Incontinence Quality Of Life Scores Research Articles

Long-Term Efficacy and Safety of OnabotulinumtoxinA in Patients with Neurogenic Detrusor Overactivity Who Completed 4 Years of Treatment

We assessed the year-to-year consistency of outcomes in patients with urinary incontinence due to neurogenic detrusor overactivity who completed 4years of onabotulinumtoxinA treatment. Eligible patients who completed a 52-week phase 3 trial of onabotulinumtoxinA for urinary incontinence could enter a 3-year open label extension study of onabotulinumtoxinA 200 or 300 U administered as needed for symptom control. This analysis focused on 227 patients who completed the 4-year study. Outcomes assessed by year of treatment included mean treatments per year, mean change from baseline at week 6 in urinary incontinence episodes per day and the I-QOL (Incontinence Quality of Life) total summary score, the proportion of patients with 50% or greater and 100% reductions in urinary incontinence episodes per day, duration of effect and adverse events. Patients reported 4.3 urinary incontinence episodes per day at baseline and received 1.4 to 1.5 onabotulinumtoxinA treatments per year. The decrease in urinary incontinence following onabotulinumtoxinA consistently ranged from -3.4 to -3.9 episodes per day across 4 years. A high proportion of patients achieved 50% or greater and 100% urinary incontinence reductions in each year (range 86.6% to 94.1% and 43.6% to 57.4%, respectively). Consistent and clinically relevant improvements in I-QOL scores were observed in each treatment year. The overall median duration of effect of onabotulinumtoxinA was 9.0months or greater (range 3.0 to 49.2) and 26.0% or more of patients experienced a duration of effect of 12 months or greater. The most common adverse event was urinary tract infection with no increased incidence with time. Patients with neurogenic detrusor overactivity who completed 4 years of onabotulinumtoxinA treatment experienced a consistent duration of treatment effect and year-to-year improvements in urinary incontinence and quality of life with no new safety signals.

Quality of Life Differences in Female and Male Patients with Fecal Incontinence.

Background/AimsTo explore and compare quality of life (QoL) differences in female and male patients with fecal incontinence.MethodsNinety-one patients with fecal incontinence (60 women, mean (SD) age 64.13 (9.72) years; 31 men, mean (SD) age 63.61 (13.33) years) were assessed for pathophysiology (anorectal manometry and ultrasound), clinical severity (Wexner and Vaizey scales), QoL (Fecal Incontinence Quality of Life Score [FIQL]) and health status (EQ-5D).ResultsExternal and internal anal sphincter impairment rates were 96.5% and 70.2%, respectively, in women, compared to 30% and 43.3% respectively in men (P < 0.05). Clinical severity was similar in both sexes, with mean (SD) Wexner scores of 10.95 (4.35) for women and 9.81 (4.30) for men, and mean (SD) Vaizey scores of 13.27 (4.66) for women and 11.90 (5.22) for men. Scores for women were significantly lower for all FIQL depression and coping subscales (P < 0.001) and the EQ-5D depression subscale (P < 0.01). EQ-5D index was 0.687 (0.20) for women and 0.835 (0.15) for men (P < 0.001). QoL was negatively affected by female gender (−1.336), anxiety/depression (−1.324) and clinical severity (−0.302), whereas age had a positive impact (0.055 per year) (P < 0.01).ConclusionsThe pathophysiology of fecal incontinence differed between the sexes. For similar severity scores, impact on QoL was higher in women. Gender had the highest impact on QoL compared to other factors. QoL measurements should be part of assessment and treatment protocols.

Effect of Coexisting Pelvic Floor Disorders on Fecal Incontinence Quality of Life Scores: A Prospective, Survey-Based Study.

The association between an objective measure of fecal incontinence severity and patient-reported quality of life is poorly understood. The purpose of this study was to evaluate patients with various degrees of fecal incontinence to determine whether their quality of life as measured by the Fecal Incontinence Quality of Life Scale is affected by coexisting pelvic floor disorders. This was a prospective, survey-based study. The study was conducted at a tertiary pelvic floor disorders center. Included patients were all of those presenting between January 2007 and March 2014. Survey data were analyzed to determine the association between Fecal Incontinence Severity Index and Fecal Incontinence Quality of Life Scale, as well as scores from the Constipation Severity Instrument, Pelvic Floor Impact Questionnaire, Pelvic Organ Distress Inventory, and Urinary Distress Inventory. A total of 585 patients reported fecal incontinence ranging from none (n = 191) to mild/moderate (n = 159) to severe (n = 235). As expected, patients with severe fecal incontinence have worse scores on all fecal incontinence quality-of-life subscales (lifestyle, coping/behavior, depression/self-perception, and embarrassment) and worse colorectal/anal symptoms than those with mild/moderate or no fecal incontinence (p < 0.0001). Patients with severe fecal incontinence also have worse bladder/urinary symptoms (p ≤ 0.0001). Pelvic organ prolapse and constipation symptoms were similar between groups (p ≥ 0.61). After correcting for baseline differences in patient comorbidities and bladder/urinary symptoms, a significant association persisted between Fecal Incontinence Severity Index and all of the subscales of the fecal incontinence quality-of-life instrument (p < 0.0001). However, urinary distress scores also remained significantly associated with all of the fecal incontinence quality-of-life subscales except for embarrassment after risk adjustment (p < 0.01). Nongeneral population and a lack of patient data on previous medical management of fecal incontinence were limitations of this study. The Fecal Incontinence Quality of Life Scale correlates strongly with instruments measuring both fecal and urinary incontinence. This underscores the importance of quantifying the presence or absence of coexistent urinary leakage in studies where a drop in fecal incontinence quality of life is considered a primary end point.

