Incontinence Score Research Articles

Real-world evidence of patient-reported outcomes following definitive radiation therapy for prostate cancer: Findings from an Australian population-based clinical outcomes registry.

244 Background: We aimed to evaluate patient-reported functional outcomes (PRO) following definitive radiation therapy (RT) for prostate cancer (PCa) in a real-life population-based setting. Methods: The population-based Victorian Prostate Cancer Outcomes Registry (PCOR-Vic) captures approximately 90% of all PCa cases in the state. From 2015 onwards, all men in PCOR-Vic were contacted to complete the Expanded Prostate Cancer Index Composite short-form 26 (EPIC-26) at 12-month post-treatment. The EPIC-26 included urinary incontinence, urinary obstructive, bowel, sexual and hormonal function domain scores, ranging from 0 to 100, with higher score representing better outcomes. We estimated differences in the EPIC-26 domain scores between different RT techniques using linear regression, adjusting for patient, tumor, and treatment related factors, including the use of androgen deprivation therapy (ADT). The nature of recruitment methods and data collection in PCOR-Vic precluded us from measuring EPIC-26 prior to treatment, and hence this was not adjusted for in our analyses. Results: Between 2015 and 2020, there were 1,898 men treated with definitive RT who completed the EPIC-26 questionnaires and were included in this study – 1551 (82%) had external beam radiation therapy (EBRT) alone, 91 (5%) had EBRT with brachytherapy boost (EBRT+BT), 204 (11%) had low-dose-rate brachytherapy (LDR-BT) alone, and 52 (3%) had high-dose-rate brachytherapy (HDR-BT) alone. There were 1,140 (60%) men who had ADT with RT – 68% with EBRT alone, 76% with EBRT+BT, 4% with LDR-BT, and 21% with HDR-BT (P < 0.001). Compared to men who had EBRT alone, men who had LDR-BT had higher adjusted mean EPIC-26 urinary incontinence (8.6 points; 95%CI: 5.3-12.0; P < 0.001), sexual (13.5 points; 95%CI: 9.2-17.8; P < 0.001) and hormonal score (6.8 points; 95%CI: 3.5-10.1; P < 0.001) at 12-month post-treatment. Compared to men who had EBRT alone, there were no statistically significant differences in all five EPIC-26 domain scores in men who had EBRT+BT or HDR-BT alone. Conclusions: This is the first Australian real-world evidence on PRO for different RT modalities for PCa on a population-based level. We observed better urinary incontinence, sexual and hormonal function in men who had LDR-BT compared to EBRT, but no significant differences between men who had EBRT, EBRT+BT or HDR-BT.

Systematic review and meta-analysis of randomized controlled trials evaluating the effect of the level of ligation of inferior mesenteric artery on functional outcomes in rectal cancer surgery.

This systematic review and meta-analysis studied the role of high (HL) versus low (LL) inferior mesenteric artery (IMA) ligation on genitourinary and defecatory dysfunction in patients who had undergone resection for rectal cancer (RC). A systematic literature search of four major databases was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Randomized controlled trials (RCTs) comparing HL and LL of IMA in RC surgery were identified. Those studies that looked at genitourinary or defecatory dysfunction were included. Random-effects modeling to summarize statistics was performed. The risk of bias was assessed using Cochrane's Risk-of-Bias tool 2. Three RCTs were included. There was clinical heterogeneity with regard to cancer stage and location as well as operative techniques and adjuvant treatments. Functional outcomes (FO) that were reported by at least two studies were International Consultation on Incontinence Questionnaire (ICIQ), International Index for Erectile Function (IIEF), Jorge-Wexner incontinence score (J-W). Difference was observed in ICIQ at 9months after surgery favoring LL (standard mean difference: - 0.66; 95% confidence intervals (CI): - 0.92, - 0.40; P = 0.37; I 2 = 0%). Difference was also observed in IIEF at 9months favoring LL (mean difference: 7.43; CI: 1.86, 13.00; P = 0.16; I 2 = 50%). Although our study has demonstrated the superiority of LL in genitourinary function preservation, these results should be taken with consciousness due to significant heterogeneity between included studies, small sample size, and potential bias. More high-quality studies are needed. CRD4202121099 https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021210998.

