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
Urinary incontinence is a common complication following robot-assisted radical prostatectomy(RARP).Urethral length has been identified as a factor affecting postoperative continence recovery.In this meta-analysis,we e...Urinary incontinence is a common complication following robot-assisted radical prostatectomy(RARP).Urethral length has been identified as a factor affecting postoperative continence recovery.In this meta-analysis,we examined the association between use of the maximal urethral length preservation(MULP)technique and postoperative urinary continence in patients undergoing RARP.We conducted a comprehensive search of PubMed,Web of Science,Embase,and the Cochrane Library up to December 31,2023.The quality of the literature was assessed using the Newcastle-Ottawa Scale.A random-effects meta-analysis was performed to synthesize data and calculate the odds ratio(OR)from eligible studies on continence and MULP.Six studies involving 1869 patients met the eligibility criteria.MULP was positively associated with both early continence(1 month after RARP;Z=3.62,P=0.003,OR=3.10,95% confidence interval[CI]:1.68-5.73)and late continence(12 months after RARP;Z=2.34,P=0.019,OR=2.10,95%CI:1.13–3.90).Oncological outcomes indicated that MULP did not increase the overall positive surgical margin rate or the positive surgical margin status at the prostate apex(both P>0.05).In conclusion,the use of the MULP technique in RARP significantly improved both early and late postoperative continence outcomes without compromising oncological outcomes.展开更多
Objective:Stress urinary incontinence(SUI)is a common condition among women that severely impairs quality of life.Pelvic floor proprioceptive training(PFPT)has attracted increasing attention for its potential to enhan...Objective:Stress urinary incontinence(SUI)is a common condition among women that severely impairs quality of life.Pelvic floor proprioceptive training(PFPT)has attracted increasing attention for its potential to enhance pelvic floor muscle function and alleviate SUI symptoms.This study aims to observe and compare the clinical efficacy of PFPT combined with electroacupuncture,electrical stimulation,and biofeedback therapy versus conventional therapy consisting of electroacupuncture,electrical stimulation,and biofeedback alone in women with SUI,and to explore the role of PFPT in improving symptom and functional outcomes.Methods:In this randomized controlled trial,72 women with mild to moderate SUI were recruited from the Department of Rehabilitation Medicine at Third Xiangya Hospital,Central South University,between December 2021 and October 2023.Participants were randomly assigned to an experimental group(n=36)or a control group(n=36).Both groups received health education.The control group underwent electroacupuncture combined with electrical stimulation and biofeedback therapy,while the experimental group additionally received PFPT 3 times per week for 4 weeks.The primary outcome was assessed using the International Consultation on Incontinence Questionnaire-Short Form(ICIQ-SF).Secondary outcomes included pelvic floor muscle strength,bladder neck mobility,and balance ability.The ICIQ-SF was reassessed at 1,3,6,and 12 months post-treatment.Results:Both groups showed statistically significant improvements in all parameters after treatment(all P<0.05).However,there were no statistically significant differences between groups in most measures(all P>0.05).The experimental group demonstrated longer singleleg stance duration with eyes closed than the control group(left leg:P=0.026;right leg:P=0.006),with a significant increase from baseline(P<0.001).At 6 months post-treatment,the cure rate in the experimental group was significantly higher than that in the control group(P=0.037).Conclusion:Conventional therapy effectively improves SUI symptoms,but adding PFPT provides notable additional benefits,including enhanced balance ability and sustained midterm cure rates.These findings suggest that PFPT is a valuable adjunct to standard SUI management strategies.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
