Consenting for pelvic nerve injury in colorectal surgery: need to address age and gender bias

INTRODUCTION Pelvic nerve injury is a recognised complication following pelvic dissection in colorectal surgery. It can lead to urinary and sexual dysfunction in men and women, which varies from 5-40% depending on the surgery and the underlying pathology. Sexual dysfunction can manifest as erectile dysfunction in men and as dyspareunia and failure to achieve sexual arousal/orgasm in women. The aim of this study was to evaluate consent for these complications prior to surgery. PATIENTS AND METHODS We carried out a retrospective audit on patients who had undergone elective colorectal surgery involving pelvic dissection over a 2-year period (June 2006 to June 2008) at University Hospital of North Staffordshire. We reviewed the consent forms and medical records of these patients, specifically looking for documentation of pelvic nerve injury, sexual dysfunction or erectile dysfunction prior to surgery. Only patients who had documented pelvic dissection in their operative notes were included in the audit, and those who were deemed unable to consent were excluded. RESULTS Medical records of 118 patients were reviewed. Of this cohort, 31% were women (n = 37). Malignancy was the indication for surgery in 79% of women and 88% of men. Consent for the procedure was obtained by a consultant in 73% (n = 86) of patients and by a middle-grade surgeon in the remaining 27% (n = 32). Only two women were consented for pelvic nerve injury whilst this number was 41 for men (5% vs 51%). Patients younger than 50 years were more consistently informed of the risks (50%) compared to the over 50-year-olds (34%). Only eight patients (males 6, females 2) were consented for urinary dysfunction. CONCLUSIONS The risk of pelvic nerve injury is not frequently stated, which is more common in women and the elderly. Overall, only 36% of patients were consented for pelvic nerve injury, while only 5% of women were consented. Is this professional discretion, or evidence that surgeons are not being assiduous enough when obtaining consent, which may leave them vulnerable to medicolegal claims? Introduction of procedure-specific consent forms would be a method to address this issue.

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Use of neuro-psychiatry medicines in patients with sexual dysfunction: a retrospective study

International Journal of Basic & Clinical Pharmacology ◽

10.18203/2319-2003.ijbcp20170813 ◽

2017 ◽

Vol 6 (3) ◽

pp. 563 ◽

Cited By ~ 1

Author(s):

Amit Shrenikraj Mutha ◽

Vijay Rajaram Kulkarni ◽

Amit Suresh Beldar ◽

Sadiq Bapumiya Patel

Keyword(s):

Erectile Dysfunction ◽

Retrospective Study ◽

Sexual Dysfunction ◽

Psychiatric Disorders ◽

Medical Records ◽

Psychiatric Comorbidity ◽

Neuropsychiatric Disorders ◽

Sexual Problems ◽

Sexual Disorders ◽

Time Of Presentation

Background: The objective of the study was to understand the usage of neuro-psychiatry medicines in patients presenting with symptoms of sexual dysfunction.Methods: Medical records of adult patients consulting in the clinic out patients with symptoms of sexual dysfunction were screened for prescriptions of neuropsychiatry medicines. Common neuropsychiatric co-morbidities and prevalence of usage of medicines used for treating neuro-psychiatric disorders was calculated.Results: A total of 628 patients with sexual disorders were included of which 57 (9.1%) had received at least one neuro-psychiatry medicine at the time of presentation. Three most common sexual problems were unconsummated marriage 16 (28.1%), psychogenic ED 14 (24.6%) and organic erectile dysfunction 8 (14.0%). A total of erectile dysfunction 46 (7.3%) patients had psychiatric comorbidity. Five most common neuropsychiatric co-morbidities were anxiety 14 (30.4%), schizhophrenia 10 (21.7%), stress 7 (15.2%), depression 6 (13.0%) and epilepsy 2 (4.3%). The most commonly used neuro-psychiatry medicines were fluoxetine 15 (19.7%), risperidone 11 (14.5%), clonazepam 10 (13.2%), escitalopram 9 (11.8%), alprazolam 5 (6.6%), olanzapine 5 (6.6%) and gabapentin 4 (5.3%). Amisulpride was used in 3 (3.9%) patients whereas valproate, fluoxamine, diazepam and paroxetine were used in 2 (2.6%) patients each. Phenytoin, imipramine, carbamazepine, venlafaxine, haloperidol and sertarline were used in one patient each.Conclusions: Anxiety, schizophrenia and depression are the most common neuropsychiatric disorders in patients with sexual dysfunction. Many patients presenting with sexual dysfunction are already on neuropsychiatry medicines. Further studies are required to evaluate the association between neuropsychiatry medicines and sexual dysfunction in Indian patients.

