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Pernilla Stenström Christina Clementson Kockum Ragnhild Emblem Einar Arnbjörnsson Kristin Bjørnland 《Journal of pediatric surgery》2014
Background
Gender specific outcome for children with anorectal malformations (ARM) is rarely reported although it is important for medical care and in parent counseling.Purpose
To assess bowel function according to the Krickenbeck system in relation to ARM-subtype, gender and age.Method
All children born with ARM in 1998–2008 and referred to two centers in two different countries were followed up. The bowel function in 50 girls and 71 boys, median age 8 years, was analyzed.Results
Among those with a perineal fistula, incontinence occurred in 42% of the females and in 10% of the males (p = 0.005) whereas constipation occurred in 62% of the females and 35% of the males (p < 0.001). No bowel symptoms differed between the females with perineal and vestibular fistulas (p > 0.3 for every symptom). Sacral malformations were associated with incontinence only in males with rectourethral fistulas. Constipation among the males differed between the age groups: 58% versus 26% (p = 0.013). Bowel symptoms did not change with age among the females.Conclusion
Gender differences in outcome for children with ARM must be considered. Males with perineal fistulas had less incontinence and constipation than the females with perineal fistulas. The females with perineal and vestibular fistulas had similar outcomes. 相似文献3.
Gill BC Swartz MA Rackley RR Moore CK Goldman HB Vasavada SP 《International urogynecology journal》2012,23(6):735-741
Introduction and hypothesis
Sacral nerve stimulation (SNS) is approved for urologic indications in the USA and, recently, fecal incontinence. This study described concomitant bowel dysfunction and improvements in bowel and urinary symptoms and quality of life (QOL) in women with refractory urge urinary incontinence (UUI) receiving SNS.Methods
Women (N?=?36) with refractory UUI receiving SNS were prospectively enrolled. Surveys and exams were completed at baseline and follow-up, with symptom and QOL scores measured using validated scales (0–100, none–worst).Results
A total 24 women were followed up at a median of 4.0?months post-implantation. Of these, 20 (83%) had bowel dysfunction, 13 (54%) used bowel medications at baseline, and 11 (45%) continued them after SNS. The mean/median urinary (54.8 to 32.6) and bowel (23.4 to 14.1) symptom scores improved significantly, as did urinary (64.2 to 14.3) but not bowel (2.4 to 0.0) QOL scores.Conclusions
Bowel dysfunction is common in women with refractory UUI. SNS improves urinary symptoms and QOL, but improvement in bowel symptoms does not translate into significant QOL changes. 相似文献4.
Shahid Khan Jalesh Panicker Alexander Roosen Gwen Gonzales Sohier Elneil Prokar Dasgupta Clare J. Fowler Thomas M. Kessler 《European urology》2010
Background
Objective improvement following intradetrusor injections of botulinum neurotoxin type A (BoNTA) is well documented. Although patient-related outcome measures are highly recommended for monitoring overactive bladder symptoms, no study before has dealt with the question of patient-reported complete continence after BoNTA treatment using validated questionnaires.Objective
To investigate the change in patient-reported continence rate after intradetrusor injections of BoNTA for treatment of refractory idiopathic detrusor overactivity (IDO) incontinence.Design, setting, and participants
Seventy-four patients (51 women, 23 men) with refractory IDO incontinence treated for the first time with intradetrusor injections of 200 U BoNTA were evaluated in this nonrandomised, open-label, cohort study.Measurements
Changes in patient-reported urinary frequency, urgency incontinence, and stress incontinence were assessed using the condition-specific validated short form of the Urogenital Distress Inventory (UDI 6) before and 4 wk after BoNTA treatment.Results and limitations
The patient-reported outcome of complete continence (defined as a score of 0 in both the urgency and stress incontinence subscales of the UDI 6) was 51% (38 of 74) 4 wk after intradetrusor injections of BoNTA. In patients who were not completely continent, median urgency incontinence scores reduced significantly from 100 to 0 (p < 0.001), stress incontinence scores from 33 to 0 (p < 0.001), and median urinary frequency scores from 100 to 33 (p < 0.001), respectively. The inclusion of patients with mixed incontinence may have resulted in underestimation of the complete continence rate.Conclusions
An excellent response with >50% of patients reporting complete continence 4 wk after BoNTA treatment reveals the efficacy of this emerging treatment for patients with refractory IDO incontinence. Furthermore, in those in whom complete continence was not achieved, there was a notable and significant reduction in reported urgency incontinence, stress incontinence, and urinary frequency. 相似文献5.
