Incontinent Patients Research Articles

Identifying the relationship between postoperative urinary continence and residual urethra stump measurements in robot assisted radical prostatectomy patients.

To investigate the feasibility of urethral stump length and width measurements in recorded videos of robot assisted radical prostatectomy procedures using the Kinovea software and to assess if these measurements could be used as predictors of postoperative urinary continence. Fifty-three patients were selected from an institutional database of 1400 cases and included in the study. All videos were analysed using the computer software 'Kinovea'. All measurements were performed using the inserted bladder catheter as a reference point. The reference point (bladder catheter) was available in 33 out of 53 patients. The median surgical urethral length (SUL) was significantly higher in the continent group (1050 vs. 1294 mm, p = 0.018). The urethral width measurements did not show a difference between the groups. In order to validate the Kinovea software as an accurate tool for the measurement of the urethral stump length and width results were correlated with the magnetic resonance imaging measurements of the urethra. The results of this study showed a significantly longer median SUL incontinent patients.

Evaluation of urodynamics parameters in different age and incontinence group of women

Aim: Overactive bladder syndrome (OAB) is known to have a negative impact on quality of life, and cause discomfort daily. Population-based studies on females report a prevalence of OAB which varies between 9.7% and 35.7%, with a substantial rise with increasing age. The primary aim of this analysis was to assess whether age was associated with differences in urodynamic testing parameters, using age as a continuous variable, and comparing women within wider age groups to understand physiologic variation. Methods: In this retrospective cohort study, we evaluated the patients who were admitted to the Department of Gynecology and Obstetrics Department of Istanbul Education and Research Hospital between January 2017 and January 2020 with lower urinary tract symptoms (LUTS). Results: We found that age, first sensation and first desire to void were strongly correlated (P=0.007, P=003 respectively), but a strong desire to void and maximum cystometric capacity were not (P=0.09, P=0.11 respectively). There was a weak negative correlation between detrusor pressure (Pdet) and age (p=0.08). Histogram analysis of bladder compliance among stress, urge, mix incontinence and normal patients revealed that maximum compliance occurred in women of reproductive age. Conclusion: Aging is associated with decreased self-control, thus, increased prevalence of LUTS symptoms among older women might be more accurately considered as the loss of an adaptive threshold to urinary control rather than age-associated decline in urinary functions.

Application of adipose‐derived, muscle‐derived, and co‐cultured stem cells for the treatment of stress urinary incontinence in rat models

Based on the recent advancements in cell therapy techniques, we aimed to evaluate the efficacy of transurethral injection of autologous adipose-derived stem cells, muscle-derived stem cells, and co-cultured cells for the rehabilitation of stress urinary incontinence rat models. We hypothesized that the utilization of co-cultured stem cells could result in enhanced therapeutic outcomes attributed to their more comprehensive environment of paracrine factors and cytokines. We performed bilateral pudendal nerve transection surgeries to simulate urinary incontinence in 25 female Wistar rats and employed urodynamic evaluations to confirm the injury. We autologously isolated and cultured adipose-derived mesenchymal stem cells, muscle-derived stem cells, and a mixed culture of the two types, which we subsequently injected into the urethral lumen of the damaged animals. Three weeks after the injection, urodynamic assays, histological staining, and immunohistochemical evaluations were performed to determine the efficacy of the implanted cell cultures in sphincter function improvements or structural modifications. Histological evaluations suggested a regenerative process in the muscular layer of the external sphincter 3 weeks after the injection. Also, immunohistochemical analysis revealed a thickened periurethral striated muscle layer in the co-cultured group. Postinjection urodynamic analysis indicated that the urethral pressure profile significantly increased in the co-cultured group compared with other groups. The outcomes of this investigation indicated that the application of co-cultured adipose-derived and muscle-derived stem cells could be associated with higher therapeutic value in stress urinary incontinence patients compared with singular-cell treatments.

Personality of patients with fecal incontinence.

