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Keywords = anorectal function

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11 pages, 194 KB  
Article
Long-Term Bowel and Urinary Function Outcomes and Quality of Life in Patients with Anorectal Malformations: 20 Years of Experience
by Fabio Baldanza, Francesco Grasso, Marco Pensabene, Maria Sergio and Maria Rita Di Pace
Children 2025, 12(8), 1042; https://doi.org/10.3390/children12081042 - 8 Aug 2025
Viewed by 650
Abstract
Background: Anorectal malformations (ARMs) are rare congenital anomalies requiring surgical correction and long-term multidisciplinary care. Despite advances in surgical techniques like posterior sagittal anorectoplasty (PSARP), patients often experience ongoing issues with bowel and urinary function and psychosocial well-being. Aim: To evaluate the long-term [...] Read more.
Background: Anorectal malformations (ARMs) are rare congenital anomalies requiring surgical correction and long-term multidisciplinary care. Despite advances in surgical techniques like posterior sagittal anorectoplasty (PSARP), patients often experience ongoing issues with bowel and urinary function and psychosocial well-being. Aim: To evaluate the long-term outcomes of bowel function, urinary function, and quality of life in patients born with anorectal malformation and treated at our center. Methods: A cross-sectional study evaluated 55 ARM patients treated at the University Hospital of Palermo between 2002 and 2020. Data on clinical characteristics, surgical management, bowel and urinary function, and quality of life were collected using the following validated tools: Rintala Bowel Function Score, PedsQL Family Impact Module, Fecal Incontinence Quality of Life Score, and Lower Urinary Tract Symptoms Questionnaire. Statistical analysis was performed using Fisher’s exact test and ANOVA. Results: Excellent bowel function was observed in 44% of patients, particularly those with low-type ARMs. A bowel management program (BMP) was required in 62% of cases, though 44% of these patients, especially adolescents, showed poor adherence. BMP non-adherence significantly correlated with lower quality of life and worse bowel function (p < 0.01). Bladder dysfunction was noted in 24% of patients, mainly younger ones. Conclusions: Tailored BMPs and transition care are important for long-term success in ARM patients. Adherence to BMPs improves continence and quality of life, highlighting the need for continuous, multidisciplinary follow-up from childhood into adulthood. Full article
(This article belongs to the Special Issue Bowel Management in Paediatric Colorectal Disease)
12 pages, 2890 KB  
Review
Home Biofeedback Training for Pelvic Floor Disorders: Is There Hope for Hopeless Patients?
by Marek Vojtko, Peter Banovcin, Martin Duricek, Jakub Hoferica and Peter Liptak
Gastrointest. Disord. 2025, 7(2), 35; https://doi.org/10.3390/gidisord7020035 - 19 May 2025
Viewed by 3892
Abstract
The most common anorectal disorders are fecal incontinence, functional anorectal pain, and functional defecation disorders. They are often presented by overlapping symptoms with various degrees of severity. Therefore, a personalized approach to the patient is crucial for diagnosing and determining the prognosis of [...] Read more.
The most common anorectal disorders are fecal incontinence, functional anorectal pain, and functional defecation disorders. They are often presented by overlapping symptoms with various degrees of severity. Therefore, a personalized approach to the patient is crucial for diagnosing and determining the prognosis of the disease. Biofeedback training is appropriate to consider when the motoric function disorder is known, the patient could learn voluntary control of response, and this could further lead to an improvement in the condition. Biofeedback is recommended for short-term and long-term treatment of constipation in adults and fecal incontinence in adults. It could also be considered for treatment of specific cases of anorectal pain. As office biofeedback is often time-consuming and comes with a substantially high cost, there is an emerging trend of home biofeedback administration. However, only a few significant studies have been published on this new approach. Although comprehensive data are needed to evaluate the proper strategy and development of various treatment protocols for different types of defecation disorders, home biofeedback therapy offers a potentially effective tool in the personalized treatment of defecation disorders. Full article
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10 pages, 2740 KB  
Article
Manometric Evaluation of the Sphincter Complex in Anterior Anus and Mild Anorectal Malformations—An Important Diagnostic Tool
by Jonathan Hencke, Raphael Staubach and Steffan Loff
Diagnostics 2025, 15(9), 1078; https://doi.org/10.3390/diagnostics15091078 - 24 Apr 2025
Viewed by 758
Abstract
Background: Distinguishing between the anatomical variant of an anterior anus and mild forms of imperforate anus with rectoperineal fistula often requires inspection, calibration, and, in uncertain cases, electrical stimulation (ES) under general anesthesia. Anorectal manometry (AM), despite its ability to assess sphincter configuration [...] Read more.