Katie W. Russell Elizabeth S. SoukupRyan R. Metzger Sarah ZobellEric R. Scaife Douglas C. BarnhartMichael D. Rollins 《Journal of pediatric surgery》2014
Background
Complex injuries involving the anus and rectum are uncommon in children. We sought to examine long-term fecal continence following repair of these injuries.Methods
We conducted a retrospective review using our trauma registry from 2003 to 2012 of children with traumatic injuries to the anus or rectum at a level I pediatric trauma center. Patients with an injury requiring surgical repair that involved the anal sphincters and/or rectum were selected for a detailed review.Results
Twenty-one patients (21/13,149 activations, 0.2%) who had an injury to the anus (n = 9), rectum (n = 8), or destructive injury to both the anus and rectum (n = 4) were identified. Eleven (52%) patients were male, and the median age at time of injury was 9 (range 1–14) years. Penetrating trauma accounted for 48% of injuries. Three (14%) patients had accompanying injury to the urinary tract, and 6 (60%) females had vaginal injuries. All patients with an injury involving the rectum and destructive anal injuries were managed with fecal diversion. No patient with an isolated anal injury underwent fecal diversion. Four (19%) patients developed wound infections. The majority (90%) of patients were continent at last follow-up. One patient who sustained a gunshot injury to the pelvis with sacral nerve involvement is incontinent, but remains artificially clean on an intense bowel management program with enemas, and one patient with a destructive crush injury still has a colostomy.Conclusions
With anatomic reconstruction of the anal sphincter mechanism, most patients with traumatic anorectal injuries will experience long-term fecal continence. Follow-up is needed as occasionally these patients, specifically those with nerve or crush injury, may require a formal bowel management program. 相似文献6.
Objectives
This article accompanies a “surgery in motion” DVD on sacral neuromodulation (SNM) with InterStim™ Therapy, which visualizes the implantation of the InterStim II system. The article describes the technical and surgical developments of SNM and their impact on treatment success, safety, and patient's quality of life (QoL).Methods
Relevant literature on SNM with regard to technical changes and related clinical outcomes has been reviewed.Results
Since its introduction in the early 1990s, SNM has proven useful in the treatment of several types of chronic urinary (and bowel) dysfunction. Recent technical improvements in devices and, in particular, the introduction of the tined lead 5 yr ago made SNM progress from an elaborate, open-surgery, general anesthesia, one-stage implant procedure to a minimally invasive, local anesthesia, percutaneous technique in two stages. The permanent tined lead implant enables a longer patient testing period (minimum of 14 d recommended) and less lead migration. This has considerably reduced technical failures and improved the success rate of the test phase; the response rate was almost doubled to approximately 80%. These improvements also affected tolerability, resulting in increased QoL for the patient. The use of the recently introduced smaller implantable neurostimulator InterStim II seems to further improve patient comfort and makes the implant procedure for the physician easier and shorter. However, this must be further addressed in clinical studies.Conclusions
SNM with InterStim Therapy using the tined lead offers an efficient treatment modality for patients in whom conservative treatment has failed. 相似文献7.
Maurizio Pacilli David PallotAfiya Andrews Angela DownerLouiza Dale Ian Willetts 《Journal of pediatric surgery》2014
Aims
Transanal colonic irrigation has been shown to be effective in bowel management program in adults. However, there exist limited data in children. We appraised the effectiveness of this technique in a series of children with incontinence or constipation and overflow soiling.Methods
Following ethical approval, a review of children with incontinence or constipation on a bowel management program with Peristeen® transanal colonic irrigation treated between 2007 and 2012 was performed. Irrigations were performed with a volume of 10–20 ml/kg of water with schedules depending on patient response. Data are reported as median (range).Results
Twenty-three patients were reviewed. Median age at commencement of irrigations was 7 (2–15) years. Median follow-up is 2 (0.7–3.4) years. Diagnoses include the following: spina bifida (n = 11), anorectal anomaly (n = 6), Hirschsprung's (n = 1), and other complex anomalies (n = 5). Sixteen (70%) patients had associated anomalies. Twelve (52%) had constipation and overflow soiling, and 11 (48%) had fecal incontinence. Twenty (87%) had associated urinary wetting. Sixteen (70%) children used alternate-day irrigations, 4 (17%) daily irrigations, and 3 (13%) every third-day irrigations. Nine (39%) patients were taking oral laxatives. Sixteen (70%) reported to be clean and 3 (13%) reported a significant improvement, although were having occasional soiling. Four patients (17%) did not tolerate the irrigations and underwent subsequent colostomy formation for intractable soiling.Conclusions
In our experience, Peristeen® transanal colonic irrigation is an effective method of managing patients with focal soiling in childhood. Majority (83%) of children achieve social fecal continence or a significant improvement with occasional soiling. This was accompanied by high parental satisfaction. Peristeen® transanal colonic irrigation is a valid alternative to invasive surgical procedures and should be considered the first line of treatment for bowel management in children with soiling where simple pharmacological maneuvers failed to be effective. 相似文献8.
