Rectal Preparation Research Articles

MODERN THERAPEUTIC APPROACHES CORRECTION OF FUNCTIONAL CONSTIPATIONSIN INFANTS

Summary: One of the common complaints of parents of infants is constipation. At the present time, based on the evidence, specialists (pediatricians, pediatric gastroenterologists, nutritional specialists) have developed modern guidelines for managing children with functional constipation. The article discusses about etiology, pathogenesis and assessment of the condition and therapy of functional constipation in babies. As a symptomatic correction of functional constipation, experience is given and recommendations for the use of the rectal preparation Microlax®.

Does rectum and bladder dose vary during the course of image-guided radiotherapy in the postprostatectomy setting?

To assess the variations in actual doses delivered to the rectum and bladder in the course of postprostatectomy radiotherapy using kilovoltage-cone-beam computed tomography datasets acquired during image-guided radiotherapy. Twenty consecutive patients treated with intensity-modulated or intensity-modulated arc therapy to the prostate bed were retrospectively evaluated. Both the planning tomography and kilovoltage-cone-beam computed tomography were acquired with an empty rectum and a half-full bladder. Target localization was performed on the basis of soft tissue matching using cone-beam computed tomography scans before each treatment fraction. A total of 16 cone-beam computed tomography scans per patient (acquired at the first 5 fractions and twice weekly thereafter) were used for the assessments. The bladder and rectum were re-contoured offline on each cone-beam computed tomography scan by a single physician, and the delivered doses were recalculated. The variations in certain dose-volume parameters for the rectum and bladder (BD2cc, RD 2cc, V40%, V50%, V60%, V65%) were analyzed using the paired t test. Most of the dose volume variations for rectum and bladder were significantly higher than predicted (P <0.05) for the 320 kilovoltage-cone-beam computed tomography sets, except for the doses received by 2 cc of the bladder and V50 and V60 of the rectum. The dose-volume parameters of the bladder did not meet our criteria of V65 ≤25% and V40 ≤50% in 10% and 20% of the patients, respectively. None of the dose-volume histograms showed rectal V65 ≥17%; however, the rectal V40 ≤35% dose constraint was not met in 11 patients. For all patients, the ANOVA test revealed no significant difference between the variations. Actual doses delivered during treatment were found to be higher than predicted, but the majority of calculated bladder and rectal doses remained in the limits of our plan acceptance criteria. Interfraction variability of the rectum and bladder is a major concern in the postprostatectomy radiotherapy setting, even when patients are instructed about rectal and bladder preparation before the radiotherapy course. Image guidance with cone-beam computed tomography at each treatment fraction may offer a viable tool to account for interfraction variations of the rectum and bladder throughout the treatment course.

THE EFFECT OF POVIDONE IODINE INTRARECTAL TO REDUCE BACTERIURIA, BACTEREMIA, AND SIRS AFTER TRUS PROSTATE BIOPSY

Objective: To compare the incidence of bacteruria, bacteremia, and Systemic Inflammatory Response Syndrome (SIRS) after Transrectal Ultrasound (TRUS) of prostate biopsy for the patients whom given intrarectal povidone iodine, enema, prophylactic antibiotic with given enema and prophylactic antibiotic. Material &amp; Methods: A Randomised, experimental study, 20 samples of men with suspicious of prostate cancer were divided into two groups, first group (control) were given enema (dulcolax supp 10 mg) and prophylactic antibiotic (ciprofloxacin 1000 mg), second group (treatment) were given enema (dulcolax supp 10 mg) prophylactic antibiotic (ciprofloxacin 1000 mg), and intrarectal povidone iodine befotre TRUS of prostate biopsy. Urine and rectal swab culture examination were performed before biopsy then urine, blood culture, and blood leucocyte 2 days after biopsy. To assess any bacterial translocation from rectum to urinary tract, we match the post biopsy urine culture antibiogram and rectal swab culture antibiogram before biopsy. Complications and serious adverse effects were also monitored. Outcomes were assessed using Unpaired T Test and Mann Whitney depends on the data distribution and homogeneity. Results: There was no significant difference bacteriuria between groups (p=0.26). Bacteremia and SIRS were not found within two groups 2 days after prostate biopsy. Post biopsy bacteriuria positive patients antibiogram were compared with pre biopsy swab rectal culture antibiogram, there was no significant difference between two groups. But, significant correlation of pre biopsy rectal swab culture with post biopsy urine culture (p=0.04) were noted. Conclusion: Intrarectal povidone iodine before TRUS of prostate biopsy were not needed as part of rectal preparation, since enema and prophylactic antibiotic was proven to decrease the incidence of bacteriuria, bacteremia, and SIRS after TRUS of prostate biopsy. The occurrance of bacteriuria were caused by bacterial translocation from rectum to urinary tract.

