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Urology Annals 2021Mitrofanoff operation or vesico-appendicostmy is a continent conduit operation performed for intractable incontinence. The long-term complications reported in the...
Mitrofanoff operation or vesico-appendicostmy is a continent conduit operation performed for intractable incontinence. The long-term complications reported in the literature are related to the stoma. Pelvic organ prolapse among women who have undergone this surgery is not reported earlier. A woman of 27 years of age presented with uterovaginal prolapse. She had sustained bladder neck transection following a road traffic accident at 16 years of age. The same was primarily repaired but incontinence had remained. Many standard operations for incontinence were performed. Finally, Mitrofanoff operation was carried out 9 years back because of persisting intractable incontinence. She got married and had two uneventful vaginal deliveries 5 and 2 years back. There was supravaginal elongation of the cervix with a rectocele. After counseling Fothergills operation with laparoscopic ligation was performed. The challenges and details of the management of the case are highlighted.
PubMed: 34421270
DOI: 10.4103/UA.UA_114_20 -
Journal of the Anus, Rectum and Colon 2021The present study aimed to explore whether symptoms of anal incontinence (AI) in patients who used electric bidet toilets to clean the anus may improve after...
OBJECTIVES
The present study aimed to explore whether symptoms of anal incontinence (AI) in patients who used electric bidet toilets to clean the anus may improve after discontinuing bidet use.
METHODS
Fifty-three patients with AI who habitually used the bidets before or after defecation and were examined between June 2019 and September 2020 were included in this retrospective study. Questionnaires on Likert-scaled items that assessed bidet use were administered at baseline. The sum of all points was regarded as the "bidet use score". The patients were instructed to discontinue bidets until subsequent examination. Incontinence severity was documented using the fecal incontinence severity index (FISI) score.
RESULTS
Follow-up data were available for 49 patients (92%). Of those, 43 had fecal incontinence and 6 had only mucus discharge at baseline. The median duration between the baseline and follow-up was 4 weeks. The median FISI score was significantly reduced at the follow-up [baseline vs. follow-up: 15 (range: 3-43) vs. 10 (range: 0-43); < 0.0001]. The incidence of fecal incontinence was significantly lower at the follow-up than at the baseline (59% vs. 88%, = 0.003). A higher maximum squeeze pressure and the absence of associated factors that may cause AI (such as rectoanal intussusception and/or rectocele, mucosal prolapse, and previous anorectal surgery) were significantly associated with a reduction of at least 50% in the FISI scores at follow-up; however, this was not observed for the bidet use score.
CONCLUSIONS
Our findings suggest that electric bidet use is a possible cause of AI.
PubMed: 34395939
DOI: 10.23922/jarc.2020-092 -
International Urogynecology Journal Jul 2022This study was aimed at determining the recurrence rate and risk factors for the recurrence of pelvic organ prolapse (POP), at 1 year post-vaginal reconstructive surgery...
INTRODUCTION AND HYPOTHESIS
This study was aimed at determining the recurrence rate and risk factors for the recurrence of pelvic organ prolapse (POP), at 1 year post-vaginal reconstructive surgery in a resource-limited setting.
METHODS
We enrolled women who underwent vaginal surgery for POP at the urogynecology unit of Mbarara Regional Referral Hospital (MRRH) in southwestern Uganda between December 2018 and February 2020. The surgeries that were performed include anterior colporrhaphy for cystocele, posterior colporrhaphy for rectocele, vaginal hysterectomy with vault suspension for uterine prolapse, and cervicopexy in those with uterine prolapse where uterine-sparing surgery was desired. The women were followed up for a period of 1 year after surgery. Pelvic examinations in lithotomy position under maximum strain were carried out to assess for recurrence using the Pelvic Organ Quantification (POP-Q) system. Recurrence was defined as a prolapse of ≥POP-Q stage II. Descriptive analyses and multivariate log binomial regression were performed to determine risk factors for recurrence.
RESULTS
Of the 140 participants enrolled, 127 (90.7%) completed the follow-up at 1 year. The recurrence rate was 25.2% (32 out of 127). Most (56.3%) of the recurrences occurred in the anterior compartment and in the same site previously operated. Women aged <60 years (RR = 2.34; 95% CI: 1.16-4.72; p = 0.018) and those who had postoperative vaginal cuff infection (RR = 2.54; 95% CI: 1.5-4.3; p = 0.001) were at risk of recurrence.
