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  1. Article ; Online: Alternative approaches to the treatment of fecal incontinence.

    Becker, Heinz / Samel, Stephan

    Deutsches Arzteblatt international

    2011  Volume 108, Issue 39, Page(s) 651–652

    MeSH term(s) Biofeedback, Psychology/instrumentation ; Electric Stimulation Therapy/instrumentation ; Electromyography/instrumentation ; Fecal Incontinence/therapy ; Female ; Humans ; Male
    Language English
    Publishing date 2011-09-30
    Publishing country Germany
    Document type Comparative Study ; Editorial ; Comment
    ZDB-ID 2406159-1
    ISSN 1866-0452 ; 1866-0452
    ISSN (online) 1866-0452
    ISSN 1866-0452
    DOI 10.3238/arztebl.2011.0651
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  2. Article: Editoral. Alternatives Behandlungskonzept zur analen Inkontinenz. Alternative Approaches to the Treatment of Fecal Incontinence

    Becker, Heinz / Samel, Stephan

    Deutsches Ärzteblatt : Ausgabe A, Praxis-Ausgabe : niedergelassene Ärzte

    2011  Volume 108, Issue 39, Page(s) 651

    Language German
    Document type Article
    ZDB-ID 1453475-7
    ISSN 0012-1207
    Database Current Contents Medicine

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  3. Article ; Online: Lateral internal sphincterotomy for chronic idiopathic anal fissure: an alternative approach.

    Bessa, Samer Saad

    Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract

    2011  Volume 15, Issue 3, Page(s) 466–470

    Abstract: ... nor permanent fecal incontinence were encountered throughout the study period.: Conclusion ... Background: An alternative approach to lateral internal sphincterotomy in the management ... The alternative approach is efficient and safe and may be added to the surgeon's armamentarium when attempting ...

    Abstract Background: An alternative approach to lateral internal sphincterotomy in the management of chronic anal fissure is presented and its potential advantages are described.
    Methods: Using the conventional diathermy, the internal sphincter along with its overlying anoderm is cut to the caudal border of the dentate line.
    Results: This prospective study included 350 patients. Twenty-six patients (7.4%) reported spotting of blood with defecation and 266 patients (76%) reported minimal perianal discharge. The cessation of the discharge and spotting of blood correlated with the complete healing of the sphincterotomy wound. Urine retention requiring temporary catheterization was encountered in 19 patients (5.4%). Neither abscesses nor fistulae were encountered. Cure was achieved in all patients. Neither recurrences nor permanent fecal incontinence were encountered throughout the study period.
    Conclusion: The alternative approach is efficient and safe and may be added to the surgeon's armamentarium when attempting lateral internal sphincterotomy for chronic anal fissure.
    MeSH term(s) Adult ; Anal Canal/surgery ; Chronic Disease ; Digestive System Surgical Procedures/methods ; Female ; Fissure in Ano/surgery ; Humans ; Male ; Middle Aged ; Prospective Studies ; Treatment Outcome ; Young Adult
    Language English
    Publishing date 2011-01-05
    Publishing country United States
    Document type Clinical Trial ; Journal Article
    ZDB-ID 2012365-6
    ISSN 1873-4626 ; 1934-3213 ; 1091-255X
    ISSN (online) 1873-4626 ; 1934-3213
    ISSN 1091-255X
    DOI 10.1007/s11605-010-1407-4
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  4. Article ; Online: Laparoscopic and transanal approach for rectal atresia: a novel alternative.

    Nguyen, Thanh Liem / Pham, Duy Hien

    Journal of pediatric surgery

    2007  Volume 42, Issue 11, Page(s) E25–7

    Abstract: ... with good fecal continence.: Conclusion: Laparoscopic and transanal approach is a novel and good ... approach in the management of rectal atresia.: Patients: Two female patients with rectal atresia were ... operated upon using laparoscopic and transanal approach. There were no intraoperative and ...