Adequate rectal preparation reduces hospital admission for urosepsis after transrectal ultrasound - guided prostate biopsy.

ABSTRACTObjectives:Previous studies have compared infectious outcomes on the basis of whether rectal preparation was performed; however, they failed to evaluate the quality of each rectal preparation, which may have led to confounding results. This study aimed to compare hospitalizations for urosepsis within 1 month after transrectal ultrasound-guided prostate biopsy between patients with adequate and traditional rectal preparations.Materials and Methods:Between January 2011 and December 2016, a total of 510 patients who underwent transrectal ultrasound - guided prostate biopsy at our institutions and were orally administered prophylactic antibiotics (levofloxacin) were included. Two rectal preparations were performed: (1) adequate rectal preparation confirmed by digital rectal examination and transrectal ultrasound (Group A, n = 310) and (2) traditional rectal preparation (Group B, n = 200). All patient characteristics were recorded. A logistic regression model was used to assess the effects of the two different rectal preparations on urosepsis, adjusted by patient characteristics.Results:There were a total of three and nine hospitalizations for urosepsis in Groups A and B, respectively. Differences in the demographic data between the two groups were insignificant. Logistic regression showed that adequate rectal preparation before biopsy significantly decreased the risk for urosepsis after biopsy (adjusted odds ratio: 0.2; 95% confidence interval: 0.05 – 0.78; P = 0.021).Conclusions:Adequate rectal preparation could significantly reduce hospitalizations for urosepsis within 1 month after transrectal ultrasound-guided prostate biopsy. The quality of rectal preparation should be evaluated before biopsy. If adequate rectal preparation is not achieved, postponing the biopsy and adjusting the rectal preparation regimen are suggested.

FUNCTIONAL CONSTIPATION IN INFANTS: THE MODERN STATE OF PROBLEMS ON THE BASIS OF EVIDENCE

One of the common complaints of parents of infants is constipation. At the present time, based on the evidence, specialists (pediatricians, pediatric gastroenterologists, nutritional specialists) have developed modern guidelines for managing children with functional constipation. Data on the classification, diagnosis and treatment of this condition in infants are included in the standard of the new IV Rome criteria for functional gastrointestinal disorders in children (San Diego, May 22, 2016). The article discusses the assessment of the condition, diagnosis and therapy of functional constipation in children under 6 months. As a symptomatic correction of proctogenic and mixed constipation, experience is given and recommendations for the use of the rectal preparation Microlax®

Transrectal rigid-hybrid NOTES cholecystectomy can be performed without peritoneal contamination: a controlled porcine survival study.