Under-classified obstetric anal sphincter injuries

Obstetric anal sphincter injuries (OASIs) that are missed at delivery can have long-term consequences. OASIs that are under-classified at delivery are likely to be inadequately repaired, resulting in a persistent anal sphincter defect. We aimed to identify women who have persistent defects on endoanal ultrasound, inconsistent with the original diagnosis, and compare the effect on St Mark's incontinence scores (SMIS). We also aimed to look for changes in numbers of under-classification over time. Records of women attending a perineal clinic who had endoanal ultrasound from 2012 to 2020 were reviewed. Women who had a modified Starck score implying a defect greater than the classification [indicated by the depth of external anal sphincter or internal anal sphincter (IAS) defect] at delivery were identified. A total of 1056 women with a diagnosis of 3a or 3b tears were included. Of these, 120 (11.36%) were found to have a defect greater than the original diagnosis and therefore were incorrectly classified at delivery. Women who had a 3b tear diagnosed at delivery, but had an IAS defect, had a significantly higher SMIS (p< 0.01). When comparing two 4-year periods, there was a significant improvement in the diagnosis of IAS tears. Some women with OASIs that have under-classified OASIs are associated with worse anorectal symptoms. This is likely because of an incomplete repair. Some improvement in diagnosis of IAS tears has been noted. We propose improved training in OASIs can help reduce the number of incorrectly classified tears and improve repair.

Clinical Utility and Characteristics of the LARS Score Compared to the CCIS.

The low anterior resection syndrome (LARS) score (LS) has been widely validated and has become an international tool for evaluating postoperative bowel dysfunction. However, many physicians still use the conventional incontinence scores in LARS treatment. Moreover, interpretation of LS and its relationship with conventional incontinence scores are not yet well understood. Here we compared the LS with the Cleveland Clinic Incontinence Score (CCIS) to clarify the clinical utility and characteristics of the LARS score. We performed a multicentre observational study, recruiting 246 rectal cancer patients following sphincter-preserving surgery. Patients completed the LS, CCIS, and SF36 questionnaires. The response rate was 76.4%, and a total of 180 patients were analysed. The LS was strongly correlated with the CCIS (P < 0.001, rs = 0.727). However, among 116 patients determined to not have incontinence (CCIS 0-5), 51 (44%) were diagnosed with LARS (29 with minor LARS and 22 with major LARS). Among 68 patients without LARS, only 3 were diagnosed as having incontinence (CCIS > 6). In comparison with background factors, aging and elapsed time were associated with only LS. High LS and CCIS both showed significant quality-of-life impairment as assessed by the SF-36. This is the first study to determine the difference in the numeric values between the CCIS and LS. The LS can be a convenient tool for LARS screening, identifying a wide range of patients with LARS, including those with incontinence evaluated by CCIS. Assessment using the CCIS may often underestimate LARS.

Dysfunctional Voiding and Incontinence Scoring System for Children and Adolescents: A Tool to Predict Clinical Course and Outcome.

Lower urinary tract symptoms (LUTS) in children are common. In 2005, Akbal et al published the dysfunctional voiding and incontinence scoring system (DVAISS) to assess patient's symptoms. Our study aimed to determine the value of this scoring system for predicting the severity and clinical course of voiding abnormalities in children and adolescents. Patients' symptoms were scored using the DVAISS in children and adolescents with LUTS presenting for the first time to our pediatric urology department between January 2010 and December 2015. We correlated the calculated score with voiding volume, clinical course, and outcome. A total of 168 patients (113 boys, 55 girls; age 5-18 years) with isolated LUTS were included. In 53 patients (group 1), the DVAISS score was less than or equal to 8.5 and in the other 115 patients (group 2), the score was greater than 8.5 suggestive for relevant voiding abnormalities. Patients in group 1 showed a significantly higher average voiding volume (200 vs. 110 mL, p = 0.001). The median time for symptom resolution was significantly higher in group 2 than group 1 (14 vs. 8 months; p = 0.018). The severity of LUTS could be determined by these parameters. Based on the DVAISS, a prediction of the clinical course and approximate treatment duration is possible. Therefore, the DVAISS is useful to assess LUTS in children and is also a valuable tool in rating the severity of the disease. It is also a quite precise predictor of the time needed to resolve the symptoms.

