Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 3.942
Filtrar
1.
Zhonghua Wei Chang Wai Ke Za Zhi ; 23(1): 71-75, 2020 Jan 25.
Artigo em Chinês | MEDLINE | ID: mdl-31958934

RESUMO

Objective: To evaluate the long-term healing rate of transsphincteric anal fistula treated with anal fistula plug procedure and the risk factors affecting the healing of anal fistula. Methods: A retrospective case-control study was conducted to analyze the clinical data of 207 patients with transsphincteric anal fistulas who received anal fistula plug procedure at the Department of General Surgery, Beijing Chaoyang Hospital of Capital Medical University from August 2008 to September 2012. Inclusion criteria: (1) consistent with the diagnosis of transsphincteric anal fistula: the anal fistula passed through the internal and external sphincter; (2) complete data; (3) initial treatment with anal fistula plug procedure. Exclusion criteria: (1) acute rectal or perianal infection or poorly controlled focal infection; (2) recent incision and drainage of perianal abscess or spontaneous rupture of abscess; (3) patients with malignant tumor; (4) patients with Crohn's disease or ulcerative colitis; (5) patients with heart, liver, brain, lung or renal insufficiency; (6) cachexia due to various chronic wasting diseases; (7) patients could not tolerate surgery. Patients were followed up for anal fistula healing. The cumulative healing rate of patients with transsphincteric anal fistula was plotted using the Kaplan-Meier method, and the factors affecting anal fistula healing were explored by univariate and multivariate logistic regression analysis. Results: There were 186 males and 21 females with age of 15 to 69 (mean 38) years. The duration of anal fistula was 3-60 (mean 15) months. Three patients had a history of previous episodes of perianal abscess and underwent incision and drainage of perianal abscess (all more than 3 months). During follow-up ending on October 31, 2018, 72 patients (34.8%) were lost to follow-up. Among 135 patients who were successfully followed up, the average follow-up period was 96 (75-124) months. Seventy-five patients had anal fistula healing, with healing rate of 55.6%. Kaplan-Meier survival curve showed that the healing time of anal fistula was prolonged and finally stabilized at 55.6%. In the patients who failed initial treatment with anal fistula plug packing, there were 6 cases whose anal fistula healed spontaneously without other treatment. Among them, 3 cases healed spontaneously 2 years and 3 cases 3 years after operation without recurrence. From 2008 to 2012, the annual healing rates of anal fistula plug treatment were 3/6, 61.5% (24/39), 42.1% (24/57), 12/15 and 12/18, respectively. Multivariate logistic regression analysis showed that the duration of anal fistula≥6 months (OR=3.187, 95% CI: 1.361-7.466, P=0.008) was an independent risk factor for anal fistula healing after treatment with anal fistula plug. Conclusion: The long-term efficacy of anal fistula plug procedure in the treatment of transsphincteric anal fistula is positive, and this procedure should be implemented as soon as possible.


Assuntos
Canal Anal/cirurgia , Implantação de Prótese , Fístula Retal/cirurgia , Adolescente , Adulto , Bioprótese , Incontinência Fecal/etiologia , Incontinência Fecal/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fístula Retal/complicações , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento , Cicatrização , Adulto Jovem
2.
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
4.
Urology ; 134: 228-231, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31560912

RESUMO

Pudendal nerve decompression surgery has not been studied or reported for the treatment of penile numbness in the absence of pain. Herein, we report a case of a male patient with chronic numbness of the penis and erectile dysfunction in the absence of pelvic pain who was found to have pudendal nerve entrapment. This patient was treated with surgical decompression of the pudendal nerves that resulted in the return of genital sensation and erections. Thus, we propose that pudendal nerve entrapment may be considered as a cause of penile numbness and that pudendal nerve decompression surgery in these patients may be effective.


Assuntos
Disfunção Erétil/etiologia , Hipestesia/etiologia , Pênis/inervação , Neuralgia do Pudendo/diagnóstico , Adulto , Constipação Intestinal/etiologia , Descompressão Cirúrgica , Incontinência Fecal/etiologia , Humanos , Masculino , Exame Neurológico , Neuralgia do Pudendo/complicações , Neuralgia do Pudendo/cirurgia , Incontinência Urinária/etiologia
5.
Dis Colon Rectum ; 62(9): 1095-1104, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31318774