Quality of life related to urinary continence in adult spina bifida patients.

IntroductionTo analyze the correlations of bladder management technique, ambulatory status and urologic reconstruction on quality of life (QOL) as affected by urinary symptoms in adult spina bifida (SB) patients.Material and methodsSixty–six adult SB patients completed the RAND 36–Item Health Survey (mSF–36) and Incontinence Quality of Life (I–QOL). Demographic information, history of urinary reconstruction, and bladder management techniques were reviewed and analyzed with respect to survey scores.ResultsMean age of patients was 32.3 (SD ±7.2) years and 44 patients (66.7%) were female. Forty–five patients (68.2%) were mainly ambulatory, 21 (31.8%) use a wheelchair and 10 (15.2%) had urologic reconstruction, while 56 (83.3%) did not. Twelve patients (18.2%) void, 42 (63.6%) perform clean intermittent catheterization (CIC), 4 (6.1%) use an indwelling catheter, 3 (4.5%) have an ileal conduit (IC) and 5 (7.6%) mainly use diapers. Mean mSF–36 General Health score was 56.5 (SD ±22.9) and mean I–QOL Sum score was 50.9 (SD ±21.7), where lower scores reflect lower QOL. mSF–36 and I–QOL scores did not significantly correlate with bladder management technique, ambulatory status or urologic reconstruction. A correlation was noted between I–QOL scales and most mSF–36 scales (all p <0.02).ConclusionsIn our cohort study of adult SB patients, bladder management technique and urologic reconstruction did not correlate with urinary (I–QOL) or general health (mSF–36) domains, although I–QOL and mSF–36 scores correlated closely, suggesting urinary continence is significantly related to general QOL. However, we are unable to identify a single factor that improves either urinary or general QOL.

Magnetic anal sphincter augmentation in patients with severe fecal incontinence.

Fecal incontinence is a common, distressing condition with limited surgical options. This study examines the results of magnetic sphincter augmentation in patients with severe fecal incontinence. This was a single-center, prospective, nonrandomized investigation. This study was conducted in a private colorectal practice. The cohort included all of the patients implanted with magnetic sphincter augmentation between January 2012 and October 2013. Magnetic sphincter augmentation was studied. Adverse events, symptom severity, quality of life, bowel diary, and manometry data were collected. Eighteen patients (15 women), with mean age of 69 years (range, 31-91 years), were implanted with magnetic sphincter augmentation. Follow-up ranged from 353 to 738 days. Previous treatment consisted of peripheral nerve evaluation test in 10 patients (56%), 2 patients (11%) with previous permanent sacral nerve stimulation, and 1 patient (6%) with previous implantation of an artificial bowel sphincter. Implantation was successful in 17 (94%) of 18 patients. Five patients (29%) had postoperative pain, and 5 patients (29%) had temporary swelling and erythema in both gluteal regions after the implantation. No devices were explanted during the follow-up. Cleveland Clinic Incontinence Score decreased from a mean of 17.5 (range, 14.0-20.0) to 7.3 (range, 0-12.0), and Fecal Incontinence Quality of Life scores improved in all of the domains. Bowel diary results showed that 76% of the patients with implants experienced a ≥50% reduction in the number of fecal incontinence episodes per week. Manometry at 6 months after implantation showed increased mean resting and squeeze pressures. This study does not allow for comparison between surgical treatments and involves a limited number of patients. Magnetic sphincter augmentation shows consistent results for the treatment of severe fecal incontinence in this patient group. The surgical procedure is straightforward as compared with other implantable devices. The safety profile is acceptable. Magnetic sphincter augmentation is a promising new treatment with the potential to become a first-line surgical therapy for patients with severe fecal incontinence.