Transanal irrigation bowel routine for people with Cauda Equina Syndrome

Objective Neurologic bowel incontinence and dysfunction are common with Cauda Equina Syndrome (CES). The study objective was to evaluate the efficacy of Peristeen Anal Irrigation System (PAIS)TM in people with CES. Design Clinical Trial. Setting Spinal Cord Rehabilitation outpatient clinic at the Health Sciences Centre in Winnipeg. Methods Twelve participants with a mean age of 46.2 years (range 34–72 years, 4 females) with CES used PAISTM bowel routine for 10 weeks. Outcome Measures Change in Neurogenic Bowel Dysfunction Score (NBD) over 10 weeks relative to baseline. Secondary outcomes: Change in St. Mark's Fecal Incontinence score (SMFI), Cleveland Clinic Constipation score (CCC), and modified Rectal Surgeons Fecal Incontinence Quality of Life Score (QOL) at week 1, 2, 4, 6, 8 and 10 compared to baseline, and self-rating of bowel function at baseline and 10 weeks. Additionally, colonic transit times were assessed using the radioactive markers (Sitzmarks) method. Results Ten participants completed the study. Post-intervention primary outcome NBD score improved (p < 0.01). Secondary outcomes also improved significantly, including SMFI (p < 0.01), CCC (p < 0.01), QOL (p < 0.01), self-rating of bowel function (p < 0.01), and transit time improved by 22% (p < 0.05). Conclusion Overall, a significant improvement was observed with the PAISTM for both primary, as well as secondary outcome measures, without any significant adverse effects. As this non-pharmaceutical method of bowel management is effective and has the potential to improve symptoms of bowel dysfunction in people with CES, it should be considered for those in which traditional methods of managing neurogenic bowel fail.

Transanal irrigation in the treatment of functional bowel disorders: a district general hospital perspective

Background: Transanal irrigation (TAI) is a long-term treatment for obstructive defaecation syndrome, slow transit constipation and faecal incontinence. Aim: This study aimed to assess the efficacy of TAI on treating these conditions. Method: Data were collected using two standard follow-up questionnaires. Pre- and post-treatment symptom perception scores were compared. A Wilcoxon matched-pairs signed rank test was performed. A p value of &lt;0.05 was considered significant. Findings: Of 54 patients who were referred for TAI to a regional pelvic floor centre, 29 agreed to participate. All used one of the four Qufora IrriSedo TAI systems (MacGregor Healthcare). Symptom perception scores were reduced by 48.3% in patients with faecal incontinence (p&lt;0.05) and 33.8% in those with constipation (p&lt;0.0001). Symptom severity decreased, with reductions of 34.8% in St Mark's Faecal Incontinence score (p=0.0249) and 28.6% in Cleveland Clinic Constipation score (p=0.03). Conclusion: TAI was shown to be an effective treatment for functional bowel problems.

Anorectal dysfunction in multiple sclerosis patients: A pilot study on the effect of an individualized rehabilitation approach.

BACKGROUND:Anorectal dysfunction (ARD), especially bowel incontinence, frequently compromises the quality of life in multiple sclerosis (MS) patients. The effect of rehabilitation procedures has not been clearly established.OBJECTIVE:To determine the effect of an individualized rehabilitation approach on bowel incontinence and anorectal pressures.METHODS:MS patients with ARD underwent 6-months of individually targeted biofeedback rehabilitation. High resolution anorectal manometry (HRAM) and St. Mark’s Fecal Incontinence Scores (SMIS) were completed prior to rehabilitation, after 10 weeks of supervised physiotherapy, and after 3 months of self-treatment.RESULTS:Ten patients (50%) completed the study. Repeated measures analysis of variance (ANOVA) demonstrated significant improvement in the SMIS questionnaire over time [14.00 baseline vs. 9.70 after supervised physiotherapy vs. 9.30 after self-treatment (p = 0.005)]. No significant improvements over time were noted in any HRAM readings: maximal pressure [49.85 mmHg baseline vs. 57.60 after supervised physiotherapy vs. 60.88 after self-treatment (p = 0.58)], pressure endurance [36.41 vs. 46.89 vs. 49.95 (p = 0.53)], resting pressure [55.83, vs 52.69 vs. 51.84 (p = 0.704)], or area under the curve [230.0 vs. 520.8 vs. 501.9 (p = 0.16)].CONCLUSIONS:The proposed individualized rehabilitation program supports a positive overall effect on anorectal dysfunction in MS patients.

Efficacy and Safety of the Japanese Herbal Medicine Daikenchuto (DKT) in Elderly Fecal Incontinence Patients: A Prospective Study.

