Fecal incontinence is a common condition that can significantly impact patients’quality of life.Obstetric anal sphincter injury and anorectal surgeries are common etiologies.Endoanal ultrasound and anorectal manometr...Fecal incontinence is a common condition that can significantly impact patients’quality of life.Obstetric anal sphincter injury and anorectal surgeries are common etiologies.Endoanal ultrasound and anorectal manometry are important diagnostic tools for evaluating patients.There are various treatment options,including diet,lifestyle modifications,drugs,biofeedback therapy,tibial and sacral nerve neuromodulation therapy,and surgery.In this editorial,we will discuss current controversies and novel approaches to fecal incontinence.Screening for asymptomatic anal sphincter defects after obstetric anal sphincter injury and in patients with inflammatory bowel disease is not generally recommended,but may be helpful in selected patients.The Garg incontinence score is a new score that includes the assessment of solid,liquid,flatus,mucous,stress and urge fecal incontinence.Novel tests such as translumbosacral anorectal magnetic stimulation and novel therapies such as translumbosacral neuromodulation therapy are promising diagnostic and treatment options,for both fecal incontinence and neuropathy.Home biofeedback therapy can overcome some limitations of the office-based therapy.Skeletal muscle-derived cell implantation of the external anal sphincter has been further studied as a possible treatment option.Sacral neuromodulation may be useful in scleroderma,congenital fecal incontinence and inflammatory bowel disease but merits further study.展开更多
Fecal incontinence(FI),which can arise from various pathogenic mechanisms,has attracted considerable attention worldwide.Despite its importance,the reproduction of the defecatory system to study the mechanisms of FI r...Fecal incontinence(FI),which can arise from various pathogenic mechanisms,has attracted considerable attention worldwide.Despite its importance,the reproduction of the defecatory system to study the mechanisms of FI remains limited,largely because of social stigma and being considered inappropriate.Inspired by the rectum’s functionalities,we developed a soft robotic system that includes a power supply,pressure sensors,data acquisition systems,a flushing mechanism,stages,and a rectal module.Specifically,the innovative soft rectal module includes actuators inspired by sphincter muscles,both soft and rigid covers,and a soft rectum mold.The rectal mold,which was fabricated from materials that mimic human rectal tissue,was produced using a mold replication fabrication method.Both the soft and rigid components of the mold were created using three-dimensional(3D)printing technology.In addition,the sphincter muscle-inspired actuators featured double-layer pouch structures that were modeled and optimized based on multilayer perceptron methods to obtain a high contraction ratio(100%),generate high pressure(9.8 kPa),and have a short recovery time(3 s).Upon assembly,this defecation robot could smoothly expel liquid feces,perform controlled solid fecal cutting,and defecate extremely solid long feces,thus closely replicating the functions of the human rectum and anal canal.This defecation robot has the potential to facilitate human understanding of the complex defecation system and contribute to the development of improved quality-of-life devices related to defecation.展开更多
Fecal incontinence,a debilitating condition that significantly impairs quality of life,affects 2%-21%of adults worldwide.For patients whose structural defects are unresponsive to conservative therapies,sphincter recon...Fecal incontinence,a debilitating condition that significantly impairs quality of life,affects 2%-21%of adults worldwide.For patients whose structural defects are unresponsive to conservative therapies,sphincter reconstruction remains the primary treatment approach.Although traditional surgical techniques effectively restore anatomy in the short term,their long-term efficacy is constrained by progressive muscle atrophy and fibrotic scarring.In complex cases,alternative interventions,including dynamic gracilis or gluteus maximus transposition and artificial sphincter implantation,offer therapeutic options yet are associated with increased surgical risks and high complication rates.Emerging therapies such as regenerative medicine and neuromodulatory approaches have potential,although further rigorous clinical validation is needed to establish standardized protocols.Optimizing fecal incontinence management necessitates precise patient stratification,multidisciplinary collaboration,and the development of individualized treatment algorithms.Advancements in this field depend on large-scale clinical trials and comprehensive long-term outcome assessments to improve therapeutic efficacy and patient-centered care.展开更多
Objective:To analyze the preventive and management effects of the 4R crisis management theory on incontinence-associated dermatitis(IAD)in ICU patients with fecal incontinence.Methods:A hundred patients with fecal inc...Objective:To analyze the preventive and management effects of the 4R crisis management theory on incontinence-associated dermatitis(IAD)in ICU patients with fecal incontinence.Methods:A hundred patients with fecal incontinence who were admitted to the ICU for treatment between January 2024 and December 2024 were selected and randomly divided into two groups using a random number table.The observation group received 4R crisis management theory,while the control group received routine management.The IAD risk score,incidence of IAD,severity of IAD,and formation and healing time of IAD were compared between the two groups.Results:After management,the IAD risk score of the observation group was lower than that of the control group(P<0.05).The incidence of IAD in the observation group was lower than that in the control group,the proportion of mild IAD was higher than that in the control group,the formation time of IAD was later than that in the control group,and the healing time was shorter than that in the control group(P<0.05).Conclusion:Adopting the 4R crisis management theory for ICU patients with fecal incontinence can reduce the risk of IAD occurrence,effectively prevent IAD,reduce its severity,delay its formation time,and promote good healing.展开更多
Fecal incontinence is not a diagnosis but a frequent and debilitating common final pathway symptom resulting from numerous different causes. Incontinence not only impacts the patient’s self-esteem and qual...Fecal incontinence is not a diagnosis but a frequent and debilitating common final pathway symptom resulting from numerous different causes. Incontinence not only impacts the patient’s self-esteem and quality of life but may result in significant secondary morbidity, disability, and cost. Treatment is difficult without any panacea and an individualized approach should be chosen that frequently combines different modalities. Several new technologies have been developed and their specific roles will have to be defined. The scope of this review is outline the evaluation and treatment of patients with fecal incontinence.展开更多
AIM:To explore the impact of fecal incontinence (FI) on quality of life (QOL) of patients attending urogynecology and colorectal clinics (CCs).METHODS:Cross-sectional study of 154 patients (27 male) with FI,who attend...AIM:To explore the impact of fecal incontinence (FI) on quality of life (QOL) of patients attending urogynecology and colorectal clinics (CCs).METHODS:Cross-sectional study of 154 patients (27 male) with FI,who attended the clinics at a regional hospital in North Queensland,Australia in 2003 and 2004,and completed the Fecal Incontinence Quality of Life Scale (FIQL:1=very affected;4=not affected).RESULTS:More than 22% of patients had their QOL affected severely by FI.Patients reported that they had not previously been asked about FI by a medical practitioner nor did they voluntarily disclose its presence.The median FIQL scores for all participants were:lifestyle=3.24;coping=2.23;depression=2.42;and embarrassment=2.33.Increasing frequency of soiling had a negative effect on all four FIQL scales (P < 0.001) as did the quantity of soiling (P < 0.01).Female CC patients had poorer FIQL scores than urogynecology clinic patients for lifestyle (P=0.015),coping (P=0.004) and embarrassment (P=0.009),but not depression (P=0.062),despite having experienced FI for a shorter period.CONCLUSION:Failure to seek treatment for FI degrades the quality of patients' lives over time.FI assessment tools should incorporate the quantity of fecal loss.展开更多