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671: Prophylactic use of the Parp1 Inhibitor INO-1002 Prevents Erectile Dysfunction Due to Cavernous Nerve Injury in Rats

The Journal of Urology ◽

10.1016/s0022-5347(18)30911-x ◽

2007 ◽

Vol 177 (4S) ◽

pp. 225-225

Author(s):

Muammer Kendirci ◽

Landon Trost ◽

Wayne J.G. Hellstrom

Keyword(s):

Erectile Dysfunction ◽

Nerve Injury ◽

Cavernous Nerve ◽

Prophylactic Use ◽

Cavernous Nerve Injury

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THE FEASIBILITY OF FAST TRACK PROTOCOL FOR ELDERELY PATIENTS WITH COLORECTAL CANCER

Koloproktologia ◽

10.33878/2073-7556-2016-0-1-26-29 ◽

2016 ◽

pp. 26-29

Author(s):

D. . Zitta ◽

V. . Subbotin ◽

Y. . Busirev

Keyword(s):

Colorectal Cancer ◽

Colorectal Surgery ◽

Blood Loss ◽

Elderly Patients ◽

Fast Track ◽

Randomized Study ◽

Conventional Group ◽

Intraoperative Blood Loss ◽

Elective Colorectal Surgery ◽

Complications Rate

Fast track protocol is widely used in major colorectal surgery. It decreases operative stress, shortens hospital stay and reduces complications rate. However feasibility and safety of this approach is still controversial in patients older than 70 years. The AIM of the study was to estimate the safety and effectiveness of fast track protocol in elderly patients with colorectal cancer. MATERIALS AND METHODS. Prospective randomized study included 138 elective colorectal resectionfor cancer during period from 1.01.10 till 1.06.15. The main criteria for the patients selection were age over 70 years and diagnosis of colorectal cancer. 82 of these patients received perioperative treatment according to fast track protocol, other 56 had conventional perioperative care. Patients underwent following procedures: right hemicolectomy (n=7), left hemicolectomy (n=12), transverse colectomy (n=1), sigmoidectomy (n=23), abdomeno-perineal excision (n=19) and low anterior resection of rectum (n=76). Following data were analized: duration of operation, intraoperative blood loss, time offirst flatus and defecation, complications rates. RESULTS. Mean age was 77,4 ± 8 years. There were no differences in gender, co morbidities, body mass index, types of operations between groups. Duration of operations didn't differ significantly between 2 groups. Intraoperative blood loss was higher in conventional group. The time of first flatus and defecation were better in FT-group. There was no mortality in FT-group vs 1,8 %o mortality in conventional group. Complications rate was lower in FT-group: wound infections 3,6% vs 9 %, anastomotic leakage 4,8 %o vs 9 %o, ileus 1,2 vs 5,4 %o, peritonitis 2,4 %o vs 3,6%o, bowel obstruction caused by the adhesions 6 % vs 5,3 %. Reoperation rate was similar 4,8 % vs 3,6 %. CONCLUSION. Fast track protocol in major elective colorectal surgery can be safely applied in elderly patients. The application of fast track protocol in elderly patients improves the restoration of bowel function and reduces the risk of postoperative complication.

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Faculty Opinions recommendation of Association of mechanical bowel preparation and oral antibiotics before elective colorectal surgery with surgical site infection.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.734249120.793551951 ◽

2018 ◽

Author(s):

Eloy Espín Basany

Keyword(s):

Colorectal Surgery ◽

Surgical Site Infection ◽

Bowel Preparation ◽

Mechanical Bowel Preparation ◽

Site Infection ◽

Oral Antibiotics ◽

Elective Colorectal Surgery

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Risk Factors for Prolonged Postoperative Ileus in Adult Patients Undergoing Elective Colorectal Surgery: An Observational Cohort Study

Reviews on Recent Clinical Trials ◽

10.2174/1574887113666180521111153 ◽

2018 ◽

Vol 13 (4) ◽

pp. 295-304 ◽

Cited By ~ 4

Author(s):

Andrea Pisani Ceretti ◽

Nirvana Maroni ◽

Marco Longhi ◽

Marco Giovenzana ◽

Roberto Santambrogio ◽

...

Keyword(s):

Risk Factors ◽

Cohort Study ◽

Colorectal Surgery ◽

Postoperative Ileus ◽

Observational Cohort Study ◽

Adult Patients ◽

Elective Colorectal Surgery ◽

Observational Cohort ◽

Prolonged Postoperative Ileus

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Spermatorrhea in a Chinese patient with temporal lobe epilepsy: a case report

Journal of International Medical Research ◽

10.1177/0300060520982814 ◽

2021 ◽

Vol 49 (1) ◽

pp. 030006052098281

Author(s):

Liang Zhang ◽

Hao Yu ◽

Dan Li ◽

Hui Qian ◽

Yuchao Chen

Keyword(s):

Erectile Dysfunction ◽

Case Report ◽

Sexual Dysfunction ◽

Temporal Lobe Epilepsy ◽

Temporal Lobe ◽

Neurological Disorder ◽

Premature Ejaculation ◽

Chinese Patient ◽

Left Temporal Lobe ◽

Rare Manifestation

Epilepsy is a chronic neurological disorder that is characterized by episodes of seizure. Sexual dysfunction has been reported in patients with seizure, which mostly manifests as erectile dysfunction and premature ejaculation in men. In this study, we report the case of a 65-year-old Chinese man with frequent spermatorrhea. Electroencephalography suggested local epilepsy in the left temporal lobe. After treatment with anti-epilepsy drugs, the symptoms disappeared and did not recur. To the best of our knowledge, this is the first reported case of epilepsy-induced spermatorrhea. The symptoms of spermatorrhea are probably a rare manifestation of seizure. When repetitive stereotyped symptoms occur, seizure should be considered, and tentative anti-epileptic treatment may be a good option.

