Sphincter In Patients Research Articles

Open or closed sphincterotomy for treatment of the chronic anal fissure? (systematic review and meta-analysis)

INTRODUCTION: up to the present time, both open and closed lateral internal sphincterotomy (LIS) are considered by surgeons as fully comparable methods for eliminating the spasm of the internal sphincter in patients with chronic anal fissure. However, each method has a number of advantages and disadvantages. AIM: determination of an effective and safe method of lateral subcutaneous sphincterotomy.MATERIALS AND METHODS: a systematic overview and meta-analysis of studies, which compare the results of treatment after an open and closed lateral sphincterotomy was performed. The following has been evaluated: the incidence of fissure epithelialization, the postoperative morbidity, the recurrence rate, the incidence of anal incontinence (AI). Statistical processing has been carried out in the Review Manager 5.3 program.RESULTS: the meta-analysis included 9 studies with the results of treatment of 452 patients after an open lateral sphincterotomy and 443 after a closed one. The groups were comparable in frequency of epithelialization of fissures (OR = 0.87; CI = 0.30; 2.53; p = 0.8), in terms of the number of postoperative complications (OR = 0.52; CI = 0.15; 1.76; p = 0.29), as well as the number of relapses of the disease (OR = 0.5; CI = 0.19; 1.31; p = 0.16). At the same time, the implementation of an open lateral sphincterotomy leads to the development of AI 2.05 times more often than the closed method (OR = 2.05; CI = 1.01; 4.16; p = 0.05).CONCLUSION: during the treatment of the chronic anal fissure, in order to eliminate the spasm of the internal sphincter, it is advisable to use a closed method, in which the chance of AI is 2.05 times lower.

ОСОБЕННОСТИ НАРУШЕНИЙ МОТОРНОЙ ФУНКЦИИ ЖЕЛУДКА ПРИ ДИСРЕГЕНЕРАТОРНЫХ ИЗМЕНЕНИЯХ ЕГО СЛИЗИСТОЙ ОБОЛОЧКИ

The study was conducted at the Department and Clinic of Hospital Therapy of the Military Medical Academy. CM. Kirov. The work studied the relationship of motor disorders of the stomach with morphological changes in the gastric mucosa in 90 patients with chronic atrophic gastritis and 93 patients with chronic non-atrophic gastritis aged 20 to 73 years (the average age of patients was 52.7+1.7 years and 48.5+ 3.6 respectively). Motor disorders were characteristic of 87% of patients with chronic atrophic gastritis and 79.6% of patients with chronic non-atrophic gastritis. It was found that in patients with chronic atrophic gastritis significantly more often (p<0.01) than in patients with chronic non-atrophic gastritis, there was an insufficiency of the lower esophageal sphincter. At the same time, insufficiency of the pylorus in comparison with its spasm was significantly more often (p<0.01) detected in chronic atrophic gastritis. Duodenogastric reflux in combination with insufficiency of the lower esophageal sphincter in patients with chronic atrophic gastritis significantly more often (p<0.01) atrophy was observed in the body and antrum of the stomach. When atrophy was localized only in the antrum, pyloric insufficiency was observed significantly more often than spasm (p<0.01). Duodenogastric reflux in combination with insufficiency of lower esophageal sphincter in patients with chronic atrophic gastritis significantly more often (p<0,01) atrophy in the body and antral part of the stomach was observed. Thus, the relationship between insufficiency of the lower esophageal and pyloric sphincters with a diffuse atrophic process has been established.

