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Oruc M, Erol T. Current diagnostic tools and treatment modalities for rectal prolapse. World J Clin Cases 2023; 11:3680-3693. [PMID: 37383136 PMCID: PMC10294152 DOI: 10.12998/wjcc.v11.i16.3680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 03/31/2023] [Accepted: 04/25/2023] [Indexed: 06/02/2023] Open
Abstract
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.
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Affiliation(s)
- Mustafa Oruc
- Department of General Surgery, Hacettepe University School of Medicine, Ankara 06100, Turkey
| | - Timucin Erol
- Department of General Surgery, Hacettepe University School of Medicine, Ankara 06100, Turkey
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2
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Keller DS, Grimes CL. Pelvic Organ and Rectal Prolapse: Developing Common Terminology and Physical Exam Pearls. SEMINARS IN COLON AND RECTAL SURGERY 2022. [DOI: 10.1016/j.scrs.2022.100934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Soare C, Lasithiotakis K, Dearden H, Singh S, McNaught C. The Surgical Management of Rectal Prolapse. Indian J Surg 2021. [DOI: 10.1007/s12262-019-02058-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Kwakye G, Maguire LH. Anorectal Physiology Testing for Prolapse-What Tests are Necessary? Clin Colon Rectal Surg 2020; 34:15-21. [PMID: 33536845 DOI: 10.1055/s-0040-1714246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Rectal prolapse frequently occurs in conjunction with functional and anatomic abnormalities of the bowel and pelvic floor. Prolapse surgery should have as its goal not only to correct the prolapse, but also to improve function to the greatest extent possible. Careful history-taking and physical exam continue to be the surgeon's best tools to put rectal prolapse in its functional context. Physiologic testing augments this and informs surgical decision-making. Defecography can identify concomitant middle compartment prolapse and pelvic floor hernias, potentially targeting patients for urogynecologic consultation or combined repair. Other tests, including manometry, ultrasound, and electrophysiologic testing, may be of utility in select cases. Here, we provide an overview of available testing options and their individual utility in rectal prolapse.
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Affiliation(s)
- Gifty Kwakye
- Division of Colorectal Surgery, University of Michigan, Ann Arbor, Michigan
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Gallo G, Martellucci J, Pellino G, Ghiselli R, Infantino A, Pucciani F, Trompetto M. Consensus Statement of the Italian Society of Colorectal Surgery (SICCR): management and treatment of complete rectal prolapse. Tech Coloproctol 2018; 22:919-931. [PMID: 30554284 DOI: 10.1007/s10151-018-1908-9] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 12/09/2018] [Indexed: 12/15/2022]
Abstract
Rectal prolapse, rectal procidentia, "complete" prolapse or "third-degree" prolapse is the full-thickness prolapse of the rectal wall through the anal canal and has a significant impact on quality of life. The incidence of rectal prolapse has been estimated to be approximately 2.5 per 100,000 inhabitants with a clear predominance among elderly women. The aim of this consensus statement was to provide evidence-based data to allow an individualized and appropriate management and treatment of complete rectal prolapse. The strategy used to search for evidence was based on application of electronic sources such as MEDLINE, PubMed, Cochrane Review Library, CINAHL and EMBASE. The recommendations were defined and graded based on the current levels of evidence and in accordance with the criteria adopted by the American College of Gastroenterology's Chronic Constipation Task Force. Five evidence levels were defined. The recommendations were graded A, B, and C.
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Affiliation(s)
- G Gallo
- Department of Colorectal Surgery, Santa Rita Clinic, Vercelli, Italy.,Department of Surgical and Medical Sciences, University "Magna Graecia" of Catanzaro, Catanzaro, Italy
| | - J Martellucci
- Department of General, Emergency and Minimally Invasive Surgery, Careggi University Hospital, Florence, Italy
| | - G Pellino
- Department of Medical, Surgical, Neurological, Metabolic and Ageing Sciences, Unit of General Surgery, Università della Campania "Luigi Vanvitelli", Naples, Italy.,Colorectal Unit, Hospital Universitario y Politecnico La Fe, University of Valencia, Valencia, Spain
| | - R Ghiselli
- Department of General Surgery, Università Politecnica delle Marche, Ancona, Italy
| | - A Infantino
- Department of Surgery, Santa Maria dei Battuti Hospital, San Vito al Tagliamento, Pordenone, Italy
| | - F Pucciani
- Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
| | - M Trompetto
- Department of Colorectal Surgery, Santa Rita Clinic, Vercelli, Italy.
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Saraidaridis JT, Molina G, Savit LR, Milch H, Mei T, Chin S, Kuo J, Bordeianou L. Pudendal nerve terminal motor latency testing does not provide useful information in guiding therapy for fecal incontinence. Int J Colorectal Dis 2018; 33:305-310. [PMID: 29330765 DOI: 10.1007/s00384-017-2959-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/31/2017] [Indexed: 02/04/2023]
Abstract
PURPOSE Pudendal nerve terminal motor latency (PNTML) testing is a standard recommendation for the evaluation of fecal incontinence. Its role in guiding therapy for fecal incontinence has been previously questioned. The aim of this study was to evaluate the relationship between PNTML testing and anorectal dysfunction. METHODS This was a retrospective analysis of data collected prospectively from patients who presented to a pelvic floor disorder center from 2007 to 2015. The relationship between PNTML (normal versus delayed) and anorectal manometry, fecal incontinence severity, and fecal incontinence-related quality of life scores was assessed using the Wilcoxon-Mann-Whitney test. RESULTS Two hundred sixty-nine patients underwent PNTML testing, and 91.1% were female (N = 245) (median age 62.2 years). Normal PNTML was seen in 234 (87.0%) patients. Among 268 patients who underwent anorectal manometry, delayed PNTML was only significantly associated with median maximum anal squeeze pressure (P = 0.04). Delayed PNTML was not associated with a decrease in median fecal incontinence severity or fecal incontinence-related quality of life scores (N = 99). CONCLUSIONS PNTML was only associated with median maximum anal squeeze pressure, and it was not associated with patient-reported severity of symptoms of fecal incontinence, changes in quality of life attributable to fecal incontinence, median mean resting anal pressure, or median maximum resting anal pressure. PNTML testing may not be relevant to current therapeutic algorithms for fecal incontinence and its routine use should be questioned.