Objectives: This study has investigated the efficacy and safety of daikenchuto (DKT) in elderly patients with fecal incontinence (FI). Methods: This was an open-label, single-arm study (UMIN Clinical Trials Registry as UMIN000030252). DKT at 15 g/day was orally administered to patients for 28 days. Patients over 70 years old with FI, who scored over 11 in the Mini-Mental State Examination, are capable of oral intake, and provided written informed consent, were enrolled in this study. Changes in abdominal pain and bloating, Cleveland Clinic Incontinence Score (CCIS), FI Quality of Life Scale (FIQLS), maximum resting pressure (MRP), FI frequency, and stool form were evaluated. Results: In total, 21 patients (1 requested to withdraw) were enrolled in this study. The compliance rate was 95.2%, and no serious adverse drug reactions were observed. Improvements in terms of abdominal pain and bloating were observed at 2 weeks (p < 0.01). In the CCIS, the total score, leakage of solid stool, and leakage of liquid stool improved after 2 weeks (p < 0.01), while pad use and lifestyle alteration improved after 4 weeks (p < 0.05). Improvement in FIQLS was also observed at 2 weeks (p < 0.01). MRP demonstrated significant improvement at 2 weeks (p < 0.01). Eleven (52.4%) patients had no FI during the study period. Conclusions: DKT improves MRP and quality of life in patients with abdominal symptoms; moreover, it is considered to be a safe and effective drug for elderly patients with FI.

Mid-term outcomes of corrective surgery for anorectal malformations at Komfo Anokye Teaching Hospital, Ghana

BackgroundAnorectal malformations (ARM) are a spectrum of congenital defects of the distal gastrointestinal tract. Although faecal continence and the absence of constipation are recognised measures of outcome of curative surgery for ARM, evaluation of these measures can be challenging particularly in resource-poor countries. The difficulty of long-term follow- up in such settings and the other plausible causes of faecal incontinence other than the surgical procedure performed are the usual reasons. The Krickenbeck score for faecal incontinence is one objective way of measuring the surgical outcome following the surgical correction of ARM. We present the medium-term outcomes of the patients who had ARM surgically corrected at our hospital.&#x0D; Methods&#x0D; The folders of all patients who had curative surgery for ARM at our hospital (Komfo Anokye Teaching Hospital, Kumasi) from 2012-2016 were retrieved from the records department. Those who had had colostomy closure after curative surgery were identified. Data on age, sex, diagnosis and type of corrective surgery for these patients were documented. Telephone interviews of their mothers were then conducted and the incidence of faecal soiling and&#x0D; constipation recorded.&#x0D; Results&#x0D; A total of 46 interviews were concluded out of the 53 patients identified. The ages ranged from 8 - 107months with an interquartile range of 9-24months (SD 16.93) and a male-female ratio of 1:1. Most patients (61%, n=28) had voluntary bowel movements without faecal soiling (Krickenbeck grade 1) and 1 had persistent constipation. Urinary disturbances were experienced by 4 patients (incontinence-3, straining at micturiction-1).&#x0D; Conclusion&#x0D; Our study reveals acceptable medium-term outcomes for most patients who had corrective surgery for ARM at our centre. Long term follow-up and further evaluation of patients with faecal incontinence is necessary.

Long-term fecal incontinence after lateral internal sphincterotomy for anal fissure.

&lt;b&gt;Introduction:&lt;/b&gt; Anal fissure is a common benign anal condition. The gold standard treatment is lateral internal sphincterotomy (LIS), and this procedure carries a risk of incontinence. &lt;/br&gt;&lt;/br&gt; &lt;b&gt; Aim:&lt;/b&gt; The aim of this study is to determine the long-term risk of fecal incontinence after LIS. &lt;/br&gt;&lt;/br&gt; &lt;b&gt; Method:&lt;/b&gt; All patients who had LIS for chronic anal fissure between the years 2004-2010 were interviewed by phone and assessed for sphincter function (incontinence) using Wexner fecal incontinence score (WIS). &lt;/br&gt;&lt;/br&gt; &lt;b&gt;Results:&lt;/b&gt; Fifty-nine patients (34 females, 57.6%) with a mean follow-up duration of 10.6 years (range 8-15 years) were interviewed. Twelve patients (20.3%) had a WIS score of one or more. The majority of the patients noticed a change in sphincter function years after the operation. There was no association between vaginal delivery and the WIS score. &lt;/br&gt;&lt;/br&gt; &lt;b&gt;Conclusion:&lt;/b&gt; The long-term risk of abnormal sphincter function after LIS appears to be higher than expected, especially in the presence of multiple vaginal deliveries or systemic diseases such as diabetes mellitus. A larger prospective study is required to establish a correct risk of incontinence in the long term.