The Effect of Education on Quality of Life in Elderly Females with Urinary Incontinence, Refereeing to Jahandidegan Center in Shiraz-Iran, 2011

Background: Urinary incontinence is a common problem in elderly females. It seems to have negative effects on different aspects of the patients’ life. Objective: To determine the effect of instruction on quality of life of the elderly females with urinary incontinence, who referred to Jahandidegan center in Shiraz-Iran, 2011. Material and methods: A preliminary study was conducted to validate the Modified QUID (Questionnaire for Urinary Incontinence Diagnosis) questionnaire for Iranian elderly. The QUID questionnaire was primarily administrated. The subjects consisted of 60 women aged 60-74 years with QUID questionnaire’s scores for different types of incontinence (stress score ≥ 4, urge score ≥ 6 and mix score ≥ 10). They completed the I-QOL (incontinence Quality of Life) questionnaire according to incontinence types. 10 subjects from each type were placed in two groups of 30 each (experimental and control groups). 10 training sessions on aging, changes related to aging in different system of the body, function of genitourinary system, urinary incontinence, risk factor and treatment (behavioral intervention, stress management, bladder training, scheduled toileting, pelvic muscle exercises, nutrition and fluid management) were held weekly for the experimental group. After the completion of the sessions I-QOL questionnaire was completed by the experimental group and after 2 and 3 months it was completed by the experimental and control groups. Descriptive statistics, paired t-Test and repeated measurement were used to analyze the data. Results: The I-QOL score of the participants attending the training sessions was significantly higher than that of the subjects in the control group (P=0.014). Conclusion: Based on our findings, training has a positive effect on QOL of females with urinary incontinence. Thus, it is suggested that the health care providers pay more attention to this issue and use health care centers to train women regarding the prevention of urinary incontinence.

Hemorrhoidal dearterialization with mucopexy versus hemorrhoidectomy: 3-year follow-up assessment of a randomized controlled trial

Background A randomized controlled trial showed that patients with grade III or IV internal hemorrhoids had similar symptomatic relief of symptoms up to 3 months following dearterialization with mucopexy or hemorrhoidectomy albeit with less postoperative pain after the former. This study aimed to compare hemorrhoidal recurrence and chronic complications at 3-year follow-up.MethodsThis study was carried out on 40 patients with grade III or IV internal hemorrhoids previously enrolled to a randomized trial comparing dearterialization to hemorrhoidectomy. Recurrence was defined as internal hemorrhoids diagnosed on proctoscopy. Chronic complications were nonresolving adverse events related to surgery. Outcome measures included patient-reported outcomes and quality of life measured by brief pain inventory (BPI), SF-12, and fecal incontinence surveys.ResultsAt median follow-up of 36 (27–43) months, 13 patients (32.5 %) were lost to follow-up. Patient-reported outcomes suggested no difference between dearterialization and hemorrhoidectomy in persistent symptoms, occurring in 1 (8.3 %) vs. 2 (13.3 %) patients (p = 0.681) and in symptom recurrence, occurring in 6 (50 %) vs. 4 (26.7 %) patients (p = 0.212). On proctoscopy, recurrence was seen in 2 (13.3 %) vs. 1 (6.7 %) patients (p = 0.411), all with index grade IV disease. One patient in each arm required reoperation (p = 0.869). Chronic complications were not seen in the dearterialization arm while they occurred in 2 (13.3 %) hemorrhoidectomy patients (p = 0.189) and included unhealed wound (n = 1), anal fissure (n = 1) and fecal incontinence (n = 1). There was a trend toward more patient reported than actual recurrence on proctoscopy (10 vs. 3, p = 0.259). There was no difference in BPI, SF-12, and fecal incontinence quality of life scores.ConclusionsRecurrence rates did not differ significantly at 3-year follow-up and occurred in patients with index grade IV hemorrhoids. Chronic complications occurred only after hemorrhoidectomy.

Mapping of incontinence quality of life (I-QOL) scores to assessment of quality of life 8D (AQoL-8D) utilities in patients with idiopathic overactive bladder.

BackgroundThe Incontinence Quality of Life (I-QOL) questionnaire is a commonly used and validated incontinence specific QOL instrument. The objective of this study is to develop an algorithm to map I-QOL to the Assessment of Quality of Life (AQoL) 8D utility instrument in patients with idiopathic overactive bladder (iOAB).MethodsI-QOL and AQoL-8D scores were collected in a survey of 177 Australian adults with urinary incontinence due to iOAB. Three statistical methods were used for estimation, namely ordinary least squares (OLS) regression, the robust MM-estimator, and the generalised linear models (GLM). Each included a range of explanatory variables. Model performance was assessed using key goodness-of-fit measures in the validation dataset.ResultsThe I-QOL total score and AQoL-8D utility scores were positively correlated (r = 0.50, p < 0.0001). Similarly, the three sub-scales of the I-QOL were correlated with the eight dimensions and two super-dimensions of the AQoL-8D. The GLM estimator, with I-QOL total score as the explanatory variable exhibited the best precision (MAE = 0.15 and RMSE = 0.18) with a mapping function given by AQoL-8D = exp(−1.28666 + 1.011072*I-QOL/100).ConclusionsThe mapping algorithm developed in this study allows the derivation of AQoL-8D utilities from I-QOL scores. The algorithm allows the calculation of preference-based QOL scores for use in cost-utility analyses to assess the impact of interventions in urinary incontinence.Electronic supplementary materialThe online version of this article (doi:10.1186/s12955-014-0133-0) contains supplementary material, which is available to authorized users.

