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At least 1,135 records · Page 63Linked to original sources
PubMed1998

Surgical management of pelvic organ prolapse and stress urinary incontinence.

There is no single operative approach to correct pelvic organ prolapse in conjunction with urinary and/or fecal incontinence or rectal prolapse. Each case needs to be individualized and dealt with surgically following the principles outlined in Table 1. In postmenopausal women, it is not only important to pretreat patients with estrogen prior to reconstructive pelvic surgery, but also maintain patients on long-term treatment after surgery. The genitourinary and reconstructive pelvic surgeon should have the skills to offer patients alternative approaches tailored to their individual symptomatology, and anatomic and pelvic pathology. Long-term follow-up of all patients is imperative to ascertain the clinical and cost effectiveness of these procedures.

Female↗
PubMedDate not supplied

Management of pediatric perineal and genital burns: twenty-year review.

Between 1966 and 1986, fifty-seven pediatric patients with partial and/or full-thickness perineal and genital burns with a minimum of 1-year follow-up were identified. Fifty percent of the patients with genital burns and 20% of the patients with perineal and/or buttock burns required skin grafting in the acute stage. No patient required suprapubic cystostomies, diverting colostomies, or local flap coverage of exposed testicles. Burn scar contractures were the most frequent complications. Thirty-two patients (56%) required contracture release of the perineum and coverage with either skin grafts or local skin flaps. In three patients (6%) contracture required release of the penis and scrotum. One patient lost a testicle. Three patients developed rectal prolapse and were treated without surgery. Four patients developed rectal stenosis with fecal incontinence because of burn scar contracture and were treated by anal dilatation, local transposition flaps, and/or excision of the scar and primary closure. Acute management of pediatric patients with such injuries can be conservative. Delayed complications of contractures of the perineum and genitals can be easily corrected with scar excisions, skin grafts, or the use of local skin flaps.

Burns↗
PubMed1990

Anorectal function in patients with defecation disorders and asymptomatic subjects: evaluation with defecography.

A controlled radiologic study of anorectal function was performed with the use of defecography in 19 patients with constipation and 13 with incontinence. All patients were age and sex matched to control subjects who were referred for barium enema study and who had no defecation disorder. There were no statistically significant differences between either patient group and the control group in anorectal angle and excursion of the anorectal junction. In the 32 patients and 155 consecutive patients referred for defecography because of a variety of defecation disturbances, approximately twice as many rectal wall abnormalities were seen compared with findings in the control group. These findings included intussusception, rectal prolapse, rectocele, mucosal prolapse, spastic pelvic floor, descending perineum syndrome, and solitary rectal ulcer syndrome. In conclusion, the main role of defecography is to document rectal wall changes during defecation straining as possible causes of evacuation difficulties. Clinical symptoms should also be taken into account when treatment is contemplated.

Anal Canal↗
PubMed1994

[Solitary ulcer of the rectum].

In line with the literature, the authors consider that solitary ulcer of the rectum, either isolated, multiple or histological, like suspended proctitis, inverted hamartomatous polyp, deep cystic colitis, is a complication of rectal prolapse, which usually shares the same clinical symptoms. Solitary ulcer of the rectum is generally discovered on proctoscopy and is due to the strain exerted on the rectal mucosa by 2 opposing forces:violent effort of defecation against an anal and/or perineal obstruction. The reduction of these pressure and counterpressure forces with age and progressive alteration of the pelvic floor accounts for the progression of acute lesions towards chronic or attenuated lesions or even complete resolution. The therapeutic strategy should therefore decrease trauma by facilitating defecation by a combination of hygiene and dietary advice and biofeedback retraining, and surgical reduction of the anal obstruction and prolapse and correction of any perineal insufficiency.

Barium Sulfate↗
PubMed2000

Rectal akinesia as a new cause of impaired defecation.