Obstructed defecation （OD） and fecal incontinence （FI） are challenging clinical problems, which are commonly encountered in the practice of colorectal surgeons and gastroenterologists. These disorders sodally and ...Obstructed defecation （OD） and fecal incontinence （FI） are challenging clinical problems, which are commonly encountered in the practice of colorectal surgeons and gastroenterologists. These disorders sodally and psychologically distress patients and greatly impair their quality of life. The underlying anatomical and pathophysiological changes are complex, often incompletely understood and cannot always be determined. As a consequence, many medical, surgical, and behavioral approaches have been described, with no panacea. Over the past decade, advances in an understanding of these disorders together with rational and similar methods of evaluation in anorectal physiology laboratories （ARP）, radiology studies, and new surgical techniques have led to promising results. In this brief review, we discuss treatment strategies and recent updates on clinical and therapeutic aspects of obstructed defecation and fecal incontinence.展开更多
AIM： To evaluate the feasibility, clinical effect and predicting factors for favorable outcome of treatment with anal plugs in fecal incontinence and retrograde colonic irrigation （RCI） in patients with fecal incon...AIM： To evaluate the feasibility, clinical effect and predicting factors for favorable outcome of treatment with anal plugs in fecal incontinence and retrograde colonic irrigation （RCI） in patients with fecal incontinence or constipation.METHODS： Patients who received treatment with an anal plug or RCI between 1980 and 2005 were investigated with a questionnaire.RESULTS： Of the 201 patients （93 adults, 108 children）, 101 （50%） responded. Adults： anal plugs （8）, five stopped immediately, one stopped after 20 mo and two used it for 12-15 too. RCl （40, 28 fecal incontinence, 12 constipation）, 63% are still using it （mean 8.5 years）, 88% was satisfied. Younger adults （〈 40 years） were more satisfied with RCI （94 % vs 65%, P = 0.05）. Children： anal plugs （7）, 5 used it on demand for an average of 2.5 years with satisfactory results, one stopped immediately and one after 5 years. RCI （26 fecal incontinence, 22 constipation）, 90% are still using it （mean time 6.8 years） and felt satisfied. Children tend to be more satisfied （P = 0.001）. Besides age, no predictive factors for success were found. There was no difference in the outcome between patients with fecal incontinence or constipation.CONCLUSION： RCI is more often applied than anal plugs and is helpful in patients with fecal incontinence or constipation, especially for younger patients. Anal plugs can be used incidentally for fecal incontinence, especially in children.展开更多
Rectal prolapse associated with traumatic fecal incontinence is a rare clinical combination. This study was designed to assess Delorme＇s operation with sphincteroplasty as a surgical management of this combination in...Rectal prolapse associated with traumatic fecal incontinence is a rare clinical combination. This study was designed to assess Delorme＇s operation with sphincteroplasty as a surgical management of this combination in terms of recurrence and improvement of fecal incontinence. In this prospective study, we enrolled patients suffering from short, full-thickness rectal prolapse associated with traumatic fecal incontinence who had been admitted to Alexandria Main University Hospital during the period of May 2010-January 2013. Preoperative data including cause of trauma, duration of symptoms, results of anal manometry, and degree of fecal incontinence using Wexner score were collected from all patients. Delorme＇s procedure with overlap sphincteroplasty was done in all patients. Recurrence of prolapse and improvement of fecal incontinence were assessed after 1, 3, 6 and 12 months. The study included 13 patients aged （32±8.7） years, 9 females and 4 males. Cause of sphincteric injury included previous anal surgery in 7 patients and normal labor in 6 patients. Duration between sphinctefic injury and operation was （8.08±2.47） months. Preoperative Wexner＇s mean score was 16.07±3.4. Early postoperative complications included superficial wound infection （69.2%）, minor wound dehiscence （61.5%）, and postoperative bleeding （7.6%）. Recurrence was detected in 1 patient at 6 month follow-up. Wexner＇s score showed significant improvement for all patients after 6 months （4.00±2.04）. In conclusion, combination of Delorme＇s procedure and sphincteroplasty for treatment of patients with short complete rectal prolapse associated with traumatic fecal incontinence is a safe, effective surgical management with satisfactory results regarding anatomical and functional outcomes.展开更多
Fecal incontinence is a disabling disease, often observed in young subjects, that may have devastating psycho-social consequences. In the last years, numerous evidences have been reported on the efficacy of bio-feedba...Fecal incontinence is a disabling disease, often observed in young subjects, that may have devastating psycho-social consequences. In the last years, numerous evidences have been reported on the efficacy of bio-feedback techniques for the treatment of this disorder. Overall, the literature data claim a success rate in more than 70% of cases in the short term. However, recent controlled trials have not confirmed this optimistic view, thus emphasizing the role of standard care. Nonetheless, many authors believe that this should be the first therapeutic approach for fecal incontinence due to the efficacy, lack of side-effects,and scarce invasiveness. Well-designed randomized,controlled trial are eagerly awaited to solve this therapeutic dilemma.展开更多
The role of sphincteroplasty in the treatment of patients with fecal incontinence due to anal sphincter defects has been questioned because the success rate declines in the long-term.A new emerging treatment for fecal...The role of sphincteroplasty in the treatment of patients with fecal incontinence due to anal sphincter defects has been questioned because the success rate declines in the long-term.A new emerging treatment for fecal incontinence,sacral nerve stimulation,has been shown to be effective in these patients.However,the success rate of sphincteroplasty may depend of several patient-related and surgical-related factors and the outcome from sphincteroplasty has been evaluated differently(with qualitative data) from that after sacral nerve stimulation(quantitative data using scoring systems and quality of life).Furthermore,the data available so far on the longterm success rate after sacral nerve modulation do not differ substantially from those after sphincteroplasty.The actual data do not support the replacement of sphincteroplasty with sacral nerve stimulation in patients with fecal incontinence secondary to sphincter defects.展开更多
