Surgical treatment of rectourethral fistula / 现代泌尿外科杂志

Rectourethral fistula (RUF) has been difficult to manage in urology due to its special anatomical location,complicated condition and uncertain prognosis. With the increasing incidence of prostate cancer,the incidence of RUF as a serious complication is also rising. Major treatment methods of RUF include conservative treatment and surgical treatment such as transabdominal approach,trans-perineal approach,trans-sphincter approach and trans-anal approach. However,there is no explicit treatment protocol. In recent years,the application of modified York-Mason technique has achieved good results. This article details the key steps and surgical experience of the technique.

Resultados del tratamiento quirúrgico del cáncer de recto y ano en el Hospital Español / Results of the surgical treatment of rectal and anal cancer in the Hospital Español / Resultados do tratamento cirúrgico do câncer de reto e ânus no Hospital Español

La cirugía del cáncer de recto y ano se ha desarrollado considerablemente en las últimas décadas. En función de dichos avances, se ha observado una disminución en la morbimortalidad operatoria, así como también una mejoría en el pronóstico de estos pacientes. El objetivo del presente estudio es exponer y analizar los resultados del tratamiento quirúrgico del cáncer de recto y ano en un servicio universitario. Se realizó un estudio observacional, descriptivo y retrospectivo de todos los pacientes intervenidos por cáncer de recto y ano en el Hospital Español entre 2016 y 2020. Las variables registradas fueron: variables demográficas, clínico-oncológicas, relacionadas a la morbimortalidad operatoria y a la recidiva locorregional, y la sobrevida a 5 años. El procedimiento más realizado fue la resección anterior de recto (RAR) en 11 intervenciones (58%), mientras que las 8 restantes correspondieron a amputaciones abdominoperineales (AAP) (42%). Se diagnosticaron un total de 6 complicaciones intraoperatorias en 5 pacientes, siendo la perforación del tumor la más frecuente, y un total de 18 complicaciones postoperatorias en 11 pacientes, siendo la más frecuente la infección de la herida quirúrgica abdominal. La morbilidad operatoria mayor fue de 31,6% y la mortalidad operatoria a 90 días fue de 0%. La sobrevida global a 5 años fue de 63,2%. Los resultados quirúrgicos en la presente casuística fueron comparables con los de la bibliografía consultada. Destacamos la nula mortalidad a 90 días, con resultados oncológicos similares a los reportados en la literatura.

Rectal and anus surgery have been developed considerably in the last decades. Based on these advancements, it has been observed a decrease in the surgical morbidity and mortality, as well as an improved prognosis of these patients. The aim of the present study is to expose and analyze the results of the anus and rectal surgical treatment in a university service. An observational, descriptive and retrospective study was performed of all the intervened patients for rectum and anus cancer in the Hospital Español between 2016 and 2020. We recorded data about demographic, clinical-oncologic, related to the surgical morbidity and mortality, locoregional relapse and overall 5 year survival. The most performed procedure was the rectum anterior resection in 11 interventions (58%), while the 8 left corresponded to abdominoperineal resection (42%). There was a total of 6 intraoperative complications diagnosed in 5 patients, being the tumor perforation the most frequent one, and a total of 18 postoperative complications diagnosed in 11 patients, being the surgical wound infection the most frequent one. The serious surgical morbidity was 31,6%, while the surgical mortality rate at 90 days was 0%. Overall 5 year survival was 63,2%. The surgical results in the present study about the rectum and anal cancer were comparable with the results reported on the consulted bibliography. We highlight the null mortality within 90 days, with oncologic results similar to the ones reported in the literature.