Although idiopathic fecal incontinence (FI) patients have some psychological characteristics, the personality of FI patients was not described. The present study aims to describe the clinical and personality characteristics of FI patients. This retrospective observational study included 996 outpatients, 72 with fecal incontinence. They filled out the Rome III diagnostic questionnaire, the personality inventory MMPI-2, the questionnaires for urological and sexual disorders, and Likert scales for bowel disorders perceived symptom severity. The main outcome measures were the presence in FI patients of functional gastrointestinal disorders, the self-reported symptom severity, and the personality profile. Patients were mainly females (72%). FI patients were characterized by higher age (P = 0.015), and by a higher prevalence of functional diarrhea (P = 0.001), urological (P = 0.001), and sexual disorders (P = 0.005). These patients also report higher diarrhea severity (P < 0.001) and lower abdominal pain severity (P = 0.009). The personality of FI patients is distinguished by a higher score for psychopathic deviate (P = 0.006), social responsibility (P = 0.003), Mac Andrew revised scale (P = 0.005), and antisocial practice (P = 0.007), and a lower score for type A behavior (P = 0.005). FI patients are characterized not only by older age, and a high prevalence of diarrhea but also by a specific personality profile characterized by an unfavorable comparison with others.

Sexual function after tension-free vaginal tape procedure in stress urinary incontinence patients.

The aim of the study was to evaluate sexual function in women before and after tension-free vaginal tape (TVT) surgery for the treatment of stress urinary incontinence (SUI). Between August 2014 and August 2018, 105 sexually active patients with SUI who underwent TVT surgery were enrolled in this prospective cohort study. The Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire Short Form (PISQ-12) was administered pre- and postoperatively. Statistical analyses were performed using paired-sample t tests. The sexual function of 105 patients 1 year after the TVT procedure improved in 81 (77.1%) patients, remained unchanged in 18 (17.1%) patients, and deteriorated in 6 (5.7%) patients. The mean PISQ-12 score increased from 29.65 at baseline to 33.04 at the 1-year follow-up (P < 0.001). Improvement was prominent in the physical domain of the PISQ-12 (P < 0.001), but the emotional (P = 0.948) and partner-related (P = 0.915) domains showed no significant changes. The increase in the physical domain score caused the increase of the total PISQ-12 score. Compared with preoperative values, there was no significant change in the score of pain during sexual intercourse (P = 0.425) at 1 year after the TVT procedure. Women experienced less coital incontinence (P < 0.001), less fear of incontinence during intercourse (P < 0.001), and less negative emotional reactions (P < 0.001) during intercourse after the TVT operation than before the TVT operation. Sexual function was improved in patients with SUI after TVT surgery.

Single-staged male bladder exstrophy-epispadias complex reconstruction with pubic bone adaptation without osteotomy: 15-year single-center experience.

To represent the 15years' experience of an academic referral center for the reconstruction of bladder exstrophy-epispadias complex with a modified single-stage approach. Single-staged reconstruction techniques are commonly used for classic bladder exstrophy. However, combined bladder closure and epispadias repair have been taken into great consideration in patients with initially failed reconstruction or delayed primary closure. A total of 49 boys underwent 1-stage bladder and epispadias repair with pubic bone adaptation and without the application of pelvic osteotomy. The mean ± SD age at surgery was 5.23 ± 2.04months. Continence and social dryness were assessed in the follow-ups with 3months intervals for the first year and biannually thereafter. The mean ± SD of follow-up was 127.25 ± 71.32months. Urethrocutaneous fistula, stricture, wound infection, and hemiglans were developed in six distinct patients. However, no other major complications were noted. Three patients (6.1%) remained incontinent; while 32 (65.3%) children were socially continent and 14 (28.6%) children were waiting for toilet training. All the patients without previous failed closure were socially continent, while all incontinent patients had two failed closures in their history. No patient was rendered hypospadiac. Based on the experience of this institution, the application of single-stage reconstructive techniques can lead to continence, cosmetically pleasing appearance with promising outcomes, and reduction of overall operations, hospital stay and costs in the majority of cases as compared to multiple surgical procedures.

Treatment outcomes and overactive bladder symptoms after midurethral sling in female patients with or without various neurological diseases.

