Introdução: A prostatectomia perineal tem sido proposta como um procedimento seguro e pouco invasivo, sem comprometer os princípios oncológicos. No entanto, este acesso tem sido questionado sobre o risco de promover a incontinência anal. Objetivo: avaliar os efeitos do acesso para a prostatectomia perineal no mecanismo de continência anal. Métodos: Trinta e um pacientes com indicação cirúrgica de prostatectomia perineal foram avaliados entre agosto de 2008 e maio de 2009. Dados do pré e pós operatório (8 meses): estadiamento do câncer de próstata, a avaliação clínica (Índice de incontinência anal da Cleveland Clinic - CCISS), índice de qualidade de vida na incontinência anal (FIQL) e manometria anorretal. Os parâmetros médios manométricos foram: pressão de repouso (RP / mmHg), pressão de contração voluntária máxima (MSP / mmHg), zona de alta pressão (ZAP / cm), índice de fadiga do esfíncter (SFI / min.), índice de assimetria esfincteriana (SAI /%), limiar de sensibilidade retal (RST / ml) e volume retal máximo tolerado (MTRV / ml). Resultados: Foi concluída a avaliação em vinte e três pacientes, com média de idade de 65 (54-72) anos. Pré-operatório: o peso médio da próstata foi de 34,5 (24-54) gramas, Gleason intervalo de valor da pontuação 06/07. Os valores médios pré e pós-operatório da CCISS foram 0,9 ± 1,9 e 0,7 ± 1,2 (p> 0,05) e não houve uma mudança significativa no valor FIQL. Os valores médios pré e pós operatório de parâmetros manométricos foram, respectivamente: RP: 64 ± 23 e 65 ± 17, SP: 130 ± 41 e 117 ± 40, ZAP: 3,0 ± 0,9 e 2,7 ± 0,8, SFI: 3,0 ± 2,1 ± 11 e 5.4, RST: 76 ± 25 e 71 ± 35, MTRV 157 ± 48 e 156 ± 56, e SAI: 22,4 ± 9 e 14,4 ± 5, sendo o SAI o único parâmetro com mudança estatisticamente significativa (p: 0, 003). Conclusão: O acesso perineal para prostatectomia não afetou os parâmetros de continência anal. Houve, no entanto melhora na simetria esfincteriana / Introduction: Perineal prostatectomy has been proposed as a less invasive and a safer procedure, without compromise of oncological principles. However, this access has been questioned about the risk of promoting anal incontinence. Purpose: this study aimed to evaluate the effects of perineal access for prostatectomy in continence mechanism. Methods: Thirty one patients with surgical indication for perineal prostatectomy were evaluated between August 2008 and May 2009. Preoperative and postoperative (8 months) data included: prostate cancer staging, clinical evaluation (Cleveland Clinic anal incontinence score system - CCISS), Fecal incontinence quality of life score (FIQL) and anal manometry. Mean manometric parameter were: resting pressure (RP/mmHg), maximal squeeze pressure (MSP/mmHg), high pressure zone (HPZ/cm), sphincter fatigue index (SFI/min), sphincter asymmetry index (SAI/%), rectal sensory threshold (RST/ml) and maximum tolerated rectal volume (MTRV/ml). Results: Twenty three patients, mean age 65 (54-72) years, completed evaluation. Preoperative: prostate weight was 34.5 (24-54) grams, Gleason score value range 6 /7. Mean pre and postoperative values of CCISS were 0.9±1.9 and 0.7±1.2 (p>0.05) and there was not a significant change in FIQLS value. The mean preoperative and postoperative values of manometric parameters were, respectively: RP: 64±23 and 65±17, SP: 130±41 and 117±40, HPZ: 3.0±0.9 and 2.7±0.8, SFI: 3.0±11and 2.1 ±5.4, RST: 76±25 and 71±35, MTRV 157±48 and 156±56, and SAI: 22.4±9 and 14.4±5. Significant statistics change only in the SAI (p=0,003). Conclusion: The perineal prostatectomy did not affect anal continence parameters

Introdução: A prostatectomia perineal tem sido proposta como um procedimento seguro e pouco invasivo, sem comprometer os princípios oncológicos. No entanto, este acesso tem sido questionado sobre o risco de promover a incontinência anal. Objetivo: avaliar os efeitos do acesso para a prostatectomia perineal no mecanismo de continência anal. Métodos: Trinta e um pacientes com indicação cirúrgica de prostatectomia perineal foram avaliados entre agosto de 2008 e maio de 2009. Dados do pré e pós operatório (8 meses): estadiamento do câncer de próstata, a avaliação clínica (Índice de incontinência anal da Cleveland Clinic - CCISS), índice de qualidade de vida na incontinência anal (FIQL) e manometria anorretal. Os parâmetros médios manométricos foram: pressão de repouso (RP / mmHg), pressão de contração voluntária máxima (MSP / mmHg), zona de alta pressão (ZAP / cm), índice de fadiga do esfíncter (SFI / min.), índice de assimetria esfincteriana (SAI /%), limiar de sensibilidade retal (RST / ml) e volume retal máximo tolerado (MTRV / ml). Resultados: Foi concluída a avaliação em vinte