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
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
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
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
This manuscript focused on the surgical challenge of urinary and sexual dysfunction after rectal cancer surgery based on the interesting results demonstrated by the observational study of Chen et al,which was publishe...This manuscript focused on the surgical challenge of urinary and sexual dysfunction after rectal cancer surgery based on the interesting results demonstrated by the observational study of Chen et al,which was published in the World Journal of Gastrointestinal Surgery.Urinary dysfunction occurs in one-third of patients treated for rectal cancer.Surgical nerve damage is the main cause of urinary dysfunction.Radiotherapy seems to exacerbate sexual dysfunction.The role of Denonvilliers'fascia preservation vs resection when performing total mesorectal excision(TME),the impact of robotic and transanal TME,alternatives to open and laparoscopic TME,as well as intraoperative pelvic neuromonitoring are discussed in this report.In conclusion,exact knowledge of the highly complex pelvic neuroanatomy and the use of novel surgical techniques can lead to a reduction in urinary and sexual dysfunction after rectal cancer surgery.展开更多
Inflammatory bowel disease(IBD)is an inflammatory disease of the gastrointestinal(GI)tract.It has financial and quality of life impact on patients.Although there has been a significant advancement in treatments,a cons...Inflammatory bowel disease(IBD)is an inflammatory disease of the gastrointestinal(GI)tract.It has financial and quality of life impact on patients.Although there has been a significant advancement in treatments,a considerable number of patients do not respond to it or have severe side effects.Therapeutic approaches such as electrical neuromodulation are being investigated to provide alternate options.Although bioelectric neuromodulation technology has evolved significantly in the last decade,sacral nerve stimulation(SNS)for fecal incontinence remains the only neuromodulation protocol commonly utilized use for GI disease.For IBD treatment,several electrical neuromodulation techniques have been studied,such as vagus NS,SNS,and tibial NS.Several animal and clinical experiments were conducted to study the effectiveness,with encouraging results.The precise underlying mechanisms of action for electrical neuromodulation are unclear,but this modality appears to be promising.Randomized control trials are required to investigate the efficacy of intrinsic processes.In this review,we will discuss the electrical modulation therapy for the IBD and the data pertaining to it.展开更多
Urinary incontinence markedly affects women’s quality of life. There are several methods to mitigate or reduce this problem such as medication, surgery, or exercises. Of various types of urinary incontinence, overact...Urinary incontinence markedly affects women’s quality of life. There are several methods to mitigate or reduce this problem such as medication, surgery, or exercises. Of various types of urinary incontinence, overactive bladder consists of one category, which is often resistant to various treatments. Electrical stimulation methods have been considered a treatment option of overactive bladder. We here briefly summarize various treatment options for urinary incontinence, with special reference to the role of electrical stimulation methods for this disease. Electrical stimulation methods include vaginal electrical stimulation (VES), posterior tibial nerve stimulation (PTNS) and sacral nerve stimulation (SNS). The three methods have shown good results, and these findings will contribute to achieving a better quality of life for patients.展开更多
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.
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.
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.
文摘This manuscript focused on the surgical challenge of urinary and sexual dysfunction after rectal cancer surgery based on the interesting results demonstrated by the observational study of Chen et al,which was published in the World Journal of Gastrointestinal Surgery.Urinary dysfunction occurs in one-third of patients treated for rectal cancer.Surgical nerve damage is the main cause of urinary dysfunction.Radiotherapy seems to exacerbate sexual dysfunction.The role of Denonvilliers'fascia preservation vs resection when performing total mesorectal excision(TME),the impact of robotic and transanal TME,alternatives to open and laparoscopic TME,as well as intraoperative pelvic neuromonitoring are discussed in this report.In conclusion,exact knowledge of the highly complex pelvic neuroanatomy and the use of novel surgical techniques can lead to a reduction in urinary and sexual dysfunction after rectal cancer surgery.
文摘Inflammatory bowel disease(IBD)is an inflammatory disease of the gastrointestinal(GI)tract.It has financial and quality of life impact on patients.Although there has been a significant advancement in treatments,a considerable number of patients do not respond to it or have severe side effects.Therapeutic approaches such as electrical neuromodulation are being investigated to provide alternate options.Although bioelectric neuromodulation technology has evolved significantly in the last decade,sacral nerve stimulation(SNS)for fecal incontinence remains the only neuromodulation protocol commonly utilized use for GI disease.For IBD treatment,several electrical neuromodulation techniques have been studied,such as vagus NS,SNS,and tibial NS.Several animal and clinical experiments were conducted to study the effectiveness,with encouraging results.The precise underlying mechanisms of action for electrical neuromodulation are unclear,but this modality appears to be promising.Randomized control trials are required to investigate the efficacy of intrinsic processes.In this review,we will discuss the electrical modulation therapy for the IBD and the data pertaining to it.
文摘Urinary incontinence markedly affects women’s quality of life. There are several methods to mitigate or reduce this problem such as medication, surgery, or exercises. Of various types of urinary incontinence, overactive bladder consists of one category, which is often resistant to various treatments. Electrical stimulation methods have been considered a treatment option of overactive bladder. We here briefly summarize various treatment options for urinary incontinence, with special reference to the role of electrical stimulation methods for this disease. Electrical stimulation methods include vaginal electrical stimulation (VES), posterior tibial nerve stimulation (PTNS) and sacral nerve stimulation (SNS). The three methods have shown good results, and these findings will contribute to achieving a better quality of life for patients.