    Abstract Aim: The aim of this study is to present the details and outcomes of laparoscopic and transanal approach in the management of rectal atresia.
    Patients: Two female patients with rectal atresia were operated upon using laparoscopic and transanal approach. There were no intraoperative and postoperative complications. Follow-up at 5 and 4 months, respectively, after closure of colostomy has shown both patients with good fecal continence.
    Conclusion: Laparoscopic and transanal approach is a novel and good alternative to the current surgical techniques in the management of rectal atresia.
    MeSH term(s) Anal Canal/surgery ; Anastomosis, Surgical/methods ; Colostomy/methods ; Digestive System Abnormalities/diagnosis ; Digestive System Abnormalities/surgery ; Fecal Incontinence/prevention & control ; Female ; Follow-Up Studies ; Humans ; Infant, Newborn ; Laparoscopy/methods ; Rectal Diseases/congenital ; Rectal Diseases/surgery ; Rectum/abnormalities ; Rectum/surgery ; Risk Assessment ; Treatment Outcome
    Language English
    Publishing date 2007-11
    Publishing country United States
    Document type Case Reports ; Journal Article
    ZDB-ID 80165-3
    ISSN 1531-5037 ; 0022-3468
    ISSN (online) 1531-5037
    ISSN 0022-3468
    DOI 10.1016/j.jpedsurg.2007.08.049
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    Zs.A 607: Show issues Location:
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  5. Article ; Online: Total endoscopic and anal irrigation management approach to noncompliant neuropathic bladder in children: a good alternative.

    Neel, Khalid F

    The Journal of urology

    2010  Volume 184, Issue 1, Page(s) 315–318

    Abstract: ... botulinum-A toxin and endoscopic treatment for vesicoureteral reflux with anal irrigation as a total endoscopic and ... conservative treatment were prospectively included in this study. All had at least 1 year of followup ... anal irrigation management approach. This minimally invasive protocol is used to manage ...

    Abstract Purpose: We prospectively evaluated the efficacy and durability of combined intradetrusor botulinum-A toxin and endoscopic treatment for vesicoureteral reflux with anal irrigation as a total endoscopic and anal irrigation management approach. This minimally invasive protocol is used to manage myelomeningocele and noncompliant bladder in children who do not respond to standard conservative therapy and have urine and stool incontinence.
    Materials and methods: Ten females and 3 males with a mean +/- SD age of 5.3 +/- 2.5 years with myelomeningocele and vesicoureteral reflux who did not respond to standard conservative treatment were prospectively included in this study. All had at least 1 year of followup. All patients received a cystoscopic intradetrusor injection of 12 U/kg (maximum 300 U) botulinum-A toxin into an infection-free bladder. Vesicoureteral reflux in a total of 20 refluxing ureters, including bilateral vesicoureteral reflux in 7 patients, showed no resolution on pretreatment voiding cystourethrogram. Thus, we administered a submucosal Deflux injection. Since most patients were still diaper dependent due to stool incontinence, we extended management to include complete bowel rehabilitation with the new Peristeen anal irrigation system to manage stool incontinence.
    Results: Mean maximum bladder capacity increased significantly from 75 +/- 35 to 150 +/- 45 ml after 1 month (p <0.02), to 151 +/- 48 after 6 months (p <0.002) and to 136 +/- 32 after 1 year (p <000). Maximum detrusor pressure decreased significantly from 58 +/- 14 to 36 +/- 9 cm H(2)O after 1 month (p <0.001), to 39 +/- 9 after 6 months (p <0.001) and to 38 +/- 6 after 1 year (p = 000). Of 20 refluxing ureters (95%) completely resolved, including 1 after attempt 2, and 1 with grade V vesicoureteral reflux remained unchanged despite 2 attempts. Seven of 8 urinary incontinent patients (87.5%) attained complete dryness between catheterizations and 1 partially improved. Ten of 13 patients achieved stool dryness with anal irrigation 1 to 2 times weekly. Three patients who were stool continent on standard enemas did not require this irrigation system.
    Conclusions: This new total endoscopic and anal irrigation management approach is a comprehensive, minimally invasive, safe, simple, effective way to achieve most goals when treating these patients by protecting the upper tract, maintaining the bladder at safe pressure and providing a satisfactory social life with satisfactory urine and stool continence.
    MeSH term(s) Botulinum Toxins, Type A/economics ; Botulinum Toxins, Type A/therapeutic use ; Child, Preschool ; Endoscopy/economics ; Endoscopy/methods ; Fecal Incontinence/etiology ; Fecal Incontinence/physiopathology ; Fecal Incontinence/therapy ; Female ; Humans ; Male ; Meningomyelocele/complications ; Neuromuscular Agents/economics ; Neuromuscular Agents/therapeutic use ; Prospective Studies ; Therapeutic Irrigation/economics ; Therapeutic Irrigation/methods ; Treatment Outcome ; Urinary Bladder, Neurogenic/etiology ; Urinary Bladder, Neurogenic/physiopathology ; Urinary Bladder, Neurogenic/therapy ; Urinary Incontinence/etiology ; Urinary Incontinence/physiopathology ; Urinary Incontinence/therapy ; Vesico-Ureteral Reflux/etiology ; Vesico-Ureteral Reflux/physiopathology ; Vesico-Ureteral Reflux/therapy
    Chemical Substances Neuromuscular Agents ; Botulinum Toxins, Type A (EC 3.4.24.69)
    Language English
    Publishing date 2010-07
    Publishing country United States
    Document type Journal Article
    ZDB-ID 3176-8
    ISSN 1527-3792 ; 0022-5347
    ISSN (online) 1527-3792
    ISSN 0022-5347
    DOI 10.1016/j.juro.2010.01.058
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  6. Article ; Online: Transanal irrigation in myelomeningocele children: an alternative, safe and valid approach for neurogenic constipation.