e três pacientes, com média de idade de 65 (54-72) anos. Pré-operatório: o peso médio da próstata foi de 34,5 (24-54) gramas, Gleason intervalo de valor da pontuação 06/07. Os valores médios pré e pós-operatório da CCISS foram 0,9 ± 1,9 e 0,7 ± 1,2 (p> 0,05) e não houve uma mudança significativa no valor FIQL. Os valores médios pré e pós operatório de parâmetros manométricos foram, respectivamente: RP: 64 ± 23 e 65 ± 17, SP: 130 ± 41 e 117 ± 40, ZAP: 3,0 ± 0,9 e 2,7 ± 0,8, SFI: 3,0 ± 2,1 ± 11 e 5.4, RST: 76 ± 25 e 71 ± 35, MTRV 157 ± 48 e 156 ± 56, e SAI: 22,4 ± 9 e 14,4 ± 5, sendo o SAI o único parâmetro com mudança estatisticamente significativa (p: 0, 003). Conclusão: O acesso perineal para prostatectomia não afetou os parâmetros de continência anal. Houve, no entanto melhora na simetria esfincteriana / Introduction: Perineal prostatectomy has been proposed as a less invasive and a safer procedure, without compromise of oncological principles. However, this access has been questioned about the risk of promoting anal incontinence. Purpose: this study aimed to evaluate the effects of perineal access for prostatectomy in continence mechanism. Methods: Thirty one patients with surgical indication for perineal prostatectomy were evaluated between August 2008 and May 2009. Preoperative and postoperative (8 months) data included: prostate cancer staging, clinical evaluation (Cleveland Clinic anal incontinence score system - CCISS), Fecal incontinence quality of life score (FIQL) and anal manometry. Mean manometric parameter were: resting pressure (RP/mmHg), maximal squeeze pressure (MSP/mmHg), high pressure zone (HPZ/cm), sphincter fatigue index (SFI/min), sphincter asymmetry index (SAI/%), rectal sensory threshold (RST/ml) and maximum tolerated rectal volume (MTRV/ml). Results: Twenty three patients, mean age 65 (54-72) years, completed evaluation. Preoperative: prostate weight was 34.5 (24-54) grams, Gleason score value range 6 /7. Mean pre and postoperative values of CCISS were 0.9±1.9 and 0.7±1.2 (p>0.05) and there was not a significant change in FIQLS value. The mean preoperative and postoperative values of manometric parameters were, respectively: RP: 64±23 and 65±17, SP: 130±41 and 117±40, HPZ: 3.0±0.9 and 2.7±0.8, SFI: 3.0±11and 2.1 ±5.4, RST: 76±25 and 71±35, MTRV 157±48 and 156±56, and SAI: 22.4±9 and 14.4±5. Significant statistics change only in the SAI (p=0,003). Conclusion: The perineal prostatectomy did not affect anal continence parameters

Introdução: Os distúrbios funcionais colorretoanais, frequentemente representados por constipação intestinal, incontinência anal e dor anorretal apresentam alta prevalência na população geral. De etiologia multifatorial onde estão envolvidas causas orgânicas, funcionais, culturais e psicológicas. Dados bibliográficos apontam que a depressão, a ansiedade e o estresse estão entre os fatores psicológicos mais presentes nesse grupo de pacientes. Representam um desafio para abordagem gerando impacto significativo na qualidade de vida. Objetivo: Este estudo prospectivo teve como objetivo avaliar o perfil de psicológico de pacientes com distúrbios funcionais colorretais: constipação intestinal crônica (CIC), incontinência anal (IA) e dor anal (DA), utilizando uma versão reduzida, mais aplicáveis do MMPI, o MMPI- IRF (Minnesota Multiphafic Personality Inventory Improved Readability Form). Métodos: Um total de 90 pacientes, sendo 30 de cada grupo sintomático, CIC, AI e DA, respectivamente, e 60 indivíduos controle foram avaliados. Todos os grupos foram igualmente distribuídos por sexo. Os dados foram obtidos através de semi-dirigidas e MMPI-IRF, que consiste de 167 propostas divididas em quatro escalas de validade (\"não posso dizer \", mentira, defensividade) e 10 escalas clínicas (hipocondria, depressão, histeria, desvio- psicopático, masculinidade e feminilidade , paranóia, psicastenia, esquizofrenia, hipomania e introversão-extroversão social). O estudo estatístico incluiu o teste ANOVA, Belferroni e exato de Fisher sendo considerados significativos quando os calores de p<0,05. Resultados: A média de idade os valores foram 48, 52, 49 e 43 anos para o CIC, IA, DA e grupos de controle, respectivamente. O IA se destacou por apresentar menor escolaridade 36% nao concluíram o 1° grau. Quanto aos antecedentes psiquiátricos DA obteve maior porcentagem de pacientes que já estiveram em tratamento psiquiátrico (43%). O início da depressão precedeu o início da queixa funcionais em 36% dos pacientes do CIC, mas em apenas 20% e 23%, respectivamente, IA e pacientes DA. Os escores de depressão, hipocondria e histeria escalas foram significativamente maiores em todos os