Silvana F. Bonilla Alejandro Flores Carl-Christian A. Jackson Walter J. Chwals Bruce A. Orkin 《Journal of pediatric surgery》2013
Background
Antegrade continence enema (ACE) is a recognized therapeutic option in the management of pediatric refractory constipation. Data on the long-term outcome of patients who fail to improve after an ACE-procedure are lacking.Purpose
To describe the rate of ACE bowel management failure in pediatric refractory constipation, and the management and long term outcome of these patients.Methods
Retrospective analysis of a cohort of patients that underwent ACE-procedure and had at least 3-year-follow-up. Detailed analysis of subsequent treatment and outcome of those patients with a poor functional outcome was performed.Results
76 patients were included. 12 (16%) failed successful bowel management after ACE requiring additional intervention. Mean follow-up was 66.3 (range 35–95 months) after ACE-procedure. Colonic motility studies demonstrated colonic neuropathy in 7 patients (58%); abnormal motility in 4 patients (33%), and abnormal left-sided colonic motility in 1 patient (9%). All 12 patients were ultimately treated surgically. Nine patients (75%) had marked clinical improvement, whereas 3 patients (25%) continued to have poor function issues at long term follow-up.Conclusions
Colonic resection, either segmental or total, led to improvement or resolution of symptoms in the majority of patients who failed cecostomy. However, this is a complex and heterogeneous group and some patients will have continued issues. 相似文献9.
IntroductionBowel dysfunction (fecal incontinence and constipation) presents in over 50% of patients after treatment of congenital anal malformations. Sacral nerve stimulation (SNS) for the treatment of fecal incontinence improves function in the majority of patients. We present a case report of the treatment of bowel dysfunction with sacral nerve stimulation in a patient with a history of an imperforate anus.Presentation of caseA twenty year-old female with a history of imperforate anus at birth, repaired during infancy with anorectoplasty, presented with fecal incontinence and constipation. Since childhood, she had been suffering from intermittent constipation with worsening fecal incontinence in early adulthood. Examination revealed mild anal stenosis and mucosal prolapse. Endoanal ultrasound demonstrated intact internal and external sphincter with low resting and squeeze pressures on anal manometry. Flexible sigmoidoscopy was normal. The patient underwent permanent sacral nerve stimulation with a primary goal of improvement in continence and, secondarily, for the alleviation of intermittent chronic constipation.DiscussionAt 15 month follow-up, the patient had improvement in fecal incontinence (CCIS of 14 pre-SNS to 1 post-SNS), constipation (CCCS of 28 pre-SNS to 20 post-SNS), and quality of life (FIQOL improved in lifestyle (3.7), coping/behavior (3.4), self perception (3.9), and social embarrassment (4.5).ConclusionSacral nerve stimulation for the treatment of bowel dysfunction in adults secondary to imperforate anus can be performed safely and with good results. 相似文献
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Emily A. Partridge Douglas Canning Christopher Long William H. Peranteau Holly L. Hedrick N. Scott Adzick Alan W. Flake 《Journal of pediatric surgery》2014
Purpose
Anorectal and urologic sequelae are observed in long-term survivors of sacrococcygeal teratoma (SCT). In this study we evaluate the incidence and predictors of anorectal and urologic complications in SCT.Methods
A retrospective review was performed for all SCT patients who underwent resection at a single institution between 2000 and 2012. Enrollment criteria included a minimum of 12 months follow-up. Categorical variables were analyzed by Fisher’s exact test and continuous variables by Mann Whitney test (p < 0.05).Results
Forty-five patients were studied. Anorectal complications occurred in 29%, including severe chronic constipation (n = 13) and fecal incontinence (n = 4). Urologic complications occurred in 33%, including neurogenic bladder (n = 12), vesicoureteral reflux (n = 5), and urinary incontinence (n = 7). Prenatal imaging by fetal MRI demonstrated mass effect with obstruction of the bowel (n = 4) or bladder and collecting system (n = 7) in a subset of patients with postnatal complications (anorectal 4/4, PPV 100%; urologic 6/7, PPV 86%). Postnatal complications were associated with obstructive findings on prenatal imaging, prenatal therapeutic interventions, Altman classification, perineal reconstruction, and tumor recurrence. No anorectal or urologic complications occurred in patients with Altman type I tumors.Conclusions
Urologic and anorectal complications are common in patients with SCT. Higher Altman classification and prenatal imaging suggestive of intestinal or urologic obstruction should prompt focused prenatal counseling and postnatal screening for anorectal and urologic dysfunction. 相似文献11.