RESUMO

BACKGROUND: In the literature on chronic spinal cord injury, neurogenic bowel dysfunction has not gained as much attention as bladder dysfunction, the traditional cause of morbidity and mortality. OBJECTIVE: The purpose of this study was to investigate the prevalence of fecal incontinence and conditions associated with fecal incontinence in women with spinal cord injury. DESIGN: In this cross-sectional study, data were obtained from an electronic medical chart database containing standardized questionnaires. SETTINGS: The study was conducted at the Clinic for Spinal Cord Injuries, Rigshospitalet, where patients from Eastern Denmark are followed every second year. PATIENTS: Women who sustained a spinal cord injury between September 1999 and August 2016 and attended a consultation between August 2010 and August 2016 were included. If the bowel function questionnaire had never been answered, the woman was excluded. MAIN OUTCOME MEASURES: The newest completed questionnaire regarding bowel function, urinary bladder function, quality of life, neurologic level/completeness/etiology of injury, mobility status, and spousal relationship was obtained from each woman. RESULTS: Among the 733 identified women, 684 were included, of whom only 11% had a complete motor injury. A total of 35% experienced fecal incontinence, varying from daily to less than monthly, and 79% experienced bowel dysfunction. Fecal incontinence was associated with urinary incontinence and decreased satisfaction with life in general and psychological health. In the multivariate logistic regression analysis, the odds of daily-monthly fecal incontinence increased significantly with increasing age, myelomeningocele as etiology of injury, a more complete paraplegic injury, use of wheelchair permanently, and follow-up <3 months. LIMITATIONS: There were missing data in the study, including 12% with no answer to the fecal incontinence question. CONCLUSIONS: Fecal incontinence is a severe problem that affects more than one third of women with spinal cord injury and is associated with decreased quality of life. The present study emphasizes that women with myelomeningocele, a more complete paraplegic injury, older age, short follow-up period, and permanent wheelchair use have an increased risk of fecal incontinence. See Video Abstract at http://links.lww.com/DCR/A985. INCONTINENCIA FECAL Y DISFUNCIÓN NEUROGÉNICA DEL INTESTINO EN MUJERES CON LESIÓN DE LA MEDULA ESPINAL TRAUMÁTICA Y NO TRAUMÁTICA: En la literatura sobre la lesión crónica de la médula espinal, la disfunción neurógena del intestino no ha ganado tanta atención como la disfunción de la vejiga, la causa tradicional de morbilidad y mortalidad. OBJETIVÓ:: Investigar la prevalencia de la incontinencia fecal y las condiciones asociadas con la incontinencia fecal en mujeres con lesión de la médula espinal. DISEÑO:: En este estudio transversal, los datos se obtuvieron de una base de datos de registros médicos electrónicos que contenía cuestionarios estandarizados. CONFIGURACIÓN:: Clínica para Lesiones de la Médula Espinal, Rigshospitalet, donde los pacientes del Este de Dinamarca son seguidos cada dos años. PACIENTES: Mujeres que sufrieron una lesión en la médula espinal entre Septiembre de 1999 a Agosto de 2016 y asistieron a una consulta entre Agosto de 2010 a Agosto de 2016. Si nunca se había respondido el cuestionario de la función intestinal, se excluyó a la mujer. MEDIDA DE RESULTADOS PRINCIPALES: Se obtuvo el cuestionario más reciente y completo sobre la función intestinal, la función de la vejiga urinaria, la calidad de vida, el nivel neurológico/integridad/etiología de la lesión, el estado de movilidad y la relación con el cónyuge. RESULTADOS: Entre las 733 mujeres identificadas, se incluyeron 684, de las cuales solo el 11% tenía una lesión de motor completa. Un total de 35% experimentó incontinencia fecal que varió de diaria a menos de mensual, y el 79% experimentó disfunción intestinal. La incontinencia fecal se asoció con incontinencia urinaria y disminución de la satisfacción de vida en general y con la salud psicológica. En el análisis de regresión logística multivariable, las probabilidades de incontinencia fecal diaria-mensual aumentaron significativamente con el aumento de la edad, el mielomeningocele como etiología de la lesión, una lesión parapléjica más completa, el uso de silla de ruedas de forma permanente y el seguimiento <3 meses. LIMITACIONES: Faltaban datos en el estudio, incluyendo el 12% sin respuesta a la pregunta sobre incontinencia fecal. CONCLUSIONES: La incontinencia fecal es un problema grave que afecta a más de un tercio de las mujeres con lesión de la médula espinal y se asocia con una disminución de calidad de vida. El presente estudio enfatiza que las mujeres con mielomeningocele, una lesión parapléjica más completa, mayor edad, corto período de seguimiento y uso de silla de ruedas permanente tienen un mayor riesgo de incontinencia fecal. Vea el Video del Resumen en http://links.lww.com/DCR/A985.


Assuntos
Incontinência Fecal/etiologia , Intestino Neurogênico/etiologia , Traumatismos da Medula Espinal/complicações , Adulto , Estudos Transversais , Dinamarca/epidemiologia , Incontinência Fecal/epidemiologia , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Morbidade/tendências , Intestino Neurogênico/epidemiologia , Qualidade de Vida , Estudos Retrospectivos , Traumatismos da Medula Espinal/epidemiologia , Inquéritos e Questionários , Taxa de Sobrevida/tendências
6.
Taiwan J Obstet Gynecol ; 58(4): 505-513, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31307742

RESUMO

OBJECTIVES: This study aims to compare pelvic floor muscle (PFM) functions in midwifes and nurses of reproductive age with and without pelvic floor dysfunction (PFD) and investigate the relationship between PFM function and the number, type and symptoms of PFDs. MATERIALS AND METHODS: 82 midwifes and nurses of reproductive age with (n = 51) and without PFD (n = 31) participated in the study. PFM function was assessed by digital palpation using PERFECT scale. Gynecological examination, ultrasonography, disease-specific questionnaires, questions and tests were used to assess symptoms of PFD. PFD was assessed in terms of risk factors, urinary incontinence, fecal incontinence, pelvic organ prolapse (POP), pelvic pain and sexual dysfunctions. RESULTS: Power parameter of PERFECT scheme was significantly lower in subjects with PFD compared to Non-PFD group (p = 0.002). 41% of the subjects with Power 5 PFM strength in PFD group were diagnosed as stage 1 POP, 5.8% as stage 2 POP, 15.7% of urge incontinence, 23.3% of stress incontinence and 10.5% of mixed incontinence. Both urinary incontinence and POP were detected in 15.7% of them. Among all subjects, incontinence symptoms decreased whereas POP and sexual function did not change as PFM increased. PFM strength was negatively correlated with the number of PFD (p = 0.002, r = -0.34). The type of dysfunction did not correlate with PFM strength (p > 0.05). CONCLUSION: PFM strength only affects of urinary incontinence sypmtoms among all PFDs in midwifes and nurses of reproductive age. PFM strength may not be the main factor in the occurrence of PFDs as pelvic floor does not consist solely of muscle structure. However, it strongly affects the number of dysfunctions. Therefore, PFM training should be performed to prevent the occurrence of extra dysfunctions in addition to the existing ones even if it does not alter the symptoms.


