High-resolution circuit for the diagnosis of faecal incontinence. Patient satisfaction. / Circuito de alta resolución en el diagnóstico de la incontinencia fecal. Satisfacción de los pacientes.

INTRODUCTION: Despite its high prevalence, faecal incontinence (FI) is still underrated and underdiagnosed. Moreover, diagnosis and subsequent treatment can be a challenge for the colorectal surgeon because of its associated social taboo and embarrassment, and the wide range of symptoms. The aim of the present study is to describe a new high-resolution circuit (HRC) for FI diagnosis, that was implemented at our center and to evaluate patient satisfaction. METHODS: The structure and organization of the HRC are described. Demographic and clinical data of the patients included in the HRC between February 2014 and June 2016 were collected. Moreover, patients' satisfaction was measured through a structured survey. RESULTS: A total of 321 patients were evaluated in our pelvic floor outpatients clinic during the study period: 65% (210) of them had FI (81% women, median age 66 years). The mean time since FI onset was 24 (range 4-540) months. A total of 79% (165) of the patients were included in the HRC. 62% of them responded to the survey. Of these, only 32% (33) had consulted for FI before coming to our centre. The majority, 88% (90) considered that performing the 2diagnostic tests the same day of the visit was a very good option. And 94% (96) were satisfied with the information received on their FI, with a median satisfaction value of 10 (5-10). CONCLUSION: With the HRC, the patient spends about 2h in the outpatient clinic of the hospital, but leaves with the complete diagnostic process performed. The satisfaction survey confirms that most patients prefer this system.

Circuito de alta resolución en el diagnóstico de la incontinencia fecal. Satisfacción de los pacientes / High-resolution circuit for the diagnosis of faecal incontinence. Patient satisfaction

Introducción: La incontinencia fecal (IF), pese a su elevada prevalencia, sigue estando infravalorada e infradiagnosticada. La potencial afectación psicológica, el tabú asociado y el amplio abanico de síntomas hacen del diagnóstico y tratamiento un reto para el cirujano colorrectal. El objetivo de este estudio es describir un nuevo circuito de atención especializado, el circuito de alta resolución (CAR) para tratar la IF, y evaluar la satisfacción de los pacientes. Métodos: Se realiza una descripción de la organización del CAR. Se analizan los datos demográficos y clínicos de los pacientes incluidos en el CAR entre febrero de 2014 y junio de 2016. Se reportan, además, los resultados de una encuesta de satisfacción sobre el CAR realizada a los pacientes incluidos. Resultados: Durante el periodo de estudio se realizaron 321 primeras visitas: 65% (210) por IF (81% mujeres; mediana de edad 66 años). El tiempo mediano de evolución de la IF fue de 24 (rango 4-540) meses. El 79% de los pacientes (165) realizaron el CAR. El 62% respondieron a la encuesta. De estos, solo un 32% (33) habían consultado por este problema en otros centros. La mayoría, 88% (90) consideró preferible el hecho de que hicieran las pruebas diagnósticas el mismo día de la visita. El 94% (96) quedó satisfecho con la información recibida sobre la IF, valorando la consulta con una mediana de 10 (5-10) sobre 10. Conclusión: Con el CAR, el paciente pasa alrededor de 2 h en las consultas externas del hospital, completando el proceso diagnóstico en el mismo día. Los resultados de satisfacción confirman que los pacientes en su mayoría prefieren este sistema (AU)