PURPOSE: The aim of this prospective study was to point out a new concept of dyschezia using dynamic videoproctography. METHODS: A total of 154 consecutive patients with impaired defecation prospectively underwent dynamic videoproctography from 1996 to 1998. Evacuation of thick barium of standardized consistency was fully videotaped under fluoroscopy in the sitting position. We measured the weight of barium injected into the rectum (Q1 in g), the weight of barium evacuated (Q2 in g) and the time for rectal evacuation (t in seconds). Flow rate and postdefecation residue were given by calculating Q2/t and (Q1 - Q2) X 100/Q1, respectively. We studied all patients whose flow rate and postdefecation residue were less than 5 g/second and more than 30 percent, respectively. These values were arbitrarily chosen, based on rectal evacuation in 25 controls (5 healthy volunteers together with 20 patients without dyschesia). RESULTS: Nine of 154 patients with dyschesia fulfilled the criteria and had none of the usually known causes of dyschezia, such as anismus, megarectum, intussusception, rectal prolapse, rectocele, or enterocele. These nine patients had a normal rectal anatomic appearance and a wide-open short anus but despite exhausting straining efforts were unable to obtain total rectal emptying. Dynamic videoproctography brings strong arguments for an absence of rectal wall contraction, despite normal functioning pelvic floor. CONCLUSIONS: Dynamic videoproctography allows identification of new features in patients with dyschesia: very slow defecation flow rate and high postdefecation residue. This new concept could be called rectal akinesia by analogy with bladder akinesia in some dysuric patients.

Administration, Rectal↗
PubMed2001

Air insufflation: a useful adjunct to the single contrast barium enema for the evaluation of the rectum.

We examined whether insufflation of a small volume of air after a single-contrast barium enema would improve evaluation of the rectum. Eighty patients presenting for barium enema by single-contrast technique underwent examination of the colon including spot films with fluoroscopy and palpation during introduction of the barium and filled overhead views, using standard apparatus and technique. The examination was completed by draining barium from the rectum only, following which air in the barium enema bag was squeezed back into the rectum and three views of the rectum obtained (lateral, left posterior oblique, and frontal). Two reviewers then chose the best image of the rectum from each study with relevance to luminal distention and visibility of surface detail of the rectum. Following air insufflation, improved surface detail visualization was recognized by both reviewers in 69 (86%) patients and by one reviewer in 10 (12%) patients, a statistically significant observation (P < 0.0001). There was a trend towards improved rectal distention, recognized by both reviewers in 37 (46%) patients and by one reviewer in 18 cases (22%). In 25 (31%) patients neither reviewer recognized any improvement in rectal distention. Rectal abnormalities were identified in nine cases; there were two large carcinomas, two radiation strictures, two rectal fistulae, two small rectal polyps (5 and 7 mm), and one case of prolapsing rectal mucosa. All rectal abnormalities were visible on the air insufflation views. In the two cases of suspected rectal polyp and one of the cases of rectal fistula, the findings were not visible on the initial barium filled views. A normal rectum was observed in 71 cases. Follow-up of these 71 patients found no later evidence of any rectal abnormalities. Improved filling of the proximal colon following air insufflation was observed in 12 (15%) patients, an additional and unexpected benefit of this maneuver. Air insufflation is a simple addition to the SCBE study that improves visualization of the rectum.

Adult↗
PubMedDate not supplied

Stapled hemorrhoidopexy. Complications and 2-year follow-up.