We investigated surgical outcomes and changes of overactive bladder (OAB) symptoms after midurethral sling in female stress urinary incontinence (SUI) patients with or without neurological disease (ND) without spinal cord injury. Patients who underwent midurethral sling for SUI between January 2009 and December 2018 were reviewed. Postoperative changes in OAB symptoms (de novo occurrence or resolution) within 1 year were compared in each preoperative symptom subset with a 1:1 matched analysis between non-neurological disease (NND) and ND group. A total of 855 patients (median follow-up: 49.8 months; mean age: 57.9 ± 9.3 years) were included. Successful SUI correction was achieved in 95.0% of NND and 93.7% of ND patients (p = .440). Among 797 patients (711 NND and 86 ND) without remnant SUI, 227 had SUI only, 198 had SUI with urgency, and 372 had mixed urinary incontinence (MUI) preoperatively. The ND patients tended to be older (62.8 ± 9.2 vs. 57.2 ± 9.0 years) and had higher proportions of diabetes (24.4% vs. 8.0%), hypertension (47.7% vs. 26.7%), and MUI (64.0% vs. 44.6%) than NND patients (p < .001, respectively). After matching age, diabetes, and hypertension, the incidence of de novo OAB was higher in ND patients (SUI only; 21.1% vs. 5.3%; p < .001) while resolution rates of urgency urinary incontinence (UUI) were similar (MUI; 57.7% vs. 53.9%; p = .414). Success rates of midurethral sling and resolution of UUI were comparable between NND and ND patients. In patients with neurological conditions, de novo OAB symptoms were more likely to develop.

Sacral Neuromodulation with the InterStim™ System for Intractable Lower Urinary Tract Dysfunctions (SOUNDS): Results of Clinical Effectiveness, Quality of Life, Patient-Reported Outcomes and Safety in a French Multicenter Observational Study

BackgroundReal-world data that support the use of sacral neuromodulation (SNM) for lower urinary tract dysfunctions are of continued interest. ObjectiveTo evaluate the effectiveness, quality of life (QoL), patient-reported outcomes (PROs), and safety of SNM with the InterStim™ system in real life during 1-yr postimplant. Design, setting, and participantsThis is a prospective, multicenter, observational study at 25 representative public and private French sites. Eligible patients received SNM therapy for overactive bladder (OAB) and non-obstructive urinary retention based on local standard of care. Overall, 320 patients were enrolled; 247 received permanent implant or replacement; 204 implanted patients completed second follow-up after mean of 10.0±3.8 mo. Outcome measurements and statistical analysisEffectiveness outcomes were change in voids, leaks, and catheterizations/day. Other outcomes included validated QoL and disease severity scores as well as PROs and adverse event data. Outcomes at follow-ups were compared with baseline using the Wilcoxon signed-rank test. Results and limitationsVoids in urinary frequency (UF) and leaks/day in urinary urge incontinence (UI) patients were significantly reduced after 10 mo in both de novo (mean baseline voids/day UF de novo: 12.7 vs 8.6 after 10 mo; p<0.001; mean baseline leaks/day UI de novo: 4.3 vs 1.1 after 10 mo; p<0.001) and replacement patients (mean baseline voids/day UF replacement: 11.5 vs 7.9 after 10 mo; p<0.001; mean baseline leaks/day UI replacement: 5.4 vs 1.0 after 10 mo; p<0.001). Disease bother, Urinary Symptom Profile score, and Ditrovie questionnaire score were also significantly improved. Revisions postimplant occurred in 20% of patients including in 9% due to permanent explantation during a mean exposure time of 24.3 mo. ConclusionsThrough a real-life study, SOUNDS (Sacral neuromOdUlation with InterStim™ therapy for intractable lower uriNary tract DySfunctions) confirms the clinical effectiveness, safety, and positive effect of SNM on QoL and PROs for the treatment of OAB patients. Patient summaryThese analyses on French patients who received sacral neuromodulation (SNM) for retention or OAB during a 10-mo period showed that SNM improved OAB symptoms, quality of life, and reduced disease bother. Trial registrationClinicalTrials.gov: NCT02186041

Managing incontinence in people with dementia.