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Affiliation(s)
- Julia T Saraidaridis
- Department of Colon and Rectal Surgery, Lahey Clinic, Burlington, MA, USA. .,Colorectal Surgery Program and the Center for Pelvic Floor Disorders, Massachusetts General Hospital, Boston, MA, USA.
| | - George Molina
- Colorectal Surgery Program and the Center for Pelvic Floor Disorders, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Lieba R Savit
- Colorectal Surgery Program and the Center for Pelvic Floor Disorders, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Holly Milch
- Colorectal Surgery Program and the Center for Pelvic Floor Disorders, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Tiffany Mei
- Colorectal Surgery Program and the Center for Pelvic Floor Disorders, Massachusetts General Hospital, Boston, MA, USA.,Brandeis University, Waltham, MA, USA
| | - Samantha Chin
- Colorectal Surgery Program and the Center for Pelvic Floor Disorders, Massachusetts General Hospital, Boston, MA, USA.,Brandeis University, Waltham, MA, USA
| | - James Kuo
- Colorectal Surgery Program and the Center for Pelvic Floor Disorders, Massachusetts General Hospital, Boston, MA, USA.,Brandeis University, Waltham, MA, USA
| | - Liliana Bordeianou
- Colorectal Surgery Program and the Center for Pelvic Floor Disorders, Massachusetts General Hospital, Boston, MA, USA.,Brandeis University, Waltham, MA, USA
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8
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Thiruppathy K, Mason J, Akbari K, Raeburn A, Emmanuel A. Physiological study of the anorectal reflex in patients with functional anorectal and defecation disorders. J Dig Dis 2017; 18:222-228. [PMID: 28261913 DOI: 10.1111/1751-2980.12462] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 02/28/2017] [Accepted: 02/28/2017] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Fecal incontinence (FI) and constipation can arise from a variety of alterations of anorectal function. This study aimed to investigate the components of the anorecal reflex in patients with these symptoms and to determine the functional significance of various physiological parameters. METHODS Altogether 21 healthy volunteers (controls) and 78 FI-predominant and 74 constipation-predominant patients were recruited and administered Wexner incontinence and constipation questionnaires. All participants underwent standardized anorectal physiology assessments. RESULTS Patients with passive FI had lower resting sphincter pressures than controls (38 cmH2 O vs 87 cmH2 O, P < 0.05), while those with urge FI had lower squeeze pressures than controls (37 cmH2 O vs 119 cmH2 O, P < 0.05). Patients with urge FI had lower maximal tolerable volumes (100 mL vs 166 mL, P < 0.05). Patients with slow-transit constipation had elevated rectal electrosensitivity thresholds compared with controls (31.4 mA vs 20.2 mA, P < 0.05), and rectal mucosal blood flow than patients with evacuation difficulty and controls (107 vs 162 flux units (FU) [evacuation difficulty] vs 169 FU [controls], P < 0.05). Only patients with passive FI were associated with reflex abnormalities (prolonged recovery phase (1.2 ms vs 0.5 ms, P < 0.05) and total duration of reflex (6.3 ms vs 4.3 ms, P < 0.05). CONCLUSIONS Anorectal motor, sensory and reflex abnormalities are seen in distinct patterns in patients with FI and constipation. This would suggest distinct physiological differences that may predict the potential for different neuromodulation treatment and behavioral modalities in these conditions.
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Affiliation(s)
- Kumaran Thiruppathy
- Department of Colorectal Surgery, Royal Berkshire Hospital, Reading, UK.,Gastrointestinal Physiology Unit, Department of Gastroenterology, University College Hospital, London, UK
| | - John Mason
- Department of Colorectal Surgery, Royal Berkshire Hospital, Reading, UK
| | - Khalid Akbari
- Department of Colorectal Surgery, Royal Berkshire Hospital, Reading, UK
| | - Amanda Raeburn
- Gastrointestinal Physiology Unit, Department of Gastroenterology, University College Hospital, London, UK
| | - Anton Emmanuel
- Gastrointestinal Physiology Unit, Department of Gastroenterology, University College Hospital, London, UK
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Abstract
Full-thickness rectal prolapse, or procidentia, is the passage of the full-thickness wall of the rectum beyond the anal sphincters. This condition results in pain and fecal incontinence which greatly impairs the quality of life of those afflicted. It is associated with several anatomic abnormalities, including decreased anal sphincter tone, levator muscle diastasis, and a deep anterior cul-de-sac. The diagnosis of rectal prolapse is made based on physical examination, although several other modalities are used to provide additional information about the patients' condition. While medical management of rectal prolapse can be effective in some cases, the mainstay of management of rectal prolapse is surgical correction.