The risk of infectious complications due to peritoneal contamination is a major concern and inhibits the widespread use of transrectal NOTES. A standardized rectal washout with a reversible colon occlusion device in situ has previously shown potential in reducing peritoneal contamination. The aim of this study was to compare the peritoneal contamination rate and inflammatory reaction for transrectal cholecystectomy after ideal rectal preparation (trCCE) and standard laparoscopic cholecystectomy (lapCCE) in a porcine survival experiment. Twenty pigs were randomized to trCCE (n=10) or lapCCE (n=10). Before trCCE, rectal washout was performed with saline solution. A colon occlusion device was then inserted and a second washout with povidone-iodine was performed. The perioperative course and the inflammatory reaction (leukocytes, C-reactive protein) were compared. At necropsy, 14days after surgery the abdominal cavity was screened for infectious complications and peritoneal swabs were obtained for comparison of peritoneal contamination. Peritoneal contamination was lower after trCCE than after lapCCE (0/10 vs. 6/10; p=0.003). No infectious complications were found at necropsy in either group and postoperative complications did not differ (p=1.0). Immediately after the procedure, leukocytes were higher after lapCCE (17.0±2.7 vs. 14.6±2.3; p=0.047). Leukocytes and C-reactive protein showed no difference in the further postoperative course. Intraoperative complications and total operation time (trCCE 114±32 vs. 111±27min; p=0.921) did not differ, but wound closure took longer for trCCE (31.5±19 vs. 13±5min; p=0.002). After standardized rectal washout with a colon occlusion device in situ, trCCE was associated without peritoneal contamination and without access-related infectious complications. Based on the findings of this study, a randomized controlled clinical study comparing clinical outcomes of trCCE with lapCCE should be conducted.

A feasibility study for the introduction of micro-enema to improve organ consistency in patients receiving radiotherapy for urinary bladder cancer

AbstractAimsThe aim of the study was to assess the effect on rectal consistency, of introducing a micro-enema in the preparation of patients receiving radiotherapy treatment of urinary bladder cancer.Materials and methodsThe treatment cone beam computed tomography (CBCT) images from patients receiving radiotherapy for bladder cancer were retrospectively assessed. CBCT datasets from nine patients treated without rectal preparation (97 CBCT), and 13 patients (134 CBCT) treated following micro-enema use before planning and treatment were evaluated. CBCT were compared with the planning computed tomography for rectal status, rectal diameter and presence of gas.ResultsReproducibility of an empty rectum was achieved in 70% of treatment fractions delivered using an enema protocol compared with 33% of fractions delivered without preparation. In total, 10% of fractions were delivered with the presence of faeces or faeces and gas, compared with 46% of fractions for the non-intervention group. Enemas did not affect the proportion of fractions delivered with gas, however, where gas was present, 65% of CBCT fractions had &lt;5% gas for patients using enemas compared with 32% without.FindingsThe use of a micro-enema before planning scan and each fraction was well tolerated and proved effective in managing and reducing inter-fraction variations in rectal volume and contents.

Impact of a rectal and bladder preparation protocol on prostate cancer outcome in patients treated with external beam radiotherapy

Impact of a rectal and bladder preparation protocol on prostate cancer outcome in patients treated with external beam radiotherapy

Prophylaxis of infectious complications following prostate biopsy

Different strategies have been developed to reduce infectious complications following prostate biopsy. Various technical aspects like number of biopsies, needle size, route of biopsy, periprostatic nerve blockade, rectal preparation by enema, or disinfection with povidone-iodine have to be discussed. Regarding antibiotic therapy, choosing the optimal antibiotic, the duration of prophylaxis, combination therapy, and rectal swab-based antimicrobial therapy are of major interest. The current review gives answers to the different aspects.

MP11-17 TRANSRECTAL PROSTATE BIOPSY AFTER PROPHYLATIC PREPARATION OF THE RECTUM WITH POVIDONE-IODINE – A PROSPECTIVE RANDOMIZED TRIAL