Transanal total mesorectal excision combined with intersphincteric resection has similar long-term oncological outcomes to laparoscopic abdominoperineal resection in low rectal cancer: a propensity score-matched cohort study.

BackgroundTransanal total mesorectal excision (taTME) or intersphincteric resection (ISR) has recently proven to be a valid and safe surgical procedure for low rectal cancer. However, studies focusing on the combination of these two technologies are limited. This study aimed to evaluate perioperative results, long-term oncologic outcomes, and anorectal functions of patients with low rectal cancer undergoing taTME combined with ISR, by comparing with those of patients undergoing laparoscopic abdominoperineal resection (laAPR).MethodsAfter 1:1 propensity score matching, 200 patients with low rectal cancer who underwent laAPR (n = 100) or taTME combined with ISR (n = 100) between September 2013 and November 2019 were included. Patient demographics, clinicopathological characteristics, oncological outcomes, and anal functional results were analysed.ResultsPatients in the taTME-combined-with-ISR group had less intraoperative blood loss (79.6 ± 72.6 vs 107.3 ± 65.1 mL, P = 0.005) and a lower rate of post-operative complications (22.0% vs 44.0%, P < 0.001) than those in the laAPR group. The overall local recurrence rates were 7.0% in both groups within 3 years after surgery. The 3-year disease-free survival rates were 86.3% in the taTME-combined-with-ISR group and 75.1% in the laAPR group (P = 0.056), while the 3-year overall survival rates were 96.7% and 94.2%, respectively (P = 0.319). There were 39 patients (45.3%) in the taTME-combined-with-ISR group who developed major low anterior resection syndrome, whereas 61 patients (70.9%) had good post-operative anal function (Wexner incontinence score ≤ 10).ConclusionWe found similar long-term oncological outcomes for patients with low rectal cancer undergoing laAPR and those undergoing taTME combined with ISR. Patients receiving taTME combined with ISR had acceptable post-operative anorectal function.

Is laparoscopic ventral rectopexy a good treatment option for rectal prolapse?

Aim: Laparoscopic ventral rectopexy (LVR) is one of the most commonly performed procedures in the treatment of rectal prolapse (RP). This study aimed to evaluate postoperative changes in the incontinence status and short-term functional outcomes of patients with RP who underwent LVR.&#x0D; Material and Method: This study included 15 patients who underwent LRV with the diagnosis of RP between January 2017 and June 2021 at Health Sciences University Ankara Numune Training and Research Hospital and Ankara City Hospital. Data were obtained by retrospectively examining the electronic records of the patients. The Wexner incontinence score (WIS) was calculated preoperatively and postoperatively by contacting the patients by phone at six months after the operation. In addition, the constipation status of the patients and whether they had recurrence of RP were questioned.&#x0D; Results: The mean age of the 15 patients included in the study was 55 (range, 30-81) years. Twelve (80%) patients were female and three (20%) were male. When the preoperative and postoperative WISs of the patients were compared, the latter was statistically significantly lower than the former (p=0.002). Among the 10 (66.7%) patients who had constipation in the preoperative period, this complaint was resolved in four (40%), but new-onset constipation was detected in two (40%) of the five (33.3%) patients without preoperative constipation. The recurrence of RP was observed in only one (6.7%) patient in the postoperative follow-up.&#x0D; Conclusion: Considering the short-term outcomes in the patients who underwent LRV for RP, it can be concluded that LVR is a good option in this patient group, with a low recurrence rate and satisfactory improvement in incontinence.

P474 Prevalence of fecal incontinence and clinical characteristics of IBD patients in remission and treated with biologics – experience from a tertiary referral center

