Fecal incontinence severity index after fistulotomy: a predictor of quality of life

PURPOSE: The purpose of this study was to use the Fecal Incontinence Severity Index to assess fecal incontinence after fistulotomy and to correlate the Fecal Incontinence Severity Index score with quality-of-life measures. METHODS: A retrospective chart review was performed on consecutive patients undergoing fistulotomy by a single colon and rectal surgeon at a university hospital from 1991 to 1999. Demographics, fistula anatomy, surgical technique, and length of follow-up were recorded. Mailed questionnaires and telephone interviews were conducted to determine the Fecal Incontinence Severity Index score, pad usage, lifestyle restriction, and psychosocial factors. A linear regression model was used to determine the relationship of clinical factors with Fecal Incontinence Severity Index. One-way ANOVA was used to correlate Fecal Incontinence Severity Index with quality-of-life measures. RESULTS: Of 110 patients who underwent fistulotomy, 96 (88 percent) had complete follow-up. Mean age was 48 (range, 17–84) years, and 68 percent were male. Follow-up was less than two years in 26 percent, two to five years in 39 percent, and more than five years in 35 percent. Of these patients, 41 percent had intersphincteric fistulas, whereas 59 percent had transsphincteric fistulas. Median Fecal Incontinence Severity Index score was 6, with a mean of 13 (maximum Fecal Incontinence Severity Index = 61); 36 percent had a Fecal Incontinence Severity Index score of zero. Linear regression revealed that only the amount of external sphincter divided correlated with Fecal Incontinence Severity Index score (P = 0.05). Quality-of-life measures strongly correlated with Fecal Incontinence Severity Index by analysis of variance (P < 0.01 for pad usage, lifestyle restriction, depression, and embarrassment), with substantial quality-of-life drop-off documented with Fecal Incontinence Severity Index >30. CONCLUSION: The Fecal Incontinence Severity Index is an excellent tool to gauge quality of life after fistulotomy. Fecal Incontinence Severity Index scores >30 predict a detrimental effect on quality of life.     

Pudendal Nerve Terminal Motor Latency Testing: Assessing The Educational Learning Curve

PURPOSE: Pudendal nerve terminal motor latency testing is useful as a diagnostic tool in fecal incontinence. It has also been used as a predictive factor in sphincteroplasty repairs. The technique is seldom taught and mastered in colorectal training programs. The purpose of this study was to assess a learning curve for teaching this procedure. METHODS: The student was a formally trained colorectal surgeon with no pudendal nerve terminal motor latency experience; the instructor has performed more than 3,000 pudendal nerve terminal motor latency studies. Fifty consecutive patients had manometry and pudendal nerve terminal motor latency testing. Both the student and instructor performed pudendal nerve terminal motor latency in a sequential fashion. Variables collected included pudendal nerve terminal motor latency, completion of test, time to complete test, and accuracy of the test. Variables were analyzed with paired t-test and chi-squared analysis. RESULTS: The study group included 41 female and 9 male patients. The average age of the patients was 53 years. Bowel complaints included constipation in 16 and incontinence in 34 patients. Data were analyzed in their entirety and at ten-patient intervals. The student tended to record longer latencies (P < 0.001). This led to false-positive rates of 23 and 21 percent, respectively, for left and right pudendal nerve terminal motor latency. On average, the time to complete the procedure was three times longer for the student than for the instructor (P < 0.001). At ten-patient intervals, the pudendal nerve terminal motor latency difference between the two groups disappeared at the 41-to-50–patient mark. CONCLUSION: Given the proper learning environment, pudendal nerve terminal motor latency testing can be mastered in a relatively short period. On the basis of this study, our estimation is 40 patients are required for a student to master this technique. The novice examiner can expect false-positive results early in the learning curve, and these should be validated accordingly.     

