Fecal incontinence in adults:diagnose and treatment / 临床外科杂志

This paper delineate the definition,etiology and treatment of fecal incontinence,Initial management of fecal incontinence consists of supportive care and medical therapy.If patients fail to re-spond to initial management,such patients should undergo additional evaluation(such as anorectal manom-etry,endorectal ultrasound and magnetic resonance imaging)to detect functional and structural abnormali-ties causing fecal incontinence and to guide subsequent management.For patients who fail to respond to initial management,options include biofeedback,injectable anal bulking agent,sacral nerve stimulation, and anal sphincteroplasty.Dynamic graciloplasty and artificial anal sphincter devices are associated with significant morbidity and should therefore only be used to treat refractory fecal incontinence.Fecal diver-sion with a colostomy should be reserved for patients with intractable symptoms who are not candidates for any other therapy,or in whom other treatments have failed.

Safety and Efficacy of Permacol Injection in the Treatment of Fecal Incontinence

PURPOSE: Permacol has been gaining popularity in recent times for the treatment of fecal incontinence (FI). This study aims to evaluate the safety and efficacy of anal submucosal Permacol injection in the treatment of FI. METHODS: All consecutive patients who underwent Permacol injection for FI over a 3-year period were included. Patients' data relating to obstetric history, anorectal/pelvic operations, type of FI, preoperative anorectal physiology results and follow-up details for outcome measures were collected. Preoperative and postoperative Cleveland Clinic Florida Incontinence Scores (CCFISs) were noted. Patients were surveyed by using a telephone questionnaire to assess the quality of life and other outcome measures. Data were analysed using SPSS ver.19.0. RESULTS: Thirty patients (28 females and 2 males) with a median age of 67 years were included in the study. Of those patients, 37%, 50%, and 13% were noted to have passive, mixed and urge FI, respectively. Six of the patients (20%) had repeat Permacol injections, 5 of whom had sustained responses to the first Permacol injection for a mean of 11 months. There was a significant improvement in the CCFIS from a baseline median of 12.5, mean 12.8 interquartile range [IQR], 6-20), to a median of 3.5, mean 4.8 (IQR, 0-20), P < 0.001. Of the patients surveyed by telephone 89% were satisfied with their overall experience and the improvement in their symptoms following Permacol injections. CONCLUSION: This study has demonstrated that Permacol injection for the treatment of FI is safe and effective and has no associated major complications. However, the results are not permanent; consequently, a significant proportion of the patients with an initial response may require repeat injections.

Reflujo vesicoureteral: Tratamiento endoscópico / Vesico-ureteral refux, endoscopic management

El refujo vesicoureteral (RVU) es el fujo de orina desde la vejiga hasta el tracto urinario superior. Está presente en el 25% al 70% de los niños con infección urinaria asociada a pielonefritis. Se realizó una revisión de la bibliografía sobre el tratamiento endoscópico del RVU analizando las técnicas, los materiales utilizados, las indicaciones y las complicaciones descritas. De los artículos encontrados, se seleccionaron los más recientes y las Guías Europeas y Norteamericanas. El tratamiento endoscópico del refujo, que se ha impuesto progresivamente como técnica de elección para el tratamiento primario del RVU asociado a pielonefritis o a infecciones, permite retrasar el recurso a la cirugía.

Introduction. Vesico-ureteral refux (VUR) is defned as the retrograde fow of urine from the bladder to the upper urinary tract and is distinguished in primary and secondary. It is present in 25-70% of children who have a urinary tract infection (UTI) associated with pyelonephritis, the association between UTI and VUR predisposes children to have renal scarring with consequent alteration of the functionality until chronic renal failure. Material and methods. We realized a review of the literature on the endoscopic treatment of vesico-ureteral refux analyzing the different techniques, materials used for endoscopic injection, indications and complications described in the literature. Results. Over 100 articles we found on the endoscopic treatment of refux with indications, complications and outcomes in the short, medium and long term. Of these we selected the most recent and current European and American Guidelines. Conclusions. Endoscopic treatment of refux has become gradually the technique of choice for the primary treatment of vesico-ureteral refux associated with pyelonephritis or urinary tract infections and permits to delay the use of open surgery.