Abstract Background Fecal incontinence (FI) is a debilitating disorder highly prevalent in inflammatory bowel disease (IBD) patients with reports in literature ranging from 20–80%. There is limited data on FI prevalence in IBD patients who are in remission, treated with biologics and their clinical characteristics. Methods In this cross-sectional observational study we have included IBD patients in remission, treated with biologics. Demographics and medical data were collected from electronic medical charts while patients were screened for FI using the St. Mark’s incontinence score (SMIS). Significant FI was characterized as SMIS ³6. Descriptive statistical analysis was used. Results We included 57 patients (24 female/33 male) in clinical remission treated with biologics, median age 41 years (18–70), 23 patients had ulcerative colitis (UC) and 34 had Crohn’s disease (CD). Median disease duration was 8 years (1–31). Significant FI was identified in 41 patient (71.9%) out of which 87.8% were in biochemical and 34.1% in endoscopical remission. FI was more prevalent among CD patients (76.4%) compared to UC (65.2%), but the difference did not reach statistical significance. FI was not significantly correlated to gender, type or number of biologics but there was significant positive correlation with disease duration (r=0.3139; p&amp;lt;0.05), especially for patients with disease duration longer than 5 years who had significantly higher mean SMIS score (9.1±4.6 vs 5.2±2.6; t-2.86; p&amp;lt;0.05). Furthermore, patients older than 50 years of age also had significantly higher average SMIS scores compared to younger patients (10.6±4.6 vs 7.6±4.3;t-2.09;p&amp;lt;0.05) Conclusion FI is highly prevalent in IBD patients treated with biologics, even in those who have reached endoscopical remission. Clinicians should be aware of this disorder and use available screening tools especially in older patients with longer disease duration in order to further improve quality of life of these patients.

Mesh safety in pelvic surgery: Our experience and outcome of biological mesh used in laparoscopic ventral mesh rectopexy.

BACKGROUNDLaparoscopic ventral mesh rectopexy (LVMR) continues to be a popular treatment option for rectal prolapse, obstructive defecation/faecal incontinence and rectoceles. In recent years there have been concerns regarding the safety of mesh placements in the pelvis. AIMTo assess the safety of the mesh and the outcome of the procedure.METHODSEighty-six patients underwent LVMR with Permacol (Biological) mesh from 2012 to 2018 at University Hospital Wishaw. Forty were treated for obstructive defecation secondary to prolapse, rectocele or internal rectal intussusception, 38 for mixed symptoms obstructive defecation and incontinence, 5 for pain and bleeding secondary to full thickness prolapse and 3 with symptoms of incontinence. Questionnaires for the calculation of Wexner scores for constipation and incontinence were completed by the patients who were followed up in the clinic 12 wk after surgery and again in 6-12 mo. The average review of their notes was 18.3 ± 4.2 mo.RESULTSThe median Wexner scores for constipation pre-operatively and post-operatively were 14.5 [Interquartile range (IQR): 10.5-18.5] and 3 (IQR: 1-6), respectively, while the median Wexner score for faecal incontinence was 11 (IQR: 7-15) and 2 (IQR: 0-5), respectively (P < 0.01). There were 4 (4.6%) recurrences, 2 cases that presented with erosion of a suture through the rectum and one with diskitis. No mesh complications or mortalities were recorded.CONCLUSIONLVMR using a Permacol mesh is a safe and effective procedure for the treatment of obstructive defecation/faecal incontinence, rectal prolapse, rectoceles and internal rectal prolapse/intussusception.

P585 Examining faecal incontinence and its impact on health-related quality of life in patients with Crohn’s perianal fistulas: results from a multi-country burden of illness study