TVT-O治疗女性压力性尿失禁11例临床分析

目的:评价经闭孔尿道中段无张力悬吊术(tension-free vaginal tape obturalor,TVT-O)治疗女性压力性尿失禁(stress urinary incontinence,SUI)的疗效。方法:回顾并分析2010年1月²012年12月采用TVT-O术式治疗SUI的临床资料。结果:手术时间202012年12月采用TVT-O术式治疗SUI的临床资料。结果:手术时间20³5 min,平均(30±5.92)min,术中出血2035 min,平均(30±5.92)min,术中出血20⁵0 ml,平均(40±8.94)ml,11例均治愈,术后随访650 ml,平均(40±8.94)ml,11例均治愈,术后随访6¹2个月,无1例复发。结论:TVT-O治疗女性SUI操作简单,效果可靠,并发症少,是一种较为理想的方法。     

护理干预对成年女性压力性尿失禁患者生活质量的影响

目的:探讨护理干预对改善成年女性轻度压力性尿失禁(stress urinary incontinence,SUI)患者生活质量的影响。方法:对80例成年女性压力性尿失禁患者进行生活质量调查,并对其进行护理干预,包括生活方式干预、盆底生物反馈训练和行为干预。采取自身对照法,比较干预前与干预3个月、6个月、1年时患者生活质量的差异,观察护理干预的效果。结果:干预3个月及6个月1年时,患者女性下尿路症状国际尿失禁标准问卷及泌尿生殖系统疾病量表-7评分均较干预前有所下降,表明患者的生活质量有所改善,差异有统计学意义(P<0.001)。结论:护理干预能提高成年女性压力性尿失禁患者的生活质量,值得推广应用。     

134 例子宫全切除术后患者盆底功能影响的调查

目的了解子宫全切除术后患者的远期盆底功能情况。方法选取2005年1月—2006年7月于武汉市江夏区第一人民医院因妇科良性疾病（子宫肌瘤、子宫腺肌症、功血）行子宫全切除术的134例患者行随访调查,调查项目包括门诊常规妇科检查、盆底肌肉肌力（PFMS）分级测试、盆底功能影响问卷简表7（PFIQ．7）及盆底功能障碍问卷简表20（PFDI-20）。结果①134例患者为子宫全切除术后6～7年,发生压力性尿失禁89例（66．4％）,尿频33例（24．6％）,尿急28例（20．9％）,便秘29例（21．6％）,盆腔器官脱垂11例（8．2％）;②PFMS测试结果：肌力I级2例（1．5％）,II级48例（35．8％）,Ⅲ级71例（53．0％）,IV级13例（9．7％）;③PFIQ-7评分的中位数为0分（0,49）,PFDI-20评分的中位数为5分（0,37）。结论子宫全切除术对患者远期盆底功能可能存在影响,主要为压力性尿失禁。     

TVT-O治疗女性压力性尿失禁的效果研究

目的 探讨经闭孔无张力尿道悬吊术治疗女性压力性尿失禁的临床效果.方法 本组80例患者均为2011年8月～2013年10月我院确诊的女性压力性尿失禁患者,按照入院的先后顺序分为TVT-O组40例,采用TVT-O治疗;TOT组40例,采用TOT治疗,比较两组患者手术时间、术中出血量、住院时间、治愈率,治疗前后I-QOL评分及P-ISQ评分.结果 TVT-O组及TOT组手术时间、术中出血量、住院时间及治愈率比较差异无统计学意义（P＞0.05）.两组术后I-QOL评分与术前比较明显较高,差异有统计学意义（P＜0.05）;术后P-ISQ评分与术前比较差异无统计学意义（P＞0.05）.TOT组术前及术后I-QOL评分、P-ISQ评分与TVT-O组比较差异无统计学意义（P＞0.05）.结论 TVT-O与TOT治疗女性压力性尿失禁效果相当,可以作为一种安全有效的方法治疗女性压力性尿失禁.     

