AIM: To evaluate the efficacy of botulinum toxin type A injection to the puborectalis and external sphincter muscle in the treatment of patients with anismus unresponsive to simple biofeedback training.
AIM: To evaluate the efficacy and safety of botulinum toxin type A(BTX-A) in the management of patients with anismus. METHODS: An organized search of published literature was conducted using electronic databases inclu...AIM: To evaluate the efficacy and safety of botulinum toxin type A(BTX-A) in the management of patients with anismus. METHODS: An organized search of published literature was conducted using electronic databases including: Pub Med/MEDLINE, and Cochrane Central Register of Control ed Trials, also an internet-based search using "Google Scholar" service was conducted. Both comparative and observational studies were included. We excluded irrelevant articles, editorials, case reports, reviews, and meta-analyses. The studies that followed the patients less than 6 mo were excluded. Variables collected were demographic data of the patients, technique of BTX-A injection and number of sessions, short-term and longterm clinical improvement, post-injection changes in electromyography(EMG), defecography, manometry, and balloon expulsion test, and complications recorded after BTX-A injection.RESULTS: Seven studies comprising 189 patients were included in the review. The median age of the patients was 41.2 years and female-to-male ratio was 1.3:1. The median dose of BTX-A injected per procedure was 100 IU(range, 20-100 IU). Lateral injection was done in five trails and combined lateral and posterior injections in two trials. Three studies used endorectal ultrasonographyguided technique, one study used EMG-guided technique,whereas the remaining three studies used manual palpation with the index finger. The median percentage of patients who reported initial improvement of symptoms was 77.4%(range 37.5%-86.7%), this percentage declined to a median of 46%(range 25%-100%) at 4 mo after injection of BTX-A. Rates of improvement evaluated by balloon expulsion test, EMG, and defecography ranged between(37.5%-80%),(54%-86.7%), and(25%-86.6%), respectively. Fourteen(7.4%) patients developed complications after injection of BTX-A. Complication rates across the studies ranged from 0% to 22.6%. CONCLUSION: Initial satisfactory improvement of symptoms after BTX-A injection remarkably deteriorated after 3 mo of the procedure. However, repeated injection may provide better sustained results with no additional morbidities. Further analysis of more patients is necessary to conclude the safety of BTX-A for the treatment of anismus.展开更多
Obstructed defecation syndrome(ODS)is a complex defecatory disorder asso-ciated with pelvic floor dysfunction.It affects approximately 50%of women over the age of 50 and significantly impacts their quality of life.The...Obstructed defecation syndrome(ODS)is a complex defecatory disorder asso-ciated with pelvic floor dysfunction.It affects approximately 50%of women over the age of 50 and significantly impacts their quality of life.The causes of ODS include structural abnormalities such as rectocele,enterocele,intussusception,and pelvic floor descent,as well as functional disorders like anismus.Accurate diagnosis is crucial for effective management due to the high risk of treatment failure associated with inaccurate findings.Various imaging modalities are used to assess pelvic floor disorders,including fluoroscopic defecography(FD),mag-netic resonance defecography(MRD),pelvic floor ultrasound(PFUS),and echode-fecography(EDF).FD is the most commonly performed test worldwide,offering high accuracy in diagnosing pelvic floor disorders.It provides dynamic visual-ization of defecation mechanics but involves radiation exposure.MRD offers ex-cellent soft tissue detail and multiplanar imaging without radiation,making it particularly useful for multicompartment disorders;however,it is associated with high procedural costs and limited availability.Both PFUS and EDF are minimally invasive and avoid radiation exposure.PFUS shows promise as a valuable screening tool that could help minimize the need for advanced imaging if findings are normal.EDF is also promising but requires specialized training and remains less widely available.This review evaluates the accuracy,advantages,and limitations of various diagnostic modalities for pelvic floor disorders,aiming to guide optimal clinical decision-making.展开更多
基金Supported by Foundation of Science and Technology Plan Projects of Shenyang,No.P112238
文摘AIM: To evaluate the efficacy of botulinum toxin type A injection to the puborectalis and external sphincter muscle in the treatment of patients with anismus unresponsive to simple biofeedback training.
文摘AIM: To evaluate the efficacy and safety of botulinum toxin type A(BTX-A) in the management of patients with anismus. METHODS: An organized search of published literature was conducted using electronic databases including: Pub Med/MEDLINE, and Cochrane Central Register of Control ed Trials, also an internet-based search using "Google Scholar" service was conducted. Both comparative and observational studies were included. We excluded irrelevant articles, editorials, case reports, reviews, and meta-analyses. The studies that followed the patients less than 6 mo were excluded. Variables collected were demographic data of the patients, technique of BTX-A injection and number of sessions, short-term and longterm clinical improvement, post-injection changes in electromyography(EMG), defecography, manometry, and balloon expulsion test, and complications recorded after BTX-A injection.RESULTS: Seven studies comprising 189 patients were included in the review. The median age of the patients was 41.2 years and female-to-male ratio was 1.3:1. The median dose of BTX-A injected per procedure was 100 IU(range, 20-100 IU). Lateral injection was done in five trails and combined lateral and posterior injections in two trials. Three studies used endorectal ultrasonographyguided technique, one study used EMG-guided technique,whereas the remaining three studies used manual palpation with the index finger. The median percentage of patients who reported initial improvement of symptoms was 77.4%(range 37.5%-86.7%), this percentage declined to a median of 46%(range 25%-100%) at 4 mo after injection of BTX-A. Rates of improvement evaluated by balloon expulsion test, EMG, and defecography ranged between(37.5%-80%),(54%-86.7%), and(25%-86.6%), respectively. Fourteen(7.4%) patients developed complications after injection of BTX-A. Complication rates across the studies ranged from 0% to 22.6%. CONCLUSION: Initial satisfactory improvement of symptoms after BTX-A injection remarkably deteriorated after 3 mo of the procedure. However, repeated injection may provide better sustained results with no additional morbidities. Further analysis of more patients is necessary to conclude the safety of BTX-A for the treatment of anismus.
文摘Obstructed defecation syndrome(ODS)is a complex defecatory disorder asso-ciated with pelvic floor dysfunction.It affects approximately 50%of women over the age of 50 and significantly impacts their quality of life.The causes of ODS include structural abnormalities such as rectocele,enterocele,intussusception,and pelvic floor descent,as well as functional disorders like anismus.Accurate diagnosis is crucial for effective management due to the high risk of treatment failure associated with inaccurate findings.Various imaging modalities are used to assess pelvic floor disorders,including fluoroscopic defecography(FD),mag-netic resonance defecography(MRD),pelvic floor ultrasound(PFUS),and echode-fecography(EDF).FD is the most commonly performed test worldwide,offering high accuracy in diagnosing pelvic floor disorders.It provides dynamic visual-ization of defecation mechanics but involves radiation exposure.MRD offers ex-cellent soft tissue detail and multiplanar imaging without radiation,making it particularly useful for multicompartment disorders;however,it is associated with high procedural costs and limited availability.Both PFUS and EDF are minimally invasive and avoid radiation exposure.PFUS shows promise as a valuable screening tool that could help minimize the need for advanced imaging if findings are normal.EDF is also promising but requires specialized training and remains less widely available.This review evaluates the accuracy,advantages,and limitations of various diagnostic modalities for pelvic floor disorders,aiming to guide optimal clinical decision-making.