Background: Distinguishing between the anatomical variant of an anterior anus and mild forms of imperforate anus with rectoperineal fistula often requires inspection, calibration, and, in uncertain cases, electrical stimulation (ES) under general anesthesia. Anorectal manometry (AM), despite its ability to assess sphincter configuration and function, is rarely reported as a diagnostic tool. This study evaluated the utility of AM in such cases. Methods: A retrospective analysis of AM and clinical data from 38 patients (35 female, 3 male) with suspected anterior anus was conducted from October 2009 to September 2021. Water-perfused catheter probes with eight radial channels were used to perform pull-through maneuvers. Sphincter locations were identified through vector reconstruction, and pressure ratios of the anterior part to the circumference were recorded. Results were compared to clinical data, including ES findings. Statistical significance was assessed using Mann–Whitney U and Chi-Square tests. Results: Following AM, ES was unnecessary in 25 patients. Of the remaining patients, 83% showed abnormal sphincter configurations on ES, and seven underwent anoplasty. Patients with abnormal sphincter complexes demonstrated significantly lower mean anterior pressures (61.2 mmHg vs. 136.4 mmHg, U = 336.5, p = 0.001) and a trend toward lower anterior-to-circumferential pressure ratios (mean 0.42 vs. 0.85, U = 613, p = 0.270). Constipation was also more frequent in this group (X2(1,N = 38) = 4.1, p = 0.044). Average anterior pressures < 75 mmHg and ratios < 0.7 indicated an anus outside the sphincter complex (sensitivity 80%, specificity 90%). Conclusions: AM proves valuable for evaluating ambiguous anterior anus cases, potentially reducing reliance on ES under general anesthesia. 3D high-resolution AM may further increase diagnostic accuracy. Full article
(This article belongs to the Special Issue Advances in the Diagnosis and Management of Pediatric Diseases)
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7 pages, 168 KB  
Article
Clinical Utility of Anorectal Manometry in Children with Functional Constipation: Can Anorectal Manometry Help Predict the Therapeutic Response?
by Dhiren Patel, Courtney Decker and Leonel Rodriguez
Children 2025, 12(4), 512; https://doi.org/10.3390/children12040512 - 16 Apr 2025
Viewed by 768
Abstract
Background: Anorectal Manometry (ARM) plays a crucial role in diagnosing potential motility disorders of anorectum in pediatric gastroenterology. Despite its prevalence, the predictive utility of ARM in guiding therapeutic response remains poorly characterized. Objectives: This study aims to evaluate the effectiveness [...] Read more.
Background: Anorectal Manometry (ARM) plays a crucial role in diagnosing potential motility disorders of anorectum in pediatric gastroenterology. Despite its prevalence, the predictive utility of ARM in guiding therapeutic response remains poorly characterized. Objectives: This study aims to evaluate the effectiveness of ARM in predicting therapeutic responses among children with functional constipation. Methods: A retrospective chart review was conducted at two tertiary centers examining pediatric patients who underwent ARM between January 2018 and July 2022. Key ARM parameters were analyzed, including anal resting pressure, recto-anal inhibitory reflex (RAIR), first rectal sensation, and bear-down maneuver (BDM). Therapeutic responses were assessed post-ARM, with success defined as an increase in bowel movement frequency and/or a decrease in fecal incontinence. In addition, we also intended to evaluate the eventual need for surgical intervention as another outcome. Results: The study included 327 patients, with a median age of 8.2 years. The overall therapeutic response rate was 40.7%, with stimulant laxatives showing a 48% response. Notably, lower anal resting pressures and delayed rectal sensations were associated with better therapeutic outcomes. Abnormal BDM correlated with a lack of response to therapies, while the presence of abnormal RAIR was linked to a higher eventual need for surgical intervention. Conclusions: ARM is instrumental in predicting therapeutic responses in pediatric patients with functional constipation. In addition to diagnosing HD, ARM could be an instrumental tool in identifying patients with dyssynergic defecation for early intervention with targeted therapy in age-appropriate patients. Full article
(This article belongs to the Section Pediatric Gastroenterology and Nutrition)
17 pages, 2189 KB  
Article
Utilisation of Deep Neural Networks for Estimation of Cajal Cells in the Anal Canal Wall of Patients with Advanced Haemorrhoidal Disease Treated by LigaSure Surgery
by Inese Fišere, Edgars Edelmers, Šimons Svirskis and Valērija Groma
Cells 2025, 14(7), 550; https://doi.org/10.3390/cells14070550 - 5 Apr 2025
Viewed by 780
Abstract
Interstitial cells of Cajal (ICCs) play a key role in gastrointestinal smooth muscle contractions, but their relationship with anal canal function in advanced haemorrhoidal disease (HD) remains poorly understood. This study uses deep neural network (DNN) models to estimate ICC presence and quantity [...] Read more.