Effect on anal pressure of percutaneous posterior tibial nerve stimulation for faecal incontinence

Previous studies on percutaneous posterior tibial nerve stimulation (PTNS) for faecal incontinence do not report anal pressure changes. In the present study the effect of percutaneous PTNS on anal manometry was determined. This was a prospective observational study of patients with faecal incontinence. They underwent one 30-min session of PTNS weekly for 12 consecutive weeks. Patients who showed improvement were given six more sessions at 2-weekly intervals. Anal manometry was performed before and after treatment. Clinical data including the Wexner score, psychological testing, quality of life using the Fecal Incontinence Quality of Life Score and the contents of a continence diary were recorded before and after the procedure. Twenty-four patients were included in the study of whom 17 (70.83%) demonstrated some degree of clinical or manometric improvement at 3 months. Before treatment 18 patients had urgency of <1 min. At 3 and 6 months this had risen to 5 min in 62.5% and 70.83% (P < 0.001). The anal resting pressure increased from 21.7 to 37.6 mmHg (P = 0.021), the maximum squeeze pressure from 58.2 to 72.2 mmHg (P = 0.045) and the Wexner score fell from 15 to 10 (P = 0.018) at 6 months. Predictive factors for a response included fewer than three incontinent episodes per week (P = 0.027). Negative predictive factors included episiotomy and an initial Wexner score of > 12 (P = 0.035). Percutaneous PTNS was effective in over 70% of patients in the present study with improvements in urgency, anal pressures and Wexner score.

MP38-06 TRANSURETHRAL RADIOFREQUENCY COLLAGEN DENATURATION IN THE TREATMENT OF MILD TO MODERATE FEMALE STRESS URINARY INCONTINENCE: TWELVE-MONTH INTERIM ANALYSIS

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Incontinence Therapy II1 Apr 2014MP38-06 TRANSURETHRAL RADIOFREQUENCY COLLAGEN DENATURATION IN THE TREATMENT OF MILD TO MODERATE FEMALE STRESS URINARY INCONTINENCE: TWELVE-MONTH INTERIM ANALYSIS James Lukban, Peter Takacs, Monisha Crisell, Douglas Van Drie, Denise Elser, Phillip Bressman, Royce Adkins, and Randall Kahan James LukbanJames Lukban More articles by this author , Peter TakacsPeter Takacs More articles by this author , Monisha CrisellMonisha Crisell More articles by this author , Douglas Van DrieDouglas Van Drie More articles by this author , Denise ElserDenise Elser More articles by this author , Phillip BressmanPhillip Bressman More articles by this author , Royce AdkinsRoyce Adkins More articles by this author , and Randall KahanRandall Kahan More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.1263AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Women with anatomic stress urinary incontinence may also have a measure of bladder neck funneling, with ultrasound confirmation of its presence found to be associated with a lower maximal urethral closure pressure, a smaller area under the urethral pressure profile curve, a lower leak point pressure, and a larger volume of leakage on pad testing. Radiofrequency (RF) collagen denaturation has been found to reduce tissue compliance, with a potential role in reducing bladder neck funneling in patients with stress urinary incontinence (SUI). We sought to determine the efficacy of RF employing the Lyrette device (Verathon Inc., Bothell, Washington, USA) in women with mild to moderate SUI. METHODS This is an on-going, prospective, 36-month, open-label, multi-center clinical study enrolling women with anatomic SUI and urodynamic indices of Valsalva Leak-point Pressure (VLPP) > or = 90 cm H2O and Maximum Urethral Closure Pressure (MUCP) > or = 45 cm H2O. Intervention was in the form of transurethral RF energy delivered to the bladder neck and proximal urethra at 65 degrees C° to a total of 36 foci. Primary endpoint was the percentage of patients deemed to be “dry” at 12 months as defined by < or = 1 leak on 3-day diary or < or = 1 gram of leak on 1-hour pad weight test (PWT). Secondary endpoints included the proportion of patients with a > or = 50% decrease on PWT; cough stress test (CST); quality of life (QoL) measures including the Incontinence Quality of Life (I-QoL) Questionnaire and the Urogenital distress Inventory (UDI-6); immediate post-treatment pain as per a ten-point Visual Analog Scale (VAS) (1 minimum –10 maximum); and patient satisfaction. RESULTS Fifty-two patients underwent treatment and had follow-up through 12 months. Subjects were analyzed by Intent-to-Treat. Dry rate was 82%; 73% had a > or = 50% decrease on PWT; and 71% exhibited a negative CST. Seventy-nine percent and 80% showed an improvement in I-QoL and UDI-6 scores, respectively. Statistically significant improvement was seen in both QoL scales as compared to baseline. No significant post-treatment pain was recorded, with a mean VAS score of 1.7 + 1.8. Seventy-four percent were “very” or “somewhat”satisfied and 88% would “…refer this treatment to a friend…”. No serious adverse events were recorded. CONCLUSIONS At 12 months, treatment of women with mild to moderate SUI employing Lyrette yielded favorable efficacy, improvement in QoL and high patient satisfaction. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e402-e403 Advertisement Copyright & Permissions© 2014MetricsAuthor Information James Lukban More articles by this author Peter Takacs More articles by this author Monisha Crisell More articles by this author Douglas Van Drie More articles by this author Denise Elser More articles by this author Phillip Bressman More articles by this author Royce Adkins More articles by this author Randall Kahan More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