Introduction: Genital prolapse is a health problem that gynaecologists are increasingly facing due to patients’ legitimate demands for care and the improvement in life expectancy without associated disabilities. The ...Introduction: Genital prolapse is a health problem that gynaecologists are increasingly facing due to patients’ legitimate demands for care and the improvement in life expectancy without associated disabilities. The objective of this work was to evaluate the clinical aspects and functional disorders of patients with genital prolapse in Butembo in Democratic Republic of the Congo (DRC). Material and Methods: A descriptive study with analytical aims was conducted from January 1 to September 30, 2024 in Butembo/DRC. It involved 112 patients with symptomatic genital prolapse in whom an interview on functional disorders as well as clinical assessment according to the Baden and Walker classification were carried out. The data were entered into Microsoft Office LTSC 2021 Excel software and analysed using R software version 4.4.0. Results: Patients aged over 50 years were exposed to developing genital prolapse especially the mixed type (81.1%) compared to those aged under 50 years (p-value 0.014). Multi and large multiparous women had developed all types of prolapse especially the mixed type (100%) compared to primiparous and pauciparous women (p-value 0.027). Associated pathologies were more observed in case of mixed prolapse (51.4%) including vesicovaginal fistula (37.8%) (p-value Conclusion: Genital prolapse is common and functional urinary, sexual and anorectal signs are frequently observed in patients in Butembo/DRC.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 study risk factors for urinary incontinence (UI) in pregnant women in six health facilities in the city of Ouahigouya. Methodology: We conducted a cross-sectional, analytical observational study from May...Objective: To study risk factors for urinary incontinence (UI) in pregnant women in six health facilities in the city of Ouahigouya. Methodology: We conducted a cross-sectional, analytical observational study from May 1 to August 30, 2023 in six health facilities in the city of Ouahigouya. Binary logistic regression was used to identify risk factors associated with UTI. Results: The prevalence of UI was 39.3%. The mean age of incontinent women was 26.5 ± 6.2 years, with extremes of 18 and 44 years. Stress UI (55%) was the most frequent type. On univariate analysis, age over 25 (OR = 2.6), multiparity (OR = 2.8), number of gestures, body mass index greater than or equal to 25 kg/m2 (OR = 2.1), infantile enuresis (OR = 2.6), recurrent urinary tract infections (OR = 2.6), previous vaginal delivery (OR = 14.5) and third trimester of pregnancy (OR = 1.7) significantly increased the risk of UTI. Independent risk factors were previous vaginal delivery (OR = 17.6), previous caesarean section (OR = 5.2), third trimester of pregnancy (OR = 2.01), body mass index greater than or equal to 25 kg/m2 (OR = 2.09) and coffee consumption (OR = 4.5). Conclusion: UTI is highly prevalent in pregnant women. Obstetrical parameters are strongly associated with the risk of UTI during pregnancy.展开更多
We report a case involving an 85-year-old man who underwent laparoscopic radical prostatectomy for prostate cancer in 2011.During follow-up,he required long-term use of a penile clamp to manage urination due to perman...We report a case involving an 85-year-old man who underwent laparoscopic radical prostatectomy for prostate cancer in 2011.During follow-up,he required long-term use of a penile clamp to manage urination due to permanent severe stress incontinence.In February 2023,he presented with a painless cystic mass in the scrotum.Upon pressing the mass with hand,fluid drained from the external urethral orifice,causing the mass to shrink in size,although it returned to its original size a few hours later.Urography and cystoscopy showed a globular urethral diverticulum located anteriorly.The patient underwent surgical excision of the diverticulum along with urethroplasty.Postoperatively,the urinary stress incontinence persisted,but he declined any further surgical intervention.An artificial urinary sphincter is currently the first-line treatment for male urinary incontinence.However,devices such as penile clamps can serve as an alternative when considering surgical suitability or cost.It is important to note that these devices can lead to serious complications such as urethral erosion,stricture,or diverticulum.Therefore,caution is advised when using such devices,and they should be removed periodically at short intervals.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