It is estimated that there are 850 000 people with dementia in the UK, and 53% of them have incontinence. Dementia adds an extra challenge to managing a patient's continence. This article discusses that challenge, looking at the nature and causes of incontinence, the effects that ageing has on continence and the associated complications. It then examines the nature of dementia and some of its causes and goes on to show how the symptoms of dementia can impact on a person's continence. The article highlights the important of conducting a thorough assessment of a person with dementia who experiences incontinence, including medical history, medications and symptom profile. Using a bladder diary, the importance of involving relatives and carers, physical examination and 'red-flag' symptoms to be aware of are also discussed. Lastly, this article talks about creating a strategy to manage a patient's incontinence, including prompted toileting, medication, using incontinence pads, catheterisation, care planning and supporting relatives and carers.

Relationship between episiotomy and fecal incontinence after delivery

Background: Fecal incontinence is an embarrassing problem and decreases the woman’s quality of life. The literature has shown that women with obstetric trauma especially by episiotomy had damaged anal sphincter (Internal and External). We aimed to find the role of episiotomy in the fecal incontinence in women after delivery. Methods: In this study, 71 females with previous vaginal deliveries were investigated by endoanal ultrasonography. The degree of FI was measured using the incontinence score of Wexner. The number of episiotomies was measured for each patient. Results: The mean Wexner score was 9.0±0.7 in the incontinent patients. The mean of normal vaginal delivery was 3.48±0.3 and 33.8% of the patients whom had a history of hemorrhoidectomy. Of patients, 70% had undergone one or more prior episiotomies during their deliveries. Conclusion: Episiotomy could be one of the risk factors in fecal incontinence but we did not find any significant difference in Wexner score between patients with or without episiotomy. Endoanal sonography seems an effective tool to evaluate and prediction of anal injury during episiotomy in some critical cases.

Efficacy and safety of Mirabegron as adjuvant treatment in children with refractory neurogenic bladder dysfunction

When patients with neurogenic bladder become refractory, there are different alternatives, such as the use of β3-adreceptor agonists. The aim of the present study is to evaluate efficacy and safety of Mirabegron as adjuvant treatment. 37 patients under 18 years of age who underwent Mirabegron were retrospectively studied. The inclusion criteria were: cases with neurogenic bladder who were under clean intermittent catheterization (CIC) programs and refractory to oral oxybutynin (Group A) and/or onabotulinumtoxinA (Group B). Once refractory neurogenic bladder was confirmed by clinical and/or urodynamic studies, Mirabegron 25mg/day was indicated and evaluation was performed in the third month without stopping therapy. Systolic/diastolic blood pressure and transaminases were monitored. Paired t test and Pearson's chi - squared test were used. Maximum cystometric capacity increased significantly by 125mL, from 322 to 446ml (p<0.0001). End-filling detrusor pressure decreased significantly by 12cm H2O, from 44 to 31cm H2O (p<0.0001). The variation in both parameters was significant in Groups A and B. The presence of detrusor overactivity increased globally from 21 to 32% after starting Mirabegron, but the intensity of contractions was reduced in 20cm H2O. Of the 18 patients who were incontinent before, 13 cases (72%) remained dry after initiating therapy with Mirabegron. None of the patients stated having suffered any adverse effects. Blood pressure and transaminases showed no significant difference. None of the patients discontinued treatment due to intolerance to Mirabegron (Summary Table). In our study the treatment with Mirabegron improved significantly the clinical and urodynamic parameters. A significant increase in bladder capacity and a significant decrease in end-filling detrusor pressure were observed in both groups. The intensity of overactivity was attenuated. According to the records of the voiding diary, over 70% of the incontinent patients became dry after the administration of Mirabegron. We did not observe any adverse effects. The most important limitations of the present study are its retrospective design, the small size of the sample population and of each group, and the use of only one dose of Mirabegron. Mirabegron as adjuvant treatment in children with refractory neurogenic bladder increased bladder capacity, reduced intravesical pressure and helped achieve continence in more than two thirds of the sample population. Mirabegron was safe and well tolerated by children.

Complications and re-operations after tension-free vaginal tape operation in women with stress urinary incontinence.