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Affiliation(s)
- Jamie A Cannon
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama
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Pucciani F, Altomare DF, Dodi G, Falletto E, Frasson A, Giani I, Martellucci J, Naldini G, Piloni V, Sciaudone G, Bove A, Bocchini R, Bellini M, Alduini P, Battaglia E, Galeazzi F, Rossitti P, Usai Satta P. Diagnosis and treatment of faecal incontinence: Consensus statement of the Italian Society of Colorectal Surgery and the Italian Association of Hospital Gastroenterologists. Dig Liver Dis 2015; 47:628-45. [PMID: 25937624 DOI: 10.1016/j.dld.2015.03.028] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Revised: 03/08/2015] [Accepted: 03/28/2015] [Indexed: 02/06/2023]
Abstract
Faecal incontinence is a common and disturbing condition, which leads to impaired quality of life and huge social and economic costs. Although recent studies have identified novel diagnostic modalities and therapeutic options, the best diagnostic and therapeutic approach is not yet completely known and shared among experts in this field. The Italian Society of Colorectal Surgery and the Italian Association of Hospital Gastroenterologists selected a pool of experts to constitute a joint committee on the basis of their experience in treating pelvic floor disorders. The aim was to develop a position paper on the diagnostic and therapeutic aspects of faecal incontinence, to provide practical recommendations for a cost-effective diagnostic work-up and a tailored treatment strategy. The recommendations were defined and graded on the basis of levels of evidence in accordance with the criteria of the Oxford Centre for Evidence-Based Medicine, and were based on currently published scientific evidence. Each statement was drafted through constant communication and evaluation conducted both online and during face-to-face working meetings. A brief recommendation at the end of each paragraph allows clinicians to find concise responses to each diagnostic and therapeutic issue.
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Affiliation(s)
| | - Filippo Pucciani
- Department of Surgery and Translational Medicine, University of Florence, Italy.
| | | | - Giuseppe Dodi
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Italy
| | - Ezio Falletto
- I Division of Surgical Sciences, Città della Salute e della Scienza Hospital, University of Turin, Italy
| | - Alvise Frasson
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Italy
| | - Iacopo Giani
- Proctological and Perineal Surgical Unit, University Hospital of Pisa, Italy
| | - Jacopo Martellucci
- General, Emergency and Minimally Invasive Surgery, Careggi University Hospital, Florence, Italy
| | - Gabriele Naldini
- Proctological and Perineal Surgical Unit, University Hospital of Pisa, Italy
| | | | - Guido Sciaudone
- General and Geriatric Surgery Unit, School of Medicine, Second University of Naples, Italy
| | | | - Antonio Bove
- Gastroenterology and Endoscopy Unit, Department of Gastroenterology - AORN "A. Cardarelli", Naples, Italy
| | - Renato Bocchini
- Gastrointestinal Physiopathology, Gastroenterology Department, Malatesta Novello Private Hospital, Cesena, Italy
| | - Massimo Bellini
- Gastrointestinal Unit, Department of Gastroenterology, University of Pisa, Italy
| | - Pietro Alduini
- Digestive Endoscopy Unit, San Luca Hospital, Lucca, Italy
| | - Edda Battaglia
- Gastroenterology and Endoscopy Unit, Cardinal Massaia Hospital, Asti, Italy
| | | | - Piera Rossitti
- Gastroenterology Unit, S.M. della Misericordia University Hospital, Udine, Italy
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11
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Abstract
Rectal prolapse continues to be problematic for both patients and surgeons alike, in part because of increased recurrence rates despite several well-described operations. Patients should be aware that although the prolapse will resolve with operative therapy, functional results may continue to be problematic. This article describes the recommended evaluation, role of adjunctive testing, and outcomes associated with both perineal and abdominal approaches.
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Gill BC, Damaser MS, Vasavada SP, Goldman HB. Stress incontinence in the era of regenerative medicine: reviewing the importance of the pudendal nerve. J Urol 2013; 190:22-8. [PMID: 23376143 DOI: 10.1016/j.juro.2013.01.082] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2013] [Indexed: 10/27/2022]
Abstract
PURPOSE Regenerative medicine will likely facilitate improved stress urinary incontinence treatment via the restoration of its neurogenic, myogenic and structural etiologies. Understanding these pathophysiologies and how each can optimally benefit from cellular, molecular and minimally invasive therapies will become necessary. While stem cells in sphincteric deficiency dominate the regenerative urology literature, little has been published on pudendal nerve regeneration or other regenerative targets. We discuss regenerative therapies for pudendal nerve injury in stress urinary incontinence. MATERIALS AND METHODS A PubMed® search for pudendal nerve combined individually with regeneration, injury, electrophysiology, measurement and activity produced a combined but nonindependent 621 results. English language articles were reviewed by title for relevance, which identified a combined but nonindependent 68 articles. A subsequent Google Scholar™ search and a review of the references of the articles obtained aided in broadening the discussion. RESULTS Electrophysiological studies have associated pudendal nerve dysfunction with stress urinary incontinence clinically and assessed pudendal nerve regeneration functionally, while animal models have provided physiological insight. Stem cell treatment has improved continence clinically, and ex vivo sphincteric bulk and muscle function gains have been noted in the laboratory. Stem cells, neurotrophic factors and electrical stimulation have benefited pudendal nerve regeneration in animal models. CONCLUSIONS Most regenerative studies to date have focused on stem cells restoring sphincteric function and bulk but whether a sphincter denervated by pudendal nerve injury will benefit is unclear. Pudendal nerve regeneration appears possible through minimally invasive therapies that show significant clinical potential. Treating poor central control and coordination of the neuromuscular continence mechanism remains another challenge.