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P7: ACUTE KIDNEY INJURY AFTER ELECTIVE COLORECTAL SURGERY: RESULTS OF A NATIONAL CLOSED-LOOP AUDIT

British Journal of Surgery ◽

10.1093/bjs/znab117.092 ◽

2021 ◽

Vol 108 (Supplement_1) ◽

Author(s):

Keyword(s):

Acute Kidney Injury ◽

Quality Improvement ◽

Colorectal Surgery ◽

Prognostic Score ◽

Univariate Analysis ◽

Kidney Injury ◽

Elective Colorectal Surgery ◽

National Quality ◽

Significant Difference ◽

The Uk

Abstract Introduction The aim of this study was to re-audit the rates of acute kidney injury (AKI) after elective colorectal surgery, following local presentations of results. Method Outcomes After Kidney injury in Surgery (OAKS) and Ileus Management International (IMAGINE), were prospective multicentre audits on consecutive elective colorectal resections, in the UK and Ireland. These were performed over 3-month periods in 2015 and 2018 respectively. During the interim period, results were presented at participating centres to stimulate local quality improvement initiatives. Risk-adjusted 7-day postoperative AKI rates were calculated through multilevel logistic regression based on the OAKS prognostic score. Result Of the 4,917 patients included, 3,133 (63.7%) originated from OAKS and 1,784 (36.3%) from IMAGINE. On univariate analysis, there was no significant difference (p=0.737) in the 7-day AKI rate between OAKS (n=346, 11.8%) and IMAGINE (n=205, 11.5%). However, the risk-adjusted AKI rate in IMAGINE was significantly lower compared to OAKS (-1.8%, 95% CI: -2.3% to -1.3%, p<0.001). Of 47 centres (40.1%) with a recorded local presentation, there was no significant difference in the subsequent AKI rate in IMAGINE (-0.7%, -2.0% to 0.6%, p=0.278). Conclusion Rates of AKI after elective colorectal surgery significantly reduced on re-audit. However, this may be related to increased awareness from participation or national quality improvement initiatives, rather than local presentation of results. Abbrev. AKI - Acute Kidney Injury, OAKS - Outcomes After Kidney injury in Surgery, IMAGINE - Ileus Management International Take-home message Risk-adjusted AKI rates significantly reduced on re-audit, however, this was most likely due to factors separate from the local presentation of initial results.

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Defining standards in colorectal optimisation: a Delphi study protocol to achieve international consensus on key standards for colorectal surgery prehabilitation

BMJ Open ◽

10.1136/bmjopen-2020-047235 ◽

2021 ◽

Vol 11 (3) ◽

pp. e047235

Author(s):

Iona Pearson ◽

Sue Blackwell ◽

Rebecca Fish ◽

Sarah Daniels ◽

Malcolm West ◽

...

Keyword(s):

Systematic Review ◽

Colorectal Surgery ◽

Outcome Measures ◽

Delphi Study ◽

Public Involvement ◽

Healthcare Professionals ◽

Patient And Public Involvement ◽

International Consensus ◽

Elective Colorectal Surgery ◽

Patient Related Outcome

IntroductionPrehabilitation in colorectal surgery is evolving and may minimise postoperative morbidity and mortality. With many different healthcare professionals contributing to the prehabilitation literature, there is significant variation in reported primary endpoints that restricts comparison. In addition, there has been limited work on patient-related outcome measures suggesting that patients with colorectal cancer needs and issues are being overlooked. The Defining Standards in Colorectal Optimisation Study aims to achieve international consensus from all stakeholders on key standards to provide a framework for reporting future prehabilitation research.Methods and analysisA systematic review will identify key standards reported in trials of prehabilitation in colorectal surgery. Standards that are important to patients will be identified by a patient and public involvement (PPI) event. The longlist of standards generated from the systematic review and PPI event will be used to develop a three-round online Delphi process. This will engage all stakeholders (healthcare professionals and patients) both nationally and internationally. The results of the Delphi will be followed by a face-to-face interactive consensus meeting that will define the final standards for prehabilitation for elective colorectal surgery.Ethics and disseminationThe University of Glasgow College of Medical, Veterinary and Life Sciences Ethics Committee has approved this protocol, which is registered as a study (200190120) with the Core Outcome Measures in Effectiveness Trials Initiative. Publication of the standards developed by all stakeholders will increase the potential for comparative research that advances understanding of the clinical application of prehabilitation.PROSPERO registration numberCRD42019120381.

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