КАЧЕСТВО ЖИЗНИ ПАЦИЕНТОВ С АХАЛАЗИЕЙ КАРДИИ В ОТДАЛЕННОМ ПОСЛЕОПЕРАЦИОННОМ ПЕРИОДЕ ПРИ 2–4 СТАДИЯХ ЗАБОЛЕВАНИЯ

Evaluation of life quality in patients with achalasia cardia (AC) during the postoperative period, regardless of the method of surgical treatment, remains an urgent topic. The purpose of the study was to assess the quality of life of patients with AC in the long-term postoperative period, depending on the stage of the disease at the time of surgery, by analyzing the results of patient questionnaires and data from instrumental methods for studying the function of the esophagus. Results. The data of 95 patients were analyzed, of which 32 people were with stage 2, 33 people with stage 3 and 30 patients with stage 4 of the disease. All patients underwent the same type of surgical intervention, video endoscopic myotomy according to Heller with fundoplication according to Dor. The long-term period of postoperative follow-up ranged from 2 to 5 years. The results of traditional esophageal manometry and esophageal fluoroscopy were evaluated and the data from the Eckardt symptom score and GIGLI scale questionnaires were evaluated. The anthropometric data showed a statistically significant decrease in the tone of the lower esophageal sphincter in patients in all study groups to normal values (p =0.001). Data obtained during contrast X-ray examination of the esophagus and stomach after surgery revealed the restoration of the evacuation function of the esophagus in all patients (p=0.001). Motor function of the esophagus could not be restored in 6 patients with stage 4 AC, according to manometric data, atony of the esophagus was observed in these patients. The severity and frequency of dysphagia after surgical treatment, according to questionnaires, decreased significantly in patients with all stages of AC, in the long-term postoperative period, patients with stage 2 showed a decrease in the number of points scored by 68.9%, patients with stage 3 by 70.5% and patients with stage 4 of AC by 66.7% (p<0.05). Conclusions. According to Eckardt score and GIGLI questionnaires and instrumental methods of examination of esophageal function, video endoscopic esophagocardiomyotomy according to Heller with Dor fundoplication leads to a decrease in the main symptoms of achalasia of the cardia in patients with stages 2-4 of the disease and increases quality of life, while the best indicators were obtained in patients with stage 2 of the disease, which allows us to consider that it is advisable to perform this organ preservation operation already at the second stage of AC.

Endosonographic variations in thickness of anal sphincters in patients with hemorrhoids and normal population

Endosonographic variations in thickness of anal sphincters in patients with hemorrhoids and normal population

Endosonographic variations in thickness of anal sphincters in patients with hemorrhoids and normal population

Endosonographic variations in thickness of anal sphincters in patients with hemorrhoids and normal population

Outcomes of Initial Transcorporal Versus Standard Placement of Artificial Urinary Sphincter in Patients With Prior Radiation.

Objective: This study aimed to evaluate both device and functional outcomes of men who underwent initial artificial urinary sphincter (AUS) placement after pelvic radiation using the transcorporal versus the standard approach.Methods: A retrospective review of patients who underwent first-time AUS placement after pelvic irradiation for prostate cancer was conducted between January 2008 and June 2020. Patients were grouped by transcorporal versus standard device placement. The primary outcomes of interest included major complications (revision or explant surgery) and functional outcomes (pads per day, International Prostate Symptom Score {IPSS}, quality of life {QOL} score).Results: We identified 45 patients who underwent first-time AUS with a history of prior pelvic irradiation for prostate cancer, 27 underwent transcorporal placement and 18 underwent standard placement. Transcorporal AUS placement resulted in a significantly lower number of major complications (p=0.01), explants (p=0.02), and revisions (p=0.04) The transcorporal artificial urinary sphincter group had better postoperative pads per day (p=0.04), IPSS (p<0.01), and IPSS QOL score (p<0.01).Conclusions: Initial transcorporal artificial urinary sphincter placement is a promising technique with lower rates of major complications in patients with a history of prior pelvic radiation and had better functional urinary outcomes.