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Affiliation(s)
- Bradley C Gill
- Glickman Urological and Kidney Institute and Department of Biomedical Engineering, Cleveland Clinic, Cleveland, Ohio 44195, USA
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Anal vector volume analysis: an effective tool in the management of pelvic floor disorders. Tech Coloproctol 2010; 15:31-7. [DOI: 10.1007/s10151-010-0658-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2010] [Accepted: 10/20/2010] [Indexed: 10/18/2022]
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Affiliation(s)
- James S Wu
- Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic Foundation, Mayfield Heights, Ohio, USA
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Rectal prolapse, rectal intussusception, rectocele, solitary rectal ulcer syndrome, and enterocele. Gastroenterol Clin North Am 2008; 37:645-68, ix. [PMID: 18794001 DOI: 10.1016/j.gtc.2008.06.001] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Rectal prolapse is best diagnosed by physical examination and by having the patient strain as if to defecate; a laparoscopic rectopexy is the preferred treatment approach. Intussusception is more an epiphenomena than a defecatory disorder and should be managed conservatively. Solitary rectal ulcer syndrome is a consequence of chronic straining and therapy should be aimed at restoring a normal bowel habit with behavioral approaches including biofeedback therapy. Rectocele correction may be considered if it can be definitively established that it is a cause of defecation disorder and only after conservative measures have failed. An enterocele should only be operated when pain and heaviness are predominant symptoms and it is refractory to conservative therapy.
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Siproudhis L, Eléouet M, Rousselle A, El Alaoui M, Ropert A, Bretagne JF. Overt rectal prolapse and fecal incontinence. Dis Colon Rectum 2008; 51:1356-60. [PMID: 18546040 DOI: 10.1007/s10350-008-9353-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2007] [Revised: 12/20/2007] [Accepted: 01/21/2008] [Indexed: 02/08/2023]
Abstract
PURPOSE Rectal prolapse is frequently associated with fecal incontinence; however, the relationship is questionable. The study was designed to evaluate fecal incontinence in a large consecutive series of patients who suffered from rectal prolapse, focusing on both past history, anal physiology, and imaging. METHODS Eighty-eight consecutive patients who suffered from an overt rectal prolapse (72 women, 16 men; mean age, 51.1 +/- 19.5 years) as a main symptom were analyzed; 48 patients also experienced fecal incontinence compared with 40 without incontinence. Logistic regression analyses were performed. RESULTS The two groups of patients did not differ with respect to parity, weekly stool frequency, main duration of symptoms before referral, occurrence of dyschezia, and digital help to defecate. Patients with prolapse who were older than 45 years (odds ratio (OR), 4.51 (1.49-13.62); P = 0.007) and those with a past history of hemorrhoidectomy (OR, 9.05 (1.68-48.8); P = 0.01) were significantly more incontinent. Incontinent group showed frequent internal anal sphincter defect compared with the continent group (60 vs. 6.2 percent; P = 0.0018). CONCLUSIONS In patients with overt rectal prolapse, the occurrence of fecal incontinence needs special consideration for age and previous hemorrhoid surgery as causative factors. Anal weakness and sphincter defects are frequently observed.
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Glasgow SC, Birnbaum EH, Kodner IJ, Fleshman JW, Dietz DW. Recurrence and quality of life following perineal proctectomy for rectal prolapse. J Gastrointest Surg 2008; 12:1446-51. [PMID: 18516652 DOI: 10.1007/s11605-008-0531-x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2008] [Accepted: 04/14/2008] [Indexed: 01/31/2023]
Abstract
BACKGROUND Surgical outcome and quality of life (QOL) following perineal proctectomy for rectal prolapse remain poorly documented. METHODS From 1994 to 2004, patients with full-thickness rectal prolapse were treated exclusively with perineal proctectomy independent of age or comorbidities. Subjective patient assessments and recurrences were determined retrospectively from hospital and clinic records. Consenting patients completed the gastrointestinal quality of life index (GIQLI). RESULTS Perineal proctectomy was performed in 103 consecutive patients with a median age of 75 years (range 30-94). Most patients underwent concurrent levatorplasty (anterior 85.8%, posterior 67.9%). Durable results were obtained in all patients; the recurrence rate was 8.5% over a mean follow-up of 36 months. Preoperatively, 75.5% of patients reported fecal incontinence, and 32.1% had obstructed defecation. Incontinence significantly improved post-proctectomy (41.5%, p < 0.001), as did constipation (10.4%, p < 0.001). GIQLI respondents reported satisfaction following proctectomy with 63% scoring within one standard deviation of healthy controls. Patients with recurrent prolapse reported a lower QOL. Risk factors for recurrence included duration of prolapse, need for posterior levatorplasty, and prior anorectal surgery. CONCLUSIONS Perineal proctectomy provides significant relief from fecal incontinence and obstructive symptoms caused by rectal prolapse, with an acceptable recurrence rate and low morbidity.
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Affiliation(s)
- Sean C Glasgow
- Department of Surgery, Section of Colon and Rectal Surgery, Washington University School of Medicine, St. Louis, MO, USA
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Felt-Bersma RJF. Endoanal ultrasound in benign anorectal disorders: clinical relevance and possibilities. Expert Rev Gastroenterol Hepatol 2008; 2:587-606. [PMID: 19072406 DOI: 10.1586/17474124.2.4.587] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Endoanal ultrasound is a well-established technique used to evaluate benign anorectal disorders. The technique is easy to perform, has a short learning curve and causes very little discomfort. Reconstruction of 3D images is possible. The clinical indications for endoanal ultrasound in benign anorectal diseases are fecal incontinence and peri-anal fistula. Sphincter defects can be depicted with precision and correlate perfectly with surgical findings. Furthermore, an impression of sphincter atrophy can be established. With perianal fistula the tracts can be visualized. Introducing hydrogen peroxide via the external fistula opening improves imaging. Endoanal ultrasound and MRI have comparable results in diagnosing anorectal disorders.
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Affiliation(s)
- Richelle J F Felt-Bersma
- VU University Medical Center, Department of Gastroenterology and Hepatology, De Boelelaan 1117, 1081 HV, PO Box 7057, Amsterdam, The Netherlands.