AIM:To determine the causes and characteristics of fecal incontinence in men and to compare these features with those presented by a group of women with the same problem.METHODS:We analyzed the medical history,clinica...AIM:To determine the causes and characteristics of fecal incontinence in men and to compare these features with those presented by a group of women with the same problem.METHODS:We analyzed the medical history,clinical and manometric data from 119 men with fecal incontinence studied in our unit and compared these data with those obtained from 645 women studied for the same problem.Response to treatment was evaluated after 6 mo of follow-up.RESULTS:Fifteen percent of patients studied in our unit for fecal incontinence were male.Men took longer than women before asking for medical help.Anorectal surgery was the most common risk factor for men related to fecal incontinence.Chronic diarrhea was present in more than 40%of patients in both groups.Decreased resting and external anal sphincter pressures were more frequent in women.No significant differences existed between the sexes regarding rectal sensitivity and recto-anal inhibitory reflex.In 17.8%of men,all presenting soiling,manometric findings did not justify fecal incontinence.Response to treatment was good in both groups,as 80.4%of patients improved and fecal incontinence disappeared in 13.2%of them.CONCLUSION:In our series,it was common that men waited longer in seeking medical help for fecal incontinence.Ano-rectal surgery was the major cause of this problem.Chronic diarrhea was a predisposing factor in both sexes.Manometric differences between groups were limited to an increased frequency of hypotony of the external anal sphincter in women.Fecal incontinence was controllable in most patients.展开更多
Fecal incontinence has a profound impact in a patient's life, impairing quality of life and carrying a substantial economic burden due to health costs. It is an underdiagnosed condition because many affected patie...Fecal incontinence has a profound impact in a patient's life, impairing quality of life and carrying a substantial economic burden due to health costs. It is an underdiagnosed condition because many affected patients are reluctant to report it and also clinicians are usually not alert to it. Patient evaluation with a detailed clinical history and examination is very important to indicate the type of injury that is present. Endoanal ultrasonography is currently the gold standard for sphincter evaluation in fecal incontinence and is a simple, well-tolerated and non-expensive technique. Most studies revealed 100%sensitivity in identifying sphincter defect. It is better than endoanal magnetic resonance imaging for internal anal sphincter defects, equivalent for the diagnosis of external anal sphincter defects, but with a lower capacity for assessment of atrophy of this sphincter.The most common cause of fecal incontinence is anal sphincter injury related to obstetric trauma. Only a small percentage of women are diagnosed with sphincter tears immediately after vaginal delivery, but endoanal ultrasonography shows that one third of these women have occult sphincter defects. Furthermore, in patients submitted to primary repair of these tears, ultrasound revealed a high frequency of persistent sphincter defects after surgery. Three-dimensional endoanal ultrasonography is currently largely used and accepted for sphincter evaluation in fecal incontinence, improving diagnostic accuracy and our knowledge of physiologic and pathological sphincters alterations. Conversely,there is currently no evidence to support the use of elastography in fecal incontinence evaluation.展开更多
BACKGROUND Fecal incontinence(FI)is an involuntary passage of fecal matter which can have a significant impact on a patient’s quality of life.Many modalities of treatment exist for FI.Sacral nerve stimulation is a we...BACKGROUND Fecal incontinence(FI)is an involuntary passage of fecal matter which can have a significant impact on a patient’s quality of life.Many modalities of treatment exist for FI.Sacral nerve stimulation is a well-established treatment for FI.Given the increased need of magnetic resonance imaging(MRI)for diagnostics,the In-terStim which was previously used in sacral nerve stimulation was limited by MRI incompatibility.Medtronic MRI-compatible InterStim was approved by the United States Food and Drug Administration in August 2020 and has been widely used.AIM To evaluate the efficacy,outcomes and complications of the MRI-compatible InterStim.METHODS Data of patients who underwent MRI-compatible Medtronic InterStim placement at UPMC Williamsport,University of Minnesota,Advocate Lutheran General Hospital,and University of Wisconsin-Madison was pooled and analyzed.Patient demographics,clinical features,surgical techniques,complications,and outcomes were analyzed.Strengthening the Reporting of Observational studies in Epidemiology(STROBE)cross-sectional reporting guidelines were used.RESULTS Seventy-three patients had the InterStim implanted.The mean age was 63.29±12.2 years.Fifty-seven(78.1%)patients were females and forty-two(57.5%)patients had diabetes.In addition to incontinence,overlapping symptoms included diarrhea(23.3%),fecal urgency(58.9%),and urinary incontinence(28.8%).Fifteen(20.5%)patients underwent Peripheral Nerve Evaluation before proceeding to definite implant placement.Thirty-two(43.8%)patients underwent rechargeable InterStim placement.Three(4.1%)patients needed removal of the implant.Migration of the external lead connection was observed in 7(9.6%)patients after the stage I procedure.The explanation for one patient was due to infection.Seven(9.6%)patients had other complications like nerve pain,hematoma,infection,lead fracture,and bleeding.The mean follow-up was 6.62±3.5 mo.Sixty-eight(93.2%)patients reported significant improvement of symptoms on follow-up evaluation.CONCLUSION This study shows promising results with significant symptom improvement,good efficacy and good patient outcomes with low complication rates while using MRI compatible InterStim for FI.Further long-term follow-up and future studies with a larger patient population is recommended.展开更多
The main aim of this opinion review is to comment on the recent article published by Garg et al in the World Journal of Gastroenterology 2023;29:4593–4603.The authors in the published article developed a new scoring ...The main aim of this opinion review is to comment on the recent article published by Garg et al in the World Journal of Gastroenterology 2023;29:4593–4603.The authors in the published article developed a new scoring system,Garg incon-tinence scores(GIS),for fecal incontinence(FI).FI is a chronic debilitating disease that has a severe negative impact on the quality of life of the patients.Rome IV criteria define FI as multiple episodes of solid or liquid stool passed into the clothes at least twice a month.The associated social stigmatization often leads to significant under-reporting of the condition,which further impairs management.An important point is that the complexity and vagueness of the disease make it difficult for the patients to properly define and report the magnitude of the problem to their physicians.Due to this,the management becomes even more difficult.This issue is resolved up to a considerable extent by a scoring ques-tionnaire.There were several scoring systems in use for the last three decades.The prominent of them were the Cleveland Clinic scoring system or the Wexner scoring system,St.Marks Hospital or Vaizey’s scores,and the FI severity index.However,there were several shortcomings in these scoring systems.In the opinion review,we tried to analyze the strength of GIS and compare it to the existing scoring systems.The main pitfalls in the existing scoring systems were that most of them gave equal weightage to different types of FI(solid,liquid,flatus,etc.),were not comprehensive,and took only the surgeon’s perception of FI into view.In GIS,almost all shortcomings of previous scoring systems had been addressed:different weights were assigned to different types of FI by a robust statistical methodology;the scoring system was made comprehensive by including all types of FI that were previously omitted(urge,stress and mucus FI)and gave priority to patients’rather than the physicians’perceptions while developing the scoring system.Due to this,GIS indeed looked like a paradigm shift in the evaluation of FI.However,it is too early to conclude this,as GIS needs to be validated for accuracy and simplicity in future studies.展开更多