grupos de pacientes quando comparados aos indivíduos do grupo controle. Conclusão: As elevações nas escalas hipocondria, depressão e histeria são indicativos que os sintomas funcionais colorretoanias são mecanismos de defesa que atuam protegendo os indivíduos da ansiedade e da depressão excessivos. Confirmando a importância de combinar a abordagem psicológica aos cuidados médicos convencionais desses pacientes / Introduction: The functional colorectal disorders frequently represented by constipation, anal incontinence and anorectal pain with a high prevalence in the general population. The multifactorial etiology which are involved in organic, functional, cultural and psychological. Bibliographic conclusions suggest that depression, anxiety and stress are among the psychological factors present in most of this patients. Represent a challenge to approach generating significant impact on quality of life.. Objective: This prospective study aimed to evaluate the psychological profile of patients with colorectal functional disorders: chronic idiophatic constipation (CIC), anal incontinence (AI) and chronic idiopathic rectal pain (CIRP), using a reduced version, the MMPI more applicable, the MMPI- IRF (Minnesota Multiphafic Personality Inventory-Improved Readability Form). Methods: A total of 90 patients, 30 of each symptomatic group, CIC, AI and CIRP, respectively, and 60 control subjects were evaluated. All groups were equally distributed by gender. Data were obtained through semi-directed interviews and MMPIIRF, which consists of 167 proposals divided into four scales of validity (\"I can not say,\" lie, infrequency, defensiveness) and 10 clinical scales (hypochondriasis, depression, hysteria, psychopathic deviate, masculinity- femininity, paranoia, psychaesthenia, schizophrenia, mania, and social introversion-extroversion). Statistical analysis included ANOVA, Fisher\'s exact and Belferroni were considered significant when the heats of p <0.05. Results: Mean age values were 48, 52, 49 and 43 years for the CIC, AI, CIRP and control groups, respectively. The AI was noted for 36% less education have not completed a degree. The psychiatric history\'s got higher percentage of patients who have been in psychiatric treatment (43%). The onset of depression preceded the onset of functional complaints in 36% of patients in the CIC, but in only 20% and 23%, respectively, and AI patients. The scores of depression, hypochondria and hysteria scales were significantly higher in all patient groups compared to control subjects. Conclusion: The elevations on the scales hypochondria, depression and hysteria are indicative that the colorectal functional symptoms are defense mechanisms that act to protect individuals from excessive anxiety and depression. Confirming the importance of combining a psychological approach to conventional medical care for these patients

Introdução: Os distúrbios funcionais colorretoanais, frequentemente representados por constipação intestinal, incontinência anal e dor anorretal apresentam alta prevalência na população geral. De etiologia multifatorial onde estão envolvidas causas orgânicas, funcionais, culturais e psicológicas. Dados bibliográficos apontam que a depressão, a ansiedade e o estresse estão entre os fatores psicológicos mais presentes nesse grupo de pacientes. Representam um desafio para abordagem gerando impacto significativo na qualidade de vida. Objetivo: Este estudo prospectivo teve como objetivo avaliar o perfil de psicológico de pacientes com distúrbios funcionais colorretais: constipação intestinal crônica (CIC), incontinência anal (IA) e dor anal (DA), utilizando uma versão reduzida, mais aplicáveis do MMPI, o MMPI- IRF (Minnesota Multiphafic Personality Inventory Improved Readability Form). Métodos: Um total de 90 pacientes, sendo 30 de cada grupo sintomático, CIC, AI e DA, respectivamente, e 60 indivíduos controle foram avaliados. Todos os grupos foram igualmente distribuídos por sexo. Os dados foram obtidos através de semi-dirigidas e MMPI-IRF, que consiste de 167 propostas divididas em quatro escalas de validade (\"não posso dizer \", mentira, defensividade) e 10 escalas clínicas (hipocondria, depressão, histeria, desvio- psicopático, masculinidade e feminilidade , paranóia, psicastenia, esquizofrenia, hipomania e introversão-extroversão social). O estudo estatístico incluiu o teste ANOVA, Belferroni e exato de Fisher sendo considerados significativos quando os calores de p<0,05. Resultados: A média de idade os valores foram 48, 52, 49 e 43 anos para o CIC, IA, DA e grupos de controle, respectivamente. O IA se destacou por apresentar menor escolaridade 36% nao concluíram