Purpose
Megarectosigmoid (MRS) is commonly seen in children with anorectal malformations (ARM) and contributes to the high incidence of constipation. Surgical resection has been advocated by some, whereas others propose intense bowel management as the treatment of choice. The aim of this study was to evaluate outcome of both bowel function and configuration after surgical or conservative treatment of MRS in ARM patients.Materials and methods
The study included 79 patients with ARM, excluding perineal fistula, (48 boys, 31 girls) from 1986 to 2007. MRS was diagnosed at colostomy formation or contrast enema performed in the neonatal period. Early in the period, the majority of the patients were treated surgically, whereas in the late 1990s, a conservative approach with intensified bowel treatment was implemented. Contrast enema and bowel function investigations were performed repeatedly during follow-up.Results
MRS, according to radiological criteria, was diagnosed in 26/79 (33%) of the ARM children. Bowel functional outcome was similar regardless of surgical or conservative treatment and comparable to function in ARM children with non-MRS. The radiological signs of rectal dilatation and elongation disappeared after surgical intervention, but normalisation of the rectosigmoidal configuration was also seen with age in the conservative group.Conclusions
Bowel functional outcome in ARM children with MRS was similar after either surgical or conservative treatment during follow-up. The radiological signs of rectal dilatation and elongation disappeared also in the conservatively treated patients over time. 相似文献12.
Maen M. Masadeh Michael KreinJoshua Peterson Molly BauerLaura Phearman Graeme PitcherJunlin Liao Joel Shilyansky 《Journal of pediatric surgery》2013
Objective
Intractable incontinence affects a large number of children and young adults in the US. The goal of this study is to evaluate the long-term outcomes of surgical access for administration of antegrade continence enemas (ACE) in affected children and young adults.Methods
Patients who underwent surgical procedure to enable administration of ACE from 1994 to 2011 were retrospectively reviewed. Data collected included patient demographics, primary diagnosis, surgical technique, conduit used, complications, follow-up duration, and social continence.Results
Sixty eighty patients underwent surgery to enable ACE; mean follow up was 61 months. Enteral conduit (EC) was performed in 19 patients, tube cecostomy catheters (CC) in 49. Meningomyelocele was diagnosed in 60% of patients. Mean age was 11 (1.67–53) years. Complications included tube dislodgement (43%), granulation tissue (46%), site infection (13%), leakage (32%), break in the tube (6%) and tract stenosis (6%). Complete social continence was achieved in 68%, partial continence was achieved in 29%, and no benefit was achieved in 3% of patients. The rate of complications and incontinence resolution following CC was 78% and 66%, and following EC 89% and 74%. The differences were not statistically significant. CC patients developed granulation tissue more frequently (53%) and leaks of fecal material less frequently (20%) compared to EC patients (26% and 53%) (p < 0.05 and < 0.01). Although children 7 years or younger developed more overall complications (94%) than older patients (69%; p < 0.05), there was not a significant difference in the frequency of any one complication or in the rate of continence, between the two groups. Multivariate analysis showed that EC is three times more likely to be complicated by fecal leakage. CC patients are at greater risk to develop granulation tissue (p < 0.05).Conclusions
Most patients achieved social continence and improved hygiene with the aid of ACE. Younger children also benefited greatly from institution of ACE. CC was associated with fewer major complications such as leak of fecal contents than EC but required regular tube changes. 相似文献13.