电刺激联合生物反馈治疗中老年女性压力性尿失禁57例临床观察

目的：探讨电刺激联合生物反馈治疗中老年女性压力性尿失禁的效果。方法采用法国PHENIX神经肌肉刺激治疗仪对57例中老年妇女压力性尿失禁患者治疗1-2个疗程,治疗3个月后进行随访、复诊,评价疗效。结果57例患者治愈21例（36.8％）,有效24例（42.1％）,无效12例（21.1％）,总有效率为78.9％。子宫脱垂和阴道膨出的患者均感到脱出物有不同程度的回缩。34例性生活不满意患者均有不同程度改善。盆底肌Ⅰ类肌纤维疲劳度改善不明显（P＞0.05）,Ⅱ类肌纤维疲劳度、Ⅰ类及Ⅱ类肌肌力、每周平均漏尿次数、A3反射异常、综合肌电位值均明显改善（ P＜0.05）。结论电刺激联合生物反馈是治疗中老年女性压力性尿失禁的一种有效、简便、无创伤的方法,值得推广。     

论生活质量在女性压力性尿失禁中应用

目的：提高人们对生活质量评价的重视,望进一步完善SUI疗效评价体系。方法：主要从压力性尿失禁（SUI）的发病率、SUI对患者生活质量的影响、目前生活质量在SUI治疗中的应用等方面阐述生活质量在SUI中的意义及存在的问题。结果：在现代医学模式下,康复的定义已不仅仅局限在症状的改善上,对于SUI患者而言．生活质量的改善才是最终目标,生活质量评价不可或缺。结论：SUI严重影响患者的生活质量,生活质量在SUI疗效评价中是十分有意义的,但目前对于SUI尚缺乏相对完善的疗效评价体系。     

中段尿道无张力吊带术对女性压力性尿失禁患者性功能的影响

目的:评估经阴道无张力尿道中段悬吊术(tension free vaginal tape,TVT)、经闭孔阴道无张力悬吊术(transobturator suburethral tape,TVT-O)对女性压力性尿失禁患者性功能的影响.方法:应用女性性功能指数(female sexual function index,FSFI)问卷,对北京大学人民医院TVT、TVT-O术后3个月至5年的66例患者进行随访,按照手术方式(TVT/TVT-O)、术后时间(1年以内与1年以上)及术前有无性交漏尿(concomitant coital incontinence,CCI)进行分组,应用多元协方差分析比较手术前后FSFI评分的变化,评分越高,提示性功能质量越好.结果:最终回收有效问卷51例,术前TVT组及TVT-O组患者年龄、FSFI、体重指数(body mass index,BMI)差异无统计学意义.多元协方差分析中,在校正术后时间及术前有无性交漏尿对患者性功能的影响后,TVT组与TVT-O组患者术后FSFI评分升高值(difference of FSFI,dFSFI)差异无统计学意义(F=2.52,P=0.119),且两组患者相比术后性生活改善率差异无统计学意义(40.0％ vs.44.4％,P＞O.05).但在协变量分析中CCI组与nCCI组术后性功能变化差异显著(F =7.41,P＜0.05),CCI组dFSFI值更高(1.86±1.95 vs.-0.09±2.24).结论:TVT与TVT-O两种手术方式对患者性功能影响无明显差异,但术前有性交时漏尿的患者术后性功能改善明显.     

Midurethral slings for stress urinary incontinence: a urogynecology perspective

Stress urinary incontinence (SUI), the involuntary leakage of urine associated with an increase in intraabdominal pressure (coughing, laughing, and sneezing), affects 12.8% to 46.0% of women. SUI is the most common type of urinary incontinence in women younger than 60 years and accounts for at least half of incontinence in all women. Retropubic and transobturator midurethral sling procedures are safe and effective treatments for stress urinary incontinence but have different complication profiles. History, examination, and additional testing may assist in choosing the correct sling type. Appropriate counseling and managing patient expectation are necessary to optimize patient satisfaction.