Assuntos
Incontinência Fecal/fisiopatologia , Prolapso de Órgão Pélvico/complicações , Inquéritos e Questionários , Incontinência Urinária/fisiopatologia , Adulto , Fatores Etários , Estudos Transversais , Incontinência Fecal/epidemiologia , Incontinência Fecal/etiologia , Feminino , Exame Ginecológico/métodos , Humanos , Incidência , Pessoa de Meia-Idade , Tocologia , Força Muscular/fisiologia , Enfermeiras e Enfermeiros , Diafragma da Pelve/fisiopatologia , Distúrbios do Assoalho Pélvico/complicações , Distúrbios do Assoalho Pélvico/diagnóstico , Prolapso de Órgão Pélvico/diagnóstico , Prolapso de Órgão Pélvico/terapia , Prognóstico , Medição de Risco , Disfunções Sexuais Fisiológicas/etiologia , Disfunções Sexuais Fisiológicas/fisiopatologia , Incontinência Urinária/epidemiologia , Incontinência Urinária/etiologia
7.
BMC Pregnancy Childbirth ; 19(1): 225, 2019 Jul 04.
Artigo em Inglês | MEDLINE | ID: mdl-31272413

RESUMO

BACKGROUND: Most women choose to have another vaginal delivery following one complicated by an obstetrical anal sphincter injury (OASIS). However, little is known about patient satisfaction or regret with this decision. Therefore, our objective was to assess decisional regret with subsequent route of delivery following one affected by an OASIS. METHODS: A survey study was conducted among women seen in a specialty postpartum perineal clinic at a tertiary teaching hospital following a vaginal delivery with an OASIS between March 2012 and December 2016 who also had a subsequent delivery during that time period. Women were mailed a 13-item questionnaire between June and October 2017 that addressed pelvic floor symptoms and regret with their decision regarding mode of subsequent delivery. Regret was assessed with a modified Decision Regret Scale. Bivariate analyses were used to compare women with no, mild, or moderate/severe regret. RESULTS: Among 115 eligible women, 50 completed the survey. The majority (82%, n = 41) had a subsequent vaginal delivery and 18% (n = 9) had a subsequent cesarean delivery. Over one-third (34.9%, n = 15) reported the counseling they received after the OASIS influenced their decision regarding route of subsequent delivery. Fifty-four percent (n = 27) had no regret regarding their decision about subsequent delivery route, while 18 (36%) had mild, and five (10%) had moderate/severe regret. Regret was associated with older age (none: 36.8 ± 3.6 vs mild: 37.3 ± 3.4 vs moderate/severe: 41.7 ± 3.8 years, p = .03) and prevalence of fecal incontinence after delivery with OASIS (none: 15% vs mild: 17% vs moderate/severe: 80%, p = .01). CONCLUSIONS: Most women with an OASIS and a subsequent pregnancy will choose a repeat vaginal delivery, and over half have no regret about this decision. Older age and fecal incontinence following the incident delivery with OASIS were associated with regret regarding subsequent delivery mode.


Assuntos
Canal Anal/lesões , Parto Obstétrico/efeitos adversos , Satisfação do Paciente/estatística & dados numéricos , Períneo/lesões , Adulto , Fatores Etários , Parto Obstétrico/métodos , Parto Obstétrico/psicologia , Emoções , Incontinência Fecal/etiologia , Feminino , Inquéritos Epidemiológicos , Humanos , Gravidez , Estudos Retrospectivos
8.
Pediatr Surg Int ; 35(9): 1009-1012, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31256299

RESUMO

BACKGROUND: Sacral nerve stimulation (SNS) is frequently used for constipation and fecal incontinence in the adult literature. The purpose of this study is to perform a systemic review of the literature for SNS for constipation and fecal incontinence in children with emphasis in anorectal malformations. METHODS: Systematic literature review was conducted to include all SNS studies in patients < 19 years of age. Studies were separated into those for (1) constipation, (2) bowel and bladder dysfunction, and (3) anorectal malformations. RESULTS: 28 articles were included in the review: (1) 12 constipation (269 patients) and (2) 16 bowel and bladder dysfunction (441 patients). Some studies overlapped groups, as they included some patients with anorectal malformations (4 articles and 29 patients). Constipation studies included slow transit and retention constipation and showed varying degrees of improvement. For bowel and bladder dysfunction, studies also reported varying degrees of improvement using different measures (number of bowel movements per day, transit times, and soiling improvement). There was no specific description of the results in anorectal malformation (ARM) cases and also information regarding specific ARM type, sacral ratio, or presence of tethered cord. CONCLUSIONS: SNS for constipation and urinary problems seems to be promising. Data are limited and heterogeneous, and SNS cannot be definitively encouraged or discouraged in patients with ARM, based on current studies. Future studies should include more objective measurements of bowel outcomes and specify outcomes related to patients with anorectal malformations including information regarding their specific malformation, sacral ratio, and presence of tethered cord. Complications' rate is considerable high.