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Glasgow SC, Birnbaum EH, Kodner IJ, Fleshman JW, Dietz DW. Preoperative anal manometry predicts continence after perineal proctectomy for rectal prolapse. Dis Colon Rectum 2006; 49:1052-8. [PMID: 16649117 DOI: 10.1007/s10350-006-0538-x] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE This study examines whether preoperative anal manometry and pudendal nerve terminal motor latency predict functional outcome after perineal proctectomy for rectal prolapse. METHODS All adult patients treated by perineal proctectomy for rectal prolapse from 1995 to 2004 were identified (N = 106). Forty-five patients underwent anal manometry and pudendal nerve terminal motor latency testing before proctectomy and they form the basis for this study. RESULTS Perineal proctectomy with levatoroplasty (anterior 88.9 percent; posterior 75.6 percent) was performed in all patients, with a mean resection length of 10.4 cm. Four patients (8.9 percent) developed recurrent prolapse during a 44-month mean follow-up. Preoperative resting and maximal squeeze pressures were 34.2 +/- 18.3 and 60.4 +/- 30.5 mmHg, respectively. Pudendal nerve terminal motor latency testing was prolonged or undetectable in 55.6 percent of patients. Grade 2 or 3 fecal incontinence was reported by 77.8 percent of patients before surgery, and one-third had obstructed defecation. The overall prevalence of incontinence (77.8 vs. 35.6 percent, P < 0.0001) and constipation (33.3 vs. 6.7 percent, P = 0.003) decreased significantly after proctectomy. Patients with preoperative squeeze pressures >60 mmHg (n = 19) had improved postoperative fecal continence relative to those with lower pressures (incontinence rate, 10 vs. 54 percent; P = 0.004), despite having similar degrees of preoperative incontinence. Abnormalities of pudendal nerve function and mean resting pressures were not predictive of postoperative incontinence. CONCLUSIONS Perineal proctectomy provides relief from rectal prolapse, with good intermediate term results. Preoperative anal manometry can predict fecal continence rates after proctectomy, because patients with maximal squeeze pressures >60 mmHg have significantly improved outcomes.
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Affiliation(s)
- Sean C Glasgow
- Department of Surgery, Section of Colon and Rectal Surgery, Washington University School of Medicine, St. Louis, Missouri 63110, USA
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21
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Abstract
The neurophysiological techniques currently available to evaluate anorectal disorders include concentric needle electromyography (EMG) of the external anal sphincter, anal nerve terminal motor latency (TML) measurement in response to transrectal electrical stimulation or sacral magnetic stimulation, motor evoked potentials (MEPs) of the anal sphincter to transcranial magnetic cortical stimulation, cortical recording of somatosensory evoked potentials (SEPs) to anal nerve stimulation, quantification of electrical or thermal sensory thresholds (QSTs) within the anal canal, sacral anal reflex (SAR) latency measurement in response to pudendal nerve or perianal stimulation, and perianal recording of sympathetic skin responses (SSRs). In most cases, a comprehensive approach using several tests is helpful for diagnosis: needle EMG signs of sphincter denervation or prolonged TML give evidence for anal motor nerve lesion; SEP/QST or SSR abnormalities can suggest sensory or autonomic neuropathy; and in the absence of peripheral nerve disorder, MEPs, SEPs, SSRs, and SARs can assist in demonstrating and localizing spinal or supraspinal disease. Such techniques are complementary to other methods of investigation, such as pelvic floor imaging and anorectal manometry, to establish the diagnosis and guide therapeutic management of neurogenic anorectal disorders.
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Affiliation(s)
- Jean-Pascal Lefaucheur
- Service de Physiologie, Explorations Fonctionnelles, Centre Hospitalier Universitaire Henri Mondor, 51 Avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France.
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Staumont G. [Diagnosis and treatment of dyschezia]. GASTROENTEROLOGIE CLINIQUE ET BIOLOGIQUE 2006; 30:427-38. [PMID: 16633309 DOI: 10.1016/s0399-8320(06)73198-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
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23
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Cazemier M, Terra MP, Stoker J, de Lange-de Klerk ESM, Boeckxstaens GEE, Mulder CJJ, Felt-Bersma RJF. Atrophy and defects detection of the external anal sphincter: comparison between three-dimensional anal endosonography and endoanal magnetic resonance imaging. Dis Colon Rectum 2006; 49:20-7. [PMID: 16328609 DOI: 10.1007/s10350-005-0220-8] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE Using endoanal magnetic resonance imaging, atrophy of the external anal sphincter can be established. This aspect has not been thoroughly investigated using three-dimensional anal endosonography. The purpose of this study was to compare prospectively three-dimensional anal endosonography to magnetic resonance imaging in the detection of atrophy and defects of the external anal sphincter in patients with fecal incontinence. In addition, we compared both techniques for anal sphincter thickness and length measurements. MATERIALS AND METHODS Patients with fecal incontinence underwent three-dimensional anal endosonography and magnetic resonance imaging. Images of both endoluminal techniques were evaluated for atrophy and defects of the external anal sphincter. External anal sphincter atrophy scoring with three-dimensional anal endosonography depended on the distinction of the external anal sphincter and its reflectivity. External anal sphincter atrophy scoring with magnetic resonance imaging depended on the amount of muscle and the presence of fat replacement. Atrophy score was defined as none, moderate, and severe. A defect was defined at anal endosonography by a hypoechogenic zone and at magnetic resonance imaging as a discontinuity of the sphincteric ring and/or scar tissue. Differences between three-dimensional anal endosonography and magnetic resonance imaging for the detection of external anal sphincter atrophy and defects were calculated. In addition, we compared external anal sphincter thickness and length measurements in three-dimensional anal endosonography and magnetic resonance imaging. RESULTS Eighteen patients were included (median age, 58 years; range, 27-80; 15 women). Three-dimensional anal endosonography and magnetic resonance imaging did not significantly differ for the detection of external anal sphincter atrophy (P = 0.25) and defects (P = 0.38). Three-dimensional anal endosonography demonstrated atrophy in 16 patients, magnetic resonance imaging detected atrophy in 13 patients. Three-dimensional anal endosonography agreed with magnetic resonance imaging in 15 of 18 patients for the detection of external anal sphincter atrophy. Using the grading system, 8 of the 18 patients scored the same grade. Three-dimensional anal endosonography detected seven external anal sphincter defects and magnetic resonance imaging detected ten. Three-dimensional anal endosonography and magnetic resonance imaging agreed on the detection of external anal sphincter defects in 13 of 18 patients. Comparison between three-dimensional anal endosonography and magnetic resonance imaging for sphincter thickness and length measurements showed no statistically significant concordance and had no correlation with external anal sphincter atrophy. CONCLUSION This is the first study that shows that three-dimensional anal endosonography can be used for detecting external anal sphincter atrophy. Both endoanal techniques are comparable in detecting atrophy and defects of the external anal sphincter, although there is a substantial difference in grading of external anal sphincter atrophy. Correlation between three-dimensional anal endosonography and magnetic resonance imaging for thickness and length measurements is poor. Inconsistency between the two methods needs to be evaluated further.