AIMTo assess the development and implementation of the Integrated Rapid Assessment and Treatment(IRAT)pathway for the management of patients with fecal incontinence and measure its impact on patients’care.METHODSPati...AIMTo assess the development and implementation of the Integrated Rapid Assessment and Treatment(IRAT)pathway for the management of patients with fecal incontinence and measure its impact on patients’care.METHODSPatients referred to the colorectal unit in our hospital for the management of faecal incontinence were randomised to either the Standard Care pathway or the newly developed IRAT pathway in this feasibility study.The IRAT pathway is designed to provide a seamless multidisciplinary care to patients with faecal incontinence in a timely fashion.On the other hand,patients in the Standard Pathway were managed in the general colorectal clinic.Percentage improvements in St.Marks Incontinence Score,Cleveland Clinic Incontinence Score and Rockwood Faecal Incontinence Quality of Life Scale after completion of treatment in both groups were the primary outcome measures.Secondary endpoints were the time required to complete the management and patients’satisfaction score.χ<sup>2</sup>,Mann-Whitney-U and Kendall tau-c correlation coefficient tests were used for comparison of outcomes of the two study groups.A P value of 0.05 or less was considered significant.RESULTSThirty-nine patients,34 females,consented to participate.Thirty-one(79.5%)patients completed the final assessment and were included in the outcome analysis.There was no significant difference in the quality of life scales and incontinence scores.Patients in the IRAT pathway were more satisfied with the time required to complete management(P=0.033)and had stronger agreement that all aspects of their problem were covered(P=0.006).CONCLUSIONDespite of the lack of significant difference in outcome measures,the new pathway has positively influenced patient’s mindset,which was reflected in a higher satisfaction score.展开更多
AIM:To compare defecographic abnormalities in symptomatic men and women and to analyze differences between men and age-and symptom-matched women.METHODS:Sixty-six men(mean age:55.4 years,range:20-81 years) who complai...AIM:To compare defecographic abnormalities in symptomatic men and women and to analyze differences between men and age-and symptom-matched women.METHODS:Sixty-six men(mean age:55.4 years,range:20-81 years) who complained of constipation and/or fecal incontinence and/or pelvic pain underwent defecography after intake of a barium meal.Radiographs were analyzed for the diagnosis of rectocele,enterocele,intussusception and perineal descent.They were compared with age-and symptom-matched women(n = 198) who underwent defecography during the same period.RESULTS:Normal defecography was observed in 22.7% of men vs 5.5% of women(P < 0.001).Defecography in men compared with women showed 4.5%vs 44.4%(P < 0.001) rectocele,and 10.6% vs 29.8%(P < 0.001) enterocele,respectively.No difference was observed for the diagnosis of intussusception(57.6% vs 44.9%).Perineal descent at rest was more frequent in women(P < 0.005).CONCLUSION:For the same complaint,diagnosis of defecographic abnormalities was different in men than in women:rectocele,enterocele and perineal descent at rest were observed less frequently in men than in women.展开更多
Rectal prolapse is a circumferential,full-thickness protrusion of the rectum through the anus.It is a rare condition,and only affects 0.5%of the general population.Multiple treatment modalities have been described,whi...Rectal prolapse is a circumferential,full-thickness protrusion of the rectum through the anus.It is a rare condition,and only affects 0.5%of the general population.Multiple treatment modalities have been described,which have changed significantly over time.Particularly in the last decade,laparoscopic and robotic surgical approaches with different mobilization techniques,combined with medical therapies,have been widely implemented.Because patients have presented with a wide range of complaints(ranging from abdominal discomfort to incomplete bowel evacuation,mucus discharge,constipation,diarrhea,and fecal incontinence),understanding the extent of complaints and ruling out differential diagnoses are essential for choosing a tailored surgical procedure.It is crucial to assess these additional symptoms and their severities using preoperative scoring systems.Additionally,radiological and physiological evaluations may explain some vague symptoms and reveal concomitant pelvic disorders.However,there is no consensus on or standardization of the optimal extent of dissection,type of procedure,and materials used for rectal fixation;this makes providing maximum benefits to patients with minimal complications difficult.Even recent publications and systematic reviews have not recommended the most appropriate treatment options.This review explains the appropriate diagnostic tools for different conditions and summarizes the current treatment approaches based on existing literature and expert opinions.展开更多
AIM To investigate compliance with transanal irrigation(TAI) one year after a training session and to identify predictive factors for compliance.METHODS The compliance of one hundred eight patients [87 women and 21 me...AIM To investigate compliance with transanal irrigation(TAI) one year after a training session and to identify predictive factors for compliance.METHODS The compliance of one hundred eight patients [87 women and 21 men; median age 55 years(range 18-83)] suffering from constipation or fecal incontinence(FI) was retrospectively assessed. The patients were trained in TAI over a four-year period at a single institution. They were classified as adopters if they continued using TAI for at least one year after beginning the treatment or as non-adopters if they stopped. Predictive factors of compliance with TAI were based on pretreatment assessments and trainingprogress. The outcomes of the entire cohort of patients who had been recruited for the TAI treatment were expressed in terms of intention-to-treat.RESULTS Forty-six of the 108(43%) trained patients continued to use TAI one year after their training session. The patients with FI had the best results, with 54.5% remaining compliant with TAI. Only one-third of the patients who complained of slow transit constipation or obstructed defecation syndrome continued TAI. There was an overall discontinuation rate of 57%. The most common reason for discontinuing TAI was the lack of efficacy(41%). However, 36% of the patients who discontinued TAI gave reasons independent of the efficacy of the treatment such as technical problems(catheter expulsion, rectal balloon bursting, instilled water leakage or retention, pain during irrigation, anal bleeding, anal fissure) while 23% said that there were too many constraints. Of the patients who reported discontinuing TAI, the only predictive factor was the progress of the training(OR = 4.9, 1.3-18.9, P = 0.02).CONCLUSION The progress of the training session was the only factor that predicted patient compliance with TAI.展开更多
AIM To establish a rat model of anal sphincter injury and test different systems to provide stem cells to injured area.METHODS Adipose-derived stem cells(ASCs)were isolated from BDIX rats and were transfected with gre...AIM To establish a rat model of anal sphincter injury and test different systems to provide stem cells to injured area.METHODS Adipose-derived stem cells(ASCs)were isolated from BDIX rats and were transfected with green fluorescent protein(GFP)for cell tracking.Biosutures(sutures covered with ASCs)were prepared with 1.5×10~6 GFPASCs,and solutions of 10~6 GFP-ASCs in normal saline were prepared for injection.Anorectal normal anatomy was studied on Wistar and BDIX female rats.Then,we designed an anal sphincter injury model consisting of a 1-cm extra-mucosal miotomy beginning at the anal verge in the anterior middle line.The sphincter lesion was confirmed with conventional histology(hematoxylin and eosin)and immunofluorescence with 4',6-diamidino-2-phenylindole(commonly known as DAPI),GFP andα-actin.Functional effect was assessed with basal anal manometry,prior to and after injury.After sphincter damage,36 BDIX rats were randomized to three groups for:(1)Cell injection without repair;(2)biosuture repair;and(3)conventional suture repair and cell injection.Functional and safety studies were conducted on all the animals.Rats were sacrificed after 1,4 or 7 d.Then,histological and immunofluorescence studies were performed on the surgical area.RESULTS With the described protocol,biosutures had been covered with at least 820000-860000 