Anatomic and Manometric Abnormalities of the Upper and Lower Esophageal Sphincters in Patients With Reflux Disease

Laryngopharyngeal reflux (LPR) may cause inflammation of the laryngeal and pharyngeal mucosa. Gastroesophageal reflux disease (GERD) involves retrograde flow of gastric content into the esophagus below the upper esophageal sphincter (UES). The goal of this study was to investigate the esophageal anatomical and manometric variations of the esophagus in patients with LPR and/or GERD. Adult voice center patients who underwent diagnostic workup for reflux complaints with 24-hour multichannel intraluminal pH-impedance testing and esophageal manometry were included in this retrospective study. Subjects were classified as having LPR (>10 proximal reflux events), LPR + GERD (>10 proximal reflux events plus >73 distal reflux events) or were assigned to a control group (≤10 proximal events and ≤73 distal reflux events) based on pH study results. Anatomic and manometric parameters were evaluated between groups. There were 169 cases (65 male, 104 female) included in this study. The average age was 50.50 ± 17.29. Subjects in the LPR group had significantly higher UES relaxation pressures and greater UES length compared with the control group. Lower esophageal sphincter relaxation pressure was significantly higher in the control group compared with the LPR group or the GERD + LPR group. Subjects in the GERD + LPR group had a significantly shorter intra-abdominal portion of the lower esophageal sphincter compared with the LPR only group and the control group. Intrabolus pressure was significantly lower in both the LPR group and the LPR + GERD group compared with the control group. Distal wave amplitude was significantly lower in the LPR + GERD group compared to both the LPR group and the control group. The percentage of swallows with incomplete clearance was significantly greater in the LPR + GERD group than both the control group and the LPR group. The LPR group had significantly fewer swallows with incomplete clearance than the control group. Anatomic and manometric abnormalities are present in subjects with LPR with or without GERD and may contribute to the pathogenesis of reflux disease. Further research is needed to confirm or refute these findings.

Clinical and functional features of rectal sphincter in patients with rectovaginal fistulas before and after split vaginal-rectal flap application

Dysfunction of the rectal sphincter is noted in more than 70 % of patients with rectovaginal fistulas (RVF), which require an extremely careful evaluation of the rectal sphincter function both by clinical and instrumental methods. Objective: to study the state of rectal sphincter in patients with rectovaginal fistulas before and after surgical treatment. Materials and methods: in the period from 2012 to 2021 198 patients (age from 20 to 73 years, Me = 35 (30; 45)) were included in the comprehensive study of the rectal sphincter functional state before and after surgical treatment. 106 (53,5 %) cases were recurrent. Traumatic childbirth was the most common cause of RVF (43,9 %). Results: dysfunction of the rectal sphincter is revealed in 154 (77,8 %) patients with rectovaginal fistulas. The etiology of the disease and the recurrent course do not affect the severity of the rectal sphincter functional disorders. Using of a split rectal-vaginal flap do not lead to a worsening of the rectal sphincter function. Conclusion: A significant mismatch between the obtained objective (sphincterometry) and subjective (Wexner scale) data of the rectal sphincter function in patients with rectovaginal fistulas proves the need for sphincterometry in this category of patients. Elimination of rectovaginal fistulas by using a split vaginal-rectal flap is a safe and low-traumatic surgical method.

Implant of Self-Expandable Artificial Anal Sphincter in Patients With Fecal Incontinence Improves External Anal Sphincter Contractility.