Bauer RM Gozzi C Hübner W Nitti VW Novara G Peterson A Sandhu JS Stief CG 《European urology》2011,59(6):985-996
Context
In recent years, despite improvement in the surgical technique, the prevalence of postprostatectomy incontinence has increased due to a rise in the number of radical prostatectomies performed annually.Objective
The aim of this review is to evaluate contemporary noninvasive and invasive treatment options for postprostatectomy incontinence.Evidence acquisition
In August 2010, a review of the literature was performed using the Medline database.Evidence synthesis
All articles concerning noninvasive and invasive treatment for postprostatectomy incontinence were included.Conclusions
No randomised controlled trials exist to compare currently used noninvasive and invasive treatments for postprostatectomy incontinence. Pelvic floor muscle training is recommended for the initial treatment of stress urinary incontinence (SUI). Additionally, antimuscarinic therapy should be applied for urgency or urge incontinence. For decades, the artificial urinary sphincter was the reference standard for persistent SUI. Nowadays, male slings are an alternative for men with mild to moderate postprostatectomy SUI. 相似文献14.
Introduction:
Pelvic neuromodulation is an established method of treating voiding dysfunction. Little is known about the pathophysiology associated with voiding dysfunction. Reports have suggested that a delay in treating patients with sacral neuromodulation therapy can impact the success rate of this type of treatment in voiding dysfunction. We examined patient response to pelvic neuromodulation when it was applied early versus late in the postdiagnosis of voiding dysfunction.Methods:
We conducted a retrospective study of 42 patients (38 women and 4 men) with voiding dysfunction who underwent surgery for implant with the Interstim (Medtronic, Minneapolis, Minn.). Prior to implantation, patients were required to pass a percutaneous nerve evaluation (PNE) over a 1-week period. Patients were observed for 20–48 months postimplantation. All patients recorded their voiding parameters at baseline, after screening and every 6 months thereafter. Twenty patients (in the early group) underwent implant surgery with the neurostimulator 2–4 weeks post-PNE, and 22 patients (the late group) had the device implanted 6–24 months post-PNE owing to local logistical circumstances.Results:
In the early group, 16 of 20 patients (80%) maintained a good response. In the late group, 13 of 22 (59%) patients showed a good response. Groups were well matched in terms of age, duration of voiding dysfunction and incidence of comorbidity.Conclusion:
Patients who were delayed more than 6 months in receiving the neurostimulator implant showed a worse response than did patients who had the device implanted soon after PNE. This indicates the possibility of disease progression, which may limit the response to sacral neuromodulation.Sacral neuromodulation (SNM), using permanent foramen S3 electrode, offers an alternative treatment for patients with conditions refractory to conventional measures. SNM has been approved by the US Food and Drug Administration for 3 indications: urge incontinence (UI), urge frequency (UF) and nonobstructive urinary retention. Several reports have been published regarding the efficacy of SNM in the treatment of UI, UF and nonobstructive urinary retention.1–4SNM is considered a minimally invasive procedure, and when compared with the more drastic procedures to control intractable overactive bladder symptoms, SNM has fewer complications and has provided patients with more durable and consistent bladder control over time.The purpose of the current study is to determine whether a delay in SNM can affect the long-term outcome of treatment in patients with voiding dysfunction. 相似文献15.