Assuntos
Malformações Anorretais/complicações , Constipação Intestinal/terapia , Terapia por Estimulação Elétrica/métodos , Incontinência Fecal/terapia , Sacro/inervação , Criança , Pré-Escolar , Constipação Intestinal/etiologia , Incontinência Fecal/etiologia , Feminino , Humanos , Masculino
9.
BMC Womens Health ; 19(1): 84, 2019 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-31262289

RESUMO

BACKGROUND: Obstetric fistula is a debilitating condition resulted from poorly (un) managed prolonged obstructed labor. It has significant psychosocial and economic consequences on those affected and their families. Data regarding experiences and coping mechanisms of Ethiopian women with fistula is scarce. METHODS: Qualitative design was employed with in depth interview technique by using open ended interview guide. Eleven fistula patients waiting for surgical repair at the fistula treatment center of Gondar Specialized Referral Hospital were selected with typical case selection. Thedata were audio-taped, transcribed and translated from Amharic to English. Open code version 4.03was used to organize data and identify themes for analysis. RESULTS: The age of participants of the study ranged between 19 to 43 years. Ten of them were from rural areas. Regarding their educational status eight cannot read and write. Similar number were either separated or divorced. Six of them lived with obstetric fistula without treatment from one to five years. Five women related their condition to their fate. The women faced challenges in role performance, marital and social relationships and economic capability. Frequent bathing, use of stripes of old clothes as a pad, self-isolation and hiding from being observed, wearing extra clothes as cover, increasing water intake and reducing hot drinks and fluids other than water were the ways they have devised to cope with the incontinence. CONCLUSION: The study participants reported that they experienced deep sense of loss, diminished self-worth and multiple social challenges. They coped with the incontinence in various ways among which some were non effective and might have continuing negative impact on woman's quality of life even after corrective surgery. Developing bridging intervention for early identification and referral could reduce period of women's suffering.


Assuntos
Complicações do Trabalho de Parto/psicologia , Qualidade de Vida/psicologia , Fístula Retovaginal/psicologia , Isolamento Social , Incontinência Urinária/psicologia , Fístula Vesicovaginal/psicologia , Adaptação Psicológica , Adulto , Etiópia , Incontinência Fecal/etiologia , Feminino , Humanos , Gravidez , Pesquisa Qualitativa , Autoimagem , Adulto Jovem
10.
Semin Pediatr Surg ; 28(3): 151-159, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31171150

RESUMO

Hirschsprung disease affects many children every year around the world. Currently, there is an extensive menu of diagnostic methods, and surgical treatments. This situation compels the physicians to follow the rationale of these interventions. The comprehensive diagnosis and treatment of Hirschsprung disease need singular procedures. The clear understanding of how to perform each of these techniques, as well as to read the results is mandatory. Otherwise, the medical team may perform unconscious errors and fall into traps. Many errors still happen in patients with Hirschsprung, resulting in a spectrum of problems; from delayed diagnosis to unnecessary colectomies. In other patients, the damage to the anal canal results in fecal incontinence. When this is established, it is an unreversed and devastating social problem. This article describes why these errors occur and how to prevent them.


Assuntos
Biópsia/normas , Técnicas de Diagnóstico do Sistema Digestório/normas , Incontinência Fecal/prevenção & controle , Doença de Hirschsprung/diagnóstico , Doença de Hirschsprung/cirurgia , Complicações Intraoperatórias/prevenção & controle , Erros Médicos , Segurança do Paciente/normas , Complicações Pós-Operatórias/prevenção & controle , Procedimentos Cirúrgicos Operatórios/normas , Biópsia/métodos , Incontinência Fecal/etiologia , Humanos , Lactente , Recém-Nascido , Complicações Intraoperatórias/etiologia , Complicações Pós-Operatórias/etiologia , Procedimentos Cirúrgicos Operatórios/efeitos adversos , Procedimentos Cirúrgicos Operatórios/métodos
11.
Ceska Gynekol ; 84(2): 111-114, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31238680

RESUMO

OBJECTIVE: To compare diagnostic possibilities of endoanal (EAUS) and transperineal (TPUS) ultrasound during anal sphincter examination and patients preferences. DESIGN: Prospective study. SETTING: Department of Obstetrics and Gynaecology, 1st Faculty of Medicine, Charles University and General University Hospital, Prague. METHODS: Patients involved had EAUS and TPUS of anal sphincter. First group were patients scheduled for control check after vaginal delivery complicated with anal sphincter injury (post OASI) and adequate suture. Second (control) group contained new patients coming for urogynecological examination with some symptoms of anal incontinence. Refusal were noted and after completing both ultrasounds patients marked on visual analog scale (VAS) the level of dyscomfort and answered few simple questions about their preference of exam in future. RESULTS: This study contains twenty-nine patients (fifteen post OASI and fourteen in control group). Two patients (post OASI) refused EAUS and one patient from control group did not mark the level of dyscomfort. In post OASI group eleven patients (84.6%) considered EAUS as botherless or slighly bothering (VAS 3). The average dyscomfort for EAUS was 1.92 and for TPUS 1.08. Five patients marked EAUS more dyscomfortable as TPUS and this difference is significant (p < 0.05). In control group eleven patients (84.6%) marked EAUS as botherless or slightly bothering (VAS 3). There was no difference between post OASI and control group. We have not found by any exam residual anal sphincter defect in any patient post OASI. For this reason we could not decide about efectivity. In matter of future preference patients would prefer TPUS to EAUS in case of similar effectivity. However, in case of different effectivity patients would prefer the more effective. CONCLUSION: Our patients prefer less dyscomfortable TPUS. The pilot study did not display higher effectivity of EAUS in diagnostics of residual anal sphincter defect.