Introduction: Despite its high prevalence, faecal incontinence (FI) is still underrated and underdiagnosed. Moreover, diagnosis and subsequent treatment can be a challenge for the colorectal surgeon because of its associated social taboo and embarrassment, and the wide range of symptoms. The aim of the present study is to describe a new high-resolution circuit (HRC) for FI diagnosis, that was implemented at our center and to evaluate patient satisfaction. Methods: The structure and organization of the HRC are described. Demographic and clinical data of the patients included in the HRC between February 2014 and June 2016 were collected. Moreover, patients’ satisfaction was measured through a structured survey. Results: A total of 321 patients were evaluated in our pelvic floor outpatients clinic during the study period: 65% (210) of them had FI (81% women, median age 66 years). The mean time since FI onset was 24 (range 4-540) months. A total of 79% (165) of the patients were included in the HRC. 62% of them responded to the survey. Of these, only 32% (33) had consulted for FI before coming to our centre. The majority, 88% (90) considered that performing the 2diagnostic tests the same day of the visit was a very good option. And 94% (96) were satisfied with the information received on their FI, with a median satisfaction value of 10 (5-10). Conclusion: With the HRC, the patient spends about 2h in the outpatient clinic of the hospital, but leaves with the complete diagnostic process performed. The satisfaction survey confirms that most patients prefer this system (AU)

Gracilis Muscle Interposition for Rectourethral Fistula After Laparoscopic Prostatectomy: A Prospective Evaluation and Long-term Follow-up.

BACKGROUND: Postoperative rectourethral fistula after radical prostatectomy is an infrequent but very serious problem. OBJECTIVE: We aimed to describe our experience with transperineal repair and unilateral gracilis muscle interposition in patients with rectourethral fistula after radical prostatectomy in nonradiated prostate cancer. DESIGN: This was a cohort study. SETTINGS: All of the procedures were performed at the same hospital by the same multidisciplinary team made up of a senior colorectal surgeon and a senior urologist. PATIENTS: Patients with postoperative rectourethral fistula after laparoscopic prostatectomy were included. INTERVENTION: Transperineal fistula repair and gracilis muscle interposition were included. MAIN OUTCOME MEASURES: Fistula healing rate was measured. RESULTS: Nine patients with postoperative rectourethral fistula were treated between November 2009 and February 2016. Four of them had received other previous treatments without success, and 5 had previously been treated with this technique. Seven patients had a fecal diverting stoma. After a median follow-up of 54 months (range, 2-72), all of the fistulas had successfully healed, and, to date, the patients remain asymptomatic without urinary diversion. Fecal diversion was closed in all but 1 patient. No intraoperative or infectious complications were detected. With the results of our series, we present specific technical details of our technique and hope to provide additional evidence of the low morbidity profile and excellent healing rate of this treatment. Moreover, we note that, although small, this series corresponds with a homogeneous group of patients with rectourethral fistula after radical prostatectomy in nonradiated prostate cancer. LIMITATIONS: This is a small but very homogeneous group of patients. CONCLUSIONS: Simple repair with perineal gracilis muscle interposition is a safe and effective technique for the treatment of postoperative rectourethral fistulas after nonradiated prostate cancer surgery.

Clinical application of the LARS score: results from a pilot study.

PURPOSE: The impact of the low anterior resection syndrome (LARS) on quality of life has underscored the importance of measuring functional outcomes after treatment for rectal cancer. The aim of this study was to evaluate whether the LARS score as a single questionnaire was useful enough in the clinical setting. METHODS: Patients treated by curative anterior resection for rectal cancer were sent the LARS score and the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 questionnaires by post. Patients classified as "minor" and "major" LARS according to the LARS score were visited. Assessment included several scores (Vaizey score, Altomare Obstructed Defecation Syndrome score, Bristol scale). Patients with urgency/faecal incontinence also filled in a bowel diary and the FIQL score. RESULTS: Seventy patients returned the questionnaires, 49 of whom ("major LARS" and "minor LARS") were visited and 19 ("no LARS") were assessed by phone. Four different clinical patterns were identified. The group with urgency/faecal incontinence was the largest (33.8 %), whereas 17.7 % referred evacuatory dysfunction. The LARS score did not correctly evaluate 18 patients: 5 who were classified as no LARS but had severe evacuatory dysfunction and 13 patients categorized as LARS but without significant bowel dysfunction, 9 of whom were classified as major LARS. CONCLUSION: The LARS score may overestimate the impact on quality of life in some patients and may underestimate the impact of severe evacuatory dysfunction. Due to the complexity of the LARS, the LARS score as a single questionnaire might not be enough to assess bowel function. A complete clinical evaluation and additional questionnaires might be required.