You have accessJournal of UrologyInfections/Inflammation/Cystic Disease of the Genitourinary Tract: Prostate & Genitalia II1 Apr 2017MP11-17 TRANSRECTAL PROSTATE BIOPSY AFTER PROPHYLATIC PREPARATION OF THE RECTUM WITH POVIDONE-IODINE – A PROSPECTIVE RANDOMIZED TRIAL José Cadilhe José CadilheJosé Cadilhe More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.418AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Transrectal ultrasound (TRUS) guided prostate biopsy can lead to urinary tract infections in up to 11% and sepsis in up to 2% of patients. We evaluate whether an original way to apply peri-procedure povidone-iodine rectal preparation prior to TRUS-guided prostate needle biopsy can reduce infectious complications. METHODS Between january/2014 and september/2016, 94 men in private office were prospectively randomized to rectal cleansing (an original transrectal prostate massage for about half a minute with 2,5ml of betadine100 mg/ml) (47) or no cleansing (47) before TRUS guided prostate biopsy with periprostatic local injection of lidocaine. All of the patients received prophylactic antibiotics: levofloxacine 500mg PO for 7 days, beginning the day before procedure. Patients completed a telephone interview 4 days after undergoing the biopsy and went to doctor office 2 weeks after biopsy. The primary end point was the rate of infectious complications, a composite end point of 1 or more of 1) fever greater than 38.0C, 2) urinary tract infection or 3) sepsis (standardized definition). RESULTS Infectious complications developed in 6 cases (11%) in the non rectal preparation group: one patient had sepsis (2%) and five had fever without sepsis. In the povidone-iodine rectal preparation group we had no infectious complication (0,0%). Of the 94 men who underwent TRUS guided biopsy 45 (47.9%) were diagnosed with prostate cancer and 3 (3,2%) had ASAP in the result. The hospital admission rate for urological complications within 30 days of the procedure was 1%, and only for infection related reasons (sepsis). CONCLUSIONS The administration of quinolone-based prophylactic antibiotics and the simple use of 2,5 ml of povidone-iodine solution in a transrectal prostate massage for about half a minute provided an excellent protocol for reducing infective complications of TRUS-guided prostate biopsy. The simplicity of these method and cost effectiveness of betadine100 mg/ml were noteworthy, with statistically significant relative risk reduction of infectious complications in this study. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e143 Advertisement Copyright & Permissions© 2017MetricsAuthor Information José Cadilhe More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Prognostic factors in prostate cancer patients treated by radical external beam radiotherapy.

The aim of this paper was to analyze, retrospectively, in prostate cancer patients treated in our Centre with external beam radiotherapy, the prognostic factors and their impact on the outcome in terms of cancer-specific survival (CSS), biochemical disease-free survival (BDFS) and clinical disease-free survival (CDFS). From October 1999 and March 2012, 1080 patients were treated with radiotherapy at our Institution: 87% of them were classified as ≤cT2, 83% had a Gleason Score (GS) ≤7, their mean of iPSA was 18 ng/mL, and the rate of clinical positive nodes was 1%. The mean follow-up was 81 months. The statistically significant prognostic factors for all groups of patients at both, univariate and multivariate analysis, were the GS and the iPSA. In intermediate- and high- or very-high-risk patients at multivariate analysis other prognostic factors for CSS were positive nodes on computed tomography (CT) scan and rectal preparation during the treatment; for BDFS, the prognostic factors were patient risk classification, positive lymph nodes on CT scan and rectal/bladder preparation; for CDFS, the prognostic factors were the number of positive core on biopsy (P=0.003), positive lymph nodes on CT scan, and radiotherapy (RT) dose. In high/very-high risk patient group at multivariate analysis other prognostic factors for CSS were clinical/radiological stage and RT dose, for BDFS they were adjuvant hormone therapy, clinical/radiological stage, and RT dose >77.7 Gy, and for CDFS they were clinical/radiological stage and RT dose >77.7 Gy. The results of this study confirm the prognostic factors described in the recent literature, with the addition of rectal/bladder preparation, generally known for its effect on toxicity but not yet on outcome.

