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Commentary on“Incidence of urinaryincontinence following endoscopic laserenucleation of the prostate by en-bloc andnon-en-bloc techniques:a multicenter,real-world experience of 5068 patients”

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Asian Journal of Andrology 2024年第3期26卷 333-334页

作者： James F Jiang Narmina K Onder Akhil K Das Department of Urology University of California Irvine Orange CA 92868 USA.

Laser enucleation of the prostate is a proven and effectivesize-independent method for the surgical management of symptomaticbenign prostatic hyperplasia(BPH)and is considered as the“goldstandard”by many clinicians.Two major hurdles that stand in theway of this becoming a universally used procedure for BPH are thesteep learning curve associated with mastering the procedure andpossibility of perioperative transient incontinence.Many advances inteaching methodologies have helped tackle the difficulty in learning itand increased the number of urologists utilizing the procedure.As forthe second hurdle,transient incontinence rates postlaser enucleationof the prostate have improved with the advent of newer techniques ofenucleation.Castellani et al.1 assesses the incidence of stress,urge,andmixed urinary incontinence following laser enucleation of the prostateby comparing en-bloc and non-en-bloc techniques in a multicenterseries of 5068 men with BPH.

关键词： urinary incontinence transient

Efficacy of Kegel exercises in preventing incontinence after partial division of internal anal sphincter during anal fistula surgery

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World Journal of Clinical Cases 2022年第20期10卷 6845-6854页

作者： Pankaj Garg Vipul D Yagnik Baljit Kaur Geetha R Menon Sushil Dawka Department of Colorectal Surgery Garg Fistula Research InstitutePanchkula 134113HaryanaIndia Department of Colorectal Surgery Indus International HospitalMohali 140507PunjabIndia Department of Surgical Gastroenterology Nishtha Surgical Hospital and Research CenterPatan 384265GujaratIndia Department of Radiology SSRD Magnetic Resonance Imaging InstituteChandigarh 160011India Department of Statistics Indian Council of Medical ResearchNew Delhi 110029India Department of Surgery SSR Medical CollegeBelle Rive 744101Mauritius

BACKGROUND The transanal opening of intersphincteric space(TROPIS)procedure,performed to treat complex anal fistulas,preserves the external anal sphincter(EAS)but involves partial incision of the internal anal sphincter(IAS).AIM To ascertain the incidence of incontinence after the division of the IAS as is done in TROPIS and to evaluate whether regular Kegel exercises(KE)in the postoperative period can prevent incontinence due to IAS division.METHODS Patients operated on for high complex fistulas and having no preoperative continence problem(score=0)were included in the study.All patients were operated on by the TROPIS procedure and were recommended KE(pelvic contraction exercises)50 times/day.KE were commenced on the 10^(th)postoperative day and continued for 1 year.incontinence was evaluated objectively(by modified Vaizey’s scores)in the immediate postoperative period(Pre-KE group)and on long-term follow-up(Post-KE group).The incontinence scores in both groups were compared to evaluate the efficacy of KE.RESULTS Of 102 anal fistula patients operated on between July 2018 and July 2020 were included in this study.There were 90 males,the mean age was 42.3±12.8,and the median follow-up was 30 mo(18-42 mo).Three patients were lost to follow-up.There were 65 recurrent fistulas,92 had multiple tracts,42 had associated abscess,46 had horseshoe fistula and 34 were supralevator fistulas.All were magnetic resonance imaging-documented high fistulas(>1/3 EAS involved).Overall incontinence occurred in 31%patients(Pre-KE group)with urge and gas incontinence accounting for the majority of cases(28.3%).The mean incontinence scores in the Pre-KE group were 1.19±1.96(in 31 patients,solid=0,liquid=7,gas=8,urge=24)and in the Post-KE group were 0.26±0.77(in 13 patients,solid=0,liquid=2,gas=3,urge=10)(P=0.00001,t-test).CONCLUSION Division of the IAS led to incontinence,mainly urge incontinence,and also to a mild degree of gas and liquid incontinence.However,regular KE led to a significant reduction in incontinence(both in the number

关键词： Anal fistula incontinence Urge Transanal opening of intersphincteric space Kegel exercises Manometry

Artificial urinary sphincter surgery in the special populations:neurological,revision,concurrent penile prosthesis and female stress urinary incontinence groups

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Asian Journal of Andrology 2020年第1期22卷 45-50页