BACKGROUND Postpartum stress urinary incontinence(SUI)symptoms affect a patient’s daily activities and quality of life and increase the negative emotions that they experience.At present,there is no research on the ef...BACKGROUND Postpartum stress urinary incontinence(SUI)symptoms affect a patient’s daily activities and quality of life and increase the negative emotions that they experience.At present,there is no research on the effect of fractional CO_(2)laser treatment combined with Kegel exercise on postpartum SUI and postpartum depression and anxiety.AIM To investigate the effect of lattice CO_(2)laser treatment combined with Kegel exercise on mild to moderate postpartum SUI and its influence on postpartum depression and anxiety.METHODS Using a retrospective study,data from 82 cases of mild to moderate postpartum SUI in Huzhou Maternal&Child Health Care Hospital from January to April 2024 were retrospectively collected.The cases were divided into groups according to the different treatment methods,namely Group S(41 cases,only receiving lattice CO_(2)laser treatment)and Group L(41 cases,receiving lattice CO_(2)laser combined with Kegel exercise treatment).The baseline data of the two groups were compared.In addition,we analyzed and compared the scores of the international commission on urinary incontinence questionnaire short form(ICI-Q-SF),incontinence quality of life questionnaire(I-QOL),Edinburgh postnatal depression scale(EPDS),and postpartum specific anxiety scale(PSAS)before treatment,at the end of treatment,and 3 months after the end of treatment between the two groups.Furthermore,the clinical efficacy and adverse reactions of the two groups were analyzed and compared at the end of treatment and 3 months after the end of treatment.RESULTS There was no significant difference in the baseline data and the ICI-Q-SF,I-QOL,EPDS,and PSAS scores between the two groups before treatment.However,at the end of treatment,the ICI-Q-SF,I-QOL,EPDS,and PSAS scores between Groups L and S were significantly different.The overall effective rate of treatment in Group L was significantly higher than that in Group S.During the 3-month follow-up after treatment,it was found that the ICIQ-SF,EPDS,and PSAS scores of Group L were still lower than those of Group S.In comparison,the I-QOL score and total effective rate of treatment were still higher in Group L than those in Group S,and this difference was significant.There was no significant difference in the adverse reactions between Group L and Group S.CONCLUSION The combination of dot lattice CO_(2)laser and Kegel exercise has a significant therapeutic effect on mild to moderate postpartum SUI.It can prolong the duration of therapeutic effects,improve a patient’s quality of life,and alleviate postpartum depression and anxiety.展开更多
This study developed an animal model with internal and external urethral sphincter insufficiency by bypassing the sphincter without major damage so that the animal under study can return to normal life after the study...This study developed an animal model with internal and external urethral sphincter insufficiency by bypassing the sphincter without major damage so that the animal under study can return to normal life after the study.There is a need for a reliable,applicable,and reproducible animal model for studying urinary incontinency disease due to incorrect sphincter function.Seven adult male dogs were used for this study.The urethral sphincter was bypassed by inserting a catheter between the bladder neck and the distal sphincter.The animals'physical condition was closely monitored for 9 weeks,and standard urodynamic and radiologic studies were performed before and 1–2 months after surgery.The animals were killed at 9 weeks after surgery for pathological assessment.Catheter placement caused complete incontinence in the animal,with urodynamic assessments indicating that the animal was unable to control urination and radiological assessments indicating an empty bladder with a residual volume of 50±10 cc.Tissue analysis did not show significant histological damage and inflammation.The study shows that by bypassing the urethral sphincter,which is a reliable and reproducible method,an animal model of urinary incontinence can be developed,which can be used in various studies such as assessing the adequacy of artificial sphincter function.The animals under study did not have any permanent defect,so they were able to return to their normal life.展开更多
Clinical bladder evaluation is a cost-effective,non-invasive method for diagnosing and managing urinary dysfunction,particularly in patients with neurogenic bladder or other impairments.This process aims to assess bla...Clinical bladder evaluation is a cost-effective,non-invasive method for diagnosing and managing urinary dysfunction,particularly in patients with neurogenic bladder or other impairments.This process aims to assess bladder capacity,storage,and voiding functions through simple,realistic,and resource-friendly approaches.It involves a structured series of steps,from history-taking and physical examination to bladder-emptying procedures,monitoring urine leaks,assessing reflex voiding,measuring