External anal sphincter contractility significantly contributes to control the passage of stool. An artificial anal sphincter placed into the intersphincteric space is a safe and effective procedure to treat fecal incontinence, even if its mechanism of action has not been fully elucidated. The aim of this study was to evaluate external anal sphincter contractility changes after a self-expandable hyexpan prostheses was implanted into the intersphincteric space of the anal canal and clinical outcomes compared. This was a prospective clinical study. The study was conducted at a university teaching hospital. Consecutive patients affected by fecal incontinence for at least 6 months after failure of conservative treatment were included. All of the patients underwent 10-prostheses implantation and were examined preoperatively and postoperatively by endoanal ultrasound and anorectal manometry. Fecal incontinence symptoms were assessed by severity scores. The external anal sphincter muscle tension was calculated using a specific equation. Thirty-nine patients (34 women; median age = 68 y) were included in the study; no morbidity was registered. After a median follow-up period of 14 months, both the median maximum voluntary squeeze pressure and the median inner radius of the external anal sphincter significantly increased. A statistically significant increase of external anal sphincter muscle tension was detected. A decrease of any fecal incontinence symptom and an improvement in severity scores were observed at the last follow-up examination. The external anal sphincter contractility was significantly higher in patients reducing incontinence episodes to solid stool by >50% and improving their ability to defer defecation for >15 minutes. This was a single-center experience with a relatively small and heterogeneous sample size, patients with a potentially more severe disease because our institution is a referral center, and an absence of quality-of-life evaluation. Artificial anal sphincter implantation improved the external anal sphincter muscle tension; there was a positive correlation between its increase and the clinical outcome. See Video Abstract at http://links.lww.com/DCR/B468. ANTECEDENTES:La contractilidad del esfínter anal externo contribuye significativamente al control del paso de las heces. Un esfínter anal artificial colocado en el espacio interesfinteriano es un procedimiento seguro y eficaz para tratar la incontinencia fecal, incluso si su mecanismo de acción no se ha definido por completo.OBJETIVO:El objetivo de este estudio fue evaluar los cambios en la contractilidad del esfínter anal externo después de la implantación de una prótesis de hyexpan autoexpandible en el espacio interesfinteriano del canal anal y comparar los resultados clínicos.DISEÑO:Estudio clínico prospectivo.ENTORNO CLINICO:El estudio se realizó en un hospital universitario.PACIENTES:Pacientes consecutivos afectados por incontinencia fecal durante al menos 6 meses, tras fracaso de tratamiento conservador.INTERVENCIONES:Todos los pacientes fueron sometidos a la implantación de 10 prótesis, y fueron examinados pre y postoperatoriamente mediante ecografía endoanal y manometría anorrectal.PRINCIPALES MEDIDAS DE VALORACION:Los síntomas de incontinencia fecal se evaluaron mediante puntuaciones de gravedad. La tensión del músculo del esfínter anal externo se calculó mediante una formula específica.RESULTADOS:Treinta y nueve pacientes (34 mujeres; mediana de edad 68 años) fueron incluidos en el estudio; no se registró morbilidad. Después de un período de seguimiento medio de 14 meses, tanto la presión de compresión voluntaria máxima media como el radio interior medio del esfínter anal externo aumentaron significativamente. Se detectó un aumento estadísticamente significativo de la tensión del músculo del esfínter anal externo. En el último examen de seguimiento se observó una disminución de cualquier síntoma de incontinencia fecal y una mejora en las puntuaciones de gravedad. La contractilidad del esfínter anal externo fue significativamente mayor en los pacientes que redujeron los episodios de incontinencia a heces sólidas en más del 50% y mejoraron la capacidad para diferir la defecación durante más de 15 minutos.LIMITACIONES:Experiencia de un solo centro; tamaño de muestra relativamente pequeño y heterogéneo; pacientes con una enfermedad potencialmente más grave porque nuestra institución es un centro de referencia; ausencia de evaluación de la calidad de vida.CONCLUSIONES:La implantación del esfínter anal artificial mejoró la tensión muscular del esfínter anal externo; hubo una correlación positiva entre su aumento y el resultado clínico. Consulte Video Resumen en http://links.lww.com/DCR/B468.