ASCs,with 100%viability.Our studies demonstrated that some ASCs remained adhered after suture passage through the muscle.Morphological assessment showed that the rat anal anatomy is comparable with human anatomy;two sphincters are present,but the external sphincter is poorly developed.Anal sphincter pressure data showed spontaneous,consistent,rhythmic anal contractions,taking the form of"plateaus"with multiple twitches(peaks)in each pressure wave.These basal contractions were very heterogeneous;their frequency was 0.91-4.17 per min(mean 1.6980,SD 0.57698),their mean duration was 26.67 s and mean number of peaks was 12.53.Our morphological assessment revealed that with the aforementioned surgical procedure,both sphincters were completely sectioned.In manometry,the described activity disappeared and was replaced by a gentle oscillation of basal line,without a recognizable pattern.Surprisingly,these findings appeared irrespective of injury repair or not.ASCs survived in this potentially septic area for 7 d,at least.We were able to identify them in 84%of animals,mainly in the muscular section area or in the tissue between the muscular endings.ASCs formed a kind of"conglomerate"in rats treated with injections,while in the biosuture group,they wrapped the suture.ASCs were also able to migrate to the damaged zone.No relevant adverse events or mortality could be related to the stem cells in our study.We also did not find unexpected tissue growths.CONCLUSION The proposed procedure produces a consistent sphincter lesion.Biosutures and injections are suitable for cell delivery.ASCs survive and are completely safe in this clinical setting.展开更多
文摘Fecal incontinence is a common condition that can significantly impact patients’quality of life.Obstetric anal sphincter injury and anorectal surgeries are common etiologies.Endoanal ultrasound and anorectal manometry are important diagnostic tools for evaluating patients.There are various treatment options,including diet,lifestyle modifications,drugs,biofeedback therapy,tibial and sacral nerve neuromodulation therapy,and surgery.In this editorial,we will discuss current controversies and novel approaches to fecal incontinence.Screening for asymptomatic anal sphincter defects after obstetric anal sphincter injury and in patients with inflammatory bowel disease is not generally recommended,but may be helpful in selected patients.The Garg incontinence score is a new score that includes the assessment of solid,liquid,flatus,mucous,stress and urge fecal incontinence.Novel tests such as translumbosacral anorectal magnetic stimulation and novel therapies such as translumbosacral neuromodulation therapy are promising diagnostic and treatment options,for both fecal incontinence and neuropathy.Home biofeedback therapy can overcome some limitations of the office-based therapy.Skeletal muscle-derived cell implantation of the external anal sphincter has been further studied as a possible treatment option.Sacral neuromodulation may be useful in scleroderma,congenital fecal incontinence and inflammatory bowel disease but merits further study.
基金supported by Grant-in-Aid for Scientific Research on Innovative Areas from the Japan Society for the Promotion of Science(Nos.18H05473 and 23K13290).
文摘Fecal incontinence(FI),which can arise from various pathogenic mechanisms,has attracted considerable attention worldwide.Despite its importance,the reproduction of the defecatory system to study the mechanisms of FI remains limited,largely because of social stigma and being considered inappropriate.Inspired by the rectum’s functionalities,we developed a soft robotic system that includes a power supply,pressure sensors,data acquisition systems,a flushing mechanism,stages,and a rectal module.Specifically,the innovative soft rectal module includes actuators inspired by sphincter muscles,both soft and rigid covers,and a soft rectum mold.The rectal mold,which was fabricated from materials that mimic human rectal tissue,was produced using a mold replication fabrication method.Both the soft and rigid components of the mold were created using three-dimensional(3D)printing technology.In addition,the sphincter muscle-inspired actuators featured double-layer pouch structures that were modeled and optimized based on multilayer perceptron methods to obtain a high contraction ratio(100%),generate high pressure(9.8 kPa),and have a short recovery time(3 s).Upon assembly,this defecation robot could smoothly expel liquid feces,perform controlled solid fecal cutting,and defecate extremely solid long feces,thus closely replicating the functions of the human rectum and anal canal.This defecation robot has the potential to facilitate human understanding of the complex defecation system and contribute to the development of improved quality-of-life devices related to defecation.
基金Supported by Science and Technology Projects in Guangzhou,No.SL2022A03J00756.
文摘Fecal incontinence,a debilitating condition that significantly impairs quality of life,affects 2%-21%of adults worldwide.For patients whose structural defects are unresponsive to conservative therapies,sphincter reconstruction remains the primary treatment approach.Although traditional surgical techniques effectively restore anatomy in the short term,their long-term efficacy is constrained by progressive muscle atrophy and fibrotic scarring.In complex cases,alternative interventions,including dynamic gracilis or gluteus maximus transposition and artificial sphincter implantation,offer therapeutic options yet are associated with increased surgical risks and high complication rates.Emerging therapies such as regenerative medicine and neuromodulatory approaches have potential,although further rigorous clinical validation is needed to establish standardized protocols.Optimizing fecal incontinence management necessitates precise patient stratification,multidisciplinary collaboration,and the development of individualized treatment algorithms.Advancements in this field depend on large-scale clinical trials and comprehensive long-term outcome assessments to improve therapeutic efficacy and patient-centered care.
基金Exploration of the Preventive Effect of Skin Management Program Based on 4R Crisis Management Theory on Incontinence-Associated Dermatitis in ICU Patients with Fecal Incontinence(Project No.:YK202335)。
文摘Objective:To analyze the preventive and management effects of the 4R crisis management theory on incontinence-associated dermatitis(IAD)in ICU patients with fecal incontinence.Methods:A hundred patients with fecal incontinence who were admitted to the ICU for treatment between January 2024 and December 2024 were selected and randomly divided into two groups using a random number table.The observation group received 4R crisis management theory,while the control group received routine management.The IAD risk score,incidence of IAD,severity of IAD,and formation and healing time of IAD were compared between the two groups.Results:After management,the IAD risk score of the observation group was lower than that of the control group(P<0.05).The incidence of IAD in the observation group was lower than that in the control group,the proportion of mild IAD was higher than that in the control group,the formation time of IAD was later than that in the control group,and the healing time was shorter than that in the control group(P<0.05).Conclusion:Adopting the 4R crisis management theory for ICU patients with fecal incontinence can reduce the risk of IAD occurrence,effectively prevent IAD,reduce its severity,delay its formation time,and promote good healing.
文摘Fecal incontinence is not a diagnosis but a frequent and debilitating common final pathway symptom resulting from numerous different causes. Incontinence not only impacts the patient’s self-esteem and quality of life but may result in significant secondary morbidity, disability, and cost. Treatment is difficult without any panacea and an individualized approach should be chosen that frequently combines different modalities. Several new technologies have been developed and their specific roles will have to be defined. The scope of this review is outline the evaluation and treatment of patients with fecal incontinence.