post-void residual(PVR),and calculating total bladder capacity.These evaluations help differentiate between upper motor neuron and lower motor neuron bladder dysfunction,providing critical insights for tailored management.The interpretation of findings focuses on identifying bladder type,assessing leak timing and volume,evaluating reflex voiding,and measuring PVR and total bladder capacity.The results guide interventions such as timing selfclean intermittent catheterization,adjusting fluid intake,and using bladder diaries to monitor patterns.Clinical bladder evaluation is particularly advantageous in low-resource settings,as it avoids the risks and costs associated with urodynamic studies while reflecting real-life patient conditions more effectively.Despite its benefits,no validation studies currently exist for clinical bladder assessment,and its parameters,like maximum voided volume,remain underexplored compared to urodynamic measures.Given the accessibility,affordability,and practicality of this approach,it holds promise for widespread application,especially in primary care settings and among economically disadvantaged populations.This editorial describes the process step-by-step and highlights its role in improving patient outcomes while minimizing complications.展开更多
妇女一生中有11%~19%的风险行盆底修复手术,而盆腔器官脱垂（pelvic organ prolapse,POP）传统修复手术是在已经薄弱和缺陷的筋膜、结缔组织及韧带上进行悬吊和修补,再次手术的风险高。近年来使用移植物尤其是合成网片的盆底重建手术降...妇女一生中有11%~19%的风险行盆底修复手术,而盆腔器官脱垂（pelvic organ prolapse,POP）传统修复手术是在已经薄弱和缺陷的筋膜、结缔组织及韧带上进行悬吊和修补,再次手术的风险高。近年来使用移植物尤其是合成网片的盆底重建手术降低了传统修复手术的复发率,改善了压力性尿失禁（stress urinary incontinence,SUI）和POP患者的生活质量。展开更多
Purpose: The purpose of this study was to demonstrate loose silk seton actually acts as a slow cutting seton contrary to the idea of simply drainage. Besides, to show the effect of loose seton on patient’s incontinen...Purpose: The purpose of this study was to demonstrate loose silk seton actually acts as a slow cutting seton contrary to the idea of simply drainage. Besides, to show the effect of loose seton on patient’s incontinence is mostly proportional to the degree of division of the sphincter muscle. Design: Fifty patients with high transsphincteric fistulas were treated with loose seton technique. We measured the length of high sphincteric fistula tracts, pre- and postoperative anal sphincter pressures and incontinence scores. Results: Loose seton with heavy silk resulted in 72% percent of progressive migration of the fistula tract caudally. The more the progressive migration of the loose seton loop, the less the pressure drop in both resting and squeezing in manometric studies. This study is limited by its retrospective design in prospectively collected data and covers relatively small number of patients. Conclusion: Seton is still useful technique in high perianal fistula surgery. Defining this technique as simply “loose” seton is misnomer since it acts as a slowly cutting seton and results in progressive migration of the fistula tract caudally. The more the progressive migration of the loose seton loop, the less the pressure drop would be possible after postoperatively.展开更多
全球约有超过2000万的人罹患尿失禁(urinary incontinence,UI)[1]。在美国约有172万人有尿失禁症状,每年尿失禁治疗的花费超过3200万美元[2]。80岁以上的人群中,女性尿失禁的发病率是男性的2～3倍[3]。20岁以上的女性人群约50%有尿失禁...全球约有超过2000万的人罹患尿失禁(urinary incontinence,UI)[1]。在美国约有172万人有尿失禁症状,每年尿失禁治疗的花费超过3200万美元[2]。80岁以上的人群中,女性尿失禁的发病率是男性的2～3倍[3]。20岁以上的女性人群约50%有尿失禁的症状,其中50%为压力性尿失禁(stress urinary incontinence,SUI),其余的为急迫性尿失禁(urge type of UI,UUI,16%)或混合性尿失禁(SUI合并UUI,34%)[4]。急迫性尿失禁是指强烈的尿急症状后立即出现的尿失禁现象,与逼尿肌过度活动(动力性尿急)展开更多
Small vessel disease （SVD） is responsible for brain chronic circular disorder,and accounts for 20%–30%cases of ischemic stroke as well as cerebral hemorrhage,and to a great extent,encephalopathy.Binswanger’s disea...Small vessel disease （SVD） is responsible for brain chronic circular disorder,and accounts for 20%–30%cases of ischemic stroke as well as cerebral hemorrhage,and to a great extent,encephalopathy.Binswanger’s disease and multiple small strokes,which are common in older people,are also closely associated with SVD.These disorders often cause decline in cognition,vascular dementia,impairment in gait and balance,mood depression,and urinary incontinence,and often brings great social and economic burdens.SVD-related encephalopathy increases the incidences of fall,disability and death in elderly people.With the aging of the society,more attention should be paid to the importance of early diagnosis and prophylactic treatment of SVD.Here the clinical manifestations and pathophysiology of SVD are reviewed.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 the National Natural Science Foundation of China(No.82170783).