o 1° grau. Quanto aos antecedentes psiquiátricos DA obteve maior porcentagem de pacientes que já estiveram em tratamento psiquiátrico (43%). O início da depressão precedeu o início da queixa funcionais em 36% dos pacientes do CIC, mas em apenas 20% e 23%, respectivamente, IA e pacientes DA. Os escores de depressão, hipocondria e histeria escalas foram significativamente maiores em todos os grupos de pacientes quando comparados aos indivíduos do grupo controle. Conclusão: As elevações nas escalas hipocondria, depressão e histeria são indicativos que os sintomas funcionais colorretoanias são mecanismos de defesa que atuam protegendo os indivíduos da ansiedade e da depressão excessivos. Confirmando a importância de combinar a abordagem psicológica aos cuidados médicos convencionais desses pacientes / Introduction: The functional colorectal disorders frequently represented by constipation, anal incontinence and anorectal pain with a high prevalence in the general population. The multifactorial etiology which are involved in organic, functional, cultural and psychological. Bibliographic conclusions suggest that depression, anxiety and stress are among the psychological factors present in most of this patients. Represent a challenge to approach generating significant impact on quality of life.. Objective: This prospective study aimed to evaluate the psychological profile of patients with colorectal functional disorders: chronic idiophatic constipation (CIC), anal incontinence (AI) and chronic idiopathic rectal pain (CIRP), using a reduced version, the MMPI more applicable, the MMPI- IRF (Minnesota Multiphafic Personality Inventory-Improved Readability Form). Methods: A total of 90 patients, 30 of each symptomatic group, CIC, AI and CIRP, respectively, and 60 control subjects were evaluated. All groups were equally distributed by gender. Data were obtained through semi-directed interviews and MMPIIRF, which consists of 167 proposals divided into four scales of validity (\"I can not say,\" lie, infrequency, defensiveness) and 10 clinical scales (hypochondriasis, depression, hysteria, psychopathic deviate, masculinity- femininity, paranoia, psychaesthenia, schizophrenia, mania, and social introversion-extroversion). Statistical analysis included ANOVA, Fisher\'s exact and Belferroni were considered significant when the heats of p <0.05. Results: Mean age values were 48, 52, 49 and 43 years for the CIC, AI, CIRP and control groups, respectively. The AI was noted for 36% less education have not completed a degree. The psychiatric history\'s got higher percentage of patients who have been in psychiatric treatment (43%). The onset of depression preceded the onset of functional complaints in 36% of patients in the CIC, but in only 20% and 23%, respectively, and AI patients. The scores of depression, hypochondria and hysteria scales were significantly higher in all patient groups compared to control subjects. Conclusion: The elevations on the scales hypochondria, depression and hysteria are indicative that the colorectal functional symptoms are defense mechanisms that act to protect individuals from excessive anxiety and depression. Confirming the importance of combining a psychological approach to conventional medical care for these patients

Este estudo teve por objetivo avaliar o hábito intestinal e os fatores de risco para incontinência anal (IA) em adultos da população geral, residentes na área urbana da cidade de Londrina - PR. Estudo epidemiológico de base populacional, de corte transversal, realizado após a aprovação do Comitê de Ética da Escola de Enfermagem da Universidade de São Paulo. Dois mil cento e sessenta e dois indivíduos, com idade igual ou superior a 18 anos, condições físicas e mentais adequadas e que aceitaram a participar do estudo, compuseram a amostra, estabelecida a partir de amostragem estratificada por conglomerado, constituídos pelas ruas sorteadas aleatoriamente dentro dos 390 setores censitários do município. Todos os residentes nos domicílios das ruas sorteadas, que atenderam aos critérios de inclusão foram entrevistados utilizando-se dois instrumentos: Dados demográficos e o Hábito intestinal na comunidade (adaptado e validado para a língua portuguesa por Domansky e Santos, 2007). Os dados foram submetidos aos testes de Qui-Quadrado e Exato de Fischer. O predomínio foi do sexo feminino (1203 / 56%); média etária de 40,6±16,4; brancos (1591/74%); união estável (1290 / 60%); 9 a 12 anos de estudo (784/ 36%); 37% pessoas sem ocupação definida; 44% tinham remuneração entre 2 e 3,9 SM; 38% com renda per capita entre 0,6 a 1 salário mínimo. Para o padrão intestinal normal (1.875/87%; p<,0001), predominância de uma evacuação por dia (1.133/52%; p<0,0001), entre as mulheres (968/52%; p<0,0001); os brancos (1591/85%; p<0,0001), ausência de esforço evacuatório (1956/90%), exonerações de fezes macias (1379/64%), esvaziamento retal completo (1938/90%). Padrão intestinal constipado (261/12,1%), entre mulheres (219/84%), esforço evacuatório (99/41,8%), fezes endurecidas (176/67%); esvaziamento retal incompleto (99/38%). Padrão intestinal diarréico (26/1,2%), sem esforço evacuatório (26/100%) fezes líquidas e amolecidas (5/19%), esvaziamento retal completo (16/61%). A prevalência das doenças anorretais, foi de 53 (2%) abscessos, 22 (1%) fístulas, 81 (3%) fissuras, 20(1%) prolapsos retais, 30 (1%) traumas anais; 229 (11%) doença hemorroidária, 58 (3%) cirurgias anorretais, para todas o predomínio foi feminino. O histórico de parto e ginecológico: 886 (74%) tiveram partos, 709 (73%) com padrão intestinal normal; 432 (49%) entre 31 e 50 anos; 168 (14%) tiveram um parto normal; destas 33 (3%) tiveram laceração anal pós-parto que necessitou de intervenção cirúrgica; porém mantiveram o padrão intestinal normal (25/75%); 109 (9%) fizeram histerectomia (109 /9%), 90 (90%) padrão intestinal normal e menos de um por cento tiveram retocele e quatro (50%) eram constipadas. Os fatores de risco para incontinência anal: 35 (2%) radioterapia pélvica, 133 (6%) diabetes mellitus, 330 (15%) doenças ou distúrbios do sistema nervoso, 291 (13%) lesão na coluna espinhal e 29 (1%) relataram o acidente vascular encefálico (AVE), para todos os fatores houve predomínio do padrão intestinal normal, predomínio feminino para distúrbios do sistema nervoso e AVE. Este estudo permitiu conhecer o hábito intestinal da população geral de uma cidade no norte do Paraná, os fatores de risco para IA que estão expostos, cooperando para a elucidação do tema entre a população, ampliando os conhecimentos daqueles que atuam na área, e colaborando para o desenvolvimento de programas de prevenção ou diagnóstico precoce das doenças intestinais / The objective of this study was to evaluate the bowel habits and anal incontinence (AI) risk factors in adults living in the urban area of Londrina, PR, Brazil. This population-based, transversal epidemiological study was carried out after being approved by the University of São Paulo Nursing School Ethics Committee. Population sample established from a stratified sampling procedure by a conglomerate constituted of streets taken randomly from 390 county census sectors, included 2162 individuals , 18 years old and over, in adequate physical and mental conditions, who accepted to participate in the study. All residents in the selected streets who met the inclusion criteria established by the study were interviewed, using two instruments: Demographic data and the Bowel function in the community (adapted and validated for the Portuguese language by Domansky and Santos, 2007). Data were submitted to Chi-square and Fischer exact tests. There was a predominance of female subjects (1203/56%); ages 40,6 ± 16,4; white (1591/74%); with a stable relationship (1290/60%), with 9 to 12 years of formal education ( 784/36%), subjects without a defined job (37%) with salaries around 2 to 3,9 / minimum wage (44%) and per capita income between 0,6 to one/minimum wage (38%). As for normal intestinal pattern (1.875/87%; p<0,0001), there was the predominance of one bowel movement per day (1.133/52%; p<0,0001), among women (968/52%; p<0,0001); whites (1591/85%; p<0,0001), absence of defecation strain (1956/90%), soft feces (1379/64%), total rectal emptying (1938/90%). Constipated intestinal pattern (261/12,1%), among women (219/84%), defecation strain (99/41,8%), hard feces (176/67%); incomplete rectal emptying (99/38%). Diarrheic intestinal pattern (26/1,2%), no defecation strain (26/100%) liquid and soft feces (5/19%), total rectal emptying (16/61%). Prevalence of anorectal diseases was 53 (2%) abscesses, 22 (1%) fistules, 81 (3%) fissures, 20(1%) rectal prolapse, 30 (1%) anal traumas; 229 (11%) hemorrhoidal disease 58 (3%) ; anorectal surgeries, mainly among females. Gynecological and delivery history, 886 (74%) had deliveries, 709 (73%) with normal intestinal pattern; 432 (49%) between 31 and 50 years old; 168 (14%) had normal deliveries; 33 (3%) with postpartum laceration that needed surgical intervention; however, they maintained a normal intestinal pattern (25/75%); 109 (9%) had hysterectomy (109 /9%), 90 (90%) normal intestinal pattern and less than one percent had rectocele and four (50%) were constipated. Anal incontinence risk factors, 35 (2%) pelvic radiotherapy, 133 (6%) diabetes mellitus, 330 (15%) nervous systems diseases and dysfunctions, 291 (13%) spinal cord lesion and 29 (1%) reported having had an encephalic vascular stroke. In all factors there was the predominance of the normal intestinal pattern; however, females presented more nervous system dysfunctions and encephalic vascular strokes. This study reports on the bowel habits of a general population in a city in Northern Paraná, and the AI risk factors they are exposed to, bringing more information about the topic to the population and to those who work in the area , helping develop prevention programs or early diagnoses of intestinal diseases

