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Liedberg F, Hagberg O, Baseckas G, Brändstedt J, Kollberg P, Lind AK, Lydrup ML, Löfgren A, Stenzelius K, Sörenby A, Starck M. Anorectal dysfunction after radical cystectomy for bladder cancer. Scand J Urol 2022; 56:155-161. [PMID: 35019814 DOI: 10.1080/21681805.2021.2025423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Objective: To prospectively assess anorectal dysfunction using patient-reported outcomes using validated questionnaires, manovolumetry and endoanal ultrasound before and 12 months after RC.Patients and methods: From 2014 to 2019, we prospectively included 44 patients scheduled for RC. Preoperatively and 12 months after surgery, 41 patients filled in a low anterior resection syndrome score (LARS-score) to assess fecal incontinence, increased frequency, urgency and emptying difficulties and a St Mark's score to assess fecal incontinence in conjunction with manovolumetry and endoanal ultrasound examinations. Pre- and postoperative patient-reported anorectal dysfunction were assessed by LARS-score and St Marks's score. At the same time-points, anorectal function was evaluated by measuring mean anal resting and maximal squeeze pressures, volumes and pressures at first desire, urgency to defecate and maximum toleration during manovolumetry. Wilcoxon's signed rank test was used to compare pre- and postoperative outcomes by questionnaires.Results: Postoperatively 6/41 (15%) patients reported flatus incontinence assessed by the LARS-questionnaire, and correspondingly the St Mark's score increased postoperatively. The median anal resting pressure decreased from 57 mmHg preoperatively to 46 mmHg after RC, but without any postoperative anatomic defects detected by endoanal ultrasound. Volumes and pressures at first desire, urgency to defecate and maximum toleration during manovolumetry all increased after RC, indicating decreased postoperative rectal sensation, as rectal compliance was unaltered.Conclusions: Postoperative flatus incontinence is reported by one out of seven patients after RC, which corresponds to decreased anal resting pressures. The finding of decreased rectal sensation might also contribute to patient-reported symptoms and anorectal dysfunction after RC.
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Affiliation(s)
- Fredrik Liedberg
- Institution of Translational Medicine, Lund University, Malmö, Sweden.,Department of Urology, Skåne University Hospital, Malmö, Sweden
| | - Oskar Hagberg
- Institution of Translational Medicine, Lund University, Malmö, Sweden.,Regional Cancer Centre South, Region Skåne, Lund, Sweden
| | - Gediminas Baseckas
- Institution of Translational Medicine, Lund University, Malmö, Sweden.,Department of Urology, Skåne University Hospital, Malmö, Sweden
| | - Johan Brändstedt
- Institution of Translational Medicine, Lund University, Malmö, Sweden.,Department of Urology, Skåne University Hospital, Malmö, Sweden
| | - Petter Kollberg
- Institution of Translational Medicine, Lund University, Malmö, Sweden.,Department of Urology, Skåne University Hospital, Malmö, Sweden.,Department of Urology, Helsingborg County Hospital, Helsingborg, Sweden
| | - Anna-Karin Lind
- Institution of Translational Medicine, Lund University, Malmö, Sweden
| | - Marie-Louise Lydrup
- Department of Surgery, Skåne University Hospital, Malmö, Sweden.,Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Annica Löfgren
- Institution of Translational Medicine, Lund University, Malmö, Sweden
| | - Karin Stenzelius
- Institution of Translational Medicine, Lund University, Malmö, Sweden
| | - Anne Sörenby
- Institution of Translational Medicine, Lund University, Malmö, Sweden.,Department of Urology, Skåne University Hospital, Malmö, Sweden
| | - Marianne Starck
- Department of Surgery, Skåne University Hospital, Malmö, Sweden.,Department of Clinical Sciences, Lund University, Malmö, Sweden
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Sunde ML, Ricanek P, Øresland T, Jahnsen J, Naimy N, Færden AE. Determinants of optimal bowel function in ileal pouch-anal anastomosis - physiological differences contributing to pouch function. Scand J Gastroenterol 2018; 53:8-14. [PMID: 29043868 DOI: 10.1080/00365521.2017.1390601] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Variability in functional outcome after ileal-pouch anal anastomosis (IPAA) is to a large extent unexplained. The aim of this study was to perform multiple physiological and biochemical tests including an endoscopic examination with histology on IPAA patients with well and poorly functioning pouches to determine factors, or combinations thereof, contributing to functional outcome. METHODS All patients with ulcerative colitis undergoing restorative proctocolectomy between 2000 and 2013 (N = 108) were interviewed using a pouch functioning score. The best and worst functioning quartiles were invited to undergo examination with a barostat measuring pouch volume at preset variable distension pressures, and a pouch endoscopy. RESULTS Forty five of 58 eligible patients agreed to participate. The most significant physiological parameter differing between the well and poorly functioning pouches was pouch volume at first sensation, urge and discomfort (p value <.001). Urge volumes were 213 (CI 171-256) ml for poorly and 352 (CI 305-401) ml for well functioning pouches. Pouchitis episodes were negatively correlated to function. The poorly functioning patients had a higher prevalence of histological signs of inflammation and hand-sewn anastomosis, and a longer remaining rectal cuff, however, nonsignificant. The pouch pressure at sensation thresholds did not differ between the groups. CONCLUSIONS Pouch volume is the most dominant predictor of pouch function in this study. The present comprehensive study of a multitude of different factors that possibly could be contributing to functional outcome, failed to shed much further light on the functional variability among pouch patients. The pouch physiology remains to a large extent unexplained.
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Affiliation(s)
- Marie Louise Sunde
- a Department of Colorectal Surgery , Akershus University Hospital , Lørenskog , Norway.,b Division of Surgical Sciences, Faculty of Medicine , University of Oslo , Oslo , Norway
| | - Petr Ricanek
- c Department of Gastroenterology , Akershus University Hospital , Lørenskog , Norway
| | - Tom Øresland
- a Department of Colorectal Surgery , Akershus University Hospital , Lørenskog , Norway.,b Division of Surgical Sciences, Faculty of Medicine , University of Oslo , Oslo , Norway
| | - Jørgen Jahnsen
- c Department of Gastroenterology , Akershus University Hospital , Lørenskog , Norway.,d Division of Medicine and Laboratory Sciences, Faculty of Medicine , University of Oslo , Oslo , Norway
| | - Nazir Naimy
- a Department of Colorectal Surgery , Akershus University Hospital , Lørenskog , Norway
| | - Arne Engebreth Færden
- a Department of Colorectal Surgery , Akershus University Hospital , Lørenskog , Norway
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