基金Supported by A James Cook University Program Grant (2003) and A Cancer Council Queensland scholarship
文摘AIM:To explore the impact of fecal incontinence (FI) on quality of life (QOL) of patients attending urogynecology and colorectal clinics (CCs).METHODS:Cross-sectional study of 154 patients (27 male) with FI,who attended the clinics at a regional hospital in North Queensland,Australia in 2003 and 2004,and completed the Fecal Incontinence Quality of Life Scale (FIQL:1=very affected;4=not affected).RESULTS:More than 22% of patients had their QOL affected severely by FI.Patients reported that they had not previously been asked about FI by a medical practitioner nor did they voluntarily disclose its presence.The median FIQL scores for all participants were:lifestyle=3.24;coping=2.23;depression=2.42;and embarrassment=2.33.Increasing frequency of soiling had a negative effect on all four FIQL scales (P < 0.001) as did the quantity of soiling (P < 0.01).Female CC patients had poorer FIQL scores than urogynecology clinic patients for lifestyle (P=0.015),coping (P=0.004) and embarrassment (P=0.009),but not depression (P=0.062),despite having experienced FI for a shorter period.CONCLUSION:Failure to seek treatment for FI degrades the quality of patients' lives over time.FI assessment tools should incorporate the quantity of fecal loss.
文摘Obstructed defecation （OD） and fecal incontinence （FI） are challenging clinical problems, which are commonly encountered in the practice of colorectal surgeons and gastroenterologists. These disorders sodally and psychologically distress patients and greatly impair their quality of life. The underlying anatomical and pathophysiological changes are complex, often incompletely understood and cannot always be determined. As a consequence, many medical, surgical, and behavioral approaches have been described, with no panacea. Over the past decade, advances in an understanding of these disorders together with rational and similar methods of evaluation in anorectal physiology laboratories （ARP）, radiology studies, and new surgical techniques have led to promising results. In this brief review, we discuss treatment strategies and recent updates on clinical and therapeutic aspects of obstructed defecation and fecal incontinence.
文摘AIM： To evaluate the feasibility, clinical effect and predicting factors for favorable outcome of treatment with anal plugs in fecal incontinence and retrograde colonic irrigation （RCI） in patients with fecal incontinence or constipation.METHODS： Patients who received treatment with an anal plug or RCI between 1980 and 2005 were investigated with a questionnaire.RESULTS： Of the 201 patients （93 adults, 108 children）, 101 （50%） responded. Adults： anal plugs （8）, five stopped immediately, one stopped after 20 mo and two used it for 12-15 too. RCl （40, 28 fecal incontinence, 12 constipation）, 63% are still using it （mean 8.5 years）, 88% was satisfied. Younger adults （〈 40 years） were more satisfied with RCI （94 % vs 65%, P = 0.05）. Children： anal plugs （7）, 5 used it on demand for an average of 2.5 years with satisfactory results, one stopped immediately and one after 5 years. RCI （26 fecal incontinence, 22 constipation）, 90% are still using it （mean time 6.8 years） and felt satisfied. Children tend to be more satisfied （P = 0.001）. Besides age, no predictive factors for success were found. There was no difference in the outcome between patients with fecal incontinence or constipation.CONCLUSION： RCI is more often applied than anal plugs and is helpful in patients with fecal incontinence or constipation, especially for younger patients. Anal plugs can be used incidentally for fecal incontinence, especially in children.
文摘Rectal prolapse associated with traumatic fecal incontinence is a rare clinical combination. This study was designed to assess Delorme＇s operation with sphincteroplasty as a surgical management of this combination in terms of recurrence and improvement of fecal incontinence. In this prospective study, we enrolled patients suffering from short, full-thickness rectal prolapse associated with traumatic fecal incontinence who had been admitted to Alexandria Main University Hospital during the period of May 2010-January 2013. Preoperative data including cause of trauma, duration of symptoms, results of anal manometry, and degree of fecal incontinence using Wexner score were collected from all patients. Delorme＇s procedure with overlap sphincteroplasty was done in all patients. Recurrence of prolapse and improvement of fecal incontinence were assessed after 1, 3, 6 and 12 months. The study included 13 patients aged （32±8.7） years, 9 females and 4 males. Cause of sphincteric injury included previous anal surgery in 7 patients and normal labor in 6 patients. Duration between sphinctefic injury and operation was （8.08±2.47） months. Preoperative Wexner＇s mean score was 16.07±3.4. Early postoperative complications included superficial wound infection （69.2%）, minor wound dehiscence （61.5%）, and postoperative bleeding （7.6%）. Recurrence was detected in 1 patient at 6 month follow-up. Wexner＇s score showed significant improvement for all patients after 6 months （4.00±2.04）. In conclusion, combination of Delorme＇s procedure and sphincteroplasty for treatment of patients with short complete rectal prolapse associated with traumatic fecal incontinence is a safe, effective surgical management with satisfactory results regarding anatomical and functional outcomes.
文摘Fecal incontinence is a disabling disease, often observed in young subjects, that may have devastating psycho-social consequences. In the last years, numerous evidences have been reported on the efficacy of bio-feedback techniques for the treatment of this disorder. Overall, the literature data claim a success rate in more than 70% of cases in the short term. However, recent controlled trials have not confirmed this optimistic view, thus emphasizing the role of standard care. Nonetheless, many authors believe that this should be the first therapeutic approach for fecal incontinence due to the efficacy, lack of side-effects,and scarce invasiveness. Well-designed randomized,controlled trial are eagerly awaited to solve this therapeutic dilemma.
文摘The role of sphincteroplasty in the treatment of patients with fecal incontinence due to anal sphincter defects has been questioned because the success rate declines in the long-term.A new emerging treatment for fecal incontinence,sacral nerve stimulation,has been shown to be effective in these patients.However,the success rate of sphincteroplasty may depend of several patient-related and surgical-related factors and the outcome from sphincteroplasty has been evaluated differently(with qualitative data) from that after sacral nerve stimulation(quantitative data using scoring systems and quality of life).Furthermore,the data available so far on the longterm success rate after sacral nerve modulation do not differ substantially from those after sphincteroplasty.The actual data do not support the replacement of sphincteroplasty with sacral nerve stimulation in patients with fecal incontinence secondary to sphincter defects.
基金Grants from "Fundacion Mutua Madrilena",No.AP11223-2013 and No.AP8540-2011,Madrid,Spain
文摘AIM:To determine the causes and characteristics of fecal incontinence in men and to compare these features with those presented by a group of women with the same problem.METHODS:We analyzed the medical history,clinical and manometric data from 119 men with fecal incontinence studied in our unit and compared these data with those obtained from 645 women studied for the same problem.Response to treatment was evaluated after 6 mo of follow-up.RESULTS:Fifteen percent of patients studied in our unit for fecal incontinence were male.Men took longer than women before asking for medical help.Anorectal surgery was the most common risk factor for men related to fecal incontinence.Chronic diarrhea was present in more than 40%of patients in both groups.Decreased resting and external anal sphincter pressures were more frequent in women.No significant differences existed between the sexes regarding rectal sensitivity and recto-anal inhibitory reflex.In 17.8%of men,all presenting soiling,manometric findings did not justify fecal incontinence.Response to treatment was good in both groups,as 80.4%of patients improved and fecal incontinence disappeared in 13.2%of them.CONCLUSION:In our series,it was common that men waited longer in seeking medical help for fecal incontinence.Ano-rectal surgery was the major cause of this problem.Chronic diarrhea was a predisposing factor in both sexes.Manometric differences between groups were limited to an increased frequency of hypotony of the external anal sphincter in women.Fecal incontinence was controllable in most patients.