<p>Patients with idiopathic anal fistula (n=85) were compared with 215 control subjects, matched for age and sex, through a 180-item questionnaire. Obesity, smoking, constipation and bowel symptoms associated with IBS were more common in the patients.</p><p>Endoanal ultrasound (EUS) and magnetic resonance imaging (MRI) were compared in the preoperative evaluation of anal fistula in 23 patients. For classifying the primary tract, EUS and surgical findings agreed in 14 cases, and MRI and surgery for 11: for identifying an internal opening, the corresponding figures were 17 and 10.</p><p>Healing and sphincter function were studied in 42 patients operated with fistula excision and closure of the internal opening. Twenty-three patients healed primarily and another 10 after one re-operation, whereas nine required further surgery until healed. Anal resting pressure was reduced after three and 12 months, and squeeze pressure after 12 months.</p><p>Eighty-three patients were randomised to surgery with or without application of gentamicin-collagen underneath the flap: 26/42 of patients randomised to gentamicin-collagen healed primarily compared with 21/41 of patients randomised to surgery only (n.s).</p><p>Micro perfusion in the flap was studied by laser Doppler flowmetry during surgery in 16 patients. No correlation was seen between change in blood flow during surgery and non-healing/recurrence of the fistula.</p><p>In conclusion, obesity, functional bowel symptoms and possibly smoking are more common in patients with idiopathic anal fistula than in the general population. Endoanal ultrasound is a useful tool in the preoperative evaluation of anal fistula. Advancement flap repair has a reasonably high primary recurrence rate and healing is not significantly improved by local application of gentamicin-collagen: impaired intraoperative blood perfusion of the flap is an unlikely reason for non-healing. A decrease in continence occurs also after this kind of surgery, probably due to an impaired internal anal sphincter function.</p>

Patients with idiopathic anal fistula (n=85) were compared with 215 control subjects, matched for age and sex, through a 180-item questionnaire. Obesity, smoking, constipation and bowel symptoms associated with IBS were more common in the patients. Endoanal ultrasound (EUS) and magnetic resonance imaging (MRI) were compared in the preoperative evaluation of anal fistula in 23 patients. For classifying the primary tract, EUS and surgical findings agreed in 14 cases, and MRI and surgery for 11: for identifying an internal opening, the corresponding figures were 17 and 10. Healing and sphincter function were studied in 42 patients operated with fistula excision and closure of the internal opening. Twenty-three patients healed primarily and another 10 after one re-operation, whereas nine required further surgery until healed. Anal resting pressure was reduced after three and 12 months, and squeeze pressure after 12 months. Eighty-three patients were randomised to surgery with or without application of gentamicin-collagen underneath the flap: 26/42 of patients randomised to gentamicin-collagen healed primarily compared with 21/41 of patients randomised to surgery only (n.s). Micro perfusion in the flap was studied by laser Doppler flowmetry during surgery in 16 patients. No correlation was seen between change in blood flow during surgery and non-healing/recurrence of the fistula. In conclusion, obesity, functional bowel symptoms and possibly smoking are more common in patients with idiopathic anal fistula than in the general population. Endoanal ultrasound is a useful tool in the preoperative evaluation of anal fistula. Advancement flap repair has a reasonably high primary recurrence rate and healing is not significantly improved by local application of gentamicin-collagen: impaired intraoperative blood perfusion of the flap is an unlikely reason for non-healing. A decrease in continence occurs also after this kind of surgery, probably due to an impaired internal anal sphincter function.

