scholarly journals Sphincter damage during fistulotomy for perianal fistulae and its relationship with faecal incontinence

2021 ◽  
Author(s):  
Stephanie García-Botello ◽  
Marina Garcés-Albir ◽  
Alejandro Espi-Macías ◽  
David Moro-Valdezate ◽  
Vicente Pla-Martí ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Anal Sphincter ◽  
Faecal Incontinence ◽  
External Anal Sphincter ◽  
Perianal Fistula ◽  
Anal Continence ◽  
Significant Deterioration ◽  
Perianal Fistulae

Abstract Background The length of sphincter which can be divided during fistulotomy for perianal fistula is unclear. The aim was to quantify sphincter damage during fistulotomy and determine the relationship between such damage with symptoms and severity of faecal incontinence and long-term quality of life (QOL). Methods A prospective cohort study was performed over a 2-year period. Patients with intersphincteric and mid to low transsphincteric perianal fistulas without risk factors for faecal incontinence were scheduled for fistulotomy. All patients underwent 3D endoanal ultrasound (3D-EAUS) pre-operatively and 8 weeks postoperatively. Measurements were taken of pre- and postoperative anal sphincter involvement and division. Anal continence was assessed using the Jorge-Wexner scale and QOL scores pre, 6 and 12 months postoperatively. Results Forty-nine patients were selected. A strong correlation between pre- and postoperative measurements was found p < 0.001. A median length of 41% of the external anal sphincter and 32% of the internal anal sphincter was divided during fistulotomy. Significant differences in mild symptoms of anal continence were found with increasing length of external anal sphincter division. But there was no significant deterioration in continence, soiling, or quality of life scores at the 1-year follow-up. Division of over two-thirds of the external anal sphincter was associated with the highest incontinence rates. Conclusions 3D-EAUS is a valuable tool for quantifying the extent of sphincter involvement pre- and postoperatively. Post-fistulotomy faecal incontinence is mild and increases with increasing length of sphincter division but does not affect long-term quality of life.

Long-term anal continence and quality of life following postpartum anal sphincter injury

2008 ◽  
Vol 10 (8) ◽  
pp. 793-799 ◽  
Author(s):  
D. N. Samarasekera ◽  
M. T. Bekhit ◽  
Y. Wright ◽  
R. H. Lowndes ◽  
K. P. Stanley ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Anal Sphincter ◽  
Anal Continence ◽  
Sphincter Injury ◽  
Anal Sphincter Injury

scholarly journals Fishing for (in)continence: long-term follow-up of women with OASIS–still a taboo

2020 ◽  
Author(s):  
Sabine Schütze ◽  
Benedikt Hohlfeld ◽  
Thomas W. P. Friedl ◽  
Stephanie Otto ◽  
Katrina Kraft ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Pelvic Floor ◽  
Anal Sphincter ◽  
Negative Impact ◽  
Urinary Stress Incontinence ◽  
University Hospital ◽  
High Rate ◽  
Cough Test

Abstract Purpose Obstetric anal sphincter injuries (OASIS) increase the risk for pelvic floor dysfunctions. The goal of this study was to examine the long-term outcomes after OASIS on pelvic floor functions and quality of life. Material and methods Between 2005 and 2013, 424 women had an OASIS at the Women University Hospital Ulm. Out of these 71 women completed the German pelvic floor questionnaire, which includes questions regarding prolapse symptoms as well as bladder, bowel and sexual function. In addition, 64 women were physically examined, including a speculum examination to evaluate the degree of prolapse, a cough test to evaluate urinary stress incontinence (SI) and an evaluation of both pelvic floor sphincter (modified Oxford score) and anal sphincter contraction. Results A high rate of pelvic floor disorders after OASIS was found, as 74.6% of women reported SI, 64.8% flatus incontinence and 18.3% stool incontinence, respectively. However, only few women stated a substantial negative impact on quality of life. The clinical examination showed that a positive cough test, a weak anal sphincter tone and a diagnosed prolapse correlated with the results of the self-reported questionnaire. Conclusion On one hand, OASIS has an influence on pelvic floor function going along with lots of complaints, while on the other hand, it still seems to be a taboo topic, as none of the participants spoke about the complaints after OASIS with a doctor. Therefore, the gynecologist should actively address these issues and offer therapy options for the women with persisting problems.

Prospective determination of long-term toxicity and quality of life (QoL) of patients with prostate cancer after intensity-modulated radiotherapy (IMRT).

2012 ◽  
Vol 30 (5_suppl) ◽  
pp. 151-151
Author(s):  
Aurore Goineau ◽  
Virginie Marchand ◽  
Sylvain Bourdin ◽  
Emmanuel Rio ◽  
Loic Campion ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Prostate Cancer ◽  
Intensity Modulated Radiotherapy ◽  
High Dose ◽  
Significant Deterioration ◽  
European Organization ◽  
Intensity Modulated ◽  
Grade 3