文摘Urinary incontinence is a common complication following robot-assisted radical prostatectomy(RARP).Urethral length has been identified as a factor affecting postoperative continence recovery.In this meta-analysis,we examined the association between use of the maximal urethral length preservation(MULP)technique and postoperative urinary continence in patients undergoing RARP.We conducted a comprehensive search of PubMed,Web of Science,Embase,and the Cochrane Library up to December 31,2023.The quality of the literature was assessed using the Newcastle-Ottawa Scale.A random-effects meta-analysis was performed to synthesize data and calculate the odds ratio(OR)from eligible studies on continence and MULP.Six studies involving 1869 patients met the eligibility criteria.MULP was positively associated with both early continence(1 month after RARP;Z=3.62,P=0.003,OR=3.10,95% confidence interval[CI]:1.68-5.73)and late continence(12 months after RARP;Z=2.34,P=0.019,OR=2.10,95%CI:1.13–3.90).Oncological outcomes indicated that MULP did not increase the overall positive surgical margin rate or the positive surgical margin status at the prostate apex(both P>0.05).In conclusion,the use of the MULP technique in RARP significantly improved both early and late postoperative continence outcomes without compromising oncological outcomes.
基金supported by the Natural Science Foundation of Hunan Province(2024JJ8121,2024JJ6626)the Hunan Provincial Key Research and Development Program(2023SK2038),China.
文摘Objective:Stress urinary incontinence(SUI)is a common condition among women that severely impairs quality of life.Pelvic floor proprioceptive training(PFPT)has attracted increasing attention for its potential to enhance pelvic floor muscle function and alleviate SUI symptoms.This study aims to observe and compare the clinical efficacy of PFPT combined with electroacupuncture,electrical stimulation,and biofeedback therapy versus conventional therapy consisting of electroacupuncture,electrical stimulation,and biofeedback alone in women with SUI,and to explore the role of PFPT in improving symptom and functional outcomes.Methods:In this randomized controlled trial,72 women with mild to moderate SUI were recruited from the Department of Rehabilitation Medicine at Third Xiangya Hospital,Central South University,between December 2021 and October 2023.Participants were randomly assigned to an experimental group(n=36)or a control group(n=36).Both groups received health education.The control group underwent electroacupuncture combined with electrical stimulation and biofeedback therapy,while the experimental group additionally received PFPT 3 times per week for 4 weeks.The primary outcome was assessed using the International Consultation on Incontinence Questionnaire-Short Form(ICIQ-SF).Secondary outcomes included pelvic floor muscle strength,bladder neck mobility,and balance ability.The ICIQ-SF was reassessed at 1,3,6,and 12 months post-treatment.Results:Both groups showed statistically significant improvements in all parameters after treatment(all P<0.05).However,there were no statistically significant differences between groups in most measures(all P>0.05).The experimental group demonstrated longer singleleg stance duration with eyes closed than the control group(left leg:P=0.026;right leg:P=0.006),with a significant increase from baseline(P<0.001).At 6 months post-treatment,the cure rate in the experimental group was significantly higher than that in the control group(P=0.037).Conclusion:Conventional therapy effectively improves SUI symptoms,but adding PFPT provides notable additional benefits,including enhanced balance ability and sustained midterm cure rates.These findings suggest that PFPT is a valuable adjunct to standard SUI management strategies.