Assuntos
Canal Anal/diagnóstico por imagem , Canal Anal/lesões , Incontinência Fecal/diagnóstico por imagem , Incontinência Fecal/etiologia , Ultrassonografia/métodos , Adulto , Parto Obstétrico/efeitos adversos , Feminino , Humanos , Projetos Piloto , Gravidez , Estudos Prospectivos
12.
Curr Urol Rep ; 20(8): 41, 2019 Jun 10.
Artigo em Inglês | MEDLINE | ID: mdl-31183573

RESUMO

PURPOSE OF REVIEW: No gold standard exists for managing neurogenic bowel dysfunction, specifically in individuals with spina bifida. Since the International Children's Continence Society published its consensus document on neurogenic bowel treatment in 2012, an increased focus on why we must manage bowels and how to improve our management has occurred. This review provides updated information for clinicians. RECENT FINDINGS: A surge in research, mostly retrospective, has been conducted on the success and satisfaction of three types of management for neurogenic bowel. All three management techniques have relatively high success rates for fecal continence and satisfaction rates. Selection of which treatment to carry out still is debated among clinicians. Transanal irrigation is a safe and effective management option for neurogenic bowel that does not require surgery. Antegrade enemas can be carried out via cecostomy tube or Malone antegrade continence enema with similar fecal continence outcomes.


Assuntos
Cecostomia , Enema/métodos , Intestino Neurogênico/terapia , Disrafismo Espinal/complicações , Irrigação Terapêutica , Canal Anal , Criança , Constipação Intestinal/etiologia , Constipação Intestinal/terapia , Incontinência Fecal/etiologia , Incontinência Fecal/terapia , Humanos , Intestino Neurogênico/etiologia , Intestino Neurogênico/cirurgia
13.
Pediatr Surg Int ; 35(8): 829-834, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31201486

RESUMO

Although most children with Hirschsprung disease ultimately achieve functional and comfortable stooling, some will experience a variety of problems after pull-through surgery. The most common problems include soiling, obstructive symptoms, enterocolitis, and failure to thrive. The purpose of this guideline is to present a rational approach to the management of postoperative soiling in children with Hirschsprung disease. The American Pediatric Surgical Association Hirschsprung Disease Interest Group engaged in a literature review and group discussions. Expert consensus was then used to summarize the current state of knowledge regarding causes, methods of diagnosis, and treatment approaches to children with soiling symptoms following pull-through for Hirschsprung disease. Causes of soiling after pull-through are broadly categorized as abnormalities in sensation, abnormalities in sphincter control, and "pseudo-incontinence." A stepwise algorithm for the diagnosis and management of soiling after a pull-through for Hirschsprung disease is presented; it is our hope that this rational approach will facilitate treatment and optimize outcomes.


Assuntos
Algoritmos , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Incontinência Fecal/cirurgia , Doença de Hirschsprung/cirurgia , Complicações Pós-Operatórias/prevenção & controle , Guias de Prática Clínica como Assunto , Criança , Incontinência Fecal/etiologia , Doença de Hirschsprung/complicações , Humanos , Período Pós-Operatório , Resultado do Tratamento
14.
Ceska Gynekol ; 84(1): 18-22, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31213053

RESUMO

OBJECTIVE: Analysis of women undergoing vaginal birth with 3rd or 4th degree perineal tears. TYPE OF STUDY: Review and analysis of the data from our department. SETTING: Department of Gynecology and Obstetrics, 1st Medical Faculty of Charles University and Hospital Na Bulovce, Prague. INTRODUCTION: Obstetric anal sphincter injuries (OASIS) belong to dreaded complications after vaginal delivery. The injury is associated with significant maternal morbidity. The most common difficulties are perineal pain, dyspareunia, flatulence and anal incontinence. OASIS are main cause of anal incontinence in women. MAIN RESULTS: During monitored period 2015-2017 we performed 6185 childbirths in our ward. Cesarean section was performed at 21% of births, instrumental vaginal birth at 5,7% and 73,3% of women had a spontaneous vaginal birth. Our analysis included 4888 births. In our group 92,8% of women gave birth spontaneously regardless of injury and at 7,2% we performed an instrumental delivery. Perineal tears of 3rd and 4th degree were detected in 1,7% (83/4888) of vaginal births independent of vaginal ending. 85,5% were nulliparous women. In a group of instrumental deliveries the risk of OASI was higher. We have detected injury at 5,4% (19/352) of this type of delivery. The most detected perineal trauma in 47% was injury involving more than 50% of external anal sphincter thickness torn (3b). Surprising was a high incidence of mediolateral episiotomy in a group of women who sustained OASI. The most frequent symptoms three months after birth were flatus incontinence and dyspareunia. CONCLUSION: Obstetric anal sphincter injury is associated with significant maternal morbidity. The most serious consequence is an anal incontinence. With other symptoms as a dyspareunia and a perineal pain it leads to psychosocial problems. Thorough treatment reduces the risk of complications.