Stapled hemorrhoidopexy (SH) presents a number of complications which differ from those of traditional haemorrhoidectomy (Milligan-Morgan, diathermy haemorrhoidectomy). The follow-up shows better symptom control than other surgical techniques. Four hundred and forty-nine patients with haemorrhoids of all degrees and mucosal rectal prolapse were treated at our institution over a five-year period (1999-2004). Patients were assessed by structural interview to assess their symptoms before and after surgery, and surgical and functional outcome was assessed at 1, 3, 6, 12 and 24 months. A visual analog scale was used for postoperative pain scoring. Patient's satisfaction is the best response to all criticism. Bleeding in the early postoperative period occurred in 3.9% of all patients and in 7 cases (1.5%) reoperation was necessary. Urge to defecate, although present in 14% of patients, disappears in a few weeks. Severe pain, when present, may depend on technical failure or learning curve. Complete or incomplete recurrence occurred in 10 cases (2.2%). We had one case of rectovaginal fistula in a young woman. In 3 cases we underestimated the extent of the mucosal prolapse and the patients were reoperated on by stapled transanal rectal resection after one (2 patients) and two years. Stapled hemorrhoidopexy is a significantly less painful operation and offers significant advantages in terms of hospital stay and symptom control in the long term, making for a significantly earlier return to work. The complications are similar to those of other techniques and are easily resolved. The unusual complications described (rectal perforation, pelvic sepsis, rectovaginal fistulas) might suggest that the operation should be performed by experienced colorectal surgeons who are familiar with the technique and aware of the possible complications.

Adolescent↗
PubMed1996

Surgical treatment of prolapse of the rectum--evaluation of distant results.

In the years 1972-1995 41 patients suffering from prolapse of the rectum were operated according to the Moore method. The method is based on the observations which suggest that the cause of prolapse is intestinal intussusception which can be prevented by translocating the anus under the pubic joint. The observation time is from 1 to 23 years. Two patients were reoperated; one-as a result of a recurrence of rectal prolapse and one due to a post-operative adhesive ileus. One patient died as result of peritonitis following an overlooked microperforation in the rectal wall. In the case of the remaining patients, the treatment was fully successful. Regular defecation cycle as well as incontination of stool and flatus returned and the anal sphincters almost fully regained their tension in comparison to the pre-operative state. Early and distant results of surgery of prolapse of the rectum are satisfactory.

Adult↗
PubMed1999

A new grading of rectal internal mucosal prolapse and its correlation with diagnosis and treatment.

The management of rectal internal mucosal prolapse (RIMP) is not based on an accepted classification of the lesion which helps to choose the appropriate treatment. The aim of this prospective study was to report a new endoscopic grading of RIMP and to evaluate its clinical value. Thirty-two patients (7 men, 25 women; mean age 56 years, range 28-72) affected by symptomatic RIMP were prospectively classified as follows: RIMP was defined as first degree when detectable below the anorectal ring on straining, as second degree when it reached the dentate line, and as third degree when it reached the anal verge. Anal manometry was carried out in 26 patients, and anal ultrasound and defecography in 6 prior to surgery. A correlation was found between the occurrence and severity of symptoms and the degree of the prolapse as obstructed defecation, bleeding and fecal soiling affected mainly patients with third-degree RIMP. At manometry the maximal resting tone was 60+/-23 mm Hg and voluntary contraction 96+/-41 mm Hg (mean+/-SEM). At anal ultrasound the mean internal sphincter thickness was 2.1+/-0.2 mm, and external sphincter thickness was 7.0+/-0.8 mm. A significant rectocele and rectal intussusception (n = 2) and a nonrelaxing puborectalis muscle on straining (n = 2) were observed at defecography in cases with third-degree RIMP. The anorectal angle was 100+/-75 degrees at rest, 63+/-20 degrees on squeezing, and 115+/-9 degrees on straining. A conservative treatment with high-fiber diet and/or rubber band ligation was carried out in all cases of first and in most patients with second-degree RIMP (n = 26). Those who required surgery, i.e., stapled transanal excision of the prolapse (n = 6), had either severely symptomatic third-degree RIMP with solitary ulcer syndrome (n = 4) or second-degree RIMP (n = 2). A positive outcome was achieved in 71% of cases. The proposed classification evaluated by the present study may be of clinical value in managing rectal internal mucosal prolapse.

Adult↗
PubMedDate not supplied

[Solitary rectal ulcer syndrome].