151 Background: To determine prospectively long-term toxicity and quality of life (QoL) of prostate cancer patients after intensity-modulated radiotherapy (IMRT). Methods: 55 patients with localized prostate adenocarcinoma were treated by IMRT (76 Gy) between February and November 2006. Physicians scored acute and late toxicity using the Common Terminology Criteria for Adverse Events version 3.0. Patients assessed general and prostate-specific QoL before IMRT (baseline) and at 2, 18 and 54 months using European Organization for Research and Treatment of Cancer questionnaires QLQ-C30 and QLQ-PR25. Results: Median age was 73 years (range 54-80 years). Risk categories were 18% low risk, 60% intermediate risk, and 32% high risk. The incidence of urinary and bowel toxicity immediately after IMRT (n=55) was, respectively, 36.8% and 23.7% (grade 1), 5.3% and 5.3% (grade 2), 2.6% and none (grade 3). At 18 months (n=55), it was 23.7% and 10.3% (grade 1), 26.3% and 13.2% (grade 2) and none and 2.6% (grade 3). At 54 months (n=38), it was, 34.2 and 23.7% (grade 1), 5.3% and 15.8% (grade 2) and 5.3% and none (grade 3). After 54 months, there was a statistically significant worsening of QoL with regards to 11 items among the 19 studied. However, the scores were clinically relevant (decrease > 10 points) only for physical functioning, role functioning, social functioning, fatigue, pain, dyspnea and constipation. No statistical differences were shown between 54 months and baseline for general health, bowel symptom, treatment related symptoms and sexual activity. Concerning urinary symptoms, there was a statistically significant deterioration but not clinically relevant (difference < 10 points). Conclusions: High-dose IMRT to the prostate with accurate positioning does not induce any clinically relevant deterioration in long-term urinary and gastrointestinal QoL. Deterioration in functioning items may also be related to age and comorbidities. To our knowledge, our study is the only prospective study regarding quality of life following prostate IMRT with a very long follow-up of 54 months.

Sacral nerve stimulation in the treatment of severe faecal incontinence: long-term clinical, manometric and quality of life results

2013 ◽  
Vol 18 (2) ◽  
pp. 179-185 ◽  
Author(s):  
P. Moya ◽  
A. Arroyo ◽  
J. Lacueva ◽  
F. Candela ◽  
L. Soriano-Irigaray ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Faecal Incontinence ◽  
Nerve Stimulation ◽  
Sacral Nerve Stimulation ◽  
Sacral Nerve

scholarly journals P442 Long-term quality of life after surgery for perianal Crohn’s disease

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S399-S399
Author(s):  
I Angriman ◽  
M Tomassi ◽  
G Bordignon ◽  
R Bardini ◽  
C Ruffolo ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Crohn’S Disease ◽  
Disease Activity ◽  
Activity Index ◽  
Disease Onset ◽  
Perianal Fistula ◽  
Disease Activity Index ◽  
Perianal Disease

Abstract Background Perianal disease is rather common among Crohn’s disease (CD) patients and quality of life is often worsened by disease activity. This study aimed to assess the possible predictors of long-term quality of life after surgery for perineal CD. Methods Data of 50 consecutive patients operated on from 2014 to 2018 for perianal fistula or abscess were retrieved. Thirty-three of them had perianal CD while 17 of them had a sporadic perianal fistula and were enrolled as controls. Patients were interviewed with the Cleveland Global Quality of Life (CGQL) and SF-12 quality of life questionnaires. Disease activity was defined as the Harvey–Bradshaw Index (HBI) and Perianal Disease Activity Index (PDAI). Comparisons between CD and sporadic groups were carried out with non-parametric tests and log-rank test and multiple regression models were used to assess predictors of quality of life. Results The total CGQL score and that of all its items were significantly lower in CD patients compared with patients with the sporadic perineal disease (p &lt; 0.05) while SF12 sub total did not differ in the two groups. At multivariate analysis, CD diagnosis and perineal disease activity index confirmed to be independent predictors of long-term overall quality of life measured with CGQL. SF-12 mental component (MCS) was predicted by PDAI (p = 0.005) and by HBI (p = 0.03) while SF-12 Physical Component (PCS) was independently predicted by PDAI (p = 0.008), oozing perineal fistulae (p = 0.01) and age at disease onset (p = 0.0003). Conclusion Long-term quality of life after surgery for perineal disease is worse in CD patients than in patients with sporadic perianal disease. Quality of life is predicted by local and systemic disease activity and age at disease onset.

Sacral neuromodulation: long-term outcome and quality of life in patients with faecal incontinence

2011 ◽  
Vol 13 (10) ◽  
pp. 1162-1166 ◽  
Author(s):  
Ö. Uludağ ◽  
J. Melenhorst ◽  
S. M. P. Koch ◽  
W. G. van Gemert ◽  
C. H. C. Dejong ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Faecal Incontinence ◽  
Sacral Neuromodulation ◽  
Term Outcome ◽  
Long Term Outcome

Thinking Beyond Language: Intervention for Severe Aphasia

2009 ◽  
Vol 19 (1) ◽  
pp. 15-22 ◽  
Author(s):  
Nina Simmons-Mackie
Keyword(s):  
Quality Of Life ◽  
Communication Training ◽  
Language Intervention ◽  
Specific Training ◽  
Environmental Support ◽  
Total Communication ◽  
Communication Partners

Abstract Purpose: This article addresses several intervention approaches that aim to improve life for individuals with severe aphasia. Because severe aphasia significantly compromises language, often for the long term, recommended approaches focus on additional domains that affect quality of life. Treatments are discussed that involve increasing participation in personally relevant life situations, enhancing environmental support for communication and participation, and improving communicative confidence. Methods: Interventions that have been suggested in the aphasia literature as particularly appropriate for people with severe aphasia include training in total communication, training of communication partners, and activity specific training. Conclusion: Several intervention approaches can be implemented to enhance life with severe aphasia.

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