Abstract Background Perianal fistulas (PAF) are a common complication associated with Crohn’s disease (CD), and patients with Crohn’s perianal fistulas (CPF) are more likely to experience faecal incontinence (FI) than patients with CD without PAF (non-PAF CD). A global study was conducted to assess the burden of illness in patients with CPF compared with patients with non-PAF CD. Here, we present data on the level of FI and its impact on quality of life (QoL). Methods This cross-sectional study was conducted in seven countries (France, Germany, Spain, UK, Canada, Australia and Japan) in patients aged ≥21 and ≤90 years with self-reported physician-diagnosed CD. Patients were classified as having non-PAF CD (cohort 1) or CPF without PAF-related surgery (cohort 2) or CPF with PAF-related surgery (cohort 3). Validated, general and disease-specific patient-reported outcome data were collected using a 45-min IRB/EC-approved web-enabled questionnaire. The level of FI was evaluated using the Revised Faecal Incontinence Score (RFIS) (1–20 scale, 0 = no incontinence, 4-week recall period) and the impact of FI on QoL in patients who had experienced FI using the Fecal Incontinence Quality of Life (FIQL) (1–5 scale, 1 = lower QoL). Data were analysed using descriptive statistics. Results Of the 929 patients recruited (cohort 1, n = 620; cohort 2, n = 174; cohort 3, n = 135), 58–69% were male and 55–67% were aged 21–40 years across all cohorts. A significantly higher proportion of patients in cohort 3 than cohort 1 had severe Crohn’s disease as classified by a physician (18% vs 9%, respectively; p &amp;lt; 0.05). Overall, 47% of patients reported experiencing FI and completed both the RFIS and FIQL. Significantly higher proportions of patients in cohorts 2 and 3 had experienced FI than in cohort 1 (59% and 59% vs 40%, respectively; p &amp;lt; 0.05), and a significantly higher proportion were currently experiencing FI in cohort 3 than in cohorts 1 and 2 (69% vs 37% and 45%, respectively; p &amp;lt; 0.05). Mean RFIS scores were significantly higher (worse) in cohorts 2 and 3 than cohort 1 (9.5 [p &amp;lt; 0.05] and 10.6 [p &amp;lt; 0.001] vs 8.2, respectively). Patients in cohort 2 had significantly lower (worse) FIQL scores than those in cohort 1 across three FIQL domains (lifestyle [2.2 vs 2.4], depression/self-perception [2.1 vs 2.3], embarrassment [2.2 vs 2.4]; p &amp;lt; 0.05), whereas patients in cohort 3 only reported significantly lower FIQL scores compared with cohort 1 in the embarrassment domain (2.2 vs 2.4; p &amp;lt; 0.05). Conclusion In this study almost half of the patients experienced faecal incontinence. Among those who experienced faecal incontinence, patients with PAF experienced a significantly higher impact on their quality of life compared with patients without PAF.

Urinary incontinence and use of incontinence surgery after radical prostatectomy: a national study using patient-reported outcomes.

To investigate whether patient-reported urinary incontinence (UI) and bother scores after radical prostatectomy (RP) result in subsequent intervention with UI surgery. Men diagnosed with prostate cancer in the English National Health Service between April 2014 and January 2016 were identified. Administrative data were used to identify men who had undergone a RP and those who subsequently underwent a UI procedure. The National Prostate Cancer Audit database was used to identify men who had also completed a post-treatment survey. These surveys included the Expanded Prostate Cancer Composite Index (EPIC-26). The frequency of subsequent UI procedures, within 6 months of the survey, was explored according to EPIC-26 UI scores. The relationship between 'good' (≥75) or 'bad' (≤25) EPIC-26 UI scores and perceptions of urinary bother was also explored (responses ranging from 'no problem' to 'big problem' with respect to their urinary function). We identified 11 290 men who had undergone a RP. The 3-year cumulative incidence of UI surgery was 2.5%. After exclusions, we identified 5165 men who had also completed a post-treatment survey after a median time of 19 months (response rate 74%). A total of 481 men (9.3%) reported a 'bad' UI score and 207 men (4.0%) also reported that they had a big problem with their urinary function. In all, 47 men went on to have UI surgery within 6 months of survey completion (0.9%), of whom 93.6% had a bad UI score. Of the 71 men with the worst UI score (zero), only 11 men (15.5%) subsequently had UI surgery. In England, there is a significant number of men living with severe, bothersome UI after RP, and an unmet clinical need for UI surgery. The systematic collection of patient-reported outcomes could be used to identify men who may benefit from UI surgery.

Comparison of four surgical approaches for rectal prolapse: multicentre randomized clinical trial.

BackgroundSeveral different procedures have been described for surgical treatment of rectal prolapse and consensus on the optimal approach has not been reached. The Swedish Rectal Prolapse Trial was performed with the aim to compare the outcomes after the most common surgical approaches to rectal prolapse.MethodA multicentre randomized trial was conducted from 2000 to 2009. Patients were randomized between a perineal or an abdominal approach for correction of rectal prolapse (randomization A) if eligible for any procedures. Patients considered unsuitable for random allocation were only included in randomizations B or C. Patients in randomization B (perineal group) were randomized to Delorme’s or Altemeier’s procedures and those in randomization C (abdominal group) to suture rectopexy or resection rectopexy. Primary outcomes were bowel function and quality of life, measured using Wexner incontinence score and RAND-36, and secondary outcomes were complications and recurrence at 3 years.ResultsDuring the study period, 134 patients were randomized: 18 in randomization A group, 80 in randomization B group and 54 in randomization C group; of these, 122 patients underwent surgery. Mean follow-up was 2.6 years. Improvements in Wexner and RAND-36 scores were seen but with no significant difference between the groups. Health change scores were significantly improved from baseline up to 1 year after surgery (P < 0.001). At 3 years, recurrence rates were two of seven patients for abdominal versus five of eight patients for perineal approach (P = 0.315), 18 of 31 patients (58 per cent) for Delorme’s versus 15 of 30 patients (50 per cent) for Altemeier’s (P = 0.611) and four of 19 patients (21 per cent) for suture rectopexy versus two of 21 patients (10 per cent) for resection rectopexy (P = 0.398). There were no significant differences regarding postoperative complications.ConclusionFor all procedures, significant improvements from baseline in health change scores were noted after surgery. Recurrence rates were higher than previously reported. Registration number: NCT04893642 (http://www.clinicaltrials.gov).