作者： Eric Chung AndroUrology Centre BrisbaneQLD 4000Australia University of Queensland Princess Alexandra HospitalBrisbaneQLD 4000Australia Macquarie University Hospital SydneyNSW 2109Australia

The artificial urinary sphincter(AUS)remains the standard of care in men with severe stress urinary incontinence(SUI)following prostate surgery and radiation.While the current AUS provides an effective,safe,and durable treatment option,it is not without its limitations and complications,especially with regard to its utility in some“high-risk”populations.This article provides a critical review of relevant publications pertaining to AUS surgery in specific high-risk groups such as men with spinal cord injury,revision cases,concurrent penile prosthesis implant,and female SUI.The discussion of each category includes a brief review of surgical challenge and a practical action-based set of recommendations.Our increased understandings of the pathophysiology of various SUI cases coupled with effective therapeutic strategies to enhance AUS surgery continue to improve clinical outcomes of many patients with SUI.

关键词： artificial urinary sphincter female stress incontinence penile prosthesis implant revision surgery spinal cord injury urinary incontinence

An epidemiology study of fecal incontinence in adult Chinese women living in urban areas

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Chinese Medical Journal 2020年第3期133卷 262-268页

作者： Yuan Yuan Lin Qiu Zhi-Yi Li Lei Zhang Tao Xu Jing-He Lang Zhao-Ai Li Jian Gong Qing Liu Xiao-Chun Liu Jun-Tao Wang Zhi-Jun Xia Zhu Lan Department of Obstetrics and Gynecology Peking Union Medical College HospitalPeking Union Medical CollegeBeijing 100730China Department of Epidemiology and Statistics Institute of Basic Medical SciencesChinese Academy of Medical Sciences and School of Basic MedicinePeking Union Medical CollegeBeijing 100730China Department of Obstetrics and Gynecology Children’s Hospital of Shanxi Province TaiyuanShanxi 030013China Department of Obstetrics and Gynecology Maternal and Child Health Hospital of Wuxi Jiangsu 214002China Department of Obstetrics and Gynecology Maternal and Child Health Hospital of Gansu Province LanzhouGansu 730050China Department of Obstetrics and Gynecology Maternal and Child Health Hospital of Foshan Guangdong 528000China Department of Obstetrics and Gynecology Maternal and Child Health Hospital of Guiyang Guizhou 550001China Department of Obstetrics and Gynecology Shengjing Hospital of China Medical UniversityShenyangLiaoning 110004China.

Background:Fecal incontinence(FI)has been shown to be a common symptom in Western countries;however,there is few researches focusing on its epidemic condition in Chinese women.We conducted this national population-based epidemiology study to estimate the prevalence and risk factors of FI among adult Chinese women living in urban regions.Methods:This is a subgroup analysis of a national population-based epidemiology study of FI.Total 28,196 adult women from urban regions of six provinces and municipalities participated in this research from 2014 to 2015.They finished the questionnaire under the direction of trained interviewers.FI was defined as accidental leakage of flatus and/or liquid or solid stool at least once in the past.The FI prevalence trend and risk factors were identified by the Cochran-Armitage test,Chi-square test,and multivariable logistic regression.Results:The prevalence of FI in adult females in urban China was 0.43%(95%confidence interval:0.35%-0.51%).Among women with FI,42.96%,82.96%,and 42.22%reported having leakage of solid,liquid stool,and gas,respectively.The overall FI prevalence and the incidence rate of solid stool/liquid stool/gas leakage increased with age.The mean Wexner score was 4.0%and 12.0%FI patients reported Wexner score≥9.Body mass index≥24 kg/m2,pelvic organ prolapses,chronic constipation,chronic cough,alcohol consumption,physical diseases including chronic bronchitis and cancer,gynecological diseases like gynecological inflammation are risk factors for FI.Vaginal delivery was the risk factor for FI in females with labor history.Conclusions:FI was not a common symptom in adult Chinese women living in urban areas and there were some potential modifiable risk factors.