Evaluation and development of an image-guided radiotherapy protocol for prostate and nodes

AbstractPurposeTo evaluate and develop an image-guided radiotherapy (IGRT) protocol for the effective treatment of prostate and pelvic lymph nodes.Methods and materialsThis study comprised of nine patients receiving radiotherapy for node negative prostate cancer, who had a pair of planar kV images taken for 37 treatment fractions. The positioning accuracy for both implanted fiducial markers and pelvic bony anatomy (surrogate for pelvic node position) was calculated using random and systematic errors. Appropriate margins were also determined. All patients followed a strict bladder and bowel protocol before computed tomography planning and treatment.ResultsIn total, 292 sets of images were used for fiducial marker and pelvic bone registration. A discrepancy of &gt;5 mm between the fiducial markers and the anatomical pelvic bone was seen in 4% of treatment sessions. The maximum displacement observed between the fiducial match and the bone match was 7, 10 and 4 mm in the A/P (anterior/posterior), S/I (superior/inferior) and R/L (right/left) directions, respectively.ConclusionThe margins used in combination with an online IGRT strategy ensure both the fiducial match and the bone match correlate within 5 mm thus allows good coverage of both prostate and nodal target volumes. It is essential that this is combined with a strict bladder and rectal preparation protocol to ensure accuracy and reproducibility.

Strategies for prevention of ultrasound guided prostate biopsy infections [Erratum

[This corrects the article on p. 161 in vol. 9, PMID: 27468242.].

Strategies to evaluate the impact of rectal volume on prostate motion during three-dimensional conformal radiotherapy for prostate cancer.

ObjectiveTo evaluate the rectal volume influence on prostate motion during three-dimensional conformal radiotherapy (3D-CRT) for prostate cancer.Materials and MethodsFifty-one patients with prostate cancer underwent a series of three computed tomography scans including an initial planning scan and two subsequent scans during 3D-CRT. The organs of interest were outlined. The prostate contour was compared with the initial CT images considering the anterior, posterior, superior, inferior and lateral edges of the organ. Variations in the anterior limits and volume of the rectum were assessed and correlated with prostate motion in the anteroposterior direction.ResultsThe maximum range of prostate motion was observed in the superoinferior direction, followed by the anteroposterior direction. A significant correlation was observed between prostate motion and rectal volume variation (p = 0.037). A baseline rectal volume superior to 70 cm3 had a significant influence on the prostate motion in the anteroposterior direction (p = 0.045).ConclusionThe present study showed a significant interfraction motion of the prostate during 3D-CRT with greatest variations in the superoinferior and anteroposterior directions, and that a large rectal volume influences the prostate motion with a cutoff value of 70 cm3. Therefore, the treatment of patients with a rectal volume > 70 cm3 should be re-planned with appropriate rectal preparation.

Povidone Iodine Rectal Preparation at Time of Prostate Needle Biopsy is a Simple and Reproducible Means to Reduce Risk of Procedural Infection

Single institution and population-based studies highlight that infectious complications following transrectal ultrasound guided prostate needle biopsy (TRUS PNB) are increasing. Such infections are largely attributable to quinolone resistant microorganisms which colonize the rectal vault and are translocated into the bloodstream during the biopsy procedure. A povidone iodine rectal preparation (PIRP) at time of biopsy is a simple, reproducible method to reduce rectal microorganism colony counts and therefore resultant infections following TRUS PNB. All patients are administered three days of oral antibiotic therapy prior to biopsy. The PIRP technique involves initially positioning the patient in the standard manner for a TRUS PNB. Following digital rectal examination, 15 ml of a 10% solution of commercially available povidone iodine is mixed with 5 ml of 1% lidocaine jelly to create slurry. A 4 cmx4 cm sterile gauze is soaked in this slurry and then inserted into the rectal vault for 2 min after which it is removed. Thereafter, a disposable cotton gynecologic swab is used to paint both the perianal area and the rectal vault to a distance of 3 cm from the anus. The povidone iodine solution is then allowed to dry for 2-3 min prior to proceeding with standard transrectal ultrasonography and subsequent biopsy. This PIRP technique has been in practice at our institution since March of 2012 with an associated reduction of post-biopsy infections from 4.3% to 0.6% (p=0.02). The principal advantage of this prophylaxis regimen is its simplicity and reproducibility with use of an easily available, inexpensive agent to reduce infections. Furthermore, the technique avoids exposing patients to additional systemic antibiotics with potential further propagation of multi-drug resistant organisms. Usage of PIRP at TRUS PNB, however, is not applicable for patients with iodine or shellfish allergies.