Modified Martius graft - a renaissance of surgical procedure.

The rectovaginal fistula (RVF) is relatively uncommon and by clinical manifestations grave illness. The surgery treatment of RVF is extremely demanding and represents the subject of frustration for many surgeons. Miscellaneous etiology of RVF and various heights of fistula in a rectovaginal septum are crucial for the choice of surgical procedure. Despite targeted treatment, more than one-half of rectovaginal fistulas recurs. We evaluated the frequency of recurrences after surgical treatment by modified Martius graft and its influence on continence and quality of life. The necessity of concomitant colostomy when performing modified Martius graft was the secondary aim. We collected and analyzed 8 years of data from our patient database. There were admitted 21 female patients with diagnosis RVF to the Surgery department of Faculty Hospital Trnava. Unfortunately, only 5 patients, concerning the etiology of disease and clinical state, were indicated for surgery by modified Martius graft. All RVFs were low and a defect in the rectovaginal septum wouldn't exceed 1.5 cm in diameter. Due to the small sample and non-confirmation of normality in all variables, nonparametric comparison tests were chosen for paired samples differences. We used the Wilcoxon sign-rank test and counted the effect sizes expressed the success of the treatment. Each female patient with low RVF included in this study has healed. The mean value of a complete healing of RVF in our cohort was 12 weeks. We had discovered one recurrence after surgery, that was successfully repaired by contralateral modified Martius graft. The significant decrease of Wexner fecal incontinence score in the observed group (p<0.05, r=0.639) and slightly elevated Cleveland Clinic Constipation Scoring System (p<0.05, r=-0.577) were confirmed. The protective colostomy was performed just once. Only two sections of the SF-36 Health Survey - the physical functioning and the bodily pain, were without significant changes. The rest of the watching sections of SF-36 have changed significantly. Treatment of low rectovaginal fistulas (LRVF) by modified Martius graft is followed by a low percentage of recurrences. It should be the first-line therapy in the algorithm of surgical treatment of LRVF, without the necessity of protective colostomy (Tab. 2, Fig. 3, Ref. 27).

A comparative study on the surgical options for male rectal prolapse.

Purpose:Rectal prolapse is known to be a rare condition in males compared to females. This study aimed to analyse the frequency of male rectal prolapse and compare the results of different surgical approaches performed at a single centre.Patients and Methods:The authors included patients who underwent surgical treatment for rectal prolapse from March 2016 to February 2021. The proportion of males, mean age and recurrence rates were calculated. Patients were divided into two groups, transanal approach and laparoscopic abdominal approach group, to identify the para-operative parameters including functional tests.Results:A total of 56 males, comprising 23.7% (56/236) of all patients. The mean age was 60.8 years, with a recurrence rate of 7 cases (12.5%) during 7.2 months of follow-up. Forty patients underwent transanal procedures, and fifteen underwent laparoscopic abdominal procedures. The mean operative time was longer in the laparoscopic group (transanal vs. abdominal, 57.5 vs. 70.6 min, P < 0.003), and intra-operative bleeding was greater in the transanal group (12.4 vs. 3.4 ml, P < 0.001). Full-layer prolapse (36.8 vs. 81.2% P = 0.003) and longer length (5.6 vs. 7.8 cm, P = 0.048) were more common in laparoscopic group. Time to feeding resumption was shorter after the transanal group (1.2 vs. 1.7 days, P = 0.028). There was no difference between the groups in terms of post-operative complications and recurrence rates. Both Wexner's constipation and incontinence scores showed significant improvement postoperatively.Conclusion:The frequency of male rectal prolapse was 23.7%, and perioperative factors differed between transanal and abdominal approaches, but recurrence rates and functional test results did not differ significantly.