Assuntos
Canal Anal/lesões , Cesárea/estatística & dados numéricos , Parto Obstétrico/métodos , Incontinência Fecal/etiologia , Lacerações/complicações , Complicações do Trabalho de Parto/etiologia , Períneo/lesões , Episiotomia/métodos , Incontinência Fecal/epidemiologia , Feminino , Humanos , Lacerações/epidemiologia , Complicações do Trabalho de Parto/epidemiologia , Gravidez , Fatores de Risco
15.
Rev. argent. coloproctología ; 30(2): 51-56, Jun. 2019. tab
Artigo em Espanhol | LILACS | ID: biblio-1025473

RESUMO

Introducción: La incontinencia anal es una compleja y devastadora patología que altera la calidad de vida de los pacientes, cuya etiología más común es la lesión esfintérica postparto vaginal. A la hora de clasificar la incontinencia, el score descripto por Jorge y Wexner es el más utilizado en nuestro medio. La ecografía endoanal ha sido definida como el gold standard para evaluar los defectos del esfínter anal. Objetivo: Determinar la correlación entre los hallazgos clínicos y ecográficos en pacientes con incontinencia fecal de causa obstétrica. Material y Métodos: Población: pacientes que consultaron en el Centro Privado de Cirugía y Coloproctología entre enero de 2015 y diciembre de 2017 por incontinencia fecal con antecedentes de trauma obstétrico y a las que se les realizó una ecografía endoanal 360° y score de Jorge y Wexner. Resultados: Se evaluaron 24 pacientes. La media de edad fue de 56 años. El número de partos en promedio fue 2,3 y el Score de Wexner en promedio fue 9.7 (±5.2). La ecografía endoanal confirmó alteración esfintérica por afinamiento o interrupción en el 100% de los pacientes. Se observó una tendencia a una asociación negativa entre el Score de Wexner y la ecografía endoanal (r=-0.328, p=0.067). Las pacientes con menor grado de lesión esfinteriana por ecografía tenían mayor severidad en el Score de Wexner que las pacientes con mayor grado de lesión. Las pacientes con evidencia ecográfica de lesiones leves refirieron un mayor Score de Wexner que aquellas con lesiones severas. Conclusión: En este trabajo no existió correlación entre los hallazgos ecográficos y el score de incontinencia. Si bien la ecografía esfintérica es el gold standard para evaluar daño muscular, la terapéutica no debe ser determinada solamente por la ecografía. Tipo de estudio: Retrospectivo, transversal y descriptivo.


Introduction: Anal incontinence is a complex and devastating pathology that alters the patient's quality of life, whose most common etiology is vaginal postpartum sphincter injury. To classify incontinence, the score described by Jorge and Wexner is the most used in our environment. Endoanal ultrasound has been defined as the gold standard for evaluating anal sphincter defects. Objective: To determine the correlation between clinical and ultrasound findings in patients with fecal incontinence due to obstetric cause. Material and Methods: Population: patients who consulted at the Private Center of Surgery and Coloproctology between January 2015 and December 2017 due to fecal incontinence with a history of obstetric trauma and who underwent a 360º endoanal ultrasound and a Jorge and Wexner score. Results: Twenty-four patients were evaluated. The average age was 56 years. The number of births on average was 2.3 and the Wexner Score on average was 9.7 (± 5.2). Endoanal ultrasound confirmed sphincter alteration by refining or interruption in 100% of patients. A tendency to a negative association was observed between the Wexner Score and the endoanal ultrasound (r = -0.328, p = 0.067). Patients with a lower degree of sphincter injury by ultrasound had greater severity in the Wexner Score than patients with a higher degree of injury. Patients with ultrasound evidence of mild lesions reported a higher Wexner Score than those with severe lesions. Conclusion: In this work, there was no correlation between the sonographic findings and the incontinence score. Although sphincter ultrasonography is the gold standard for assessing muscle damage, therapy should not be determined only by ultrasound. Type of study: Retrospective, cross-sectional and descriptive.


Assuntos
Humanos , Feminino , Gravidez , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Canal Anal/lesões , Canal Anal/diagnóstico por imagem , Endossonografia/métodos , Incontinência Fecal/etiologia , Fatores de Risco , Incontinência Fecal/diagnóstico por imagem , Complicações do Trabalho de Parto
16.
Rev. argent. coloproctología ; 30(2): 65-70, Jun. 2019. ilus, tab
Artigo em Espanhol | LILACS | ID: biblio-1025568

