SUI in postmenopausal women: advantages of an intraurethral + intravaginal Er:YAG laser.

OBJECTIVE: This study aimed to compare the efficacy of concomitant application of an intraurethral (IU) + intravaginal (IV) non-ablative Erbium (Er):YAG laser with IV application in improving the symptoms of stress urinary incontinence (SUI) in women. METHODS: This observational retrospective cohort study included 122 patients with SUI, 60 women in the IU + IV laser arm and 62 in the IV laser arm. The primary outcome was the International Consultation on Incontinence Questionnaire - Urinary Incontinence Short Form score at entry and at 3, 6 and 12 months from baseline. RESULTS: Demographic characteristics were comparable in both arms. Significant improvement in SUI symptoms was seen 3 months after the intervention and was sustained until the end of month 12 in both arms. The women who had severe SUI symptoms initially showed greater improvement. A higher number of women who initially had mild to moderate SUI symptoms were dry after treatment. Patients treated with IU + IV Er:YAG laser showed significant improvement in SUI symptoms compared to IV laser only, especially at postmenopausal state (p = 0.003). CONCLUSIONS: The Er:YAG laser appears to be an efficient treatment method for SUI. Concomitant application of an IU + IV Er:YAG laser is more effective in relieving SUI symptoms at postmenopausal state.

A systematic review and meta-analysis of complications of artificial urinary sphincters in female patients with urinary incontinence due to internal sphincter insufficiency.

BACKGROUND: Urinary incontinence (UI) is a common worldwide rising health issue among women with a prevalence of 5 to 70%. Stress urinary incontinence (SUI) is the most common subtype of UI. There are different treatments for UI, including AUS (artificial urinary sphincter) implantation, as one of the surgical options for treating SUI. The aim of this study was to determine the complication rate of AUS, exclusively in female patients with SUI, which resulted from ISD (intrinsic sphincter deficiency). We also compared the complication rate between minimally invasive (laparoscopic or robotic surgery) and open approaches. METHODS: Scopus, PubMed, Web of Science, Embase, and Google Scholar were searched for studies regarding complications in AUS implantation surgery, from the beginning of the project to March 2022. After screening and reviewing of full text, the general characteristics of the study and study population including follow-up time, type of surgery, and the number of complications that occurred such as necrosis, atrophy, erosion, infection, mechanical failure, revision, and leak, were extracted. RESULTS: We found that atrophy occurred in 1 of 188 (0.53%) patients treated with minimally invasive surgery and in 1 of 669 (0.15%) patients treated with open surgery. None of the 17 included studies reported the occurrence of necrosis in the patients under study. Erosion occurred in 9 of 188 (4.78%) patients treated with minimally invasive surgery and in 41 of 669 (6.12%) patients treated with open surgery. Infection occurred in 12 of 188 (6.38%) patients treated with minimally invasive surgery and in 22 of 669 (3.2%) patients treated with open surgery. The mechanical failure occurred in 1 of 188 (0.53%) patients treated with minimally invasive surgery and in 55 of 669 (8.22%) patients treated with open surgery. Reconstructive surgery occurred in 7 of 188 (3.72%) patients treated with minimally invasive surgery and in 95 of 669 (14.2%) patients treated with open surgery. Leaks occurred in 4 of 188 (2.12%) patients treated with minimally invasive surgery and in 6 of 669 (0.89%) patients treated with open surgery. The type of surgery was associated with a statistically significant increase in mechanical failure (p-value = 0.067) and infection (p-value = 0.021), and reconstructive surgery (p-value = 0.049). Out of the 857 participats in the study,469 were studied for less than five years and 388 were studied for more than five years.21 of 469 (4.4%) (p-value = 0.08) patients and 81 of 388 (20.8%) (p-value = 0.001) patients required reconstructive surgery. Erosion occurred in 23 of 469 (4.9%) (p-value = 0.01)patients with following time less than five years and in 27 of 388 (6.9%) (p-value = 0.001) patients with following time more than five years. CONCLUSION: The use of artificial urinary sphincters in the treatment of UI causes complications such as atrophy, erosion, and infection; the amount of which is influenced by the surgical method and the duration of using the artificial urinary sphincter. It seems that the use of new surgical methods, such as laparoscopic surgery, is useful in reducing the incidence of complications.

Internal anal sphincter: Clinical perspective.