Сhronic gastritis: impaired motor-evacuation function of the stomach

The effect of morphological changes in the gastric mucosa on the motor-evacuation function of the stomach was evaluated in 90 patients with chronic atrophic gastritis and 93 patients with chronic non-atrophic gastritis aged 18 to 82 years. Motor function disturbances were discovered of 90% of patients with chronic atrophic gastritis and 80,6% with chronic non-atrophic gastritis. It was established that the pyloric insufficiency compared with its spasm was significantly more (p0,01) often in chronic atrophic gastritis. Insufficiency of the lower esophageal sphincter in patients with atrophic gastritis was significantly (p0,01). Insufficiency of the lower esophageal sphincter in combination with duodenogastric reflux in patients with chronic atrophic gastritis was significantly more (p0,01) often observed during diffuse atrophy, i. e. when mucous membrane of stomach corpus and antrum is involved in the process. With the localization of atrophy in the antrum alone, pyloric insufficiency was observed significantly more (p 0,01) often than spasm. Thus, an interrelation between the insufficiency of the lower esophageal and pyloric sphincters with the diffuse atrophic process has been established. There are no significant differences of disorders of gastric motor function in patients with different types of chronic gastritis. Accelerated evacuation from the stomach with localization of atrophy in the mucous membrane of the stomach corpus is more (p 0,01) often observed in patients with chronic atrophic gastritis.

Regenerative medicine and injection therapies in stress urinary incontinence

Stress urinary incontinence (SUI) is a common and bothersome condition. Anti-incontinence surgery has high cure rates, but concerns about mesh tapes have resulted in the resurgence of surgical procedures that involve increased abdominopelvic dissection and morbidity. Injection therapy with urethral bulking agents or stem cell formulations have been developed as minimally invasive alternatives. Many synthetic and biological bulking agents havebeen trialled, but several have been discontinued owing to safety concerns. The use of Macroplastique and Contigen has the largest evidence base, but, overall, success rates seem to be similar between the various agents and positive outcomes are poorly sustained for more than 6 months. Furthermore, subjective cure rates, although initially high, also deteriorate over time. The available data consistently demonstrate manifestly poorer outcomes for injection therapies than for surgery. Stem cell treatments are thought to functionally regenerate the urethral sphincter in patients with suspected intrinsic sphincter deficiency. Autologous adipose and muscle-derived stem cells seem to be the intuitive cell source, as they are comparatively abundant, can be harvested and cause minimal donor site morbidity. To date, only a few small clinical studies have been reported and most data are derived from animal models. The success rates of stem cell injection therapies seem to be comparable with those of bulking agents.

Pharyngeal motility in patients submitted to type I thyroplasty

IntroductionType 1 thyroplasty is performed to improve glottis closure as well as dysphagic symptoms in patients with unilateral vocal fold immobility. ObjectivesThis study aims to compare the motility of the pharynx and upper esophageal sphincter in patients with unilateral vocal fold immobility before and after thyroplasty Type I. MethodsWe prospectively studied 15 patients with unilateral vocal fold immobility who underwent thyroplasty Type I. Subjects were divided according to the topography of vagal injury and presence of dysphagia. High resolution manometry was performed before and 30 days after surgery. Time and pressure manometric parameters at the topography of the velopharynx, epiglottis and upper esophageal sphincter were recorded. ResultsDysphagia was present in 67% of patients. 63% had lower vagal injuries. Manometric parameters did not change after thyroplasty for the whole population. The group of dysphagic patients, however, had an increase in residual pressure at the upper esophageal sphincter after thyroplasty (1.2 vs. 5.2mmHg; p=0.05). Patients with low vagal injury developed higher peak pressure (100 vs. 108.9mmHg p≤0.001), lower rise time (347 vs. 330ms p = 0.04), and higher up stroke (260 vs. 266.2mmHg/ms p=0.04) at the topography of the velopharynx after thyroplasty. ConclusionPharyngeal motility is affected by thyroplasty Type I in patients with dysphagia and low vagal injury.