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.
文摘Introduction: Genital prolapse is a health problem that gynaecologists are increasingly facing due to patients’ legitimate demands for care and the improvement in life expectancy without associated disabilities. The objective of this work was to evaluate the clinical aspects and functional disorders of patients with genital prolapse in Butembo in Democratic Republic of the Congo (DRC). Material and Methods: A descriptive study with analytical aims was conducted from January 1 to September 30, 2024 in Butembo/DRC. It involved 112 patients with symptomatic genital prolapse in whom an interview on functional disorders as well as clinical assessment according to the Baden and Walker classification were carried out. The data were entered into Microsoft Office LTSC 2021 Excel software and analysed using R software version 4.4.0. Results: Patients aged over 50 years were exposed to developing genital prolapse especially the mixed type (81.1%) compared to those aged under 50 years (p-value 0.014). Multi and large multiparous women had developed all types of prolapse especially the mixed type (100%) compared to primiparous and pauciparous women (p-value 0.027). Associated pathologies were more observed in case of mixed prolapse (51.4%) including vesicovaginal fistula (37.8%) (p-value Conclusion: Genital prolapse is common and functional urinary, sexual and anorectal signs are frequently observed in patients in Butembo/DRC.
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.
文摘Objective: To study risk factors for urinary incontinence (UI) in pregnant women in six health facilities in the city of Ouahigouya. Methodology: We conducted a cross-sectional, analytical observational study from May 1 to August 30, 2023 in six health facilities in the city of Ouahigouya. Binary logistic regression was used to identify risk factors associated with UTI. Results: The prevalence of UI was 39.3%. The mean age of incontinent women was 26.5 ± 6.2 years, with extremes of 18 and 44 years. Stress UI (55%) was the most frequent type. On univariate analysis, age over 25 (OR = 2.6), multiparity (OR = 2.8), number of gestures, body mass index greater than or equal to 25 kg/m2 (OR = 2.1), infantile enuresis (OR = 2.6), recurrent urinary tract infections (OR = 2.6), previous vaginal delivery (OR = 14.5) and third trimester of pregnancy (OR = 1.7) significantly increased the risk of UTI. Independent risk factors were previous vaginal delivery (OR = 17.6), previous caesarean section (OR = 5.2), third trimester of pregnancy (OR = 2.01), body mass index greater than or equal to 25 kg/m2 (OR = 2.09) and coffee consumption (OR = 4.5). Conclusion: UTI is highly prevalent in pregnant women. Obstetrical parameters are strongly associated with the risk of UTI during pregnancy.
文摘We report a case involving an 85-year-old man who underwent laparoscopic radical prostatectomy for prostate cancer in 2011.During follow-up,he required long-term use of a penile clamp to manage urination due to permanent severe stress incontinence.In February 2023,he presented with a painless cystic mass in the scrotum.Upon pressing the mass with hand,fluid drained from the external urethral orifice,causing the mass to shrink in size,although it returned to its original size a few hours later.Urography and cystoscopy showed a globular urethral diverticulum located anteriorly.The patient underwent surgical excision of the diverticulum along with urethroplasty.Postoperatively,the urinary stress incontinence persisted,but he declined any further surgical intervention.An artificial urinary sphincter is currently the first-line treatment for male urinary incontinence.However,devices such as penile clamps can serve as an alternative when considering surgical suitability or cost.It is important to note that these devices can lead to serious complications such as urethral erosion,stricture,or diverticulum.Therefore,caution is advised when using such devices,and they should be removed periodically at short intervals.
