Cause Of Outlet Obstruction Research Articles

Diagnóstico do anismus através dos exames de fisiologia anal

Dentre as causas de defecação obstruída, a disfunção do pubo-retal ou anismus é a mais frequente e o seu diagnóstico é feito com maior frequência através de eletromiografia , considerado como o melhor exame para o diagnóstico desta afecção. O objetivo deste trabalho é verificar a influência do anismus ou contração paradoxal do pubo-retal nos exames de fisiologia anal. Para este trabalho foram estudados 40 pacientes com diagnóstico de defecação obstruída e separados em dois grupos: com e sem anismus. Todos os pacientes foram submetidos aos exames de manometria, sensibilidade retal, eletromiografia, latência do nervo pudendo e proctografia com a finalidade de observar a influência da presença de anismus nos resultados de exames de fisiologia anal. Não observamos diferenças entre os dois grupos em relação aos exames realizados, exceto na eletromiografia que é considerada padrão ouro e no ângulo ano retal na proctografia em que nos pacientes com anismus foi significantemente menor. CONCLUSÃO: a presença de anismus interferiu nos resultados dos exames de fisiologia anal apenas na eletromiografia, considerado padrão ouro para esse diagnóstico.

A presença de retocele interfere nos resultados de exames de fisiologia anal?

INTRODUÇÃO: A retocele é causa comum de constipação por defecação obstruída. Freqüentemente está relacionada com outras causas de defecação obstruída, e os exames de fisiologia anal são importantes para o diagnóstico preciso da causa de constipação intestinal. OBJETIVO: observar a influência da retocele nos exames de fisiologia anal, e a necessidade da realização desses após o diagnóstico da retocele. MÉTODO: Para este trabalho foram estudados 40 pacientes com diagnóstico de defecação obstruída. Todos os pacientes foram submetidos aos exames de manometria, sensibilidade retal, eletromiografia, latência do nervo pudendo e proctografia, e foram separados em 2 grupos: portadores e não portadores de retocele . Foram encontrados 18 pacientes com retocele, e o diagnóstico mais freqüentemente associado foi o anismus . Em relação aos exames foi encontrada diferença significante apenas na proctografia no ângulo ano retal, demonstrando que a presença de retocele não interferiu nos resultados de exames de fisiologia anal quando comparados com outros constipados, mas esteve associada a outras causas de constipação, como anismus que necessita de outro tipo de tratamento. CONCLUSÃO: A retocele não interferiu nos valores dos exames de fisiologia anal, mas esteve associada a outros diagnósticos, sendo importante a realização dos mesmos.

Exaggerated rectal adaptation - another cause of outlet obstruction

Exaggerated rectal adaptation - another cause of outlet obstruction

Stapled transanal rectal resection (STARR): a new option in the treatment of obstructive defecation syndrome

Rectocele and distal intussusception are organic causes of outlet obstruction. A new surgical option called the stapled transanal rectal resection (STARR) is described within a prospective study. Fourteen patients with symptomatic rectocele (four females), rectocele with coexistent intussusception (eight females), and intussusception (two males) underwent STARR procedure. The symptoms were measured by means of a defecation score (0-20 points). Complications included local bleeding postoperatively in two cases, and temporary ischuria in four cases. The subjective sense of pain was low; from day 1 postoperatively five patients did not need any analgetics. Only one female patient had prolonged pelvic pain, without any organic reason. All patients showed improvement in rectal evacuation. The mean score of defecation (0-20 points) decreased from 13+/-3 to 4+/-3 after 1 month (p<0.05) and remained low. The overall follow-up was 19+/-9 months. Only one male patient with intussusception had defecation disorder again 6 months after surgery. Three patients had temporary urge incontinence. STARR is an effective therapy for obstructive defecation disorder due to a symptomatic rectocele and/or a distal intussusception.

Gastric outlet obstruction secondary to a large trichobezoar

A bezoar is an accumulation of indigestible exogenous matter in the stomach or intestine. Many different types of bezoars have been described, including phytobezoars, pharmacobezoars, and trichobezoars. A gastric trichobezoar consists of an accumulation of hair-usually the patient’s own-in the stomach. They can become very large, often with a btailQ extending into the patient’s duodenum (Rapunzel syndrome) which can cause small bowel obstruction, jaundice or even acute pancreatitis. Gastric trichobezoars are an unusual cause of outlet obstruction in the pediatric emergency department.

Exaggerated rectal adaptation — Another cause of outlet obstruction

Exaggerated rectal adaptation — Another cause of outlet obstruction

PROSTATISM: Benign Prostatic Hyperplasia

This article is devoted to the most common cause of outlet obstruction in the male geriatric population, benign prostate hyperplasia (BPH). The prevalence, pathophysiology, and natural history of BPH is discussed, along with the work-up and indications for medical or surgical intervention. The authors also focus on medical and surgical options now available for management of BPH.

Functional bladder neck obstruction in males: a progressive disorder?

Functional bladder neck obstruction is often an elusive cause of outlet obstruction in males. If the entity escapes timely diagnosis and treatment, it may progress to acute or chronic retention, terminating in renal failure. The diagnosis can be accurately made by a synchronous pressure flow electromyograph (EMG) study. This is a report on 16 men under 45 years of age encountered during the past 2.5 years. A high sustained detrusor pressure (mean 157 cm H2O) during voiding with poor flow (mean 9.89 ml/s) was observed in all patients. External sphincteric activity during EMG and video study was found to be completely quiescent at the time of voiding. All these patients had inadequate funneling and bladder neck opening. Some of these patients had intermittent bladder neck opening. Three patients presented with renal failure. Following therapy, renal function could be reversed back to normal in 2 patients. Clean intermittent catheterisation, pharmacotherapy using alpha-blockers and endoscopic bladder neck incision were the modalities used to treat this group of patients.