Effect of adipocytokines disbalance on the function of the lower esofhageal sphincter in patients with type 2 diabetes mellitus against the background of obesity

The review presents the recent data on the pathogenesis of gastroesophageal reflux disease (GERD) against the background of type 2 diabetes mellitus (DM 2). An analysis of studies of the comorbidity of these nosologies has been carried out, diagnostic significance of the distribution of fat deposits has been examined. It has been revealed that perivascular and visceral adipose tissue against the background of DM 2 undergo considerable functional changes, that results in the formation of peripheral insulin resistance. The changes in eating behaviors based on the levels of adipocytokines (ghrelin, leptin) have been analyzed. Ghrelin concentration was significantly reduced in patients with an overweight and empty stomach. According to the recent data, normal body weight promotes reducing postprandial ghrelin level, which does not normally take place in people with obesity. High leptin levels and the onset of leptin resistance are associated with the trigger of insulin resistance. It is believed that increased GERD morbidity may be explained by the increasing number of overweight people. Insulin resistance, dyslipidemia, hyperglycemia play an important role in the chronic systemic inflammation of esophageal mucosa. Pathogenetic GERD mechanisms can also include the leptin resistance against the background of obesity and decreasing of the ghrelin concentration. Low ghrelin level is associated with slow-up the motility process of the upper parts of the digestive tract and increase the risk of pathological reflux. New data proving the correlation between adipocytokines with lower esophageal sphincter tone in patients with DM 2 and obesity have been presented. The perspective investigations in this area should be purposed on the study of possible risk factors, pathogenesis processes and peculiarities of the GERD course in patients with DM 2 against the background of obesity with the aim of optimization of the diagnosis, prophylaxis and treatment of these pathologies, and prevention of their negative effects on the quality of life and health of this group of patients.

Evaluation of upper oesophageal sphincter in unilateral vocal fold paralysis.

To evaluate dysphagia and manometric changes in the upper oesophageal sphincter in patients with unilateral vocal fold paralysis. Thirty patients with unilateral vocal fold paralysis due to vagal nerve paralysis scheduled for evaluation were enrolled in the study group; 24 healthy subjects were included in the control group. Upper oesophageal sphincter basal and residual pressure, relaxation time, and pharyngeal pressure values were evaluated by manometry. All patients completed the Turkish Eating Assessment Tool 10 questionnaire, the MD Anderson dysphagia questionnaire and the reflux symptom index form. Swallowing assessment questionnaires and reflux symptom index results were significantly higher in the study group. Upper oesophageal sphincter basal and relaxation pressures were lower in the study group. Upper oesophageal sphincter relaxation time was shorter in the study group, but pressure values recorded from the pharynx were higher. Upper oesophageal sphincter manometric pressure was lower in patients with unilateral vocal fold paralysis. A hypotonic sphincter likely contributes to dysphagia and aspiration.

Effectiveness of surgical management with an adjustable sling versus an artificial urinary sphincter in patients with severe urinary postprostatectomy incontinence: a systematic review and network meta-analysis.

Background:The purpose of this study was to determine the effectiveness of an adjustable sling compared with an artificial urinary sphincter (AUS) in patients with severe urinary incontinence (SUI) postprostatectomy (PP).Methods:This review was carried out following the Cochrane Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) declaration. We searched Medline, Embase, LILACS, and CENTRAL databases. Studies with patients older than 18 years of age with SUI PP who underwent sling or AUS intervention and had been monitored for longer than 12 months were included.Results:Seven studies were included, yielding a sample size of 420. Pads were reportedly dry or improved in 70% of the sling group compared with 74% in the AUS group. The Incontinence Impact Questionnaire, Short Form (IIQ-7) was the most frequently used scale and showed improvement, with a score of 82.8% in the AUS group compared with 86.1% in the sling group. When comparing interventions with nonintervention, relative risks (RRs) of 35.37 (95% confidence interval [CI]: 7.17–174.35) and 45.14 (95% CI: 11.09–183.70) were found for the adjustable sling and AUS, respectively, which were statistically significant. No significant differences were found when AUS versus adjustable sling were compared, with an RR of 0.78 (95% CI: 0.09–6.56). We found a low risk of bias in most studies.Conclusions:Both interventions can reduce incontinence and improve the quality of life of patients with SUI PP. The published literature is substantially limited as no randomized clinical trials are available, no consensus has been reached regarding the definition of severity of incontinence, and considerable heterogeneity exists across the outcome variables measured.

