Anterior intussusception descent during defecation is correlated with the severity of fecal incontinence in patients with rectoanal intussusception

Abstract Background Rectoanal intussusception (RAI) is a common finding on evacuation proctography in patients with defecation disorders. However, it remains unclear whether intussusception morphology affects the severity of fecal incontinence (FI). The aim of this study was to examine the effect of morphology during defecation on the severity of FI in patients with RAI. Methods We included 80 patients with FI who were diagnosed as having RAI on evacuation proctography. Various morphological parameters were measured, and the level of RAI was divided by the extent of descent onto (level I) or into (level II) the anal sphincter. FI symptoms were documented using the FI Severity Index (FISI). Results Twenty-eight patients had level I and 52 had level II RAI. The mean (range) FISI score was 24.0 (8–47). FISI scores tended to be significantly higher in level II than in level I [26.3 (10–47) vs. 21.8 (8–42); p = 0.05]. The mean anterior intussusception descent was significantly greater in level II than in level I [24.2 (9.2–39.5) vs. 17.7 (7.8–39.4) mm; p 
Source: Techniques in Coloproctology - Category: Surgery Source Type: research

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This study assessed the relationships between various pelvic floor abnormalities and anal sphincter function in patients with RI and FI.MethodsData for patients with RI, collected in a prospective pelvic floor database, were assessed retrospectively. All women with FI, without anal sphincter defect, were included. Data on anorectal physiology and evacuation proctography were analyzed.ResultsOf 397 patients with RI, 85, who had predominantly passive FI, met the inclusion criteria. Maximum resting pressure (MRP) was significantly lower in patients with rectoanal intussusception (RAI) than in those with rectorectal intussusce...
Source: International Journal of Colorectal Disease - Category: Gastroenterology Source Type: research
ConclusionsThe modified technique of bladder neck intussusception in laparoscopic radical prostatectomy prolongs the length of functional posterior urethra and is effective to improve postoperative early continence.
Source: International Urology and Nephrology - Category: Urology & Nephrology Source Type: research
ConclusionFailure of STARR to treat ODS, documented by persisting ODS symptoms, fecal urgency, or chronic pelvic pain, is often justified by the persistence or de novo onset of alteration of the anorectal anatomy at defecation. This occurs in about half of the patients, but in 40% of the cases who complained of incomplete emptying or incontinence, anatomical abnormalities were not recognized.
Source: International Journal of Colorectal Disease - Category: Gastroenterology Source Type: research
CONCLUSIONS: The STARR technique performed with a single stapler CPH34HV is safe, faster and less expensive than the STARR performed by a double PPH01. Besidas, with the parachute technique, it is possible to resect asymmetric prolapses. PMID: 30620165 [PubMed - as supplied by publisher]
Source: Minerva Chirurgica - Category: Surgery Tags: Minerva Chir Source Type: research
ConclusionsLVR for RAI produced adequate improvement of FI, and successful anatomical correction of RAI was confirmed by postoperative proctography. Postoperative increase in the rectal volume may have a positive effect on continence.
Source: Techniques in Coloproctology - Category: Surgery Source Type: research
AbstractMR defecography (MRD) is an alternative to conventional defecography (CD) which allows for dynamic visualisation of the pelvic floor. The aim of this study was to assess whether MRI features indicative of pelvic floor dysfunction correlated with patient-reported symptom severity. MR proctograms were matched to a prospectively-maintained functional database. Univariate and multivariate analyses were performed using pre-treatment questionnaire responses to the Birmingham Bowel, Bladder and Urinary Symptom Questionnaire (BBUSQ), Wexner Incontinence Score (WIS), and modified Obstructed Defecation Symptom (ODS) Score. 3...
Source: Updates in Surgery - Category: Surgery Source Type: research
Conclusion: Most surgeons involved in STARR operation with subsequent poor outcome do not rely on MR imaging. PMID: 29158730 [PubMed]
Source: Gastroenterology Research and Practice - Category: Gastroenterology Tags: Gastroenterol Res Pract Source Type: research
AbstractBackgroundIn recent years, stapled transanal resection (STARR) has been adopted worldwide with convincing short-term results. However, due to the high recurrence rate and some major complications after STARR, there is still controversy about when the procedure is indicated. The aim of this study was to assess the safety, efficacy and feasibility of STARR performed with a new dedicated device for tailored transanal stapled surgery.MethodsAll the consecutive patients affected by obstructed defecation syndrome (ODS) due to rectocele or/and rectal intussusception, who underwent STARR with the TST STARR-Plus stapler, we...
Source: Techniques in Coloproctology - Category: Surgery Source Type: research
AbstractPurpose of ReviewDefecatory dysfunction is infrequently considered a gynaecological problem. However, obstructed defecation (OD) more commonly affects women than men and is associated with pelvic floor dysfunction. Therefore, we set out to write a review from a urogynaecologists ’ prospective focusing on OD as it relates to the pelvic floor.Recent FindingsLiterature on this topic remains sparse and the studies tend to have a low sample size. It is clear that OD is associated with pelvic floor dysfunction including urinary incontinence and structural dysfunction; however, it is less clear which is the primary ...
Source: Current Obstetrics and Gynecology Reports - Category: OBGYN Source Type: research
ConclusionsThese data show that proctographic findings can help predict functional outcomes after LVMR. Presence of an enterocele and a vertical axis of the rectum at rest may be associated with a better resolution of symptoms.
Source: Techniques in Coloproctology - Category: Surgery Source Type: research
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