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Affiliation(s)
- Marcel Cazemier
- Department of Gastroenterology and Hepatology, VU Medical Center, Amsterdam, The Netherlands.
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Abstract
Rectal prolapse or procidentia is a common condition with detrimental effects on continence and social function. One of the most devastating complications for patients suffering from this disorder is fecal incontinence. The psychologic trauma these patients experience can be debilitating. This article provides an overview of rectal procidentia, including a review of the symptomatic presentation, etiology, classification, diagnosis, and treatment.
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Affiliation(s)
- Elisa A Stein
- Division of Colon and Rectal Surgery, Department of Surgery, Drexel University College of Medicine, Philadelphia, PA 19102-1192, USA
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25
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Woods R, Voyvodic F, Schloithe AC, Sage MR, Wattchow DA. Anal sphincter tears in patients with rectal prolapse and faecal incontinence. Colorectal Dis 2003; 5:544-8. [PMID: 14617237 DOI: 10.1046/j.1463-1318.2003.00469.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Faecal incontinence often persists after surgery for rectal prolapse. Multiple mechanisms have been proposed as responsible, however, anal sphincter integrity has only been studied in a handful of cases. This study assesses the incidence of ultrasound detected anal sphincter tears in patients with rectal prolapse and faecal incontinence. METHODS Retrospective search of medical records at Flinders Medical Centre over a 7-year period to identify patients with full thickness rectal prolapse and faecal incontinence who had undergone endosonographical imaging of the anal sphincter complex. Anal manometry and pudendal nerve terminal motor latency studies were also included. RESULTS Twenty-one patients were identified (1 male, 20 female) of median age 67.5 years. Fifteen (71%) subjects had an abnormality in the anal sphincter complex on endoanal ultrasound. Of these, the defects in 4 (19%) patients were isolated to the internal sphincter, 3 (14%) to the external sphincter and in the remaining 8 (38%) subjects, defects were found in both internal and external sphincters. The degree of sphincteric defect was variable but at least 6 (29%) of the study group had full-length external sphincter tears. In the 19 patients studied, anal manometry revealed reduced basal and squeeze pressures in the majority. Delayed pudendal nerve terminal motor latency was evident in 9 of 18 patients studied. CONCLUSION Anal sphincter tears are common in patients presenting with rectal prolapse and faecal incontinence. The faecal incontinence associated with prolapse appears to be multifactorial in aetiology. Anal sphincter defects are likely to contribute to persistent faecal incontinence or recurrence following rectal prolapse. Endoanal ultrasound derived knowledge of anal sphincter injury may guide surgical management in problematic cases.
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Affiliation(s)
- R Woods
- Department of Surgery Division of Medical Imaging, Flinders Medical Centre, Bedford Park, South Australia, Australia
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26
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Abstract
This review describes the pathogenesis, diagnosis, preoperative testing, and surgical decision making involved in the management of full-thickness rectal protrusion in adults. Historic and current procedures are described in detail. No one procedure is favored over others, and selection depends on the individual characteristics of the patient.
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Affiliation(s)
- James S Wu
- Department of Colorectal Surgery, The Cleveland Clinic Foundation, A30, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
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Damon H, Henry L, Roman S, Barth X, Mion F. Influence of rectal prolapse on the asymmetry of the anal sphincter in patients with anal incontinence. BMC Gastroenterol 2003; 3:23. [PMID: 12925237 PMCID: PMC194588 DOI: 10.1186/1471-230x-3-23] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2003] [Accepted: 08/19/2003] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Anal sphincter defects have been shown to increase pressure asymmetry within the anal canal in patients with fecal incontinence. However, this correlation is far from perfect, and other factors may play a role. The goal of this study was to assess the impact of rectal prolapse on anal pressure asymmetry in patients with anal incontinence. METHODS 44 patients, (42 women, mean age: 64 (11) years), complaining of anal incontinence, underwent anal vector manometry, endo-anal ultrasonography (to assess sphincter defects) and pelvic viscerogram (for the diagnosis of rectal prolapse). Resting and squeeze anal pressures, and anal asymmetry index at rest and during voluntary squeeze were determined by vector manometry. RESULTS Ultrasonography identified 19 anal sphincter defects; there were 9 cases of overt rectal prolapse, and 14 other cases revealed by pelvic viscerogram (recto-anal intussuception). Patients with rectal prolapse had a significantly higher anal sphincter asymmetry index at rest, whether patients with anal sphincter defects were included in the analysis or not (30 (3) % versus 20 (2) %, p < 0.005). Among patients without rectal prolapse, a higher anal sphincter asymmetry index during squeezing was found in patients with anal sphincter defects (27 (2) % versus 19 (2) %, p < 0.03). CONCLUSIONS In anal incontinent patients, anal asymmetry index may be increased in case of anal sphincter defect and/or rectal prolapse. In the absence of anal sphincter defect at ultrasonogaphy, an increased anal asymmetry index at rest may point to the presence of a rectal prolapse.