CONCLUSION
Recurrence of POP was common. Younger women, and those with postoperative vaginal cuff infection, were more likely to experience recurrent prolapse after vaginal repair.
Topics: Female; Humans; Pelvic Organ Prolapse; Postoperative Complications; Prospective Studies; Recurrence; Risk Factors; Treatment Outcome; Uganda; Uterine Prolapse
PubMed: 34319430
DOI: 10.1007/s00192-021-04930-8 -
Autopsy & Case Reports 2021Intestinal duplications are rare congenital developmental anomalies with an incidence of 0.005-0.025% of births. They are usually identified before 2 years of age and...
BACKGROUND
Intestinal duplications are rare congenital developmental anomalies with an incidence of 0.005-0.025% of births. They are usually identified before 2 years of age and commonly affect the foregut or mid-/hindgut. However, it is very uncommon for these anomalies, to arise in the colon or present during adulthood.
CASE PRESENTATION
Herein, we present a case of a 28-year-old woman with a long-standing history of constipation, tenesmus, and rectal prolapse. Colonoscopy results were normal. An abdominal computed tomography (CT) revealed a diffusely mildly dilated redundant colon, which was prominently stool-filled. The gastrografin enema showed ahaustral mucosal appearance of the sigmoid and descending colon with findings suggestive of tricompartmental pelvic floor prolapse, moderate-size anterior rectocele, and grade 2 sigmoidocele. A laparoscopic exploration was performed, revealing a tubular duplicated colon at the sigmoid level. A sigmoid resection rectopexy was performed. Pathologic examination supported the diagnosis. At 1-month follow-up, the patient was doing well without constipation or rectal prolapse.
CONCLUSIONS
Tubular colonic duplications are very rare in adults but should be considered in the differential diagnosis of chronic constipation refractory to medical therapy. Due to the non-specific manifestations of this entity, it is rather challenging to make an accurate diagnosis pre-operatively. Surgery remains the mainstay of treatment. Some reports suggest that carcinomas are more prone to develop in colonic/rectal duplications than in other GI tract duplications.
PubMed: 34307222
DOI: 10.4322/acr.2021.260 -
Journal of Clinical Imaging Science 2021The objectives of the study were to compare the imaging findings and patient's perception of barium defecating proctography and dynamic magnetic resonance (MR)...
OBJECTIVES
The objectives of the study were to compare the imaging findings and patient's perception of barium defecating proctography and dynamic magnetic resonance (MR) proctography in patients with pelvic floor disorders.
MATERIAL AND METHODS
This is a prospective study conducted on patients with pelvic floor disorders who consented to undergo both barium proctography and dynamic MR proctography. Imaging findings of both the procedures were compared. Inter-observer agreement (IOA) for key imaging features was assessed. Patient's perception of these procedures was assessed using a short questionnaire and a visual analog scale.
RESULTS
Forty patients (M: F =19:21) with a mean age of 43.65 years and range of 21-75 years were included for final analysis. Mean patient experience score was significantly better for MR imaging (MRI) (p < 0.001). However, patients perceived significantly higher difficulty in rectal evacuation during MRI studies (p = 0.003). While significantly higher number of rectoceles (p = 0.014) were diagnosed on MRI, a greater number of pelvic floor descent (p = 0.02) and intra-rectal intussusception (p = 0.011) were diagnosed on barium proctography. The IOA for barium proctography was substantial for identifying rectoceles, rectal prolapse and for determining M line, p < 0.001. There was excellent IOA for MRI interpretation of cystoceles, peritoneoceles, and uterine prolapse and substantial to excellent IOA for determining anal canal length and anorectal angle, p < 0.001. The mean study time for the barium and MRI study was 12 minutes and 15 minutes, respectively.
CONCLUSION
Barium proctography was more sensitive than MRI for detecting pelvic floor descent and intrarectal intussusception. Although patients perceived better rectal emptying with barium proctography, the overall patient experience was better for dynamic MRI proctography.
PubMed: 34221640
DOI: 10.25259/JCIS_56_2021 -
World Journal of Gastrointestinal... May 2021The most common causes of outlet obstructive constipation (OOC) are rectocele and internal rectal prolapse. The surgical methods for OOC are diverse and difficult, and...
