Use of endoanal ultrasound as complimentary evaluation for detection of anal sphincter injury after vaginal birth / Uso da ultrassonografia endoanal como avaliação complementar para a detecção de lesão do esfíncter anal após parto vaginal

Abstract Purpose Anal sphincter injury after delivery is the main factor in the pathogenesis of fecal incontinence. Clinical obvious and specific injury to anal canal sphincter is seen in 3% of vaginal deliveries. There are many women who do not have a clear and specific laceration but they are damaged by sphincter muscles of anal canal. The purpose of the present study is to investigate the frequency of occult anal sphincter injury after vaginal delivery by Endo-anal sonography. Methods Fifty women with first pregnancy were assessed at 27-33 weeks of pregnancy, and at 6 weeks and 6 months after vaginal delivery by questionnaire, examination and Endo-anal sonography. Women age, duration of delivery, the effect of epidural anesthesia, episiotomy and birth weight were studied and Endo-anal sonography results were recorded. Anal manometry was performed for all mothers before delivery and 5 ones with sphincter injury at 6 months and 3 years after delivery. Results Five (10%) patients, with mean age 29.4 ± 6.5 years, mean neonatal weight of 3874 ± 287, and mean duration of delivery 11.6 ± 1.51 h, had signs of sphincter injury in Endo-anal sonography. The injury was persisted at six months after delivery. Also, significant differences were seen between anal manometry before delivery and 6 months and 3 years after delivery (p = 0.006 for mean squeezing pressure) in the five mothers. Conclusion Endo-anal sonography might be a good screening tool for early detection of postpartum anal sphincter damages. However, further prospective cost benefit studies should be performed to propose it as a standard of care.

Resumo Finalidade A lesão de esfíncter anal após o parto é o fator principal na patogênese da incontinência fecal. Observa-se uma lesão clínica óbvia e específica ao esfíncter no canal anal em 3% dos partos vaginais. Em muitas mulheres não se percebe uma laceração nítida e específica, mas houve lesão nos músculos esfinctéricos do canal anal. A finalidade desse estudo é investigar a frequência de lesão oculta de esfíncter no canal anal em seguida ao parto vaginal por meio da ultrassonografia endoanal. Métodos Cinquenta mulheres primíparas foram avaliadas no período de 27-33 semanas de gestação e também a 6 semanas e 6 meses após o parto vaginal por meio de questionário, exame e ultrassonografia endoanal. Foram anotados a idade das pacientes, a duração do parto, o efeito da anestesia epidural, episiotomias e peso do bebê ao nascer; também foram registrados os resultados da ultrassonografia endoanal. Antes do parto, todas as gestantes foram submetidas a um exame de manometria; e 5 mães com lesão esfinctérica também passaram por esse procedimento a 6 meses e 3 anos após o parto. Resultados Cinco (10%) pacientes, com média de idade = 29,4 ± 6,5 anos, peso médio do bebê ao nascer = 3874 ± 287 gramas e duração média do parto = 11,6 ± 1,51 horas, apresentavam sinais de lesão esfinctérica ao exame por ultrassonografia endoanal. Seis meses após o parto, as lesões persistiam. Também foram observadas diferenças significativas entre a manometria anal antes do parto e a 6 meses e 3 anos após o parto (p = 0,006 para média de pressão de contração) nas cinco mães. Conclusão A ultrassonografia endoanal pode ser um bom instrumento de triagem para a detecção precoce de lesões do esfíncter anal no pós-parto. Contudo, é importante que sejam realizados novos estudos prospectivos e de custo-benefício, para que essa técnica possa ser proposta como padrão terapêutico.

The risk factors of prostate cancer: a multicentric case-control study in Iran.

Prostate cancer (PC), in Iran, is the third most frequently diagnosed visceral cancer among men and the seventh most common underlying cause of cancer mortality. We evaluated the relation between speculated factors and PC risk using data from a multicentric case-control study conducted in Iran from 2005 to 2007 on 130 cases of incident, clinicopathologically confirmed PC, and 75 controls admitted to the same network of hospitals without any malignant disease. Odds ratios (OR) and corresponding 95% confidence intervals (CIs) were estimated using conditional logistic regression models. The risk of PC was increased with aging (OR: 5.35, 95% CI: 2.17-13.19; P<0.0001), and with the number of sexual intercourse >or=2 times/week (OR: 3.14, 95% CI: 1.2-8.2; P=0.02). One unit elevation in serum estradiol and testosterone concentration was related to increase (OR: 1.04, 95% CI: 1.01-1.06; P=0.006) and decrease (OR: 0.79; 95% CI: 0.64-0.96; P=0.02) of PC risk, respectively. Cases were less likely to have a history of diabetes (OR: 0.34, 95% CI: 0.12-0.98; P=0.04). Increasing in dietary consumption of lycopene and fat was associated with declined (OR: 0.45, 95% CI: 0.09-2.12) and increased (OR: 2.38, 95% CI: 0.29-19.4) PC development, respectively. Other factors including educational level, marriage status, dietary meat consumption, vasectomy and smoking have not been shown to affect PC risk in the Iranian population. Our study adds further information on the potential risk factors of PC and is the first epidemiologic report from Iran. However, justification of these results requires more well-designed studies with a larger number of participants.