The solitary rectal ulcer syndrome is an infrequent entity consisting of a rectal lesion, caused by straining during defecation; it is characterized by specific histological changes. The condition is most frequent in adults between 30 and 50 years of age, but a few pediatric cases have been reported. Five patients (4 boys) are presented. All suffered from moderate rectal bleeding, straining, tenesmus and mucous discharge. One of them had clinical and endoscopic evidence of rectal prolapse. On defecography all children showed failure of pelvic floor relaxation during straining. Endoscopic evaluation showed single or multiple ulcers in four patients and a nodular fibrotic lesion in one. The histopathology of the rectal mucosa revealed replacement of the stroma of the lamina propria by collagen, lack of orientation of smooth muscle fibers and considerable hyperthopy of the muscularis mucosae. Medical treatment was satisfactory in four patients, one case required transabdominal rectopexy for relief of his symptoms. The most appropriate form of treatment has not been determined, but surgery should be used when prolapse is a prominent clinical feature. Greater awareness of this condition will lead to more frequent diagnosis.

Adolescent↗
PubMed1998

[The solitary rectal ulcer today. A review of the literature].

The solitary rectal ulcer (SRU) is a benign lesion of adults of either sex, which presents with chronic constipation, peculiar defecatory disorders, rectal prolapse and smaller psychological abnormalities. The characteristic appearance of this disease is a "neither being always ulcerate, nor always solitary" lesion, but often with polypoid or granular feature, typically localized in anterior rectal wall, a few inches from anal channel. Distinctive histopathological specimens are localized mucosal distortion, hypertrophic proliferation of muscularis mucosae and obliteration of lamina propria by fibroblasts and muscle fibres from the muscularis mucosae. Very few intermittent or recurrent symptoms are rectal bleeding and mucous discharge with defecations, difficulty of a complete ampullar evacuation and sometimes pelvic or rectoperineal pain. Clinical picture and endoscopic biopsies led to diagnosis. Barium enema, defecography, transrectal ultrasound, manometry and electromyography have an additional role. Medical treatment is performed by high-fiber diet, but biofeedback training is very helpful. Surgical management is as an excisional surgery, as a rectopexy if there is prolapse. Fecal diversion and rectocolic resection are considered only for patients with obstinate and severe symptoms. Even in patients who seem to advocate a surgical approach it is important to heal a dyskinetic puborectalis muscle.

Adult↗
PubMed1995

Simultaneous dynamic proctography and peritoneography for pelvic floor disorders.

PURPOSE: We sought to evaluate a new diagnostic technique for the identification of rectal and pelvic floor pathology in patients with obstructed defecation, pelvic fullness/prolapse, and/or chronic intermittent pelvic floor pain. METHODS: Thirteen symptomatic women with either a nondiagnostic physical examination or nondiagnostic dynamic proctography (DPG) were studied. After placement of intraperitoneal and intrarectal contrast material, resting and straining pelvic x-rays were obtained in all patients, and defecation was videotaped using fluoroscopy. RESULTS: Simultaneous DPG and peritoneography identified clinically suspected and unsuspected enteroceles in 10 of the 13 patients studied. An enterocele or other pelvic floor hernia was ruled out by the technique in three of the women studied. Rectoceles and rectal prolapse that were identified during physical examination were confirmed by DPG with peritoneography. Simultaneous DPG and peritoneography also gave a qualitative assessment of the severity and clinical significance of the identified pelvic floor disorders. Results of simultaneous DPG and peritoneography affected operative treatment planning in 85 percent of patients studied. CONCLUSION: Simultaneous DPG and peritoneography identifies both rectal and pelvic floor pathology and provides a qualitative assessment of pelvic floor pathology severity, which allows for better treatment planning in selected patients with obstructed defecation and pelvic prolapse.

Adult↗
PubMed1998

Duplication of the rectum: report of four cases and review of the literature.

