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141.
Management of vault prolapse in a patient who has previously undergone successful colposuspension has not been considered in the literature. The two cases presented highlight the risk of incontinence and illustrate measures that should help to reduce it. The approach aims to reveal potential stress incontinence and to prevent excessive stretching of the upper anterior vaginal wall during surgical correction. Potential stress incontinence is revealed by a cough stress test while reducing the prolapse without a speculum, a pessary test for a few days, and urodynamics both with and without a pessary. Patients with potential incontinence undergo perineal ultrasound to assess bladder neck position. If sacrospinous fixation is used, epidural anesthesia is recommended so as to allow the patient to cough during the procedure to ensure accurate suture placement. When sacrocolpopexy is done, preoperative assessment of the degree of safe elevation ensures accurate suture placement. 相似文献
142.
We have used a series of urethral models to test a theory of flow through distensible tubes having a pressure maximum (elastic constriction) near the midpoint. From measurements of pressure head and flow rate the properties of each elastic constriction have been deduced by means of the theory, and have been compared with those known from static measurements (paper I). For models with a sufficiently broad elastic constriction the theory is correct. Increasing departures occur as the elastic constriction becomes more sharply localised. In particular, pressures measured by a static method, similar to the Brown-Wickham method used clinically, become greater than those deduced from the flow measurements. Similar behaviour is expected for the real urethra, and may be important in the understanding of incontinence. These models show the negative-resistance behaviour believed to be characteristic of sharply localised elastic constrictions. 相似文献
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Dr. Anne-Marie Leroi M.D. Marie-Paule Dorival Marie-Françoise Lecouturier Christine Saiter Marie-Laure Welter M.D. Jean-Yves Touchais M.D. Philippe Denis Ph.D. 《Diseases of the colon and rectum》1999,42(6):762-769
PURPOSE: It has been suggested that the severity of fecal incontinence, the presence of pudendal neuropathy, or an external anal sphincter defect does not preclude clinical improvement with biofeedback therapy. A discrepancy, however, is frequently found between subjective improvement and objective results after biofeedback therapy. Our aim was to assess whether severity of fecal incontinence, presence of pudendal neuropathy, or an external anal sphincter defect could influence the results of manometric parameters after biofeedback therapy in patients with fecal incontinence. METHODS: Biofeedback therapy was used to treat 27 patients with fecal incontinence (25 women; mean age, 53; range, 29–74 years), according to a strict protocol. Manometry, pudendal nerve terminal motor latency, and anal ultrasound were performed in all patients before biofeedback therapy. Manometric evaluation of external anal sphincter function was performed after the biofeedback sessions. RESULTS: Eight of 27 patients had a good clinical response to biofeedback, but with no significant difference in their mean amplitude and duration of squeeze pressure before and after biofeedback. There was no relationship between the clinical results of biofeedback therapy and the initial severity of fecal incontinence, pudendal neuropathy, or external sphincter defect. Patients with severe incontinence (incontinence to solids) and pudendal neuropathy failed to improve the amplitude and duration of their maximum voluntary contraction after biofeedback therapy. Patients with mild fecal incontinence (incontinence to flatus, liquids, or both) (P<0.04), without pudendal neuropathy (P<0.02), or with (P<0.05) and without (P<0.05) external sphincter defect improved their external anal sphincter function after biofeedback therapy. CONCLUSION: In patients with fecal incontinence, the severity of symptoms and pudendal neuropathy should be considered as two factors of poor prognosis of favorable manometric results after biofeedback therapy. Improvement, on the other hand, may be expected after biofeedback therapy despite an external anal sphincter defect.Presented at the XXIst congress of the Societé Internationale Francophone d'Urodynamique, Lisbon, Portugal, May 14 to 16, 1998. 相似文献
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目的 形成成人失禁患者一次性吸收型护理用品临床应用专家共识。方法 系统地查阅国内外文献,组织国内专家进行评议,通过专家会议法和德尔菲专家函询法,结合实验室数据及专家意见,对各条目进行修改、完善。结果 对成人失禁患者一次性吸收型护理用品的指标要求及临床应用2个方面、20个条目达成共识。结论 制定成人失禁患者一次性吸收型护理用品临床应用专家共识,可对成人失禁患者住院期间使用一次性吸收型护理用品提供指导,并为住院失禁患者的皮肤环境保护提供规范指引。 相似文献
148.
J.A. Álvarez F. Bermejo A. Algaba M.P. Hernandez M. Grau 《Journal of Crohn's and Colitis》2011,5(6):598-607
Background and aims
Surgeons have traditionally tried to avoid any complex surgical procedures in Crohn's patients with complex perianal diseases because of the fear of complications, worsening the patient's condition and risking an eventual proctectomy. The introduction of biological therapy has changed the management of Crohn's disease. This study assesses the long-term success of addressing defects in anal sphincter and complex fistula when patients receive anti-TNF-α antibodies.Methods
Ten consecutive patients were prospectively scheduled for induction therapy with 5 mg/kg Infliximab at week 0, 2 and 6 and maintenance every 8 weeks associated with azathioprine. Elective surgery was performed conducting a simultaneous approach to the sphincter defect and fistula tracts. Outcomes were long-term continence, complications which were assessed by a Wexner's score along with a complementary questionnaire. Statistical analysis was performed using general linear model of repeated measures.Results
Three patients had complications related to surgery: two abscesses and low intersphincteric fistula and one case of rectal stenosis causing fecal urgency. There was no suture dehiscence. Wexner's score improved at 12 months (10.0 ± 2.4 vs. 18.0 ± 2.6; p = 0.003) and over time (48 month 9.5 ± 2.8; p = 0.001). These scores were significantly worse when patients had urgency before treatment (12.8 ± 1.2 vs. 9.5 ± 2.8; p = 0.03) but not when the urgency appeared later. No patient remained incontinent to solid stools. Three patients had occasional incontinence to liquid stools associated to disease reactivation.Conclusion
Surgical repair and immunomodulator therapy with infliximab could be an option in incontinent patients with Crohn's disease involving both a sphincter defect and severe or refractory fistulas. 相似文献149.
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