It can be inferred that the addition of a simple treatment method can lead to a lower rate of recurrence.


Assuntos
Canal Anal/fisiopatologia , Canal Anal/cirurgia , Procedimentos Cirúrgicos em Ginecologia/métodos , Retocele/fisiopatologia , Retocele/cirurgia , Reto/fisiopatologia , Constipação Intestinal/complicações , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Retocele/etiologia , Prevenção Secundária , Fatores de Tempo , Resultado do Tratamento
15.
Pediatr Surg Int ; 36(3): 295-303, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31844977

RESUMO

PURPOSE: There is a lack of diagnostic credibility to direct focused management for children with chronic constipation (CC) and faecal incontinence (FI). The aim is to assess the impact of an innovative Children's Anorectal Physiology Service (CAPS) focusing on improving outcomes in children with CC/FI. METHODS: Prospective data: demographics, bowel and quality of life (QoL)/risk of distress questionnaires. Diagnostics: awake high-resolution anorectal manometry (AHRAM), endoanal ultrasound and transit marker studies (TMS). RESULTS: Total patients: 112; 66 males (59%); median 9 years (17 months to 16 years). Patient groups included: 89 (79%) had functional CC/FI; 9 (8%), Hirschsprung's disease; 12 (11%), anorectal malformations and 2 (2%), trauma. St Marks Incontinence score (SMIS) abnormal in 91 (81%) and Cleveland Constipation Score (CCS) in 101 (90%) patients. Anorectal manometry: 94 (84%) awake and 18 (17%) under anaesthesia. Play specialist input 37 (33%) patients. AHRAM abnormal 65 (58%): sphincter dysfunction 36 (32%) and altered rectal sensation: hyposensitive 22% (20/91); 21% (19/91) hypersensitive. TMS normal in 64 (57%), 17 (15%) slow transit and 27 (24%) rectal evacuatory disorder. Risk of distress in 38% and poor QoL in 55% patients which correlated with abnormal SMIS (p = 0.02). Patient/parent satisfaction improved significantly (p < 0.05). CONCLUSIONS: Scientific investigations combined with multidisciplinary team improve patient satisfaction and reduces patient self-report illness severity. A complex problem requires a scientific solution.


Assuntos
Canal Anal/anormalidades , Malformações Anorretais/fisiopatologia , Constipação Intestinal/fisiopatologia , Incontinência Fecal/fisiopatologia , Equipe de Assistência ao Paciente , Qualidade de Vida , Adolescente , Canal Anal/fisiopatologia , Malformações Anorretais/complicações , Criança , Pré-Escolar , Doença Crônica , Constipação Intestinal/etiologia , Incontinência Fecal/etiologia , Feminino , Humanos , Lactente , Masculino , Manometria , Satisfação do Paciente , Estudos Prospectivos , Inquéritos e Questionários , Ultrassonografia
16.
Dig Dis Sci ; 65(2): 423-430, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31471861

RESUMO

BACKGROUND: Electromyographic studies have shown that external anal sphincter activity is modified in response to distension in animals with spinal cord injury. Gonadotropin-releasing hormone and its agonist leuprolide acetate have neurotrophic properties in animals with spinal cord injury. AIM: This study was to determine the effects of leuprolide acetate treatment on electromyographic activity of the external anal sphincter and anorectal manometry in ovariectomized rats with spinal cord injury. METHODS: Adult ovariectomized rats were divided in three groups: (a) sham of spinal cord injury, (b) spinal cord injury treated with saline solution, and (c) spinal cord injury treated with leuprolide acetate. The spinal cord injury was induced by clamping at level T9. Leuprolide acetate dosage of 10 µg/kg was proctored intramuscular for 5 weeks, commencing the day after the lesion. Electromyography of the external anal sphincter, anorectal manometry, and volume of the cecum were evaluated in all groups. RESULTS: The electromyographic study of the external anal sphincter activity showed a significant improvement in injured rats treated with leuprolide acetate. Manometric analysis and cecum volume data obtained in animals with leuprolide acetate were very similar to those found in the sham group. CONCLUSIONS: These results demonstrate that leuprolide acetate treatment improves the neurogenic colon in ovariectomized rats with spinal cord injury.