MP80-11 ADULT SPINA BIFIDA PATIENTS AND QUALITY OF LIFE RELATED TO URINARY CONTINENCE

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Neurogenic Voiding Dysfunction1 Apr 2014MP80-11 ADULT SPINA BIFIDA PATIENTS AND QUALITY OF LIFE RELATED TO URINARY CONTINENCE Joceline Liu, MD Jessica T. Casey, MS MD Alyssa Greiman, Shubhra Mukherjee, andMD Stephanie KielbMD Joceline LiuJoceline Liu More articles by this author , Jessica T. CaseyJessica T. Casey More articles by this author , Alyssa GreimanAlyssa Greiman More articles by this author , Shubhra MukherjeeShubhra Mukherjee More articles by this author , and Stephanie KielbStephanie Kielb More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.2534AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES With improvements in the management and understanding of spina bifida (SB), 75-85% of children with SB are expected to reach early adulthood. Bladder dysfunction is common, with advances in urologic reconstruction and bladder management leading to improved urinary continence. We analyze the correlations of bladder management technique, ambulatory status and urologic reconstruction on quality of life (QOL) as affected by urinary symptoms. METHODS Sixty-five adult SB patients completed the RAND 36-Item Health Survey v2 (SF-36) and Incontinence Quality of Life (I-QOL). Demographic information, history of urinary reconstruction, and bladder management techniques were reviewed and correlated with survey scores. RESULTS The mean age of patients was 32.3 (22-54) years and 44 patients (66.7%) were female. Forty-five patients (68.2%) were mainly ambulatory, 21 (31.8%) use a wheelchair and 10 (15.4%) had urologic reconstruction, while 55 (84.6%) did not. Twelve patients (18.5%) void, 41 (63.1%) perform clean intermittent catheterization (CIC), 4 (6.2%) use an indwelling catheter, 3 (4.6%) have an ileal conduit (IC), and 5 (7.7%) mainly use diapers. Average SF-36 General Health score was 56.5 (SD±22.9) and average I-QOL Sum score was 50.9 (SD±21.7), where lower scores reflect lower QOL. The 8 SF-36 and 3 I-QOL domains were not significantly different with and without urologic reconstruction or based on ambulatory status. No I-QOL scales significantly differed based on bladder management technique; with SF-36 questionnaires, general health rating significantly differed (p=0.027) with highest scores in patients managed with voiding, followed by CIC, IC and diapers, with lowest scores with indwelling catheters. A correlation was noted between I-QOL scales and most SF-36 scales (all p<0.02). CONCLUSIONS Urologic reconstruction and bladder management techniques have evolved in SB patients and affect patients’ daily urinary regimens. In our cohort of adult SB patients, although bladder management technique and urologic reconstruction did not affect scores in the urinary (I-QOL) or general health (SF-36) domains, I-QOL scores correlated with SF-36 scores. Thus, urinary-related QOL is significantly related to overall QOL. However, we are unable to identify a single factor (ambulatory status, reconstruction, management technique, sex, age) that improved either urinary or overall QOL. We need to continue to study the effect of bladder management technique pre- and post-operatively, over time with urologic reconstruction on overall health and urinary QOL in the SB population. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e941-e942 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Joceline Liu More articles by this author Jessica T. Casey More articles by this author Alyssa Greiman More articles by this author Shubhra Mukherjee More articles by this author Stephanie Kielb More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Postoperative digestive function after radical versus conservative surgical philosophy for deep endometriosis infiltrating the rectum