OBJECTIVE: To summarise current knowledge of Internal anal sphincter. BACKGROUND: The internal anal sphincter (IAS) is the involuntary ring of smooth muscle in the anal canal and is the major contributor to the resting pressure in the anus. Structural injury or functional weakness of the muscle results in passive incontinence of faeces and flatus. With advent of new assessment and treatment modalities IAS has become an important topic for surgeons. This review was undertaken to summarise our current knowledge of internal anal sphincter and highlight the areas that need further research. METHOD: The PubMed database was used to identify relevant studies relating to internal anal sphincter. RESULTS: The available evidence has been summarised and advantages and limitations highlighted for the different diagnostic and therapeutic techniques. CONCLUSION: Our understanding of the physiology and pharmacology of IAS has increased greatly in the last three decades. Additionally, there has been a rise in diagnostic and therapeutic techniques specifically targeting the IAS. Although these are promising, future research is required before these can be incorporated into the management algorithm.

Guidelines for the management of postoperative obstructive symptoms in children with Hirschsprung disease.

Although most children with Hirschsprung disease ultimately do well, many experience a variety of ongoing problems after pull-through surgery. The most common include obstructive symptoms, soiling, enterocolitis and failure to thrive. The purpose of this guideline is to present a rational approach to the management of postoperative obstructive symptoms in children with Hirschsprung disease. The American Pediatric Surgical Association Board of Governors established a Hirschsprung Disease Interest Group. Group discussions, literature review and expert consensus were then used to summarize the current state of knowledge regarding causes, methods of diagnosis, and treatment approaches to children with obstructive symptoms following pull-through for Hirschsprung disease. Causes of obstructive symptoms post-pull-through include mechanical obstruction; persistent or acquired aganglionosis, hypoganglionosis, or transition zone pull-through; internal sphincter achalasia; disordered motility in the proximal intestine that contains ganglion cells; or functional megacolon caused by stool-holding behavior. An algorithm for the diagnosis and management of obstructive symptoms after a pull-through for Hirschsprung disease is presented. A stepwise, logical approach to the diagnosis and management of patients experiencing obstructive symptoms following pull-through for Hirschsprung disease can facilitate treatment. Level of evidence V.

Comparison of long-term quality of life based on surgical procedure in patients with rectal cancer.

Introduction: Reports on the long-term quality of life (QOL) over 3 years after surgery in patients who have undergone surgery for rectal cancer are limited. Therefore, we aimed to evaluate the long-term QOL of patients who underwent high anterior resection (HAR), low anterior resection (LAR), internal sphincter resection (ISR), or abdominoperineal resection (APR) for rectal cancer. Methods: A questionnaire regarding QOL was sent to 360 patients with rectal cancer who underwent curative resection by HAR, LAR, ISR, or APR between January 2005 and December 2015. QOL was assessed using the short-form 36 (SF-36) and modified fecal incontinence QOL (mFIQL) questionnaire. QOL between surgical procedures was analyzed using a multivariate model adjusted for age, sex, and postoperative time. Results: A total of 144 patients responded with a median follow-up period of 94 months (range 38-233 months). According to surgical procedure, HAR was performed in 26 patients, LAR in 80 patients, ISR in 32 patients, and APR in 6 patients. Patients who underwent HAR had significantly better mFIQL scores than those who underwent LAR and ISR (p=0.013 and p=0004, respectively) and significantly better role/social component summary scores on the SF-36 subscales (p=0.007). No difference was observed in the mFIQL scores between patients who underwent ISR and those who underwent APR (p=0.8423). In addition, postoperative anastomotic leakage sutures did not influence the mFIQL and SF-36 scores after surgery. Conclusion: The QOL of patients who underwent anus-preserving surgery was best in the HAR group, with the QOL of other groups similar to the APR group. These results suggest that anus- preserving surgery is acceptable from a QOL standpoint. However, a colostomy may be a more satisfactory procedure in some patients.

Anal Fissure - an extensive update.

Anal fissure is one of the most common anorectal diseases resulting from a longitudinal tear in anoderm under the dentate line. It causes painful defecation and bleeding per anum. Most of the fissures heal by conservative means but a significant proportion turns chronic, leading to a negative impact upon the overall quality of life of a patient. The treatment options for chronic fissures are generally based on reducing the anal pressures and include non-surgical and surgical modalities. Lateral internal sphincterotomy still remains the gold standard for definitive management of anal fissure though anal incontinence is a serious complication of the procedure. In recent years, various modifications have evolved to minimize chances of incontinence besides the evolution of a wide range of non-surgical options of management. This review outlines the key points in the clinical presentation, etiopathogenesis, impact on the quality of life and management of anal fissure in the light of the recent updates in literature.

Milligan-Morgan hemorrhoidectomy with anal cushion suspension and partial internal sphincter resection for circumferential mixed hemorrhoids.