Assuntos
Canal Anal/efeitos dos fármacos , Hormônio Liberador de Gonadotropina/agonistas , Leuprolida/farmacologia , Intestino Neurogênico/fisiopatologia , Ovariectomia , Reto/efeitos dos fármacos , Traumatismos da Medula Espinal/fisiopatologia , Canal Anal/fisiopatologia , Animais , Ceco/efeitos dos fármacos , Ceco/fisiopatologia , Eletromiografia , Feminino , Manometria , Intestino Neurogênico/etiologia , Ratos , Ratos Wistar , Reto/fisiopatologia , Traumatismos da Medula Espinal/complicações
17.
Ann Ital Chir ; 90: 447-450, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31814598

RESUMO

INTRODUCTION: The conventional video colpo-cysto entero defecography describing the morpho- functional imaging features, physiological and pathological of the recto-anal region and pelvic floor . It represents the gold standard examination for the identification and staging of morphological and functional disorders of the recto-anal region and pelvic floor in evacuation dysfunctions. MATERIALS AND METHODS: Between January 2010 to January 2013 88 patients underwent STARR procedure for obstructed defecation syndrome (ODS) caused by single rectocele or internal rectal intussusception. We retrospectively analyzed the collected data,in particular we reviewed the defecography results before surgery. RESULTS: At defecography imaging , 30 patients (34 %) had an anal canal opening between 0 and 5 seconds, 44 (50 %) between 6 and 10 seconds and 14 patients (16 %) over 10 seconds at defecography imaging. The defecography showed an enterocele in 30 patients (34 %) The enterocele was functional in 25 (28,4 %) and stable in 5 (5,6 %) patients. 53 patients have a II° rectocele (60,2 %) and 35 patients a III° rectocele (39,7 %). The average preoperative ODS score was 14 . The average ODS score revaluated at 1 year was 3.1, 4.3 at 3 years an 6,4 after 5 years. The improvement of the ODS score was lower in the subgroup of patients presenting a slow opening of the anal canal (> 10 sec): 7.5 at one year, 9.1 at 3 years and 11 after 5 years follow-up. Also in the subgroup of patients with stable enterocele (5,6 %) the improvement was less evident: 6.7 at 1 year, 8 at 3 years and 9.7 after 5 years follow-up. DISCUSSION AND CONCLUSION: We have observed that a coexistence of a long opening time of the anal canal and / or the presence of a stable enterocele are factors that significantly reduce the effectiveness of the surgery leading over time to ODS score values close to those present before surgery. In the fisrt case we suggest a pre and post-operative perineal physiotherapy, in the second case a Dougla's platsy KEY WORDS: Defecography, Obstructed defecation syndrome, Rectocele, Recto-anal prolapse.


Assuntos
Defecografia , Intussuscepção/cirurgia , Cuidados Pós-Operatórios/métodos , Cuidados Pré-Operatórios/métodos , Doenças Retais/cirurgia , Idoso , Canal Anal/diagnóstico por imagem , Canal Anal/fisiopatologia , Feminino , Seguimentos , Humanos , Intussuscepção/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Prognóstico , Recuperação de Função Fisiológica , Doenças Retais/diagnóstico por imagem , Doenças Retais/fisiopatologia , Retocele/diagnóstico por imagem , Retocele/fisiopatologia , Retocele/cirurgia , Estudos Retrospectivos , Índice de Gravidade de Doença , Resultado do Tratamento , Gravação em Vídeo
18.
Zhonghua Wei Chang Wai Ke Za Zhi ; 22(12): 1101-1104, 2019 Dec 25.
Artigo em Chinês | MEDLINE | ID: mdl-31874522

RESUMO

Low anterior resection syndrome (LARS) is defined as a syndrome characterized by various abnormal defecation symptoms, including increased defecation times, urgency, frequent defecation, and fecal incontinence. LARS commonly develops after sphincter-preserving operation or reduction of protective ileostomy. The symptoms of LARS will alleviate gradually, and some patients may return to normal or basically normal. However, 60%-80% of the patients remains to suffer from LARS. Their daily life and psychosocial functionare seriously impaired. At present, the etiology of LARS is not well understood, but many factors are associated with LARS, such as tumor location, radiotherapy and surgical techniques and so on.