We evaluate intraoperative and short-term postoperative (≤ 3months) complications and long-term re-operations (up to 6years) after tension-free vaginal tape (TVT) operation in women with stress urinary incontinence (SUI). Data from 446 women undergoing TVT operation between 2012 and 2016 at a tertiary referral center was retrospectively collected. Data included patient baseline demographics, information from the TVT operation and the following postoperative period, and scores from patient questionnaires [the International Consultation of Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF) and Patient Global Impression of Improvement (PGI-I)]. Collected data were investigated for incidence of complications and re-operations, postoperative improvement in patient questionnaires, and association between complications and baseline patient demographics. The only intraoperative complication was bladder perforation (2.0%). Postoperative complications included: infection (0.7%), hematoma (0.9%), bleeding (0.2%), pain (0.9%), erosion of the vaginal mucosa (1.1%), persistent SUI (0.7%), and voiding dysfunction > 24h (10.3%). Re-operations included: operation due to infections (0.4%), incontinence surgery for persistent SUI (0.4%), revision for tape erosion (1.1%), tape mobilization (3.6%), and tape division (0.2%). A significant reduction in urinary incontinence symptoms was observed in the ICIQ-UI SF and PGI-I. The reduction in ICIQ-UI SF did not vary significantly between patients with and without complications. No association between complications and baseline patient demographics was found. This study demonstrated high safety and efficacy of the TVT operation with only minor short-term complications and few long-term re-operations. The ICIQ-UI SF improved significantly postoperatively and was not statistically significantly affected by the occurrence of complications.

Fistula Excision with Sphincter Repair and/ or Approximation Leaving Long Braided Sutures for Drainage of Intersphencteric Space for Management of Fistula in Ano

Background: Fistula-in-ano is the most common form of perineal sepsis. Typically, a fistula includes an internal opening, a track, and an external opening. The external opening might acutely appear following infection and/or an abscess, or more insidiously in a chronic manner. Objective: To analyze the results of surgical excision of intersphencteric, transsphencteric or suprasphencteric perianal fistula by fistula excision with sphincter repair and / or approximation leaving braided sutures for drainage Patients and method: In this prospective study a group consisted of 124 patients with intersphencteric, transsphencteric or suprasphencteric perianal fistulae were treated with fistula excision followed by sphincter repair and / or approximation leaving the ends of the threads long for drainage of intersphencteric space. All patients were observed along one year after surgery for complications, recurrence and / or incontinence Results: The technique was done under spinal anesthesia for 92 patients (74 %) and under general anesthesia for the other 32 patients (26 %). The median operative time was 30 minutes; ranging from 25 to 40 min. there were no postoperative deaths. Hospital stay was less than 24 hrs for all patients. The overall recurrence rate was 4.8 %, with no permanent incontinence. Conclusion: This technique has shown to be highly effective and applicable for management of intersphencteric, transsphencteric or suprasphencteric perianal fistula with low recurrence rate (4.8%), no permanent incontinence and good patient satisfaction.

Fistula Excision with Sphincter Repair and/ or Approximation Leaving Long Braided Sutures for Drainage of Intersphencteric Space for Management of Fistula in Ano

Background: Fistula-in-ano is the most common form of perineal sepsis. Typically, a fistula includes an internal opening, a track, and an external opening. The external opening might acutely appear following infection and/or an abscess, or more insidiously in a chronic manner. Objective: To analyze the results of surgical excision of intersphencteric, transsphencteric or suprasphencteric perianal fistula by fistula excision with sphincter repair and / or approximation leaving braided sutures for drainage Patients and method: In this prospective study a group consisted of 124 patients with intersphencteric, transsphencteric or suprasphencteric perianal fistulae were treated with fistula excision followed by sphincter repair and / or approximation leaving the ends of the threads long for drainage of intersphencteric space. All patients were observed along one year after surgery for complications, recurrence and / or incontinence Results: The technique was done under spinal anesthesia for 92 patients (74 %) and under general anesthesia for the other 32 patients (26 %). The median operative time was 30 minutes; ranging from 25 to 40 min. there were no postoperative deaths. Hospital stay was less than 24 hrs for all patients. The overall recurrence rate was 4.8 %, with no permanent incontinence. Conclusion: This technique has shown to be highly effective and applicable for management of intersphencteric, transsphencteric or suprasphencteric perianal fistula with low recurrence rate (4.8%), no permanent incontinence and good patient satisfaction.