关键词： Epidemiology Fecal incontinence Prevalence Risk factor Urban area

The therapeutic effect of pelvic floor muscle exercise on urinary incontinence after radical prostatectomy:a meta-analysis

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Asian Journal of Andrology 2019年第2期21卷 170-176页

作者： Mei-Li-Yang Wu Cheng-Shuang Wang Qi Xiao Chao-Hua Peng Tie-Ying Zeng Department of Nursing Tongji HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhan 430030China School of Nursing Tongji Medical CollegeHuazhong University of Science and TechnologyWuhan 430030China

Pelvic floor muscle exercise(PFME)is the most common con servative manageme nt for urinary incon tine nee(Ul)after radical prostatectomy(RP).However,whether the PFME guided by a therapist(G-PFME)can contribute to the recovery of urinary continenee for patients after RP is still controversial.We performed this meta-analysis to investigate the effectiveness of G-PFME on Ul after RP and to explore whether the additional preoperative G-PFME is superior to postoperative G-PFME alone.Literature search was con ducted on Cochra ne Library,Embase,Web of Scie nee,and PubMed,to obtai n all re leva nt randomized controlled trials published before March 1,2018.Outcome data were pooled and an a lyzed with Review Man ager 5.3 to compare the conti nence rates of G-PFME with control and to compare additional preoperative G-PFME with postoperative G-PFME.Twenty-two articles with 2647 patients were included.The conti nence rates of G?PFME were all superior to con trol at d iff ere nt follow-up time points,with the odds ratio(OR)(95%confidence interval[Cl])of 2.79(1.53-5.07),2.80(1.87-4.19),2.93(1.19-7.22),4.11(2.24-7.55),and 2.41(1.33-4.36)at 1 mon th,3 months,4 months,6 months,and 12 months after surgery,respectively.However,there was no difference between additional preoperative G-PFME and postoperative G-PFME,with the OR(95%Cl)of 1.70(0.56-5.11)and 1.35(0.41-4.40)at 1 month and 3 months after RP,respectively.G-PFME could improve the recovery of urinary continence at both early and Iong-term stages.Starting the PFME preoperatively might not produce extra benefits for patients at early stage,compared with postoperative PFME.

关键词： continence rate pelvic floor muscle exercise radical prostatectomy urinary incontinence

Diagnostic approach to faecal incontinence:What test and when to perform?

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World Journal of Gastroenterology 2021年第15期27卷 1553-1562页

作者： Wisam Sbeit Tawfik Khoury Amir Mari Department of Gastroenterology Galilee Medical CenterNaharia 2210001Faculty of Medicine in the GalileeBar-Ilan UniversitySafedIsrael Gastroenterology and Endoscopy Unit The Nazareth HospitalEMMSNazareth 464000Faculty of Medicine in the GalileeBar-Ilan UniversitySafedIsrael

Faecal incontinence(FI)is a debilitating common end result of several diseases affecting the quality of life and leading to patient disability,morbidity,and increased societal burden.Given the various causes of FI,it is important to assess and identify the underlying pathomechanisms.Several investigatory tools are available including high-resolution anorectal manometry,transrectal ultrasound,magnetic resonance imaging,and electromyography.This review article provides an overview on the causes and pathophysiology of FI and the author’s perspective of the stepwise investigation of patients with FI based on the available literature.Overall,high-resolution anorectal manometry should be the first investigatory tool for FI,followed by either transrectal ultrasound or magnetic resonance imaging for anal internal sphincter and external anal sphincter injury,respectively.

关键词： incontinence Manometry Ultrasound Rectal Magnetic resonance imaging Faecal

Stem cell therapy for faecal incontinence: Current state and future perspectives

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World Journal of Stem Cells 2018年第7期10卷 82-105页

作者： Jacobo Trébol Ana Carabias-Orgaz Mariano García-Arranz Damián García-Olmo General and Digestive Tract Surgery Department Salamanca University Healthcare Centre Anaesthesiology Department Complejo Asistencial de ávila New Therapies Laboratory Instituto de Investigación Sanitaria-Fundación Jiménez Díaz General and Digestive Tract Surgery Department Quiron-Salud Hospitals Surgery Department Universidad AutónomaMadrid