BACKGROUND
The most common causes of outlet obstructive constipation (OOC) are rectocele and internal rectal prolapse. The surgical methods for OOC are diverse and difficult, and the postoperative complications and recurrence rate are high, which results in both physical and mental pain in patients. With the continuous deepening of the surgeon's concept of minimally invasive surgery and continuous in-depth research on the mechanism of OOC, the treatment concepts and surgical methods are continuously improved.
AIM
To determine the efficacy of the TST36 stapler in the treatment of rectocele combined with internal rectal prolapse.
METHODS
From January 2017 to July 2019, 49 female patients with rectocele and internal rectal prolapse who met the inclusion criteria were selected for treatment using the TST36 stapler.
RESULTS
Forty-five patients were cured, 4 patients improved, and the cure rate was 92%. The postoperative obstructed defecation syndrome score, the defecation frequency score, time/straining intensity, and sensation of incomplete evacuation were significantly decreased compared with these parameters before treatment, and the differences were statistically significant ( < 0.05). The postoperative anal canal resting pressure and maximum squeeze pressure in patients decreased compared with before treatment, and the differences were statistically significant ( < 0.05). The initial and maximum defecation thresholds after surgery were significantly lower than those before treatment, and the differences were statistically significant ( < 0.05). The postoperative ratings of rectocele, resting phase, and defecation phase in these patients were significantly decreased compared with those before treatment, and the differences were statistically significant ( < 0.05).
CONCLUSION
The TST36 stapler is safe and effective in treating rectocele combined with internal rectal prolapse and is worth promoting in clinical work.
PubMed: 34122734
DOI: 10.4240/wjgs.v13.i5.443 -
Journal of the Anus, Rectum and Colon 2021To clarify the long-term outcomes of transvaginal anterior levatorplasty with posterior colporrhaphy for symptomatic rectocele with defecographic changes.
OBJECTIVES
To clarify the long-term outcomes of transvaginal anterior levatorplasty with posterior colporrhaphy for symptomatic rectocele with defecographic changes.
METHODS
Consecutive patients undergoing transvaginal anterior levatorplasty with posterior colporrhaphy for symptomatic rectocele were prospectively registered and retrospectively reviewed using medical records. Symptoms, fecal incontinence, and defecographic findings were evaluated before and after surgery.
RESULTS
Fifty-seven women (mean age, 68 years) were identified, and the median disease duration was 24 months. Symptoms of vaginal mass (n 32) and difficult defecation (n 21) disappeared (90.6% and 71.4%, respectively) or improved (6.3% and 28.6%, respectively) after surgery. However, the feeling of residual stool was unchanged in two of eight patients. Seventeen patients who performed digitation on defecation before surgery discontinued digitation after surgery. The proportion of patients who had fecal incontinence preoperatively (40.4%) decreased significantly after surgery (17.5%) during a median follow-up period of 47 months. Defecography revealed a disappearance or improvement of rectocele in all 18 patients examined. The average rectocele size decreased significantly in six improved patients ( 0.0006, paired t-test).
CONCLUSIONS
Transvaginal anterior levatorplasty with posterior colporrhaphy for symptomatic rectocele was a useful option to improve symptoms and anatomical disorders in the long term, but it had limitations in improving defecatory symptoms.
PubMed: 33937553
DOI: 10.23922/jarc.2020-062 -
BMC Women's Health Apr 2021The aim of this study is to examine the relationship between rectal-vaginal pressure and symptomatic rectocele in patients with pelvic organ prolapse (POP).
OBJECTIVE
The aim of this study is to examine the relationship between rectal-vaginal pressure and symptomatic rectocele in patients with pelvic organ prolapse (POP).
METHOD
Patients with posterior vaginal prolapse staged III or IV in accordance with the POP Quantitation classification method who were scheduled for pelvic floor reconstructive surgery in the years 2016-2019 were included in the study. Rectocele was diagnosed using translabial ultrasound, and obstructed defecation (OD) was diagnosed in accordance with the Roma IV diagnostic criteria. Both rectal and vaginal pressure were measured using peritron manometers at maximum Vasalva. To ensure stability, the test was performed three times with each patient.