Assuntos
Canal Anal/cirurgia , Protectomia/efeitos adversos , Neoplasias Retais/cirurgia , Reto/cirurgia , Canal Anal/fisiopatologia , Colectomia/efeitos adversos , Defecação/fisiologia , Incontinência Fecal/etiologia , Incontinência Fecal/fisiopatologia , Incontinência Fecal/prevenção & controle , Humanos , Qualidade de Vida , Reto/fisiopatologia , Síndrome
19.
Obstet Gynecol Clin North Am ; 46(4): 715-732, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31677751

RESUMO

Obstetric anal sphincter injury (OASI) and levator ani muscle (LAM) trauma are common disorders in parous women. Four sonographic signs have been published in cases of OASI: external or internal anal sphincter discontinuity; thickening of external anal sphincter at the area of repair; thinning of internal anal sphincter in the area of rupture in conjunction with thickening opposite the rupture site ("half-moon" sign); and abnormality of mucous folds ("mucosal star sign"). Levator trauma can be asymptomatic, with abnormality arising years later. Discontinuity of the LAM is the main sonographic sign but may appear as increased hiatal area in severe cases.


Assuntos
Canal Anal/diagnóstico por imagem , Distúrbios do Assoalho Pélvico/diagnóstico por imagem , Diafragma da Pelve/diagnóstico por imagem , Ultrassonografia/métodos , Canal Anal/lesões , Canal Anal/fisiopatologia , Feminino , Humanos , Diafragma da Pelve/fisiopatologia , Distúrbios do Assoalho Pélvico/fisiopatologia
20.
Parkinsonism Relat Disord ; 66: 195-201, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31473084

RESUMO

INTRODUCTION: Despite clinical relevance and potential role on the disease pathogenesis, underlying mechanisms of constipation in Parkinson's disease (PD) remain poorly understood. A systematic assessment using complementary physiological investigations was performed to elucidate constipation pathophysiology in order to improve its symptomatic management. METHODS: PD patients with constipation were evaluated with clinical questionnaires, colonic transit, high-resolution anorectal manometry and MRI defecography. Results were compared and correlated with clinical features. RESULTS: A total of 42 patients (69% male; age 68 ±â€¯8 years; disease duration 10.5 ±â€¯6.1 years) were included, of whom 33 (78.6%) had objective constipation defined by < 3 bowel movements per week or straining. Severity of constipation measured by self-administered questionnaires correlated with disease severity, burden of motor and non-motor symptoms but not with age, disease duration or Parkinson's medications. Colonic transit and anorectal function (high-resolution anorectal manometry and/or MRI defecography) was assessed in 15 patients. A combination of both delayed colonic transit and anorectal dysfunction was the pattern most commonly found (60% of patients) and overall anorectal dysfunction was more prevalent than isolated slow transit constipation. Physiological findings were heterogeneous including reduced colonic motility, rectal hyposensitivity, defecatory dyssynergia and poor motor rectal function. CONCLUSION: Subjective constipation in PD is poorly correlated with commonly used definition, assessment questionnaires and physiological results. Multiple complex overlapping pathophysiological mechanisms are responsible including slow transit and anorectal dysfunction. Complementary investigations to assess colonic transit and anorectal function are required in those with refractory symptoms for a systematic assessment and appropriate symptomatic management.


Assuntos
Canal Anal/fisiopatologia , Colo/fisiopatologia , Constipação Intestinal/diagnóstico por imagem , Constipação Intestinal/etiologia , Defecografia , Trânsito Gastrointestinal/fisiologia , Doença de Parkinson/complicações , Reto/fisiopatologia , Idoso , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Manometria , Pessoa de Meia-Idade
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