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.
基金Supported by Huzhou Science and Technology Bureau,No.2023GYB16.
文摘BACKGROUND Postpartum stress urinary incontinence(SUI)symptoms affect a patient’s daily activities and quality of life and increase the negative emotions that they experience.At present,there is no research on the effect of fractional CO_(2)laser treatment combined with Kegel exercise on postpartum SUI and postpartum depression and anxiety.AIM To investigate the effect of lattice CO_(2)laser treatment combined with Kegel exercise on mild to moderate postpartum SUI and its influence on postpartum depression and anxiety.METHODS Using a retrospective study,data from 82 cases of mild to moderate postpartum SUI in Huzhou Maternal&Child Health Care Hospital from January to April 2024 were retrospectively collected.The cases were divided into groups according to the different treatment methods,namely Group S(41 cases,only receiving lattice CO_(2)laser treatment)and Group L(41 cases,receiving lattice CO_(2)laser combined with Kegel exercise treatment).The baseline data of the two groups were compared.In addition,we analyzed and compared the scores of the international commission on urinary incontinence questionnaire short form(ICI-Q-SF),incontinence quality of life questionnaire(I-QOL),Edinburgh postnatal depression scale(EPDS),and postpartum specific anxiety scale(PSAS)before treatment,at the end of treatment,and 3 months after the end of treatment between the two groups.Furthermore,the clinical efficacy and adverse reactions of the two groups were analyzed and compared at the end of treatment and 3 months after the end of treatment.RESULTS There was no significant difference in the baseline data and the ICI-Q-SF,I-QOL,EPDS,and PSAS scores between the two groups before treatment.However,at the end of treatment,the ICI-Q-SF,I-QOL,EPDS,and PSAS scores between Groups L and S were significantly different.The overall effective rate of treatment in Group L was significantly higher than that in Group S.During the 3-month follow-up after treatment,it was found that the ICIQ-SF,EPDS,and PSAS scores of Group L were still lower than those of Group S.In comparison,the I-QOL score and total effective rate of treatment were still higher in Group L than those in Group S,and this difference was significant.There was no significant difference in the adverse reactions between Group L and Group S.CONCLUSION The combination of dot lattice CO_(2)laser and Kegel exercise has a significant therapeutic effect on mild to moderate postpartum SUI.It can prolong the duration of therapeutic effects,improve a patient’s quality of life,and alleviate postpartum depression and anxiety.
文摘This study developed an animal model with internal and external urethral sphincter insufficiency by bypassing the sphincter without major damage so that the animal under study can return to normal life after the study.There is a need for a reliable,applicable,and reproducible animal model for studying urinary incontinency disease due to incorrect sphincter function.Seven adult male dogs were used for this study.The urethral sphincter was bypassed by inserting a catheter between the bladder neck and the distal sphincter.The animals'physical condition was closely monitored for 9 weeks,and standard urodynamic and radiologic studies were performed before and 1–2 months after surgery.The animals were killed at 9 weeks after surgery for pathological assessment.Catheter placement caused complete incontinence in the animal,with urodynamic assessments indicating that the animal was unable to control urination and radiological assessments indicating an empty bladder with a residual volume of 50±10 cc.Tissue analysis did not show significant histological damage and inflammation.The study shows that by bypassing the urethral sphincter,which is a reliable and reproducible method,an animal model of urinary incontinence can be developed,which can be used in various studies such as assessing the adequacy of artificial sphincter function.The animals under study did not have any permanent defect,so they were able to return to their normal life.