    Ausili, E / Focarelli, B / Tabacco, F / Murolo, D / Sigismondi, M / Gasbarrini, A / Rendeli, C

    Spinal cord

    2010  Volume 48, Issue 7, Page(s) 560–565

    Abstract: ... 16) for fecal incontinence. Wheelchair-bound and walking patients showed same high improvement ... 5) (P<0.01); frequency of fecal incontinence: 5.5 (1.2) versus 1.3 (1.7) (P<0.01) and degree ... Objective: To investigate whether transanal irrigation is a valid and alternative approach for neurogenic ...

    Abstract Study design: A total of 60 children with myelomeningocele referred to Spina Bifida Center of Rome (31 boys and 29 girls; aged 8-17 years) were treated with transanal irrigation for three months.
    Objective: To investigate whether transanal irrigation is a valid and alternative approach for neurogenic constipation in children with myelomeningocele.
    Methods: A questionnaire on bowel disturbances, quality of life and side effects was completed before the beginning and at the termination of the study.
    Setting: Italy.
    Results: About 60% (36/60) of patients reported relief from constipation and 75% (12/16) for fecal incontinence. Wheelchair-bound and walking patients showed same high improvement of bowel habit. Mean (s.d.) scores before and after the study were: neurogenic bowel dysfunction total score: 17.5 (5.2) versus 8.5 (4.3) (P<0.001); digital stimulation of anorectum: 4.2 (2.8) versus 1.3 (2.5) (P<0.01); frequency of fecal incontinence: 5.5 (1.2) versus 1.3 (1.7) (P<0.01) and degree of general satisfaction: 3.0 (2.4) versus 7.7 (1.5) (P<0.001).We observed a reduction of urinary tract infections during the course of treatment: 14 total urinary tract infections (9 caused by Escherichia coli) before versus 6 (3) during treatment (P<0.01).
    Conclusion: Transanal irrigation in children with myelomeningocele is an alternative and relatively safe approach for managing neurogenic constipation; in fact, it improves bowel disturbances, quality of life and seems to reduce the risk of urinary tract infections.
    MeSH term(s) Adolescent ; Anal Canal ; Child ; Constipation/etiology ; Constipation/psychology ; Constipation/therapy ; Female ; Humans ; Italy ; Male ; Meningomyelocele/complications ; Prospective Studies ; Quality of Life ; Statistics as Topic ; Therapeutic Irrigation/instrumentation ; Therapeutic Irrigation/methods ; Treatment Outcome ; Urinary Bladder, Neurogenic/etiology ; Urinary Bladder, Neurogenic/psychology ; Urinary Bladder, Neurogenic/therapy ; Urodynamics/physiology
    Language English
    Publishing date 2010-07
    Publishing country England
    Document type Clinical Trial ; Journal Article
    ZDB-ID 1316161-1
    ISSN 1476-5624 ; 1362-4393
    ISSN (online) 1476-5624
    ISSN 1362-4393
    DOI 10.1038/sc.2009.186
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  7. Article ; Online: Posterior sagittal pararectal approach with rectal mobilization for repair of rectourethral fistula: an alternative approach.