Steven D. Wexner Tracy Hull Yair Edden John A. Coller Ghislain Devroede Richard McCallum Miranda Chan Jennifer M. Ayscue Abbas S. Shobeiri David Margolin Michael England Howard Kaufman William J. Snape Ece Mutlu Heidi Chua Paul Pettit Deborah Nagle Robert D. Madoff Darin R. Lerew Anders Mellgren 《Journal of gastrointestinal surgery》2010,14(7):1081-1089
Introduction
Treatment options for patients with fecal incontinence (FI) are limited, and surgical treatments can be associated with high rates of infection and other complications. One treatment, sacral nerve stimulation (SNS), is approved for FI in Europe. A large multicenter trial was conducted in North America and Australia to assess the efficacy of SNS in patients with chronic fecal incontinence. The aim of this report was to analyze the infectious complication rates in that trial.Methods
Adult patients with a history of chronic fecal incontinence were enrolled into this study. Those patients who fulfilled study inclusion/exclusion criteria and demonstrated greater than two FI episodes per week underwent a 2-week test phase of SNS. Patients who showed a ≥50% reduction in incontinent episodes and/or days per week underwent chronic stimulator implantation. Adverse events were reported to the sponsor by investigators at each study site and then coded. All events coded as implant site infection were included in this analysis.Results
One hundred twenty subjects (92% female, 60.5?±?12.5 years old) received a chronically implanted InterStim® Therapy device (Medtronic, Minneapolis, MN, USA). Patients were followed for an average of 28 months (range 2.2-69.5). Thirteen of the 120 implanted subjects (10.8%) reported infection after the chronic system implant. One infection spontaneously resolved and five were successfully treated with antibiotics. Seven infections (5.8%) required surgical intervention, with infections in six patients requiring full permanent device explantation. The duration of the test stimulation implant procedure was similar between the infected group (74 min) and the non-infected group (74 min). The average duration of the chronic neurostimulator implant procedure was also similar between the infected (39 min) and non-infected group (37 min). Nine infections occurred within a month of chronic system implant and the remaining four infections occurred more than a year from implantation. While the majority (7/9) of the early infections was successfully treated with observation, antibiotics, or system replacement, all four of the late infections resulted in permanent system explantation.Conclusion
SNS for FI resulted in a relatively low infection rate. This finding is especially important because the only other Food and Drug Administration-approved treatment for end-stage FI, the artificial bowel sphincter, reports a much higher rate. Combined with its published high therapeutic success rate, this treatment has a positive risk/benefit profile. 相似文献16.
Ralph DJ Garaffa G Muneer A Freeman A Rees R Christopher AN Minhas S 《European urology》2009,56(6):1033-1038
Background
Ischaemic priapism (IP), which is refractory to conventional medical and surgical intervention, results in necrosis of the corpus cavernosum smooth muscle. These patients eventually develop a variable degree of corporal smooth muscle fibrosis that presents as erectile dysfunction and penile shortening.Objectives
To evaluate the long-term outcome of patients who have undergone the immediate insertion of a penile prosthesis as a treatment for an acute episode of IP refractory to medical therapy or shunt surgery.Design, setting, and participants
A total of 50 patients presented with prolonged IP that was unresponsive to conventional treatment. Unsuccessful shunt surgery had been performed in 13 patients. All patients had evidence of cavernosal smooth muscle necrosis and, therefore, underwent an immediate insertion of a penile prosthesis in the acute setting.Measurements
Mean age, duration of priapism in hours, intraoperative and postoperative complications, the surgical outcome, and patients’ satisfaction were recorded.Results and limitations
A malleable penile prosthesis was inserted in 43 patients and a three-piece inflatable implant in was inserted in 7 patients; a subsequent elective exchange of a malleable to an inflatable device was performed in 6 patients.After a median follow-up of 15.7 mo (4–60 mo), 42 patients had already resumed successful sexual intercourse. Prosthesis infection occurred in three patients (6%), which was managed by explantation and delayed reinsertion.A further six patients needed revision surgery. No patient complained of penile shortening, and the overall satisfaction rate was 96%.Conclusions
The immediate insertion of a penile prosthesis for acute refractory ischaemic priapism is a simple and successful procedure that treats the acute episode as well as the inevitable erectile dysfunction that will occur with preservation of penile length. 相似文献17.
Background
Contemporary surgical treatment of female stress urinary incontinence (SUI) includes retropubic and transobturator (TO) midurethral slings (MUS). Case series of single-incision slings (SIS) have shown similar outcomes with lower morbidity.Objective
Our aim was to assess the cure rates, complications, and quality-of-life impact of one standard TO MUS and two SIS.Design, setting, and participants
Ninety consecutive patients with clinically and urodynamically proven SUI were enrolled in an exploratory randomised phase 2 trial. Patients with previous SUI surgery, major pelvic organ prolapse, mixed incontinence, or detrusor overactivity were excluded.Interventions
Patients were treated randomly with TVT-O, TVT-Secur, or Mini-Arc.Measurements
Postoperative visits were scheduled at 6 and 12 mo. The King's Health Questionnaire (KHQ) was repeated at 6 mo. Cure was defined as the absence of urine leakage, no pad use, and a negative cough test at 12 mo. Pain and other complications were also investigated.Results and limitations
Cure rate was 83% after TVT-O, 67% after TVT-Secur, and 87% after Mini-Arc. Improvement was found in 10%, 13%, and 7% of the patients, respectively. Failures were 7% after TVT-O and Mini-Arc and 20% after TVT-Secur.TVT-O and Mini-Arc improved at least 15 points in >80% of the patients in six KHQ domains, whereas TVT-Secur could only achieve improvement in three of the nine domains. The pain score was lower in the Mini-Arc group. Complications were more numerous after TVT-O. This study has the limitations inherent in a phase 2 trial with a follow-up limited to 12 mo.Conclusions
Mini-Arc offers cure and improvement rates similar to TVT-O, whereas TVT-Secur may yield an inferior outcome. These findings recommend the urgent launch of large randomised phase 3 studies comparing conventional MUS with SIS, with Mini-Arc the advised option. 相似文献18.
Sacral neuromodulation is a therapy technique used in the treatment of bowel function disorders. The correct positioning of the stimulation electrode in contact with the nerve of interest is essential to therapeutic success, not only during the testing, but also in the long term. The benefit of using a specific curved electrode (Interstim 3889?) using a specific guidewire has been recently demonstrated. This change in device and implantation technique has enabled functional and electrophysiological results to be obtained that are superior to those achieved with the procedure used previously with the Interstim 3093? electrode, with a more frequently positive response to the test phase, a wider choice of stimulation parameters at lower voltages, thus extending the potential life expectancy of the neurostimulator. The surgical implantation technique itself has changed and requires specific precautions to be taken and very precise radiological controls to be carried out that will be described in this paper. 相似文献
19.
《Seminars in Colon and Rectal Surgery》2017,28(4):185-188
Sacral neuromodulation has become an established treatment option for adults with fecal incontinence, but has only been applied to children with defecatory disorders over the past decade. Unlike in adults, the primary cause of fecal incontinence in children is poorly controlled constipation. There is growing evidence that sacral neuromodulation can be effective in the treatment of children with both constipation and fecal incontinence refractory to conventional treatment, and sacral nerve stimulation appears to be a promising treatment for a population of children with limited treatment options and debilitating symptoms. However, both experience with this treatment modality and the quality of evidence for its use remain limited. Given the relatively high complication rate associated with sacral nerve stimulation, further research is needed before more widespread acceptance of this treatment in the management of children with refractory constipation and fecal incontinence. 相似文献
20.
Long-term effectiveness of sacral nerve stimulation for refractory urge incontinence 总被引:5,自引:0,他引:5
Janknegt RA Hassouna MM Siegel SW Schmidt RA Gajewski JB Rivas DA Elhilali MM Milam DC van Kerrebroeck PE Dijkema HE Lycklama à Nÿeholt AA Fall M Jonas U Catanzaro F Fowler CJ Oleson KA 《European urology》2001,39(1):101-106
OBJECTIVES: To evaluate the long-term efficacy of sacral nerve stimulation for refractory urinary urge incontinence. STUDY DESIGN AND METHODS: Urge incontinent patients qualified for surgical implantation of a neurostimulator system after trial screening with percutaneous test stimulation. Surgical implantation of the InterStim System (Medtronic Inc., Minneapolis, Minn., USA) was performed in cases where a >50% reduction in incontinence symptoms was documented during the 3- to 7-day test stimulation period. The InterStim System consists of an implantable pulse generator, a transforamenally placed quadripolar lead, and an extension that connects these two devices for unilateral stimulation of the S3 or S4 sacral nerve. Efficacy for 96 implanted patients was based on urinary symptom changes as quantified in voiding diaries collected at baseline and annually after surgical implantation. RESULTS: As compared to baseline, the group of 96 implanted patients demonstrated significant reductions in urge incontinent symptoms at an average of 30.8+/-14.8 (range 12-60) months with respect to the number of urge incontinent episodes per day, severity of leaking, and the number of absorbent pads/diapers replaced per day due to incontinence (all p<0.0001, respectively). Gender, pretreatment variables, and age were not found to be relevant factors that affected these results. 11 of the 96 patients underwent device explant due to lack of efficacy, pain or bowel dysfunction. These data were conservatively included in the efficacy results. No permanent injuries associated with the devices or therapy were reported. CONCLUSION: Sacral nerve stimulation is an effective treatment for refractory urge incontinence with sustained long-term benefit through an average of 30.8 months. 相似文献