Estimulación de raíces sacras en el tratamiento de la incontinencia fecal / No disponible

No disponible

Cordoma sacrococcígeo. Abordaje por vía posterior / No disponible

No disponible

[Proposal for a new consensus classification for faecal incontinence]. / Propuesta de una nueva clasificación de consenso para la incontinencia fecal.

Due to the complexities of the mechanisms involved in incontinence, there are many potential causes for this disorder. The causes of incontinence and the grouping of patients according to aetiological factors are described in the literature in various forms, without there being a consensus as such. Therefore, the objective of this review is to propose a new classification of faecal incontinence to the scientific community, which will enable criteria to be unified, which should lead to an improvement in the diagnosis and treatment of patients with faecal incontinence. It is an aetiopathogenic classification that can be obtained from the clinical history of the patient along with an endoanal ultrasound.

Propuesta de una nueva clasificación de consenso para la incontinencia fecal / Proposal for a new consensus classification for faecal incontinence

Debido a la complejidad en los mecanismos involucrados en la continencia, existen múltiples causas potenciales de este trastorno. Las causas de incontinencia y la agrupación de los pacientes según factores etiopatogénicos están descritas en la literatura de forma muy variada, sin un consenso al respecto. Así pues, el objetivo de esta revisión es plantear a la comunidad científica una propuesta de nueva clasificación de la incontinencia fecal que nos permita unificar criterios, que conlleven una mejora en el diagnóstico y el tratamiento de los pacientes con incontinencia fecal. Se trata de una clasificación etiopatogénica que se puede obtener con la historia clínica del paciente y una ecografía endoanal (AU)

Due to the complexities of the mechanisms involved in incontinence, there are many potential causes for this disorder. The causes of incontinence and the grouping of patients according to aetiological factors are described in the literature in various forms, without there being a consensus as such. Therefore, the objective of this review is to propose a new classification of faecal incontinence to the scientific community, which will enable criteria to be unified, which should lead to an improvement in the diagnosis and treatment of patients with faecal incontinence. It is an aetiopathogenic classification that can be obtained from the clinical history of the patient along with an endoanal ultrasound (AU)

Cost-effectiveness analysis of sacral neuromodulation (SNM) with Interstim for fecal incontinence patients in Spain.

INTRODUCTION: Fecal incontinence (FI) is a condition with a high impact on the psychological and social life of healthy people. Interstim, the sacral neuromodulation (SNM) therapy, has shown higher effectiveness and safety rates than surgical procedures like dynamic graciloplasty or artificial anal sphincter in patients with intact anal sphincter (IAS) and after sphincteroplasty in patients with structurally deficient anal sphincter (SDAS). OBJECTIVE: To assess the cost-effectiveness of FI management in two scenarios - with and without SNM - and to estimate the potential budget impact of its progressive introduction in the Spanish setting. METHODS: Two decision analytical models were developed (IAS and SDAS patients) representing the possible clinical paths for each of the scenarios (with and without SNM), as well as its clinical and economic consequences in the mid-to long term with a Markov model. Clinical and resource use data were retrieved from the literature and validated by a clinician expert panel. Effectiveness was measured with both QALYs and symptom-free years (SFY). A 3% discount rate was used for future costs and benefits (time horizon = 5 years). Prevalence figures were combined with Interstim sales forecasts to estimate the total number of patients to receive therapy over the next 5 years and the associated budget impact. RESULTS: The introduction of Interstim in the therapeutic management of FI has an associated cost-effectiveness of euro16 181 (IAS patients) and euro22 195 (SDAS patients) per QALY gained. The progressive introduction of Interstim in 75 to 100 patients/year will have an estimated budget impact of 0.1% of incremental costs in patients with FI. CONCLUSIONS: Introducing Interstim in the management of FI in IAS and SDAS patients in the Spanish setting has shown to be an efficient measure with an incremental cost-effectiveness ratio below the accepted Spanish threshold (around euro35 000/QALY), and with a relatively low additional cost for the Spanish NHS.