文摘Fecal incontinence has a profound impact in a patient's life, impairing quality of life and carrying a substantial economic burden due to health costs. It is an underdiagnosed condition because many affected patients are reluctant to report it and also clinicians are usually not alert to it. Patient evaluation with a detailed clinical history and examination is very important to indicate the type of injury that is present. Endoanal ultrasonography is currently the gold standard for sphincter evaluation in fecal incontinence and is a simple, well-tolerated and non-expensive technique. Most studies revealed 100%sensitivity in identifying sphincter defect. It is better than endoanal magnetic resonance imaging for internal anal sphincter defects, equivalent for the diagnosis of external anal sphincter defects, but with a lower capacity for assessment of atrophy of this sphincter.The most common cause of fecal incontinence is anal sphincter injury related to obstetric trauma. Only a small percentage of women are diagnosed with sphincter tears immediately after vaginal delivery, but endoanal ultrasonography shows that one third of these women have occult sphincter defects. Furthermore, in patients submitted to primary repair of these tears, ultrasound revealed a high frequency of persistent sphincter defects after surgery. Three-dimensional endoanal ultrasonography is currently largely used and accepted for sphincter evaluation in fecal incontinence, improving diagnostic accuracy and our knowledge of physiologic and pathological sphincters alterations. Conversely,there is currently no evidence to support the use of elastography in fecal incontinence evaluation.
文摘BACKGROUND Fecal incontinence(FI)is an involuntary passage of fecal matter which can have a significant impact on a patient’s quality of life.Many modalities of treatment exist for FI.Sacral nerve stimulation is a well-established treatment for FI.Given the increased need of magnetic resonance imaging(MRI)for diagnostics,the In-terStim which was previously used in sacral nerve stimulation was limited by MRI incompatibility.Medtronic MRI-compatible InterStim was approved by the United States Food and Drug Administration in August 2020 and has been widely used.AIM To evaluate the efficacy,outcomes and complications of the MRI-compatible InterStim.METHODS Data of patients who underwent MRI-compatible Medtronic InterStim placement at UPMC Williamsport,University of Minnesota,Advocate Lutheran General Hospital,and University of Wisconsin-Madison was pooled and analyzed.Patient demographics,clinical features,surgical techniques,complications,and outcomes were analyzed.Strengthening the Reporting of Observational studies in Epidemiology(STROBE)cross-sectional reporting guidelines were used.RESULTS Seventy-three patients had the InterStim implanted.The mean age was 63.29±12.2 years.Fifty-seven(78.1%)patients were females and forty-two(57.5%)patients had diabetes.In addition to incontinence,overlapping symptoms included diarrhea(23.3%),fecal urgency(58.9%),and urinary incontinence(28.8%).Fifteen(20.5%)patients underwent Peripheral Nerve Evaluation before proceeding to definite implant placement.Thirty-two(43.8%)patients underwent rechargeable InterStim placement.Three(4.1%)patients needed removal of the implant.Migration of the external lead connection was observed in 7(9.6%)patients after the stage I procedure.The explanation for one patient was due to infection.Seven(9.6%)patients had other complications like nerve pain,hematoma,infection,lead fracture,and bleeding.The mean follow-up was 6.62±3.5 mo.Sixty-eight(93.2%)patients reported significant improvement of symptoms on follow-up evaluation.CONCLUSION This study shows promising results with significant symptom improvement,good efficacy and good patient outcomes with low complication rates while using MRI compatible InterStim for FI.Further long-term follow-up and future studies with a larger patient population is recommended.
文摘The main aim of this opinion review is to comment on the recent article published by Garg et al in the World Journal of Gastroenterology 2023;29:4593–4603.The authors in the published article developed a new scoring system,Garg incon-tinence scores(GIS),for fecal incontinence(FI).FI is a chronic debilitating disease that has a severe negative impact on the quality of life of the patients.Rome IV criteria define FI as multiple episodes of solid or liquid stool passed into the clothes at least twice a month.The associated social stigmatization often leads to significant under-reporting of the condition,which further impairs management.An important point is that the complexity and vagueness of the disease make it difficult for the patients to properly define and report the magnitude of the problem to their physicians.Due to this,the management becomes even more difficult.This issue is resolved up to a considerable extent by a scoring ques-tionnaire.There were several scoring systems in use for the last three decades.The prominent of them were the Cleveland Clinic scoring system or the Wexner scoring system,St.Marks Hospital or Vaizey’s scores,and the FI severity index.However,there were several shortcomings in these scoring systems.In the opinion review,we tried to analyze the strength of GIS and compare it to the existing scoring systems.The main pitfalls in the existing scoring systems were that most of them gave equal weightage to different types of FI(solid,liquid,flatus,etc.),were not comprehensive,and took only the surgeon’s perception of FI into view.In GIS,almost all shortcomings of previous scoring systems had been addressed:different weights were assigned to different types of FI by a robust statistical methodology;the scoring system was made comprehensive by including all types of FI that were previously omitted(urge,stress and mucus FI)and gave priority to patients’rather than the physicians’perceptions while developing the scoring system.Due to this,GIS indeed looked like a paradigm shift in the evaluation of FI.However,it is too early to conclude this,as GIS needs to be validated for accuracy and simplicity in future studies.
文摘AIMTo assess the development and implementation of the Integrated Rapid Assessment and Treatment(IRAT)pathway for the management of patients with fecal incontinence and measure its impact on patients’care.METHODSPatients referred to the colorectal unit in our hospital for the management of faecal incontinence were randomised to either the Standard Care pathway or the newly developed IRAT pathway in this feasibility study.The IRAT pathway is designed to provide a seamless multidisciplinary care to patients with faecal incontinence in a timely fashion.On the other hand,patients in the Standard Pathway were managed in the general colorectal clinic.Percentage improvements in St.Marks Incontinence Score,Cleveland Clinic Incontinence Score and Rockwood Faecal Incontinence Quality of Life Scale after completion of treatment in both groups were the primary outcome measures.Secondary endpoints were the time required to complete the management and patients’satisfaction score.χ<sup>2</sup>,Mann-Whitney-U and Kendall tau-c correlation coefficient tests were used for comparison of outcomes of the two study groups.A P value of 0.05 or less was considered significant.RESULTSThirty-nine patients,34 females,consented to participate.Thirty-one(79.5%)patients completed the final assessment and were included in the outcome analysis.There was no significant difference in the quality of life scales and incontinence scores.Patients in the IRAT pathway were more satisfied with the time required to complete management(P=0.033)and had stronger agreement that all aspects of their problem were covered(P=0.006).CONCLUSIONDespite of the lack of significant difference in outcome measures,the new pathway has positively influenced patient’s mindset,which was reflected in a higher satisfaction score.