Objective Our aim was to compare two regimens of antibiotic prophylaxis at the time of repair of obstetric anal sphincter injury. Benefit of long regimen of antibiotic prophylaxis in comparison with short regimen of antibiotic administration haven't been till now proven. Material and Methods Women who gave vaginal birth in department of gynaecology and obstetrics of the First Faculty of Medicine of Charles University and Hospital Bulovka from 1.1.2008 to 30.6.2013 and who sustained third - or fourth - degree perineal tears have been enrolled in our trial. All women who fulfilled trial criteria received at the time of repair antibiotic prophylaxis which was cefuroxim (second - generation cephalosporin). This antibiotic has good sensitivity to vaginal gram-positive flora and to rectal gram-negative microorganisms too. Suture technique and following postpartum care have been standardized. All enrolled women were checked 2 weeks and 3 months after delivery. We evaluated subjective and objective parameters of healing of the obstetric perineal injury and 3 months postpartum we looked for symptomps regarding anal incontinence. The Manchester questionnaire was used for evaluation of anal incontince occurance. Results Incidence of third - and fourth - degree perineal tears was 1,4 % during period of our...

Este estudo teve por objetivo avaliar o hábito intestinal e os fatores de risco para incontinência anal (IA) em adultos da população geral, residentes na área urbana da cidade de Londrina - PR. Estudo epidemiológico de base populacional, de corte transversal, realizado após a aprovação do Comitê de Ética da Escola de Enfermagem da Universidade de São Paulo. Dois mil cento e sessenta e dois indivíduos, com idade igual ou superior a 18 anos, condições físicas e mentais adequadas e que aceitaram a participar do estudo, compuseram a amostra, estabelecida a partir de amostragem estratificada por conglomerado, constituídos pelas ruas sorteadas aleatoriamente dentro dos 390 setores censitários do município. Todos os residentes nos domicílios das ruas sorteadas, que atenderam aos critérios de inclusão foram entrevistados utilizando-se dois instrumentos: Dados demográficos e o Hábito intestinal na comunidade (adaptado e validado para a língua portuguesa por Domansky e Santos, 2007). Os dados foram submetidos aos testes de Qui-Quadrado e Exato de Fischer. O predomínio foi do sexo feminino (1203 / 56%); média etária de 40,6±16,4; brancos (1591/74%); união estável (1290 / 60%); 9 a 12 anos de estudo (784/ 36%); 37% pessoas sem ocupação definida; 44% tinham remuneração entre 2 e 3,9 SM; 38% com renda per capita entre 0,6 a 1 salário mínimo. Para o padrão intestinal normal (1.875/87%; p<,0001), predominância de uma evacuação por dia (1.133/52%; p<0,0001), entre as mulheres (968/52%; p<0,0001); os brancos (1591/85%; p<0,0001), ausência de esforço evacuatório (1956/90%), exonerações de fezes macias (1379/64%), esvaziamento retal completo (1938/90%). Padrão intestinal constipado (261/12,1%), entre mulheres (219/84%), esforço evacuatório (99/41,8%), fezes endurecidas (176/67%); esvaziamento retal incompleto (99/38%). Padrão intestinal diarréico (26/1,2%), sem esforço evacuatório (26/100%) fezes líquidas e amolecidas (5/19%), esvaziamento retal completo (16/61%). A prevalência das doenças anorretais, foi de 53 (2%) abscessos, 22 (1%) fístulas, 81 (3%) fissuras, 20(1%) prolapsos retais, 30 (1%) traumas anais; 229 (11%) doença hemorroidária, 58 (3%) cirurgias anorretais, para todas o predomínio foi feminino. O histórico de parto e ginecológico: 886 (74%) tiveram partos, 709 (73%) com padrão intestinal normal; 432 (49%) entre 31 e 50 anos; 168 (14%) tiveram um parto normal; destas 33 (3%) tiveram laceração anal pós-parto que necessitou de intervenção cirúrgica; porém mantiveram o padrão intestinal normal (25/75%); 109 (9%) fizeram histerectomia (109 /9%), 90 (90%) padrão intestinal normal e menos de um por cento tiveram retocele e quatro (50%) eram constipadas. Os fatores de risco para incontinência anal: 35 (2%) radioterapia pélvica, 133 (6%) diabetes mellitus, 330 (15%) doenças ou distúrbios do sistema nervoso, 291 (13%) lesão na coluna espinhal e 29 (1%) relataram o acidente vascular encefálico (AVE), para todos os fatores houve predomínio do padrão intestinal normal, predomínio feminino para distúrbios do sistema nervoso e AVE. Este estudo permitiu conhecer o hábito intestinal da população geral de uma cidade no norte do Paraná, os fatores de risco para IA que estão expostos, cooperando para a elucidação do tema entre a população, ampliando os conhecimentos daqueles que atuam na área, e colaborando para