Research progress in coping style assessment tools for elderly patients with urinary incontinence.

Coping style is a cognitive or behavioral strategy taken by individuals in the face of stress. Positive coping style is of great significance for improving the physical and mental outcomes of elderly patients with urinary incontinence. Accurate assessment of coping styles for the elderly patients with urinary incontinence can provide reference for the subsequent development of intervention measures. The existing coping style assessment tools for elderly incontinence at home and abroad include specific scale of incontinence, relevant psychological assessment scale, and universal scale. In a word, the progress in the studies on relevant assessment tools is slow, and it mainly focuses on the assessment of female population. The assessment content is relatively single and lacks of pertinence and systematization. In the future, a comprehensive scale with strong adaptability should be developed based on the characteristics of elderly incontinence patients in China.

Cross-cultural adaptation and validation of the Moroccan version of the incontinence quality of life questionnaire (I-QoL) in urinary incontinence patients

ObjectiveBecause of the importance and prevalence of incontinence in women, there is growing interest in the development and use of well-designed quality of life questionnaires. The objective of this study is to adapt and validate, the I-QoL, a quality of life questionnaire, in Moroccan dialect, and to assess its psychometric properties in people suffering from urinary incontinence Study DesignOne hundred patients (77 % female) with a symptom of urinary incontinence participated in the study and filled out the Moroccan version of the questionnaire. The reliability and validity of the questionnaire were assessed by Cronbach’s alpha coefficient (α), the intraclass correlation coefficient (ICC), and confirmatory factor analysis. ResultsThe results showed that the Moroccan version of the I-QOL has very good psychometric properties. The overall I-QoL summary score and subscales showed high internal consistency (alpha ranging from 0.94 to 0.99). Inter-rater reliability was substantial for the three subscales and the total score. The ICC, assessing reproducibility at two weeks, ranged from 0.89 to 0.99, demonstrating the stability of the scores. The I-QOL was able to discriminate between different levels of self- perceived severity. Significant differences in I-QOL scores (p<0.001) were observed when comparing I-QOL scores by the number of incontinence-related medical visits made by patients during the past year. ConclusionThe Moroccan version of the I-QOL is a valid and reliable tool to determine the influence of urinary incontinence on health-related quality of life in Moroccan persons

Validation and cultural translation for the Brazilian Portuguese version of the Questionnaire for Urinary Incontinence Diagnosis.

Short questionnaires are important for validating the clinical diagnosis of urinary incontinence (UI). We sought to validate and culturally translate the Questionnaire for Urinary Incontinence Diagnosis (QUID) for the Brazilian Portuguese language. A cross-sectional study with 457 women (330 with urinary incontinence and 127 controls) was performed in a Southeastern Brazilian outpatient clinic. Patients answered a pilot-tested, notarized, six-item questionnaire (QUID) for internal consistency as well as a control questionnaire (ICIQ-SF and ICIQ-OAB) for construct validity. In both groups, floor and ceiling effects were calculated. Within UI women, test-retest (n=41) and responsiveness to conservative treatment (n=74) were also analyzed. Internal consistency (Cronbach's alpha) from the QUID was adequate between the UI (0.845-0.850) and control (0.724-0.775) groups. Mean QUID scores were statistically different between UI and control groups (p<0.05). No ceiling or floor effects were observed in incontinent patients. Test-retest reliability after 4 weeks (intraclass correlation coefficient [ICC]: 0.780-0.814) and responsiveness (0.867-0.889) were also adequate within UI women. Construct validity was adequate at all correlations between QUID and ICIQ-SF and ICIQ-OAB (r: 0.19-0.58; p<0.05). Responsiveness was demonstrated by a statistically significant difference in questions/subscale sores after physical therapy. The QUID presented adequate cultural translation, reliability, and good responsiveness to treatment in the Brazilian Portuguese language.