    Abdalla, Medhat Ahmed

    Urology

    2009  Volume 73, Issue 5, Page(s) 1110–1114

    Abstract: ... as an alternative approach for treatment of rectourethral fistulas (RUFs). RUFS are a devastating complication ... complication of urinary incontinence.: Conclusions: Our approach is safe, provides excellent exposure, and ... of the urinary tract. The most appropriate approach remains controversial.: Methods: From March 2002 to August 2007 ...

    Abstract Objectives: To present this clinical series to report our initial experience with our technique as an alternative approach for treatment of rectourethral fistulas (RUFs). RUFS are a devastating complication of the urinary tract. The most appropriate approach remains controversial.
    Methods: From March 2002 to August 2007, 8 patients with RUF were referred to our institution. The etiology of the RUF was a fractured pelvis in 2, radical prostatectomy in 1, transurethral resection of the prostate in 1, anterior bowel resection in 1, and a pull-through operation in 3. Of the 8 patients, 5 had undergone urinary diversion and 3 had undergone a previous repair that had failed. They were evaluated and treated using the posterior sagittal approach with rectal mobilization. The fistulas were excised, and both the urethra and rectum were repaired. The inferior half of the gluteus maximus muscle was used as barrier in 5 of the 8 patients. The operative and immediate and late postoperative complications were recorded. The clinical outcome was defined as success when the patients experienced no fecaluria or pneumaturia.
    Results: All 8 patients, with a mean age of 38.7 years, were completely cured of their RUF. The mean operative time was 290 minutes, and the mean blood loss was 637.5 mL. The median hospital stay was 18 days. Early postoperative complications included wound infection in 1 and deep vein thrombosis in 1 patient. One patient developed a late complication of urinary incontinence.
    Conclusions: Our approach is safe, provides excellent exposure, and allows for dissection under direct vision. The gluteus maximus flap is a good, nearby flap that can be used with minimal host morbidity.
    MeSH term(s) Adolescent ; Adult ; Aged ; Anastomosis, Surgical/methods ; Buttocks ; Child ; Child, Preschool ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Prostatectomy/adverse effects ; Prostatectomy/methods ; Quality of Life ; Reconstructive Surgical Procedures/methods ; Rectal Fistula/diagnosis ; Rectal Fistula/etiology ; Rectal Fistula/surgery ; Rectum/surgery ; Retrospective Studies ; Risk Assessment ; Sampling Studies ; Surgical Flaps ; Treatment Outcome ; Urethral Diseases/diagnosis ; Urethral Diseases/etiology ; Urethral Diseases/surgery ; Urinary Fistula/diagnosis ; Urinary Fistula/etiology ; Urinary Fistula/surgery ; Urinary Incontinence/prevention & control ; Urologic Surgical Procedures/methods ; Wounds and Injuries/complications ; Young Adult
    Language English
    Publishing date 2009-05
    Publishing country United States
    Document type Journal Article
    ZDB-ID 192062-5
    ISSN 1527-9995 ; 0090-4295
    ISSN (online) 1527-9995
    ISSN 0090-4295
    DOI 10.1016/j.urology.2008.11.061
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