To compare delayed digestive outcomes in women managed by two different surgical philosophies: a radical approach mainly related to colorectal resection, and a conservative approach involving rectal shaving and rectal nodule excision. "Before and after" comparative retrospective study. University tertiary referral center. Seventy-five patients managed by surgery for deep endometriosis infiltrating the rectum. Twenty-four women were managed during a period when surgeons pursued a radical philosophy toward treatment, and 51 women were managed during a period when a conservative philosophy was adopted. Standardized gastrointestinal questionnaires: the Gastrointestinal Quality of Life Index, the Knowles-Eccersley-Scott Symptom Questionnaire, the Bristol Stool Score, and the Fecal Incontinence Quality of Life Score. Preoperative patient characteristics, rectal nodule features, and associated localizations of the disease were comparable between the two groups. During the radical period, colorectal resection was carried out in 67% of patients, whereas during the second period only 20% of women underwent colorectal resection. Women managed according to the conservative philosophy had significantly improved results on the Knowles-Eccersley-Scott Symptom Questionnaire, Gastrointestinal Quality of Life Index, and depression/self-perception Fecal Incontinence Quality of Life Score, and significantly improved values for various items related to postoperative constipation: unsuccessful evacuatory attempts, feeling incomplete evacuation, abdominal pain, time taken to evacuate, difficulty evacuating causing a painful effort, and stool consistency. It seems that reducing the rate of colorectal resection leads to better functional outcomes in women presenting with rectal endometriosis, lending support to the conservative surgical philosophy over mandatory colorectal resection.

Long-term Durability of Sacral Nerve Stimulation Therapy for Chronic Fecal Incontinence

Limited data have been published regarding the long-term results of sacral nerve stimulation, or sacral neuromodulation, for severe fecal incontinence. The aim was to assess the outcome of sacral nerve stimulation with the use of precise tools and data collection, focusing on the long-term durability of the therapy. Five-year data were analyzed. Patients entered in a multicenter, prospective study for fecal incontinence were followed at 3, 6, and 12 months and annually after device implantation. Patients with chronic fecal incontinence in whom conservative treatments had failed or who were not candidates for more conservative treatments were selected. Patients with ≥ 50% improvement over baseline in fecal incontinence episodes per week during a 14-day test stimulation period received sacral nerve stimulation therapy. Patients were assessed with a 14-day bowel diary and Fecal Incontinence Quality of Life and Fecal Incontinence Severity Index questionnaires. Therapeutic success was defined as ≥ 50% improvement over baseline in fecal incontinence episodes per week. All adverse events were collected. A total of 120 patients (110 women; mean age, 60.5 years) underwent implantation. Seventy-six of these patients (63%) were followed a minimum of 5 years (maximum, longer than 8 years) and are the basis for this report. Fecal incontinence episodes per week decreased from a mean of 9.1 at baseline to 1.7 at 5 years, with 89% (n = 64/72) having ≥ 50% improvement (p < 0.0001) and 36% (n = 26/72) having complete continence. Fecal Incontinence Quality of Life scores also significantly improved for all 4 scales between baseline and 5 years (n = 70; p < 0.0001). Twenty-seven of the 76 (35.5%) patients required a device revision, replacement, or explant. The therapeutic effect and improved quality of life for fecal incontinence is maintained 5 years after sacral nerve stimulation implantation and beyond. Device revision, replacement, or explant rate was acceptable, but future efforts should be aimed at improvement.

Long-term Outcome After Transanal Rectal Resection in Patients With Obstructed Defecation Syndrome

Stapled transanal rectal resection with a new, curved, multifire stapler (Transtar procedure) has shown promising short- and midterm results for treating obstructed defecation syndrome. However, few results have been published on long-term outcome. This study aimed to investigate long-term functional results and quality of life after the Transtar procedure. This is a retrospective study. This study was conducted at a tertiary hospital in Switzerland. Seventy consecutive patients (68 female) with obstructed defecation syndrome had a median age of 65 years (range, 20-90). The Transtar procedure was performed between January 2007 and March 2010. Postoperative functional results were evaluated with the Symptom Severity Score, Obstructed Defecation Score, and Cleveland Incontinence Score. Quality of life was evaluated with the Fecal Incontinence Quality of Life Score and the SF-36 Health Survey. Data were divided into 4 groups of 1-, 2-, 3-, and 4-year follow-ups. The functional scores showed significant postoperative improvement throughout the studied period (p = 0.01). The quality-of-life scores showed a tendency for improvement only in the mental components on the SF-36 Health Survey (p = 0.01). Sixteen patients reported postoperative fecal urgency, but this subsided within a few months. Nine patients reported new postoperative episodes of incontinence and required further treatment. This study was limited by its retrospective nature, the selection bias, and a bias by the small number of questionnaires available for some scores. The Transtar procedure was successful for long-term treatment of obstructed defecation syndrome. Fecal urgency and incontinence were observed, but typically resolved within months. Therefore, the Transtar procedure appears to be a reasonable approach to treating obstructed defecation syndrome in the long term.

Surgical Implantation of Artificial Urinary Device and Penile Prosthesis Through Trans-scrotal Incision for Postprostatectomy Urinary Incontinence and Erectile Dysfunction: Synchronous or Delayed Procedure?