AIM: To identify a more effective treatment protocol for circumferential mixed hemorrhoids. METHODS: A total of 192 patients with circumferential mixed hemorrhoids were randomized into the treatment group, where they underwent Milligan-Morgan hemorrhoidectomy with anal cushion suspension and partial internal sphincter resection, or the control group, where traditional external dissection and internal ligation were performed. Postoperative recovery and complications were monitored. RESULTS: The time to wound healing was 12.96 ± 2.25 d in the treatment group shorter than 19.58 ± 2.71 d in the control group. Slight pain rate was 58.3% in the treatment group higher than 22.9% in the control group; moderate pain rate was 33.3% in the treatment group lower than 56.3% in the control group severe pain rate was 8.4% in the treatment group lower than 20.8% in the control group. No edema rate was 70.8% in the treatment group higher than 43.8% in the control group; mild local edema rate was 26% in the treatment group lower than 39.6% in the control group obvious local edema was 3.03% in the treatment group lower than 16.7% in the control group. No stenosis rate was 85.4% in the treatment group higher than 63.5% in the control group; moderate stenosis rate was 14.6% in the treatment group Lower than 27.1% in the control group severe anal stenosis rate was 0% in the treatment group lower than 9.4% in the control group. CONCLUSION: Milligan-Morgan hemorrhoidectomy with anal cushion suspension and partial internal sphincter resection is the optimal treatment for circumferential mixed hemorrhoids and can be widely applied in clinical settings.

Minimally Invasive Stealth Lateral Internal Sphincter Release for Chronic Anal Fissure:a Report of 42 Cases / 中国微创外科杂志

Objective To investigate the safety and feasibility of minimally invasive stealth lateral release operation in the treatment of chronic anal fissure . Methods Clinical data of 42 patients with chronic anal fissure who underwent minimally invasive stealth lateral release from May 2012 to May 2014 was analyzed retrospectively .We use the homemade fine steel wire to pierce into the sphincter ditch with a distance from the anus of 1 cm, and put the steel wire out above the dentate line .Then the wire was took out from the other edge under the skin through the needle of bobbin .After the needle was fixed by an assistant , the free end of the steel wire was pulled quickly to cut the internal sphincter tissue instantly . Results All the 42 patients were successfully treated and discharged without complications .The recovery time was in 7 -14 d, with an average of 9 d.The healing standards included disappeared symptoms and totally healed wound .All the patients were followed up for 3-6 months, with an average of 4 months.No recurrence was found . Conclusion Minimally invasive stealth lateral release in the treatment of chronic anal fissure is safe and feasible, with many advantages such as simple performance , reliable curative effect, fast recovery time, and less postoperative complications .

Comparison of the effect of improved lateral incision of internal sphincter and posterior incision in the treat-ment of old anal cleft / 中国基层医药

Objective To compare the curative effect of improved lateral incision of internal sphincter and posterior incision in the treatment of old anal cleft .Methods 100 patients with old anal cleft were selected .60 patients were given the improved lateral incision of internal sphincter ( lateral incision group ) , and 40 patients were given the traditional posterior median incision of internal sphincter ( control group ) .The postoperative hospitalization time,wound healing time ,postoperative pain level and complications were observed ,and the clinical curative effect was compared.Results The operations of the two groups were successful .The postoperative hospitalization time ,wound healing time,postoperative 24h pain level in the lateral incision group were less than those in control group (t=2.13, 2.19,2.17,all P<0.05).The total effective rate of the lateral incision group (98.3%) was significantly higher than that of the control group(85.0%)(χ2 =4.67,P<0.05),while the incidence rate of postoperative complications in the lateral incision group(13.3%) was significantly lower than that of the control group (35.0%)(χ2 =6.57,P<0.05 ) .Conclusion Compared with traditional posterior median incision of internal sphincter , the improved lateral incision of internal sphincter in the treatment of old anal cleft has advantages , such as better postoperative curative effect,shorter postoperative hospitalization ,less wound healing time ,lighter postoperative pain ,less postoperative com-plication,and etc.

Transurethral Division of Internal Sphincter for Non-reflex Pubovesical Muscle Neurogenic Bladder(A Report of 40 Cases) / 中国医师杂志

Objective To study the relationship between the operative programs and curative effects in treating non-reflex pubovesical muscle neurogenic bladder by transurethral division of internal sphincter. Methods Bilateral or one laternal division of internal sphincter were performed separately,followed-up for 3 months to 5 years in postoperation,and analysed data obtained .Results Bilateral division had a much higher improving rate(92%) than that of one laternal(60%)(P