The acid pocket - a novel target for the treatment of gastro-esophageal reflux disease

Increased acid reflux after meals is a key feature of gastro-esophageal reflux disease (GERD) and is the most important cause for patient symptoms, particularly heartburn and acid regurgitation. Chronic acid exposure also predisposes to associated pathologies including reflux esophagitis, esophageal stricture, Barrett's esophagus, and Barrett's carcinoma (esophageal adenocarcinoma). The severity of esophageal symptoms and mucosal damage is related to two key factors, (i) the acidity of the refluxate, which depends primarily on the gastric secretory output and its distribution within the stomach, and (ii) the frequency and duration of reflux events which depends on the efficacy of the reflux barrier at the gastro-esophageal junction and the esophageal clearance function. The concept of the acid pocket is an attempt to bring these two factors into a unified patho-mechanism.The acid pocket describes an area of unbuffered, highly acidic, gastric secretion in the proximal stomach adjacent to the esophago-gastric junction (GEJ) which forms in the postprandial period and is the source of acid refluxate into the esophagus. It is observed both in healthy individuals as well as in reflux patients. However, the presence of a hiatus hernia and/or a weak lower esophageal sphincter in patients allows the acid pocket to encroach on the gastro-esophageal junction. This results in very high acid exposure of the squamous epithelium of the distal esophagus, leading to mucosal damage and symptoms. Recently, the acid pocket has been proposed as a target for pharmacological and surgical therapies of GERD. Proton pump inhibitors and related medications reduce its acidity; whereas, alginate preparations, prokinetics, and fundoplication displace it away from the gastro-esophageal junction.

Efficacité des injections intra-sphinctériennes de toxine botulique dans la facilitation technique à la réalisation des auto-sondages

To evaluate safety and efficacy of botulinum toxin A injections in the urethral striated sphincter in patients with difficulties to perform self-intermittent catherization. In this prospective study, 12patients suffering from upper motor neuron diseases (8multiple sclerosis, 2myelitis, 1brain injury, 1multi system atrophy) and with difficulties to perform self-intermittent catherization, defined by a ICDQ score>1 (Intermittent Catheterization Difficulty Questionnaire) have had injections of 100U BOTOX® under EMG guidance in the urethral striated sphincter, for a total of 15injections. Evaluations consisted of two questionnaires (ICDQ and PGI-A, Patient Global Improvement) 30days after the injection. 30days after the injection, ICDQ was improved with a mean decrease of the total score of 7.8 (SD=5.9, P<0,001). In the same manner, all the patients were improved with a mean PGI-A score of 2.3. In 73.3% of cases, the PGI-A score was equal to 2 (improvement=much better), and in 20% it was equal to 3 (improvement=a little better). Botulinum toxin A injections in the urethral striated sphincter in patients with difficulties to perform self-intermittent catherization seem to safe and effective. 4.

Clinical efficacy of anal fistula plug treatment regimens in anal fistula patients