To compare simultaneous and 2-stage surgical implantation of an artificial urinary sphincter (AUS) and penile prosthesis (PP) for patients with severe urinary incontinence and erectile dysfunction after prostatectomy. The data from 23 patients were reviewed, 15 (group 1) underwent simultaneous implantation and 8 (group 2) underwent 2-stage surgery. The operative time, complications, postoperative pain, incidence of pre- and postoperative urinary incontinence, erectile dysfunction rating (International Consultation on Incontinence questionnaire, Incontinence Quality of Life, International Index of Erectile Function, and Erectile Dysfunction Inventory of Treatment Satisfaction), and patient satisfaction were evaluated. The mean operative time was 140 minutes for the simultaneous procedure (group 1) and 105 minutes for AUS placement and 65 minutes for PP placement (group 2). No major postoperative complications were recorded. The average postoperative hospital stay was 2.5 days after the double-implant procedure and 2.4 days after AUS and 1.2 days after PP placement. The visual analog scale score at 6 and 24 hours after surgery was 5 and 3 in group 1, and 4 and 3 after AUS and 3 and 2 after PP (group 2; P > .05). At 1 year, all patients were socially continent, with an average International Consultation on Incontinence score of 2 in group 1 and 2 in group 2. Of the patients in groups 1 and 2, 65% and 68% were completely dry, respectively (P > .05). The Incontinence Quality of Life score increased from 37 to 84 in group 1 and from 41 to 82 in group 2. The Patient Global Impression of Improvement revealed that 92% of group 1 and 95% of group 2 experienced "great improvement" (P > .05). The International Index of Erectile Function and Erectile Dysfunction Inventory of Treatment Satisfaction score was 70 of 75 and 87 of 100 in group 1 and 72 of 75 and 86 of 100 in group 2, respectively (P > .05). Group 1 patients were completely satisfied, and all group 2 patients stated they would have preferred synchronous surgery. AUS and PP synchronous placement is feasible and safe and as effective as the 2-stage procedure, with better acceptance by patients.

Functional disorders after rectal cancer resection: does a rehabilitation programme improve anal continence and quality of life?

A poor functional outcome is often reported after total mesorectal excision (TME) for rectal cancer, especially when sphincter-saving resection with intersphincteric dissection is performed for low tumours. Anal sphincter rehabilitation is widely proposed for faecal incontinence. Very few studies have reported results to improve anal dysfunction following rectal surgery. This prospective study aimed to assess the benefits of sphincter training after TME in terms of functional outcome and quality of life. Anal sphincter training was performed in patients undergoing laparoscopic sphincter-saving TME for rectal cancer. Rehabilitation was performed after ileostomy closure. This group was compared with 24 matched patients. Assessment included one functional and two quality of life questionnaires (SF-36 Health Status and Faecal Incontinence Quality of Life score). From 2007 to 2009, 22 patients underwent laparoscopic TME. The median follow-up after stoma closure was 21.2 (range 8-46) months. The mean stool frequency per day was significantly lower after sphincter training (2.6 in the training group vs 4.0 in the control group, P=0.025). Following rehabilitation, patients complained significantly less about dyschezia (22 vs 63%, P=0.008). Both groups had similar continence (Wexner score 8.3 after training vs 9.9 in controls, NS). Quality of life was significantly improved by sphincter training as measured by the vitality (P=0.004) and mental functioning (P=0.02) subscales on the SF-36 Health Status questionnaire and by the depression and self-perception (P = 0.005) categories of the Faecal Incontinence Quality of Life score. This study suggests that anal sphincter training following TME could decrease stool frequency and improve both general and specific quality of life.

The magnetic anal sphincter: a new device in the management of severe fecal incontinence

The authors aim to report the concept and technique of implantation and the first results of the clinical use of the magnetic anal sphincter (MAS) in the management of fecal incontinence (FI). The MAS device is designed to augment the native anal sphincter. The implant is a series of titanium beads with magnetic cores linked together with independent titanium wires. To defecate, the force generated by straining separates the beads to open up the anal canal. The technique of implantation is simple with no requirement of adjustments. The MAS has a role in the management of severe FI. The device has acceptable and comparable adverse effects to other therapies. FI and Fecal Incontinence Quality of Life scores are significantly improved in the short term. The MAS offers a simple and less invasive option of anal reinforcement. It is one step further in the quest for an ideal artificial anal sphincter device.