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Affiliation(s)
- Henri Damon
- Fédération des Spécialités Digestives, Hôpital E. Herriot, 69437 Lyon cedex 03, France
| | - Luc Henry
- Fédération des Spécialités Digestives, Hôpital E. Herriot, 69437 Lyon cedex 03, France
| | - Sabine Roman
- Fédération des Spécialités Digestives, Hôpital E. Herriot, 69437 Lyon cedex 03, France
| | - Xavier Barth
- Urgences Viscérales, Hôpital E. Herriot, 69437 Lyon cedex 03, France
| | - François Mion
- Fédération des Spécialités Digestives, Hôpital E. Herriot, 69437 Lyon cedex 03, France
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Felt-Bersma RJ, Cuesta MA. Rectal prolapse, rectal intussusception, rectocele, and solitary rectal ulcer syndrome. Gastroenterol Clin North Am 2001; 30:199-222. [PMID: 11394031 DOI: 10.1016/s0889-8553(05)70174-6] [Citation(s) in RCA: 119] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Rectal prolapse can be diagnosed easily by having the patient strain as if to defecate. A laparoscopic rectopexy should be recommended. Intussusception is more an epiphenomenon than a cause of defecatory disorder and should be managed conservatively. Solitary rectal ulcer syndrome is a consequence of chronic straining, and therapy should include restoring a normal defecation habit. Rectocele should be left alone; an operation may be considered if it is larger than 3 cm and is causing profound symptoms despite maximizing medical therapy for the associated defecation disorder.
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Affiliation(s)
- R J Felt-Bersma
- Department of Gastroenterology, University Hospital Rotterdam Dijkzigt, The Netherlands
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Morren GL, Walter S, Lindehammar H, Hallböök O, Sjödahl R. Evaluation of the sacroanal motor pathway by magnetic and electric stimulation in patients with fecal incontinence. Dis Colon Rectum 2001; 44:167-72. [PMID: 11227931 DOI: 10.1007/bf02234288] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE The aim of this controlled study was to examine whether it was feasible to use magnetic stimulation as a new diagnostic tool to evaluate the motor function of the sacral roots and the pudendal nerves in patients with fecal incontinence. PATIENTS AND METHODS Nineteen consecutive patients (17 females) with a median age of 67 (range, 36-78) years referred for fecal incontinence and 14 healthy volunteers (six females) with a median age of 42 (range, 23-69) years were examined. Latency times of the motor response of the external anal sphincter were measured after electric transrectal stimulation of the pudendal nerve and magnetic stimulation of the sacral roots. RESULTS The success rates of pudendal nerve terminal motor latency and sacral root terminal motor latency measurements were 100 and 85 percent, respectively, in the control group and 94 and 81 percent, respectively, in the fecal incontinence group. Median left pudendal nerve terminal motor latency was 1.88 (range, 1.4-2.9) milliseconds in the control group and 2.3 (range, 1.8-4) milliseconds in the fecal incontinence group (P < 0.006). Median right pudendal nerve terminal motor latency was 1.7 (range, 1.3-3.4) milliseconds in the control group and 2.5 (range, 1.7-6) milliseconds in the fecal incontinence group (P < 0.003). Median left sacral root terminal motor latency was 3.3 (range, 2.1-6) milliseconds in the control group and 3.7 (range, 2.8-4.8) milliseconds in the fecal incontinence group (P < 0.03). Median right sacral root terminal motor latency was 3 (range, 2.6-5.8) milliseconds in the control group and 3.9 (range, 2.5-7.2) milliseconds in the fecal incontinence group (P = 0.15). CONCLUSIONS Combined pudendal nerve terminal motor latency and sacral root terminal motor latency measurements may allow us to study both proximal and distal pudendal nerve motor function in patients with fecal incontinence. Values of sacral root terminal motor latency have to be interpreted cautiously because of the uncertainty about the exact site of magnetic stimulation and the limited magnetic field strength.
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Affiliation(s)
- G L Morren
- Department of Colorectal Surgery, University Hospital Linköping, Sweden
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Abstract
PURPOSE For precise diagnosis and rational treatment of the increasing number of patients with descent of intrapelvic organ(s) and anatomic plane(s), dynamic contrast roentgenography of multiple intrapelvic organs and planes is described. METHODS Sixty-six patients, consisting of 11 males, with a mean age (+/- standard deviation) of 65.6+/-14.2 years and with chief complaints of intrapelvic organ and perineal descent or defecation problems, were examined in this study. Dynamic contrast roentgenography was obtained by opacifying the ileum, urinary bladder, vagina, rectum, and the perineum. Films were taken at both squeeze and strain phases. On the films the lowest points of each organ and plane were plotted, and the distances from the standard line drawn at the upper surface of the sacrum were measured. The values were corrected to percentages according to the height of the sacrococcygeal bone of each patient. From these corrected values, organ or plane descents at strain and squeeze were diagnosed and graphically demonstrated as a descentgram in each patient. RESULTS Among 17 cases with subjective symptoms of bladder descent, 9 cases (52.9 percent) showed roentgenographic descent. By the same token, among the cases with subjective feeling of descent of the vagina, uterus, peritoneum, perineum, rectum, and anus, roentgenographic descent was confirmed in 15 of 20 (75 percent), 7 of 9 (77.8 percent), 6 of 16 (37.5 percent), 33 of 33 (100 percent), 25 of 37 (67.6 percent), and 22 of 36 (61.6 percent), respectively. The descentgrams were divided into three patterns: anorectal descent type, female genital descent type, and total organ descent type. CONCLUSIONS Dynamic contrast roentgenography and successive descentgraphy of multiple intrapelvic organs and planes are useful for objective diagnosis and rational treatment of patients with descent disorders of the intrapelvic organ(s) and plane(s).