Fecal continence outcomes are associated with the type, height, and stage procedure of ileal pouch-anal anastomosis

PurposeThis study aims to analyze the quality of life in patients with an ileal pouch-anal anastomosis (IPAA) and to investigate the association between height and type of the anastomosis, the number of stage procedures and age, and the fecal continence outcomes.MethodsThis is a cross-sectional retrospective study in patients who had undergone IPAA between 1992 and 2016 (N = 133). We sent questionnaires to 102 eligible patients (64% response rate). We used the Wexner score to assess fecal incontinence: 0 = no incontinence to 20 = complete incontinence. We used RAND-36 to measure quality of life.ResultsPatients who underwent mucosectomy with hand-sewn anastomoses (n = 11, 17%) had significantly higher median Wexner scores than patients with stapled anastomoses (10 versus 3, P = 0.003). Lower anastomoses correlated significantly with increasing Wexner scores (r = − 0.468, P < 0.001). Quality of life of incontinent patients was diminished. Patients who were older at the time of IPAA surgery had higher Wexner scores (P = 0.004), while the time between surgery and questionnaire did not influence their Wexner scores (P = 0.810). Considering the stage procedures, multiple linear regression showed that the two-stage procedure without diverting ileostomy was significantly associated with higher Wexner scores (B = 0.815, P = 0.02), adjusted for sex (P = 0.008) and anastomosis type (P = 0.002). The three-stage procedure showed equally low complications and anastomotic leakage rates.ConclusionMucosectomy with more distal, hand-sewn anastomosis and increasing age at IPAA surgery was associated with poorer fecal continence outcomes. The three-stage procedure appears to give the best fecal continence results without increasing complications. Furthermore, incontinence reduced patient’s quality of life.

Early 3-month treatment with comprehensive physical therapy program restores continence in urinary incontinence patients after radical prostatectomy: Arandomized controlled trial.

The objective of this study is to ascertain whether an early three-month treatment with electrotherapy and biofeedback restores continence in urinary incontinence patients after radical prostatectomy (RP). Design: The study performed a randomized, controlled trial of parallel and open groups. Configuration: Secondary care, urology department of a university hospital complex. Patients sent for RPdue to prostate cancer (n = 60), 47 patients finally completed the study. The treatment group (TG) received physiotherapy consisting of electrotherapyand biofeedback, 3 days a week for 3 months, while the control group (CG) received no specific treatment. Both groups received a guide to perform pelvic floor exercises at home. The measurement instruments used were the 1-and 24-hour pad tests and the International Consultation on Incontinence Questionnaire Short-Form. The recording method used was a micturition (urinary) diary. The results of the 1-hour pad test (PT) show statistically significant differences between groups at 3 months (P = .001) and 6 months (P = .001), in favor of those in the TG. Sixty-four percent of patients in the TG recovered continence as against 9.1% in the CG after 3 months in the 1-hour PT, in line with the objective of this study. An early physiotherapy program helps RP patients with urinary incontinence recover continence after 3 months. Moreover, they lead a better quality life.

Standardized Method of the Thiersch Operation for the Treatment of Fecal Incontinence.

Conventionally, the Thiersch operation has typically involved blind positioning of the sling, and sling tension is subjectively based on a rule-of-thumb estimate. The aim of this study was to describe standardized methods for performing the Thiersch operation. Seventeen patients with fecal incontinence underwent the calibrated method of the Thiersch procedure. As an encircling sling, a 6-mm-wide silastic tube was used. Through 4 minimal perianal skin incisions, the sling was placed proximal to the anal skin 3cm from the anal verge and 4cm in depth. The circumference of the sling was 10cm in length. Results were assessed by clinical responses and by comparing pre- and postoperative Wexner scores. The data were collected retrospectively. The median follow-up period was 9months (range 6-19). In 16 out of 17 fecal incontinence patients (94.1%), the median Wexner incontinence score was 0 (range 0-3) postoperatively. Localized sepsis developed in three cases (17.7%, 3/17), which were controlled with drainage and antibiotics. Fecal impaction occurred in one case (5.9%, 1/17). There was no removal or breakage of the inserted sling. The elasticity of the silastic tube reduced the incidence of sling breakage. According to the standardized method, the sling was placed external to the external anal sphincter muscle and at the junction of the external anal sphincter muscle and puborectalis muscle. Fecal incontinence was controlled effectively, and the incidence of fecal impaction was negligible. High reproducibility was observed with this method.