A cirurgia do câncer retal e anal desenvolveu-se consideravelmente nas últimas décadas. Com base nesses avanços, observou-se diminuição da morbimortalidade operatória, bem como melhora no prognóstico desses pacientes. O objetivo deste estudo é apresentar e analisar os resultados do tratamento cirúrgico do câncer de reto e anal em um serviço universitário. Foi realizado um estudo observacional, descritivo e retrospectivo de todos os pacientes operados por câncer de reto e ânus no Hospital Espanhol entre 2016 e 2020. As variáveis ​​registradas foram: variáveis ​​demográficas, clínico-oncológicas, relacionadas à morbidade e mortalidade operatórias e recorrência locorregional. , e sobrevida em 5 anos. O procedimento mais realizado foi a ressecção anterior do reto (RAR) em 11 intervenções (58%) e as 8 restantes corresponderam a amputações abdominoperineais (AAP) (42%). Foram diagnosticadas 6 complicações intraoperatórias em 5 pacientes, sendo a perfuração tumoral a mais frequente, e um total de 18 complicações pós-operatórias em 11 pacientes, sendo a infecção da ferida operatória abdominal a mais frequente. A morbidade operatória maior foi de 31,6% e a mortalidade operatória em 90 dias foi de 0%. A sobrevida global em 5 anos foi de 63,2%. Os resultados cirúrgicos da presente casuística foram comparáveis ​​aos da bibliografia consultada. Destacamos a mortalidade nula em 90 dias, com resultados oncológicos semelhantes aos relatados na literatura.

Association between Introduction of the Diagnosis-Related Groups System for Anal Operation and Length of Stay: Higher Effectiveness at Hospitals with Longer Length of Stay / 보건행정학회지

BACKGROUND: We investigated association between introduction of the diagnosis-related groups (DRG) system for anal operation and length of stay. Also, we investigated how it is different among hospitals with longer length of stay and among hospitals with shorter length of stay before introduction of the DRG system. METHODS: We used data from Health Insurance Review and Assessment which were national health insurance claim data. Total 13,111 cases of anal surgery cases were included which were claimed by hospitals since July 2012 to June 2014. Two-level multivariable regression was conducted to analysis the association between length of stay and characteristics of hospital and patient. RESULTS: Before introducing DRGs, the average length of stay was 5.41 days. After introducing DRGs, average length of stay was decreased to 3.92 days. After introducing DRGs, length of stay has decreased (β=−1.0450, p < 0.0001) and it was statistically significant. Among hospitals which had short length of stay (shorter than mean of length of stay) before introducing DRGs, effect of introducing DRGs was smaller (β=−0.4282, p < 0.0001). On contrary, among hospitals which had long length of stay (longer than mean of length of stay) before introducing DRGs, effect of introducing DRGs was bigger (β=−1.8280, p < 0.0001). CONCLUSION: Introducing DRGs was more effective to hospitals which had long length of stay before introducing DRGs.

Características clínicas asociadas al escurrimiento fecal ''soiling'' en pacientes operados de enfermedades anales / Clinical characteristics associated to fecal ''soiling'' in patients subjected to anal surgeries

Objetivo: Describir las características clínicas relacionadas con el escurrimiento fecal ''soiling'' que presentan los pacientes operados de enfermedad hemorroidal, fístula, fisura anal y drenaje de absceso. Sede: Unidad de Coloproctología del Servicio de Gastroenterología del Hospital General de México ''Dr. Eduardo Liceaga''. Diseño: Estudio de casos y controles. Análisis estadístico: Medidas de tendencia central, t de Student, cálculo de momios (odds ratio; OR) y análisis no paramétrico con χ². Pacientes y métodos: Se aplicó un cuestionario de ocho ítems a 132 pacientes que acudieron a la consulta externa de nuestra unidad. El manchado de ropa interior, eritema anal, cicatriz, prurito y utilización de material para proteger la región anal, así como el cambio de alimentación, la presencia de materia fecal en el ano y la limpieza de la región anal sin haber evacuado fueron las variables evaluadas y comparadas entre pacientes operados y no operados. Resultados: Se incluyeron 59 hombres y 73 mujeres con edad media de 45 años, 58 pacientes operados y 74 no operados. El manchado de ropa interior fue el síntoma más frecuente en los pacientes operados (37% versus 25%). Las otras variables con significancia estadística, al compararse ambos grupos, fueron: prurito, la presencia de una cicatriz y eritema anal. El OR para cirugía en pacientes con manchado de ropa fue 3.22 (95% IC 1.57-6.60), para prurito 2.24 (95% IC 1.11-4.52) y la presencia de una cicatriz anal 91.38 (95% IC 24.46-341.43). Conclusiones: El soiling caracterizado como manchado de la ropa interior se presenta en al menos un tercio de los pacientes operados de cirugía anal. La presencia de eritema, materia fecal en el ano y una cicatriz anal asociadas hacen pensar en esta alteración.