RESUMO

Introducción: Las fístulas perianales tienen dos problemas fundamentales, la tasa de recurrencia y de incontinencia fecal postoperatoria, complicaciones que varían en frecuencia dependiendo de varios factores como el tipo de fistula, la técnica quirúrgica usada y la experiencia del cirujano. Debido a esto existen técnicas quirúrgicas no conservadoras y conservadoras de esfínteres donde se incluye el tratamiento video asistido que aparece desde el año 2006 y en la cual se utiliza un sistema de video endoscopio sofisticado y de alto valor económico el cual hemos adaptado a nuestro medio. Pacientes y método: De septiembre del 2015 al 2017 en la Unidad de Coloproctología del Hospital Domingo Luciani IVSS se realizó un estudio prospectivo experimental, donde se incluyeron 18 pacientes con fístulas perianales complejas diagnosticadas previamente con Ecofistulografía 3D y los cuales se operaron con un sistema adaptado usando citoscopio pediátrico de 4 mm y energía láser. Se evaluaron parámetros referentes a la técnica así como la tasa de éxito y riesgo de incontinencia. Resultados: Tiempo quirúrgico de 40 a 80 minutos, con tasa de éxito de 89%, recidiva en 2 pacientes, con tiempo de seguimiento entre 12 a 36 meses y sin cambios en la escala de incontinencia pre y post quirúrgica. Conclusión: El tratamiento video asistido modificado para fistulas anales (VAMAFT) es una técnica innovadora y factible de realizar al adaptar algunos instrumentos, con una tasa de éxito adecuada y sin riesgo de incontinencia, pero más trabajos aleatorizados con mayor números de pacientes deben ser realizados.


Introduction: Anal fistulas have two basic problems, rate of recurrence and postoperative anal incontinence. These complications vary according to several factors such as type of anal fistula, surgical technique and the surgeon´s experience. For each cases there are different surgical techniques with and without conservation of anal sphincters like conservative video assisted anal fistula treatment, described in 2006, this technique uses a sophisticated and expensive endoscope system but that we modified to use in our hospitals. Patients and method: Between September 2015 to 2017 in the Unit of Coloproctology of Domingo Luciani Hospital, was perfomed a prospective and experimental trial in 18 patients with anal complex fistulas previously diagnosed using tridimensional anal ultrasound and operated with a modified system consisting of pediatric cystoscope of 4 mm and laser energy. Some parameters were evaluated including surgical technique, recurrence and anal incontinence rate. Results: Surgical times were between 40 to 80 minutes, success rate of 89%, recurrence in two patients with follow up of 12 to 36 months and no changes in pre and post surgical anal incontinence scale. Conclusion: Video assited modified anal fistula treatment (VAMAFT) is an innovative and feasible surgical technique to do adapting some instruments, with suitable success rate and without anal incontinence risk but many randomized research with more patients have to be perfomed.


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Adulto Jovem , Fístula Retal/cirurgia , Fístula Retal/diagnóstico , Cirurgia Vídeoassistida/métodos , Complicações Pós-Operatórias , Recidiva , Incontinência Fecal/etiologia
17.
Urologe A ; 58(6): 634-639, 2019 Jun.
Artigo em Alemão | MEDLINE | ID: mdl-31139864

RESUMO

BACKGROUND: Sacral neuromodulation (SNM) has been used in the treatment of refractory overactive bladder syndrome, nonobstructive urinary retention and faecal incontinence for almost 40 years now. It is not to be confused with the sacral anterior root stimulation which is exclusively used for bladder dysfunction due to spinal paraplegia. MECHANISM OF ACTION: The principles of SNM are yet to be fully understood. Nevertheless, there is proof of modulating the activity of several micturition-associated, afferent neurons in the spine, brainstem and cerebrum. Thus, premature detrusor contractions are suppressed, the desire to void is delayed and detrusor-sphincter coordination improves. TECHNIQUES OF IMPLANTATION AND STIMULATION: Motor reactions are an important indicator of correct electrode placement. The implantation procedure consists of two stages with an initial trial phase to determine the best possible treatment response through an external generator before implanting the whole stimulating device. Yearly check-up examinations are recommended; wireless adjustments allow for long-lasting symptom reduction. INDICATION AND OUTCOME: Success rates in the treatment of the refractory overactive bladder syndrome and the non-obstructive urinary retention lie above 70% and can still be perceived as sufficient after 5 years of ongoing SNM therapy. There is also profound evidence of SNM being an effective option for patients with faecal incontinence or chronic obstipation. CONTRAINDICATIONS AND RISKS: Children, pregnant women and patients in need of frequent MRI examinations are usually not eligible for SNM therapy. Infection of the implant, technical failure (including lead displacement and battery depletion) and pain in the implantation site are important adverse effects which might require surgical revision. CONCLUSIONS: The indications for SNM in the German health care system can be expected to be expanded upon the chronic pelvic pain syndrome, erectile dysfunction and additional gastrointestinal conditions. Technical progress will continue to improve the risk-benefit ratio of SNM.


Assuntos
Terapia por Estimulação Elétrica/métodos , Incontinência Fecal/terapia , Neuroestimuladores Implantáveis , Plexo Lombossacral/fisiopatologia , Dor Pélvica/terapia , Bexiga Urinária Hiperativa , Bexiga Urinária/inervação , Retenção Urinária/terapia , Criança , Incontinência Fecal/etiologia , Incontinência Fecal/fisiopatologia , Feminino , Humanos , Masculino , Dor Pélvica/fisiopatologia , Gravidez , Sacro , Bexiga Urinária Hiperativa/terapia , Bexiga Inativa , Retenção Urinária/etiologia , Retenção Urinária/fisiopatologia
18.
J Clin Nurs ; 28(19-20): 3408-3415, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31090966