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Affiliation(s)
- M Takano
- Coloproctology Center, Takano Hospital, Kumamoto, Japan
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32
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Abstract
Rectal prolapse and fecal incontinence are problems with enormous social, functional, and economic significance to hundreds of thousands of people every year. Through a knowledgeable approach and careful diagnostic studies, many people can be cured or helped.
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Affiliation(s)
- D Nagle
- Department of Surgery, Allegheny Health Systems/Graduate Hospital, Philadelphia, Pennsylvania, USA
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Abstract
This article has addressed the value, technique, rationale, and limitations of the commonly performed physiologic tests of the pelvic floor. Urodynamics provides a means for evaluation of the lower urinary tract and for assessment of the filling and emptying phases of the bladder. Neurophysiologic tests including EMG and nerve conduction studies offer methods to assess the neuromuscular integrity of the urethral and anal sphincteric mechanisms and the pelvic floor. Anorectal manometry studies provide a means of measuring pressure in the rectum and anal canal, rectal compliance, and anorectal reflexes and sensation in patients with anal incontinence and select patients with constipation. Colonic transit studies permit an assessment of functional constipation and may be helpful in the evaluation of patients in whom standard management of constipation has failed. Any test used in the evaluation of patients with pelvic floor dysfunction should be validated and found to be reliable. Most patients in need of complex physiologic evaluation are identified on the basis of their history and physical examination findings.
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Affiliation(s)
- K W Coates
- Department of Obstetrics and Gynecology, Texas A&M University College of Medicine, Scott & White Clinic, Temple, USA
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Siproudhis L, Bellissant E, Juguet F, Mendler MH, Allain H, Bretagne JF, Gosselin M. Rectal adaptation to distension in patients with overt rectal prolapse. Br J Surg 1998; 85:1527-32. [PMID: 9823917 DOI: 10.1046/j.1365-2168.1998.00912.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND High recovery rates of continence are observed after surgical procedures for rectal prolapse. Increases in rectal compliance but no obvious rise in anal pressures have been reported. The authors' hypothesis was that decreased rectal adaptation to distension may contribute to incontinence in patients suffering from overt rectal prolapse. METHODS This was a prospective study conducted in 20 consecutive incontinent patients suffering from overt rectal prolapse with no mucosal change (two men and 18 women; mean(s.e.m.) age 50(3) years). They were compared with 20 age- and sex-matched patients with incontinence without rectal prolapse and ten age- and sex-matched healthy volunteers observed during the same period. The subjects were submitted to phasic isobaric distension of the rectum with an electronic barostat. Anal pressures, perception scores and rectal volumes were recorded at six different preselected pressures. RESULTS Compared with healthy subjects, maximum rectal volumes (mean(s.e.m) 98(6) versus 167(11) ml; P= 0.005), volumes related to compliance (56(5) versus 100(9) ml; P= 0.004) and tone (41(3) versus 67(4) ml; P = 0.003) were decreased significantly in the rectal prolapse group. Prolapse and incontinence groups did not differ significantly with respect to rectal adaptation for all three parameters and steps of distension considered. CONCLUSION Patients suffering from overt rectal prolapse had markedly impaired rectal adaptation to distension which may contribute to incontinence.
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Affiliation(s)
- L Siproudhis
- Gastroenterology, Unit, Pointeau du Ronceray, Hôpital Pontchaillou, Rennes, France
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Schultz I, Mellgren A, Nilsson BY, Dolk A, Holmström B. Preoperative electrophysiologic assessment cannot predict continence after rectopexy. Dis Colon Rectum 1998; 41:1392-8. [PMID: 9823805 DOI: 10.1007/bf02237055] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE The aim of this study was to evaluate preoperative electrophysiologic assessment for prediction of anal continence after rectopexy. METHODS Forty-three patients with rectal prolapse (n = 26) or internal rectal intussusception (n = 17) underwent concentric-needle electromyography, fiber density determination by single-fiber electromyography of the external anal sphincter, and pudendal nerve terminal motor latency evaluation before Ripstein rectopexy. A detailed history was obtained from each patient preoperatively and postoperatively. RESULTS Anal continence was improved after rectopexy, both in patients with rectal prolapse (P = 0.06) and in those with internal rectal intussusception (P = 0.003). Abnormal results were registered in one or several aspects of the electrophysiologic assessment in 31 (72 percent) of the patients. However, functional outcome with respect to continence was not predicted by preoperative electromyography or pudendal nerve terminal motor latency assessment results. CONCLUSION Electrophysiologic examinations in the preoperative assessment of patients with rectal prolapse and internal rectal intussusception do not predict continence after the Ripstein rectopexy. The routine use of electrophysiologic assessment requires further definition.
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Affiliation(s)
- I Schultz
- Department of Surgery, Karolinska Institute at Danderyd Hospital, Stockholm, Sweden
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Pescatori M. Anal continence after surgery for rectal prolapse. Dis Colon Rectum 1998; 41:405. [PMID: 9514443 DOI: 10.1007/bf02237503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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