o desenvolvimento de programas de prevenção ou diagnóstico precoce das doenças intestinais / The objective of this study was to evaluate the bowel habits and anal incontinence (AI) risk factors in adults living in the urban area of Londrina, PR, Brazil. This population-based, transversal epidemiological study was carried out after being approved by the University of São Paulo Nursing School Ethics Committee. Population sample established from a stratified sampling procedure by a conglomerate constituted of streets taken randomly from 390 county census sectors, included 2162 individuals , 18 years old and over, in adequate physical and mental conditions, who accepted to participate in the study. All residents in the selected streets who met the inclusion criteria established by the study were interviewed, using two instruments: Demographic data and the Bowel function in the community (adapted and validated for the Portuguese language by Domansky and Santos, 2007). Data were submitted to Chi-square and Fischer exact tests. There was a predominance of female subjects (1203/56%); ages 40,6 ± 16,4; white (1591/74%); with a stable relationship (1290/60%), with 9 to 12 years of formal education ( 784/36%), subjects without a defined job (37%) with salaries around 2 to 3,9 / minimum wage (44%) and per capita income between 0,6 to one/minimum wage (38%). As for normal intestinal pattern (1.875/87%; p<0,0001), there was the predominance of one bowel movement per day (1.133/52%; p<0,0001), among women (968/52%; p<0,0001); whites (1591/85%; p<0,0001), absence of defecation strain (1956/90%), soft feces (1379/64%), total rectal emptying (1938/90%). Constipated intestinal pattern (261/12,1%), among women (219/84%), defecation strain (99/41,8%), hard feces (176/67%); incomplete rectal emptying (99/38%). Diarrheic intestinal pattern (26/1,2%), no defecation strain (26/100%) liquid and soft feces (5/19%), total rectal emptying (16/61%). Prevalence of anorectal diseases was 53 (2%) abscesses, 22 (1%) fistules, 81 (3%) fissures, 20(1%) rectal prolapse, 30 (1%) anal traumas; 229 (11%) hemorrhoidal disease 58 (3%) ; anorectal surgeries, mainly among females. Gynecological and delivery history, 886 (74%) had deliveries, 709 (73%) with normal intestinal pattern; 432 (49%) between 31 and 50 years old; 168 (14%) had normal deliveries; 33 (3%) with postpartum laceration that needed surgical intervention; however, they maintained a normal intestinal pattern (25/75%); 109 (9%) had hysterectomy (109 /9%), 90 (90%) normal intestinal pattern and less than one percent had rectocele and four (50%) were constipated. Anal incontinence risk factors, 35 (2%) pelvic radiotherapy, 133 (6%) diabetes mellitus, 330 (15%) nervous systems diseases and dysfunctions, 291 (13%) spinal cord lesion and 29 (1%) reported having had an encephalic vascular stroke. In all factors there was the predominance of the normal intestinal pattern; however, females presented more nervous system dysfunctions and encephalic vascular strokes. This study reports on the bowel habits of a general population in a city in Northern Paraná, and the AI risk factors they are exposed to, bringing more information about the topic to the population and to those who work in the area , helping develop prevention programs or early diagnoses of intestinal diseases

Objective Our aim was to compare two regimens of antibiotic prophylaxis at the time of repair of obstetric anal sphincter injury. Benefit of long regimen of antibiotic prophylaxis in comparison with short regimen of antibiotic administration haven't been till now proven. Material and Methods Women who gave vaginal birth in department of gynaecology and obstetrics of the First Faculty of Medicine of Charles University and Hospital Bulovka from 1.1.2008 to 30.6.2013 and who sustained third - or fourth - degree perineal tears have been enrolled in our trial. All women who fulfilled trial criteria received at the time of repair antibiotic prophylaxis which was cefuroxim (second - generation cephalosporin). This antibiotic has good sensitivity to vaginal gram-positive flora and to rectal gram-negative microorganisms too. Suture technique and following postpartum care have been standardized. All enrolled women were checked 2 weeks and 3 months after delivery. We evaluated subjective and objective parameters of healing of the obstetric perineal injury and 3 months postpartum we looked for symptomps regarding anal incontinence. The Manchester questionnaire was used for evaluation of anal incontince occurance. Results Incidence of third - and fourth - degree perineal tears was 1,4 % during period of our...