Phase 3 Efficacy and Tolerability Study of OnabotulinumtoxinA for Urinary Incontinence From Neurogenic Detrusor Overactivity

We assessed the efficacy, safety and effects on quality of life of onabotulinumtoxinA in patients with neurogenic detrusor overactivity. In this 52-week, international, multicenter, double-blind, randomized, placebo controlled trial 416 patients with neurogenic detrusor overactivity and urinary incontinence (14 or more episodes per week) resulting from multiple sclerosis (227) and spinal cord injury (189) were treated with intradetrusor injections of onabotulinumtoxinA (200 or 300 U) or placebo. The primary end point was the change from baseline in the mean number of urinary incontinence episodes per week at week 6. Maximum cystometric capacity, maximum detrusor pressure during the first involuntary detrusor contraction and Incontinence Quality of Life total score were secondary end points. Adverse events were monitored. OnabotulinumtoxinA at a dose of 200 U in 135 patients and 300 U in 132 decreased mean urinary incontinence at week 6 by 21 and 23 episodes per week, respectively, vs 9 episodes per week in 149 on placebo (each dose p<0.001). Also, maximum cystometric capacity, maximum detrusor pressure during the first involuntary detrusor contraction and Incontinence Quality of Life score were significantly improved over values in the placebo group (each dose p<0.001). Median time to patient re-treatment request was greater for onabotulinumtoxinA 200 and 300 U than for placebo (256 and 254 days, respectively, vs 92). The most common adverse events were urinary tract infection and urinary retention. Of patients who did not catheterize at baseline 10% on placebo, 35% on 200 U and 42% on 300 U initiated catheterization due to urinary retention. OnabotulinumtoxinA significantly improved neurogenic detrusor overactivity symptoms vs placebo. Clean intermittent catheterization initiation due to urinary retention appeared to increase in a dose dependent fashion. No clinically relevant benefit in efficacy or duration was identified for the 300 U dose over the 200 U dose.

Long-term Outcomes of the Tension-Free Vaginal Tape Procedure for Female Stress Urinary Incontinence: 7-Year Follow-up in China

Study ObjectiveTo estimate the long-term objective rates of cure, late complications, and satisfaction after tension-free vaginal tape (TVT) procedure. DesignRetrospective study (Canadian Task Force classification II-3). SettingSingle-center. PatientsFifty-five patients with moderate to severe stress urinary incontinence (SUI) underwent the TVT procedure from May 2002 to March 2005. InterventionTVT procedure. Measurements and Main ResultsChanges in 1-hour pad test results and incontinence quality-of-life (I-QOL) questionnaire scores before surgery and at 1- and 7-year follow-up were compared. Changes in objective rates of cure, late complications, and satisfaction at 1- and 7-year follow-up were also compared. The mean duration of follow-up was 6.80 years. Both the 1-hour pad test results and the I-QOL questionnaire scores improved significantly after surgery (p < .001). The TVT procedure satisfaction rate at 7-year follow-up decreased significantly compared with that at 1-year follow-up (p = .001); however, I-QOL score did not change significantly. ConclusionsThe TVT procedure is an effective treatment for SUI in female patients. Despite little persistent or recurrent SUI over 7-year follow-up, satisfaction with the procedure decreases. Therefore, other age-related bladder conditions must be considered when counseling patients about the TVT procedure. Assessment of the efficacy of the TVT procedure should include both objective and subjective standards.

Influence of perineal prostatectomy on anal continence

OBJECTIVE:Perineal prostatectomy has been proposed as a less invasive and safe procedure, but the risk of anal incontinence has been studied. This study aimed to evaluate the effects of perineal access on anal continence mechanisms after perineal prostatectomy.METHODS:From August 2008 to May 2009, twenty three patients underwent perineal prostatectomy. These patients were evaluated before surgery and eight months postoperatively using the Cleveland Clinic Anal Incontinence Score, the Fecal Incontinence Quality of Life Score, and anorectal manometry.RESULTS:The mean age of the subjects was 65 (range, 54-72) years, and the mean prostate weight was 34.5 (range, 24-54) grams. Gleason scores ranged from 6-7, and the mean Cleveland Clinic Anal Incontinence Score (mean±standard deviation) values were 0.9±1.9 and 0.7±1.2 (p>0.05) before and after surgery, respectively. The Fecal Incontinence Quality of Life Score did not change significantly after surgery. The mean values for anal manometric parameters before and after surgery were, respectively: Resting Pressures of 64±23 mmHg and 65±17 mmHg (p = 0.763), Maximum Squeezing Pressures of 130±41 mmHg and 117±40 mmHg (p = 0.259), High Pressure Zones of 3.0±0.9 cm and 2.7±0.8 cm (p = 0.398), Rectal Sensory Thresholds of 76±25 ml and 71±35 ml (p = 0.539), Maximum Tolerated Rectal Volumes of 157±48 ml and 156±56 ml (p = 0.836), and Sphincter Asymmetry Indexes 22.4±9% and 14.4±5% (p = 0.003).CONCLUSION:There was a significant decrease in the sphincter symmetry index after perineal prostatectomy. With the exception of the sphincter asymmetry index, perineal prostatectomy did not affect anal continence parameters.