Aim: Anal Fistula Plug (AFP) is considered as a new promising technique in treating anal fistula patients, mainly due to it could maintain the integrity of patients’ integrity and decrease patients’ discomfort with a simple operation. It also is beneficial to the following surgical options if needed. However, the underlying clinical efficacy is still unknown. Herein, we aimed to investigate the clinical efficacy of AFP in anal fistula patients by a retrospective analysis. Methods: We collected 52 anal fistula patients from the 2nd affiliated hospital of Wenzhou Medical University and the hospital of traditional Chinese and Western medicine in Wenzhou between August 2012 and July 2016. Among them, 25 patients were treated with AFP, while 27 patients were treated with incision-thread-drawing. After treatments, all patients were evaluated by analyzing the differences on postoperative pain, cure rates, healing time, scar area and anal sphincter function at the subsequent follow-up. Results: The results showed that there were significant differences on postoperative pain between the two groups (P<0.001). Further, the healing time in patients with AFP treatment was remarkably lower than those with incision-thread-drawing treatment (P<0.05), whereas the anal scar area and the functional score of anal sphincterin patients with AFP treatment was markedly higher than those with incision-thread-drawing treatment (P<0.001). Nevertheless, the cure rates were not obviously different between the two groups. Conclusions: Taken together, these data suggested that AFP procedure could notably alleviate postoperative pain, shorten healing time, and retain anal sphincter function as compared to incisionthread- drawing procedure.

Prior Radiation Therapy Decreases Time to Idiopathic Erosion of Artificial Urinary Sphincter: A Multi-Institutional Analysis

Substantial controversy and conflicting data exist regarding the survival of the artificial urinary sphincter in patients with prior radiation therapy. We present data from a multi-institutional analysis examining the effect of prior radiation for prostate cancer on device survival. A database was compiled of patients with artificial urinary sphincter cuff erosion, which included demographic and comorbid patient characteristics, functional analyses and interventions. We identified 80 patients with iatrogenic or idiopathic artificial urinary sphincter erosion. Idiopathic erosion cases were further analyzed to determine factors influencing device survival with specific stratification for radiation therapy. A total of 56 patients were identified with idiopathic artificial urinary sphincter erosion. Of those men 33 (58.9%) had not undergone radiation treatment while 23 (41.1%) had a history of brachytherapy or external beam radiotherapy. In patients without radiation erosion-free median device survival was 3.15 years (95% CI 1.95-5.80), in contrast to the median device survival of only 1.00 year (95% CI 0.36-3.00) in irradiated patients. The erosion-free survival experience of patients with vs without radiation differed significantly (Wilcoxon-Breslow test for equality of survivor functions p = 0.03). Radiation therapy in patients with known idiopathic cuff erosion in this contemporary analysis correlated with significantly increased time to erosion. Mean time to idiopathic cuff erosion was accelerated by approximately 2 years in irradiated cases. To our knowledge these data represent the first demonstration of substantial outcome differences associated with radiation in patients with an artificial urinary sphincter who present specifically with cuff erosion.

Fecal incontinence and radiation dose on anal sphincter in patients with locally advanced rectal cancer (LARC) treated with preoperative chemoradiotherapy: a retrospective, single-institutional study.

The objective of the study is to determine the correlations among the variables of dose and the sphincter function (SF) in patients with locally advanced rectal cancer treated with preoperative capecitabine/radiotherapy followed by low anterior resection (LAR)+TME. We retrospectively reviewed 92 consecutive patients with LARC treated at our center with LAR from 2006 and more than 2years free from disease. We re-contoured the anal sphincters (AS) of patients with the help of the radiologist. SF was assessed with the Wexner scale (0-20 points, being punctuation inversely proportional to annal sphincter functionality). All questionnaires were filled out between January 2010 and December 2012. Dosimetric parameters that have been studied include V 20, V 30, V 40, V 50, mean dose (D mean), minimum dose (D min), D 90 (dose received by 90% of the sphincter) and D 98. The correlations among the variables of dose and SF were studied by the Spearman correlation coefficient. Differences in SF relating to maximum doses to the sphincter were assessed by the Mann-Whitney test. Mean Wexner score was 5.5 points higher in those patients with V 20>0 compared to those for which V 20=0 (p=0.008). In a multivariate regression model, results suggest that the effect of V 20 on poor anal sphincter control is independent of the effect of distance, with an adjusted OR of 3.42. In order to improve the SF in rectal cancer treated with preoperative radiotherapy/capecitabine followed by conservative surgery, the maximum radiation dose to the AS should be limited, when possible, to <20Gy.