Objective: To describe the clinical characteristics related to soiling present in patients subjected to anal surgery due to hemorrhoidal disease, fistula, anal fissure, and abscess drainage. Setting: Coloproctology unit of the Gastroenterology Service of the General Hospital of Mexico ''Dr. Eduardo Liceaga''. Design: Cases and controls study. Statistical analysis: Central tendency measures, Student's t test, odds ratio (OR) and non-parametric analysis using χ². Patients and methods: We applied an eight-item questionnaire to 132 patients that came to the out-patient consultation of our unit. Soiling of underwear, anal erythema, scar, pruritus, use of material to protect the anal region, change in feeding habits, presence of fecal matter in the anus, and cleaning of the anal region without having defecated were the assessed variables and these were compared between operated and non-operated patients. Results: We included 59 men and 73 women, average age of 45 years, 58 operated and 74 non-operated. Soiling of underwear was the most frequent sign in operated patients (37% versus 25%). The other variables with statistical significance when comparing both groups were: pruritus, presence of a scar and anal erythema. The OR for surgery in patients with underwear soiling was 3.22 (95% CI 1.57-6.60); for pruritus, 2.24 (95% CI 1.11-4.52) and presence of anal scar, 91.38 (95% CI 24.46-341.43). Conclusions: Soiling of underwear was found in at least one third of patients subjected to anal surgery. The presence of erythema, fecal matter in the anus, and an anal scar should lead to consider this alteration.

The Effects of Early Ambulation on Urinary Retention and

INTRODUCTION: Urinary retention (UR) is one most common complication of anal surgery and its cause is multifactorial. Postdural puncture headache (PDPH) is caused by cerebrospinal fluid leakage after spinal anesthesia, therefore it may be aggravated by early ambulation. PURPOSE: To determine whether early ambulation (EA) vs. bed rest (BR) reduces the incidence of UR after anal surgery under spinal anesthesia, without causing PDPH. METHODS: In this prospective, randomized study, 107 patients undergoing anal surgery under spinal anesthesia were randomly assigned in the EA group (n=54) or the BR group (n=53). UR was defined as a voiding difficulty that needs catheterization. In the BR group, the patients were positioned flat in bed on the operation day. Anesthetic techniques (tetracaine injection using 24-gauge needle in sitting position, bupivacaine local infiltration) and postoperative pain therapy (intramuscular demerol injection every 6 hours, oral nonsteriodal antiinflammatory drug plus acetaminophen) were standardized. Perioperative intravenous fluids were restricted. RESULTS: Urinary retention and PDPH occurred in 32 (29.9%) and 7 (6.5%) patients, respectively. UR was significantly reduced in the EA group (10/54=18.5%) vs. the BR group (22/53=41.5%) (p=0.017, Chi-square). The incidence of PDPH, however, was not different between the two groups (5.6% in the EA vs. 7.5% in the BR group). CONCLUSIONS: Early ambulation has important implication on reducing the incidence of urinary retention after anal surgery under spinal anesthesia, without causing PDPH.

Comparison of Mepivacaine and Bupivacaine as an Adjuvant of Morphine for Benign Anorectal Surgery under Caudal Anesthesia

BACKGROUND/AIMS: The caudal anesthsia is most commonly used for benign anorectal surgery, The combination of long-acting anesthetics and opiates has been used for longer duration and successful control of postoperative pain. But the side effects of peridural anesthesics and morphine have commonly occured in caudal anesthesia. This study was performed to assess the difference in clinical effects between peridural mepivacaine and bupivacaine with morphine. METHODS: We evaluated the clinical effects in 60 patients who had anal operation with Jack-Knife position under caudal anesthesia. We divided randomly these 60 patients into two groups, M and B groups (in each group, 30 patients included). Group M (n=30) was given 2% mepivacaine 20 ml with morphine 2 mg caudally, and Group B (n=30) was given 0.5% bupivacaine 20 ml with morphine 2 mg in the same manner. We measured the onset time, duration, postoperative analgesia, and side effects including urinary retention. RESULTS: The onset time for analgesia was significantly shorter in group M than in group B. The duration of postoperative pain complaints was significantly longer in group M than in group B. The postoperative analgesic effects and side effects were not significantly different between two groups. CONCLUSIONS: Caudal mepivacaine and morphine mixture is effective for control of postoperative pain without significant side effects.