文摘AIM:To compare defecographic abnormalities in symptomatic men and women and to analyze differences between men and age-and symptom-matched women.METHODS:Sixty-six men(mean age:55.4 years,range:20-81 years) who complained of constipation and/or fecal incontinence and/or pelvic pain underwent defecography after intake of a barium meal.Radiographs were analyzed for the diagnosis of rectocele,enterocele,intussusception and perineal descent.They were compared with age-and symptom-matched women(n = 198) who underwent defecography during the same period.RESULTS:Normal defecography was observed in 22.7% of men vs 5.5% of women(P < 0.001).Defecography in men compared with women showed 4.5%vs 44.4%(P < 0.001) rectocele,and 10.6% vs 29.8%(P < 0.001) enterocele,respectively.No difference was observed for the diagnosis of intussusception(57.6% vs 44.9%).Perineal descent at rest was more frequent in women(P < 0.005).CONCLUSION:For the same complaint,diagnosis of defecographic abnormalities was different in men than in women:rectocele,enterocele and perineal descent at rest were observed less frequently in men than in women.
文摘Rectal prolapse is a circumferential,full-thickness protrusion of the rectum through the anus.It is a rare condition,and only affects 0.5%of the general population.Multiple treatment modalities have been described,which have changed significantly over time.Particularly in the last decade,laparoscopic and robotic surgical approaches with different mobilization techniques,combined with medical therapies,have been widely implemented.Because patients have presented with a wide range of complaints(ranging from abdominal discomfort to incomplete bowel evacuation,mucus discharge,constipation,diarrhea,and fecal incontinence),understanding the extent of complaints and ruling out differential diagnoses are essential for choosing a tailored surgical procedure.It is crucial to assess these additional symptoms and their severities using preoperative scoring systems.Additionally,radiological and physiological evaluations may explain some vague symptoms and reveal concomitant pelvic disorders.However,there is no consensus on or standardization of the optimal extent of dissection,type of procedure,and materials used for rectal fixation;this makes providing maximum benefits to patients with minimal complications difficult.Even recent publications and systematic reviews have not recommended the most appropriate treatment options.This review explains the appropriate diagnostic tools for different conditions and summarizes the current treatment approaches based on existing literature and expert opinions.
文摘AIM To investigate compliance with transanal irrigation(TAI) one year after a training session and to identify predictive factors for compliance.METHODS The compliance of one hundred eight patients [87 women and 21 men; median age 55 years(range 18-83)] suffering from constipation or fecal incontinence(FI) was retrospectively assessed. The patients were trained in TAI over a four-year period at a single institution. They were classified as adopters if they continued using TAI for at least one year after beginning the treatment or as non-adopters if they stopped. Predictive factors of compliance with TAI were based on pretreatment assessments and trainingprogress. The outcomes of the entire cohort of patients who had been recruited for the TAI treatment were expressed in terms of intention-to-treat.RESULTS Forty-six of the 108(43%) trained patients continued to use TAI one year after their training session. The patients with FI had the best results, with 54.5% remaining compliant with TAI. Only one-third of the patients who complained of slow transit constipation or obstructed defecation syndrome continued TAI. There was an overall discontinuation rate of 57%. The most common reason for discontinuing TAI was the lack of efficacy(41%). However, 36% of the patients who discontinued TAI gave reasons independent of the efficacy of the treatment such as technical problems(catheter expulsion, rectal balloon bursting, instilled water leakage or retention, pain during irrigation, anal bleeding, anal fissure) while 23% said that there were too many constraints. Of the patients who reported discontinuing TAI, the only predictive factor was the progress of the training(OR = 4.9, 1.3-18.9, P = 0.02).CONCLUSION The progress of the training session was the only factor that predicted patient compliance with TAI.
基金Supported by Spanish Ministry of Health and Consumer Affairs,No.PI060305
文摘AIM To establish a rat model of anal sphincter injury and test different systems to provide stem cells to injured area.METHODS Adipose-derived stem cells(ASCs)were isolated from BDIX rats and were transfected with green fluorescent protein(GFP)for cell tracking.Biosutures(sutures covered with ASCs)were prepared with 1.5×10~6 GFPASCs,and solutions of 10~6 GFP-ASCs in normal saline were prepared for injection.Anorectal normal anatomy was studied on Wistar and BDIX female rats.Then,we designed an anal sphincter injury model consisting of a 1-cm extra-mucosal miotomy beginning at the anal verge in the anterior middle line.The sphincter lesion was confirmed with conventional histology(hematoxylin and eosin)and immunofluorescence with 4',6-diamidino-2-phenylindole(commonly known as DAPI),GFP andα-actin.Functional effect was assessed with basal anal manometry,prior to and after injury.After sphincter damage,36 BDIX rats were randomized to three groups for:(1)Cell injection without repair;(2)biosuture repair;and(3)conventional suture repair and cell injection.Functional and safety studies were conducted on all the animals.Rats were sacrificed after 1,4 or 7 d.Then,histological and immunofluorescence studies were performed on the surgical area.RESULTS With the described protocol,biosutures had been covered with at least 820000-860000 ASCs,with 100%viability.Our studies demonstrated that some ASCs remained adhered after suture passage through the muscle.Morphological assessment showed that the rat anal anatomy is comparable with human anatomy;two sphincters are present,but the external sphincter is poorly developed.Anal sphincter pressure data showed spontaneous,consistent,rhythmic anal contractions,taking the form of"plateaus"with multiple twitches(peaks)in each pressure wave.These basal contractions were very heterogeneous;their frequency was 0.91-4.17 per min(mean 1.6980,SD 0.57698),their mean duration was 26.67 s and mean number of peaks was 12.53.Our morphological assessment revealed that with the aforementioned surgical procedure,both sphincters were completely sectioned.In manometry,the described activity disappeared and was replaced by a gentle oscillation of basal line,without a recognizable pattern.Surprisingly,these findings appeared irrespective of injury repair or not.ASCs survived in this potentially septic area for 7 d,at least.We were able to identify them in 84%of animals,mainly in the muscular section area or in the tissue between the muscular endings.ASCs formed a kind of"conglomerate"in rats treated with injections,while in the biosuture group,they wrapped the suture.ASCs were also able to migrate to the damaged zone.No relevant adverse events or mortality could be related to the stem cells in our study.We also did not find unexpected tissue growths.CONCLUSION The proposed procedure produces a consistent sphincter lesion.Biosutures and injections are suitable for cell delivery.ASCs survive and are completely safe in this clinical setting.