Povidone Iodine Rectal Preparation at Time of Prostate Needle Biopsy is a Simple and Reproducible Means to Reduce Risk of Procedural Infection

Povidone Iodine Rectal Preparation at Time of Prostate Needle Biopsy is a Simple and Reproducible Means to Reduce Risk of Procedural Infection

The comparison of saline enema and bisacodyl in rectal preparation before anorectal surgery

BackgroundGiven the limited data on the need of mechanical bowel preparation application before anorectal surgeries and the preferred method for bowel preparation, we aimed to compare saline enema and bisacodyl in rectal preparation before anorectal surgery. Materials and methodsThis is a randomized clinical trial study. Seventy-nine hospitalized patients for anorectal surgery (hemorrhoid, fissure, and fistula) were recruited by convenient sampling and then randomly allocated to receive 500 cc Saline by rectal enema or six bisacodyl tablets (Sobhan company) beginning from a day before the operation in order to prepare the bowel. After surgery, surgeons' satisfaction of the surgery and patients' satisfaction of the preparation process were evaluated in the ward using Likert score by a nurse blind to the study. Also, the patients were interviewed for pain after the first defecation, using numeric rating scale based on a 0–10 scores. All patients were actively followed-up after discharge for 1 mo concerning postoperative complications. The obtained data were analyzed by SPSS software (version 16), Mann–Whitney, chi-squared, and Fisher exact tests at the significant level of P < 0/0.5. ResultsA total of 79 patients participated in the study, 38 received 500-cc saline by rectal enema and 41 bisacodyl tablets. No significant differences were observed between the two groups in most variables except for pain after the first defecation (P = 0.032). ConclusionsAccording to the results, the bisacodyl approach results in less pain in the first postoperative defecation and fewer complications than the rectal enema. Thus, bisacodyl can be suggested as a superior counterpart for enema.

A Novel Method of Optimising the CTV to PTV Margin in Prostate Radiotherapy using Fiducials and Strict Organ Filling

Purpose: Even with modern modulated radiotherapy techniques, achieving a minimum dose of 74 Gy for prostate radiotherapy [1] can be technically difficult due to the proximate organs at risk. Online image guidance (IG) offers a potential solution by allowing a reduction in the set-up uncertainty margin [2]. This approach should be performed pragmatically though, as each centre has different uncertainties due to variations in patient bladder and rectal preparation, imaging equipment, imaging tolerances and action levels. We describe a method to calculate residual systematic and random errors for online IG using fiducial markers and strict bladder and rectal filling.

Manometric analysis of the influence of rectal content on anal pressures in chronically constipated patients

ObjectiveThe aim of our study was to analyze whether the presence of content in the rectum influences the anorectal manometry examination results in chronically constipated patients. MethodsWe evaluated 38 chronically constipated patients, 36 women and 2 men, with an average age of 53.55 years of age, all with a score above 10 on the Agachan Constipation Scoring System. All the patients underwent rectal preparation and then had the anorectal manometry examination without rectal content and after 5min had it with a rectal balloon inflated with 200ml of air in the rectum. Statistical analysisThe statistical parametric paired-t test was applied in order to verify the difference in response between the groups after an intervention, adopting a significant level of 5% (p<0.05). ResultsThe anal pressure was analyzed from the standard anal manometry examination and we found a statistically significant influence on the manometric results for the patients’ average resting pressures, absolute average contractions, average contractions, evacuations, and sustained contractions in the functional anal canals. ConclusionThe presence of rectal content influences the manometric values of average resting pressure, average absolute contraction, average contraction, evacuation, and average sustained contractions in the functional anal canal in the group of chronically constipated patients.

PTU-070 Non-adherence With Rectal Preparations In Colitic Patients. Fact Or Fiction?

IntroductionRectal preparations containing steroids or 5-aminosalicylates are an effective treatment for distal colitis. Nonetheless, it is perceived that this therapy is associated with poor levels of adherence and that patients...