文摘Clinical bladder evaluation is a cost-effective,non-invasive method for diagnosing and managing urinary dysfunction,particularly in patients with neurogenic bladder or other impairments.This process aims to assess bladder capacity,storage,and voiding functions through simple,realistic,and resource-friendly approaches.It involves a structured series of steps,from history-taking and physical examination to bladder-emptying procedures,monitoring urine leaks,assessing reflex voiding,measuring post-void residual(PVR),and calculating total bladder capacity.These evaluations help differentiate between upper motor neuron and lower motor neuron bladder dysfunction,providing critical insights for tailored management.The interpretation of findings focuses on identifying bladder type,assessing leak timing and volume,evaluating reflex voiding,and measuring PVR and total bladder capacity.The results guide interventions such as timing selfclean intermittent catheterization,adjusting fluid intake,and using bladder diaries to monitor patterns.Clinical bladder evaluation is particularly advantageous in low-resource settings,as it avoids the risks and costs associated with urodynamic studies while reflecting real-life patient conditions more effectively.Despite its benefits,no validation studies currently exist for clinical bladder assessment,and its parameters,like maximum voided volume,remain underexplored compared to urodynamic measures.Given the accessibility,affordability,and practicality of this approach,it holds promise for widespread application,especially in primary care settings and among economically disadvantaged populations.This editorial describes the process step-by-step and highlights its role in improving patient outcomes while minimizing complications.
文摘妇女一生中有11%~19%的风险行盆底修复手术,而盆腔器官脱垂（pelvic organ prolapse,POP）传统修复手术是在已经薄弱和缺陷的筋膜、结缔组织及韧带上进行悬吊和修补,再次手术的风险高。近年来使用移植物尤其是合成网片的盆底重建手术降低了传统修复手术的复发率,改善了压力性尿失禁（stress urinary incontinence,SUI）和POP患者的生活质量。
文摘Purpose: The purpose of this study was to demonstrate loose silk seton actually acts as a slow cutting seton contrary to the idea of simply drainage. Besides, to show the effect of loose seton on patient’s incontinence is mostly proportional to the degree of division of the sphincter muscle. Design: Fifty patients with high transsphincteric fistulas were treated with loose seton technique. We measured the length of high sphincteric fistula tracts, pre- and postoperative anal sphincter pressures and incontinence scores. Results: Loose seton with heavy silk resulted in 72% percent of progressive migration of the fistula tract caudally. The more the progressive migration of the loose seton loop, the less the pressure drop in both resting and squeezing in manometric studies. This study is limited by its retrospective design in prospectively collected data and covers relatively small number of patients. Conclusion: Seton is still useful technique in high perianal fistula surgery. Defining this technique as simply “loose” seton is misnomer since it acts as a slowly cutting seton and results in progressive migration of the fistula tract caudally. The more the progressive migration of the loose seton loop, the less the pressure drop would be possible after postoperatively.
文摘全球约有超过2000万的人罹患尿失禁(urinary incontinence,UI)[1]。在美国约有172万人有尿失禁症状,每年尿失禁治疗的花费超过3200万美元[2]。80岁以上的人群中,女性尿失禁的发病率是男性的2～3倍[3]。20岁以上的女性人群约50%有尿失禁的症状,其中50%为压力性尿失禁(stress urinary incontinence,SUI),其余的为急迫性尿失禁(urge type of UI,UUI,16%)或混合性尿失禁(SUI合并UUI,34%)[4]。急迫性尿失禁是指强烈的尿急症状后立即出现的尿失禁现象,与逼尿肌过度活动(动力性尿急)
文摘Small vessel disease （SVD） is responsible for brain chronic circular disorder,and accounts for 20%–30%cases of ischemic stroke as well as cerebral hemorrhage,and to a great extent,encephalopathy.Binswanger’s disease and multiple small strokes,which are common in older people,are also closely associated with SVD.These disorders often cause decline in cognition,vascular dementia,impairment in gait and balance,mood depression,and urinary incontinence,and often brings great social and economic burdens.SVD-related encephalopathy increases the incidences of fall,disability and death in elderly people.With the aging of the society,more attention should be paid to the importance of early diagnosis and prophylactic treatment of SVD.Here the clinical manifestations and pathophysiology of SVD are reviewed.