Faecal continence is a complex function involving different organs and systems. Faecal incontinence is a common disorder with different pathogeneses, disabling consequences and high repercussions for quality of life. Current management modalities are not ideal, and the development of new treatments is needed. Since 2008, stem cell therapies have been validated, 36 publications have appeared(29 in preclinical models and seven in clinical settings), and six registered clinical trials are currently ongoing. Some publications have combined stem cells with bioengineering technologies. The aim of this review is to identify and summarise the existing published knowledge of stem cell utilization as a treatment for faecal incontinence. A narrative or descriptive review is presented. Preclinical studies have demonstrated that cellular therapy, mainly in the form of local injections of muscle-derived(muscle derived stem cells or myoblasts derived from them) or mesenchymal(bone-marrow-or adipose-derived) stem cells, is safe. Cellular therapy has also been shown to stimulate the repair of both acute and subacute anal sphincter injuries, and some encouraging functional results have been obtained. Stem cells combined with normal cells on bioengineered scaffolds have achieved the successful creation and implantation of intrinsically-innervated anal sphincter constructs. The clinical evidence, based on adipose-derived stem cells and myoblasts, is extremely limited yet has yielded some promising results, and appears to be safe. Further investigation in both animal models and clinical settings is necessary to drawing conclusions. Nevertheless, if the preliminary results are confirmed, stem cell therapy for faecal incontinence may well become a clinical reality in the near future.

关键词： Faecal incontinence Anal sphincter Cell implantation Tissue engineering Cell therapy Stem cells

Prevalence and Risk Factors of Stress Urinary incontinence Among Perimenopausal Women and Its Influence on Daily Life in Women with Sexual Desire Problem

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Current Medical Science 2019年第4期39卷 615-621页

作者： Tao LI Ya-jun ZHANG Hong-ling ZHANG Xue-hui DING Zi-jie YU Shi LU Department of Obstetrics and Gynecology Union HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhan 430022China Department of Obstetrics and Gynecology Xiangyang Central HospitalAffiliated Hospital of Hubei University of Arts and ScienceXiangyang 441000China College of Health Science and Nursing Wuhan Polytechnic UniversityWuhan 430023China Department of Obstetrics and Gynecology Central Hospital of Hefeng CountyEnshi 445000China

The prevalence of,and related factors to,stress urinary incontinence (SUI) among perimenopausal Chinese women and its impact on daily life among those women with sexual desire problem in Hubei province were investigated.In this study,1519 perimenopausal women aged 40 to 65 years were selected from three urban communities in the Wuhan area,and two impoverished,mountainous communities in Hubei province,and followed from April to October 2014.Detailed information about demographic characteristics,menstruation,pregnancy,sexual life and chronic diseases was collected.A cross-sectional survey was carried out following information collection by Chi-square test and multiple logistic regression analysis.Univariate and multivariate logistic regression analysis demonstrated that the potential factors associated with developing SUI were old age (OR=3.4,95% CI:1.92-6.04),vaginal delivery (OR=0.623,95% CI:0.45-0.87),low income (OR=0.063,95% CI:0.40-0.92),atrophic vaginitis (OR=1.4,95% CI:1.03-1.80),pelvic organ prolapse (OR=2.81,95% CI:1.36-5.80),chronic pelvic pain (OR=2.17,95% CI:1.90-4.03),constipation (OR=1.44,95% CI:1.07-1.93) and incontinence of feces (OR=3.32,95% CI:2.03-5.43).Moreover,the ratio of SUI (33.2%) was higher than the ratio of urgency urinary incontinence (24.1 %) or the ratio of mixed urinary incontinence (17.4%),and SUI had a greater impact on daily life among women with decreased sexual desire.In conclusion,SUI is a common disorder affecting over one third of the women surveyed,and has a severe impact on the daily life of perimenopausal women with declined sexual desire.Age,mode of delivery,and monthly income are major risk factors involved in the development of SUI.

关键词： stress urinary incontinence perimenopause risk factors sexual desire

Comment on“Diagnostic approach to faecal incontinence:What test and when to perform?”

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World Journal of Gastroenterology 2021年第33期27卷 5622-5624页

作者： Jiang-Tao Wang Yan-Dong Miao Quan-Lin Guan The First Clinical Medical College of Lanzhou University Lanzhou UniversityLanzhou 730000Gansu ProvinceChina Department of Oncology The First Hospital of Lanzhou UniversityLanzhou UniversityLanzhou 730000Gansu ProvinceChina

We recently read with interest the article"Diagnostic approach to faecal incontinence:What test and when to perform?".This is a comprehensive and practical review,which has particular significance for guiding clinicians to improve the examination strategy.Although we appreciate their work very much,based on the in-depth analysis of this research,we found some detailed problems in the article and will give our comments in this letter.If the author can further improve the relevant research,it will be valuable.

关键词： Faecal incontinence Manometry Diagnostic Pathophysiology Tools