RESUMO

BACKGROUND AND AIMS: Microscopic colitis causes chronic or recurrent nonbloody, watery diarrhoea, which is associated with urgency, faecal incontinence and abdominal pain. The patient's health-related quality of life is often impaired. In microscopic colitis, health-related quality of life has been studied using questionnaires originally constructed and validated for patients with inflammatory bowel disease. The aim of this study was to explore the impact of microscopic colitis on everyday life. METHODS AND RESULTS: Inductive, qualitative, semi-structured interviews were performed with 15 persons suffering from microscopic colitis. Content analysis was used to explore the impact of the condition on everyday life. The study followed the consolidated criteria for reporting qualitative research. The qualitative inductive content analysis generated one theme and five subthemes. The theme was "struggling with an invisible, disabling disease." The five subthemes were as follows: physical experience of bowel function; associated symptoms affecting quality of life; impact of the disease on everyday life; disease-related worry; and strategies for managing everyday life. CONCLUSIONS: The semi-structured interviews with persons suffering from microscopic colitis provided a wide spectrum of answers to the question of how everyday life is affected. Microscopic colitis can be a disabling life experience, and patients develop different strategies to adapt, cope and regain their previous performance level. RELEVANCE TO CLINICAL PRACTICE: There are new and interesting findings in our study that everyday life still remains affected even when patients are in remission. These findings have relevance in clinical practice and may create a better understanding of the patient's symptoms and situation.


Assuntos
Colite Microscópica/psicologia , Qualidade de Vida , Dor Abdominal , Atividades Cotidianas/psicologia , Adaptação Psicológica , Adulto , Idoso , Colite Microscópica/complicações , Diarreia/etiologia , Incontinência Fecal/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa , Inquéritos e Questionários
19.
Vasc Health Risk Manag ; 15: 81-87, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31114214

RESUMO

A 74-year-old patient presented with isolated fecal incontinence 6 weeks following endovascular aneurysm repair. The delayed presentation of spinal cord ischemia was precipitated by commencement of alpha-blockers for benign prostatic hyperplasia. This case stresses that vulnerability to spinal cord perfusion is not limited to the perioperative period. In addition, systemic arterial pressure should be closely monitored in cases of marginal vascular insufficiency of the spinal cord.


Assuntos
Antagonistas de Receptores Adrenérgicos alfa 1/efeitos adversos , Aneurisma da Aorta Abdominal/cirurgia , Pressão Arterial/efeitos dos fármacos , Implante de Prótese Vascular/efeitos adversos , Procedimentos Endovasculares/efeitos adversos , Hiperplasia Prostática/diagnóstico por imagem , Quinazolinas/efeitos adversos , Isquemia do Cordão Espinal/etiologia , Isquemia do Cordão Espinal/terapia , Idoso , Angiografia Digital , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Aortografia/métodos , Angiografia por Tomografia Computadorizada , Incontinência Fecal/etiologia , Incontinência Fecal/terapia , Humanos , Imagem por Ressonância Magnética , Masculino , Hiperplasia Prostática/diagnóstico , Isquemia do Cordão Espinal/diagnóstico por imagem , Isquemia do Cordão Espinal/fisiopatologia , Fatores de Tempo , Resultado do Tratamento
20.
Int J Colorectal Dis ; 34(6): 1079-1086, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30997602

RESUMO

PURPOSE: Despite a high incidence of fecal incontinence following sphincter-preservation surgery (SPS), there are no definitive factors measured before ileostomy reversal that predict fecal incontinence. We investigated whether vector volume anorectal manometry before ileostomy reversal predicts major fecal incontinence following SPS in patients with mid or low rectal cancer. METHODS: This longitudinal prospective cohort study comprised 173 patients who underwent vector volume anorectal manometry before ileostomy reversal. The Fecal Incontinence Severity Index was measured 1 year after the primary SPS and classified as major incontinence (FISI score ≥ 25) or continent/minor incontinence (FISI score < 25). Multivariable logistic regression analysis was used to identify predictors of major incontinence. RESULTS: Ninety-two patients (53.1%) had major incontinence. Although tumor stage, location, and neoadjuvant chemoradiotherapy were comparable, the major incontinence group had lower resting pressure (28.4 vs. 34.3 mmHg, P = 0.027), greater asymmetry at rest (39.1% vs. 34.1%, P = 0.002) and squeezing (34.2% vs. 31.4%, P = 0.046), shorter sphincter length (3.3 vs. 3.7 cm, P = 0.034), and lower resting vector volume (143,601 vs. 278,922 mmHg2 mm, P < 0.001) compared with the continent/minor incontinence group. Resting vector volume was the only independent predictor of major incontinence (odds ratio = 0.675 per 100,000 mmHg2 mm, 95% confidence interval, 0.532-0.823; P = 0.006). CONCLUSIONS: This study revealed that resting vector volume before ileostomy reversal may predict major fecal incontinence. We suggest that the physiology of the anorectum should be discussed with patients before ileostomy reversal in patients at high risk of fecal incontinence.


Assuntos
Bases de Dados como Assunto , Incontinência Fecal/diagnóstico , Incontinência Fecal/etiologia , Ileostomia/efeitos adversos , Neoplasias Retais/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Canal Anal/fisiopatologia , Canal Anal/cirurgia , Humanos , Estudos Longitudinais , Manometria , Pessoa de Meia-Idade , Análise Multivariada , Estudos Prospectivos , Curva ROC , Reto/fisiopatologia , Reto/cirurgia
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA