Does the magnetic anal sphincter device compare favourably with sacral nerve stimulation in the management of faecal incontinence?

Aim The magnetic anal sphincter (MAS) is a recent surgical innovation for severe faecal incontinence (FI). With its place in the treatment algorithm of FI yet to be defined, we report a nonrandomized comparison between MAS and sacral nerve stimulation (SNS) in a single‐centre cohort of patients with FI. Method Data were reviewed from prospective databases. From December 2008 to December 2010, 12 women [median age 65 (42–76) years], having FI for a median of 6.5 years, were implanted with a MAS. Sixteen women, of similar age, preoperative function scores, aetiology and duration of incontinence, and implanted with a permanent SNS pulse generator during the same period, served as a reference group. The duration of hospital stay, complications, change in incontinence and quality of life scores and anal physiology were compared between the two groups. Results The duration of follow up was similar [MAS = 18 (8–30) months vs SNS = 22 (10–28) months; P = 0.318]. Four patients with MAS experienced a 30‐day complication, and the device was removed from one patient in each group. A significant improvement in incontinence (P < 0.001) and quality‐of‐life scores (P < 0.04) occurred in both groups. Mean anal resting pressure increased significantly in patients implanted with a MAS (P = 0.027). Conclusion In this single‐centre nonrandomized cohort of FI patients, MAS was as effective as SNS in improving continence and quality of life, with similar morbidity. These results can now serve as a prelude to a randomized trial comparing the procedures.     

Long-acting muscarinic M3 receptor antagonists

Two applications claim a novel class of muscarinic M₃ receptor antagonists and their use as long-acting agents for the treatment of chronic obstructive pulmonary disease. The two applications claim closely related structures with one claiming quaternary amine salts of the tertiary amines claimed in the other. The claimed compounds comprise a biarylmethylamine core with the amino group modified by acylation or sulfonation and a tertiary or quaternary amine coupled to the distal ring of the biaryl system.     

Progress in studies on pathological changes and future treatment strategies of obesity-associated female stress urinary incontinence: a narrative review

With the increasing prevalence of obesity worldwide, obesity-related female stress urinary incontinence (FSUI) has become a key health problem. Recent studies indicated that FSUI is primarily caused by obesity-related pathological changes, such as fat droplet deposition, and results in pelvic floor nerve, vascular, and urethral striated muscle injury. Meanwhile, treatments for obesity-associated FSUI (OA-FSUI) have garnered much attention. Although existing OA-FSUI management strategies, including weight loss, pelvic floor muscle exercise, and urethral sling operation, could play a role in symptomatic relief; they cannot reverse the pathological changes in OA-FSUI. The continued exploration of safe and reliable treatments has led to regenerative therapy becoming a particularly promising area of researches. Specifically, micro-energy, such as low-intensity pulsed ultrasound (LIPUS), low-intensity extracorporeal shock wave therapy (Li-ESWT), and pulsed electromagnetic field (PEMF), have been shown to restore the underlying pathological changes of OA-FSUI, which might be related by regulation endogenous stem cells (ESCs) to restore urine control function ultimately in animal experiments. Therefore, ESCs may be a target for repairing pathological changes of OA-FSUI. The aim of this review was to summarize the OA-FSUI-related pathogenesis, current treatments, and to discuss potential therapeutic options. In particular, this review is focused on the effects and related mechanisms of micro-energy therapy for OA-FSUI to provide a reference for future basically and clinical researches.     

老年大便失禁患者的综合护理干预

目的探讨老年大便失禁患者的护理方法，改进老年大便失禁患者的护理措施。方法选择96例老年大便失禁患者，随机分为例数相等的观察组与对照组，观察组应用综合护理模式，对照组采用传统护理模式，对两组患者的排便频率及肛周皮肤保持干燥时间进行比较及统计学分析，观察组间是否存在差异。结果应用综合护理模式的观察组排便频率明显低于应用传统经验护理模式的对照组，且肛周皮肤保持干燥时间明显较长，差异具有统计学意义（P〈0．05）。结论综合护理模式应用于老年大便失禁患者，可显著提高患者生活质量，值得临床推广应用。     

Urinary incontinence in schizophrenic patients treated with atypical antipsychotics: urodynamic findings and therapeutic perspectives

Objective

The present study was a urodynamic evaluation of schizophrenic patients with urinary incontinence occurring during treatment with atypical antipsychotics

Methods

A total of 12 schizophrenic patients (mean age?=?30.7 years, SD?=?6.5) presenting urinary incontinence during treatment with atypical antipsychotics at stable doses underwent urodynamic evaluations. Clinical assessment included the administration of Positive and Negative Syndrome Scale (PANSS)

Results

Four patients out of 12 presented urodynamic patterns consistent with an overactive bladder, while five patients presented reduced bladder compliance; only three patients showed normal urodynamic patterns

Conclusion

Detrusor overactivity is a condition associated with urinary incontinence in schizophrenic patients treated with atypical antipsychotics. Urodynamic evaluations can improve our knowledge of the mechanisms that subtend atypical antipsychotic-induced incontinence, an invalidating side-effect with strong repercussion on compliance and rehabilitation in schizophrenic patients