Rectal duplications are rare anomalies. Recently, we observed four cases of rectal duplication, each presenting with different clinical features including chronic constipation, a prolapsing rectal "polyp, " a "growth" from the vulva, and acute retention of urine. The variety of clinical presentations may lead to delay in diagnosis and multiple operations.

Biopsy, Needle↗
PubMed1989

The appreciation of rectal distention in fecal incontinence.

The subjective response to rectal balloon sensation was assessed with anorectal manometry and pudendal nerve terminal motor latency measurement (PNTML) in three groups of patients. There were 37 healthy subjects, 54 patients with idiopathic fecal incontinence (IFI), and 36 with complete rectal prolapse and incontinence (CRP). There was no significant difference for any parameter of rectal balloon sensation between patients with IFI and normals. Patients with CRP differed only in onset (P = .001). The results show that the appreciation of rectal distention is maintained in IFI.

Action Potentials↗
PubMed2006

Colitis cystica profunda: MRI appearance.

Colitis cystica profunda (CCP) is an uncommon benign condition characterized by mucin-filled cysts located in the submucosa, frequently associated with the solitary ulcer and rectal prolapse syndromes. The diagnosis of this entity is important as it can mimic rectal cancer and therefore may result in unnecessary surgical resection. Endoscopic examination and barium enema findings are suggestive but not specific, neither are superficial biopsy findings. Transrectal ultrasound is helpful in the diagnosis by imaging the layers of the rectal wall. The authors report a 16-year-old male with a rectal lesion mimicking malignant mass on endoscopic examination. The lesion was defined as CCP, based on MR imaging findings which disclosed multiple noninfiltrating submucosal cysts, confirmed by histopathological examination. To our knowledge, this is the first case of CCP in the radiology literature describing MRI findings.

Adolescent↗
PubMed1996

Electroureterogram: human study of the electromechanical activity of the ureter.

OBJECTIVES: To study the electromechanical activity of the normal ureter in 5 men and 4 women (mean age 39.4 +/- 10.8 years) scheduled for rectopexy due to rectal prolapse. The results of urinary tract investigations were normal. METHODS: During anesthesia for rectopexy, rectal mobilization necessitates ureteral exposure for protective reasons. One electrode was applied to each of the upper, middle, and lower third of the right ureter, and signals were registered for 30 minutes. Simultaneous recording of intraureteral pressure was performed. RESULTS: Slow waves, or pacesetter potentials (PPs), were recorded from the three electrodes. Identical readings for frequency, amplitude, and velocity of conduction were obtained from the three electrodes in the same ureter. Action potentials (APs) followed the PPs and were inconsistent and were associated with an intraureteral pressure increase (P < 0.001). No pressure elevation occurred with PPs. CONCLUSIONS: In contrast to PPs, APs seem to have a role in ureteral mechanical activity and might initiate ureteral peristalsis. The function of the PPs is unknown; they might pace the APs in terms of direction and frequency. The present study could characterize an electroureterographic pattern for the normal ureter. It is suggested that this pattern is changed in the various ureteral pathologic conditions and, thus, the electroureterogram be considered a useful investigative tool in ureteral disorders. However, the procedure in its present from is not applicable to clinical practice. Nevertheless, the present study might be of significance in explaining the mechanisms of ureteral motility and urinary bolus transport.

Adult↗
PubMedDate not supplied

Solitary rectal ulcer syndrome: stopping the prolapse heals the ulceration.

The solitary rectal ulcer syndrome is an uncommon condition in which a benign ulceration area develops in the rectum. There is evidence that the solitary rectal ulcer syndrome is associated with rectal prolapse either overt or occult. The place of surgery in the management of this condition is not yet clearly defined. The Authors report a case where the patient was managed surgically because of persistent severe complications. This case confirms that stopping even occult prolapse may lead to rapid healing of the solitary rectal ulcer.

Adult↗