RESULTS
A total of 217 patients were enrolled in this study. True rectocele was diagnosed in 68 patients at a main rectal ampulla depth of 19 mm. Furthermore, 36 patients were diagnosed with OD. Symptomatic rectocele was significantly associated with older age (p < 0.01), a higher OD symptom score (p < 0.001), and a lower grade of apical prolapse (p < 0.001). The rectal-vaginal pressure gradient was higher in patients with symptomatic rectocele (37.4 ± 11.7 cm HO) compared with patients with asymptomatic rectocele (16.9 ± 8.4 cm HO, p < 0.001), and patients without rectocele (17.1 ± 9.2 cm HO, p < 0.001).
CONCLUSION
The rectal-vaginal pressure gradient was found to be a risk factor for symptomatic rectocele in patients with POP. A rectal-vaginal pressure gradient of > 27.5 cm HO was suggested as the cut-off point of the elevated pressure gradient.
Topics: Aged; Female; Humans; Pelvic Organ Prolapse; Rectocele; Rectum; Ultrasonography; Vagina
PubMed: 33879140
DOI: 10.1186/s12905-021-01304-6 -
Frontiers in Cellular and Infection... 2021It has been well documented that cytolethal distending toxin (CDT) from (), () and other Gram-negative intestinal pathogens is linked to the inflammatory bowel disease...
It has been well documented that cytolethal distending toxin (CDT) from (), () and other Gram-negative intestinal pathogens is linked to the inflammatory bowel disease (IBD). However, the mechanisms underlying the progression of induced colitis remains unclear. In this study, male B6.129P2- /J mice were infected by and ΔCdtB for 6, 12, 18, and 24 weeks. Histopathology, colonization levels, expression of inflammatory cytokines, signaling pathways, and content of NO in proximal colon were examined. We found that Cytolethal distending toxin subunit B (CdtB) deletion had no influence on colonization ability of in colon of B6.129P2-J mice, and there was no significant difference in abundance of colonic over infection duration. aggravated rectocele and proximal colonic inflammation, especially at 24 WPI, while ΔCdtB could not cause significant symptom. Furthermore, mRNA levels of , , , and significantly increased in the proximal colon of -infected mice compared to ΔCdtB infected group from 12 WPI to 24 WPI. In addition, the elevated content of NO and activated and in colon were observed in infected mice. These data demonstrated that CdtB promote colitis development in male B6.129P2- /J mice by induction of inflammatory response and activation of - signaling pathway.
Topics: Animals; Bacterial Toxins; Colitis; Helicobacter Infections; Helicobacter hepaticus; Interleukin-10; Male; Mice; Signal Transduction
PubMed: 33777833
DOI: 10.3389/fcimb.2021.616218 -
International Urogynecology Journal Jun 2021The objective was to identify structural failure sites in rectocele by comparing women with and those without posterior vaginal wall prolapse and accessing their...
INTRODUCTION AND HYPOTHESIS
The objective was to identify structural failure sites in rectocele by comparing women with and those without posterior vaginal wall prolapse and accessing their relative contribution to rectocele size based on stress MRI-based measurements.
METHODS
We studied three-dimensional stress MRI at maximal Valsalva of 25 women with (cases) and 25 without (controls) posterior vaginal prolapse of similar age and parity. Vaginal wall factors (posterior wall length and width); attachment factors (paravaginal posterior wall location, posterior fornix height, and perineal height); and hiatal factors (hiatal size and levator ani defects) were measured using Slicer 4.3.0® and a custom Python program. Stepwise linear regression was used to assess the relative contribution of all factors to the posterior prolapse size.
RESULTS
We identified three primary factors with large effect sizes of 2 or greater: two attachment factors-posterior paravaginal descent and perineal height; and one hiatal factor-genital hiatus size. These were the strongest predictors of the presence and size of rectocele, the most common failure sites, found in 60-76% of cases; and highly correlated with one another (r = 0.72-0.84, p < .001). Longer vaginal length, wider distal vagina, lower posterior fornix, and larger levator ani hiatus had smaller effect sizes and were less likely to fall outside the norm (20-24%) than the three primary factors. When considering all the supporting factors, the combination of perineal height, posterior fornix height, and vaginal length explained 73% of the variation in rectocele size.
CONCLUSIONS
Lower perineal and lateral posterior vaginal location and enlarged genital hiatus size were strong predictors of rectocele occurrence and size and correlated highly.
Topics: Female; Humans; Magnetic Resonance Imaging; Pelvic Floor; Rectocele; Uterine Prolapse; Vagina
PubMed: 33704534
DOI: 10.1007/s00192-021-04685-2