Interstitial cells of Cajal (ICCs) play a key role in gastrointestinal smooth muscle contractions, but their relationship with anal canal function in advanced haemorrhoidal disease (HD) remains poorly understood. This study uses deep neural network (DNN) models to estimate ICC presence and quantity in anal canal tissues affected by HD. Haemorrhoidectomy specimens were collected from patients undergoing surgery with the LigaSure device. A YOLOv11-based machine learning model, trained on 376 immunohistochemical images, automated ICC detection using the CD117 marker, achieving a mean average precision (mAP50) of 92%, with a recall of 86% and precision of 88%. The DNN model accurately identified ICCs in whole-slide images, revealing that one-third of grade III HD patients and 60% of grade IV HD patients had a high ICC density. Preoperatively, pain was reported in 35% of grade III HD patients and 41% of grade IV patients, with a significant reduction following surgery. A significant decrease in bleeding (p < 0.0001) was also noted postoperatively. Notably, patients with postoperative bleeding, diagnosed with stage IV HD, had high ICC density in their anorectal tissues (p = 0.0041), suggesting a potential link between ICC density and HD severity. This AI-driven model, alongside clinical data, may enhance outcome prediction and provide insights into HD pathophysiology. Full article
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14 pages, 604 KB  
Review
From Diversion to Permanence: Trends in Ostomy Creation in Rectal Cancer Surgery
by Alice Jo and Matthew Z. Wilson
J. Clin. Med. 2025, 14(6), 1913; https://doi.org/10.3390/jcm14061913 - 12 Mar 2025
Viewed by 2480
Abstract
Rectal cancer surgery has undergone transformative advancements over the past few decades, evolving from radical, high-morbidity procedures to more refined techniques focused on both oncological outcomes and the preservation of anorectal function. This review provides a brief overview of the history of rectal [...] Read more.
Rectal cancer surgery has undergone transformative advancements over the past few decades, evolving from radical, high-morbidity procedures to more refined techniques focused on both oncological outcomes and the preservation of anorectal function. This review provides a brief overview of the history of rectal cancer surgery, highlighting key innovations in imaging, neoadjuvant therapy, and minimally invasive techniques that have significantly reduced the need for permanent and temporary ostomies. Additionally, the current indications for both permanent and temporary ostomies are reviewed, including a discussion of associated complications, such as non-reversal, parastomal hernias, stomal prolapse, stenosis, and skin-related issues, along with strategies and techniques to mitigate these complications. This review underscores the importance of ongoing innovation and individualized surgical planning to enhance patient outcomes in rectal cancer care by understanding the historical context, contemporary practices, and associated challenges. Full article
(This article belongs to the Special Issue Personalized Treatment Modalities for Rectal Cancer)
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23 pages, 5532 KB  
Article
Characterization of Leptin and Leptin Receptor Gene in the Siberian Sturgeon (Acipenser baerii): Molecular Cloning, Tissue Distribution, and Its Involvement in Feeding Regulation
by Hongwei Wu, Jiamei Li, Kezhen Jiang, Yingzi Li, Zhaoxiong Yu, Bin Wang, Bo Zhou, Xin Zhang, Ni Tang and Zhiqiong Li
Int. J. Mol. Sci. 2025, 26(5), 1968; https://doi.org/10.3390/ijms26051968 - 25 Feb 2025
Viewed by 1011
Abstract
Leptin is an adipokine known as a regulator of feeding and metabolism in mammals. Previous studies on fish have revealed its role in food intake regulation in limited teleosts. However, its specific function in Siberian sturgeon, an ancient Chondrostei fish, remains poorly understood. [...] Read more.
Leptin is an adipokine known as a regulator of feeding and metabolism in mammals. Previous studies on fish have revealed its role in food intake regulation in limited teleosts. However, its specific function in Siberian sturgeon, an ancient Chondrostei fish, remains poorly understood. This study represents the first successful cloning of sequences for leptin and leptin receptors in Siberian sturgeon, achieved using RT-PCR. The predicted leptin sequence in this species consists of 168 amino acids that exhibit low identity with other fish species, except within the Acipenseriformes order. Tissue distribution analysis revealed a high expression of Siberian sturgeon leptin mRNA in the liver and lepr mRNA in the hypothalamus. Fasting differentially affected the expression of leptin and lepr mRNA, with decreased levels in the hypothalamus and increased levels in the liver (leptin: 3–15 days; lepr: 6–15 days). Recombinant Siberian sturgeon leptin (Ssleptin) was produced via E. coli expression, and intraperitoneal injection (100 ng/g BW) significantly inhibited food intake. The anorectic effect was correlated with changes in hypothalamic gene expression, including downregulation of orexigenic factors (agrp, orexin, npy, and ghrelin) and upregulation of anorexigenic factors (pomc, mch, and insulin). Meanwhile, the peripheral administration of Ssleptin promoted the expression of resistin in the liver and concurrently increased cck and pyy mRNA levels in the valvular intestine. Furthermore, Ssleptin injection stimulated the expression of hypothalamic lepr, jak2, akt, and ampkα2 mRNA. These findings suggest that leptin plays a significant role in the feeding control of Siberian sturgeon and provide new insights into the evolutionary function of leptin in fish. Full article
(This article belongs to the Special Issue Fish Nutrition, Metabolism and Physiology)
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10 pages, 843 KB  
Article
Analysis of Risk Factors for Anorectal Malformations Combined with Tethered Cord Syndrome and the Impact of Untethering Surgery on Anorectal Function in Related Children: Preliminary Results from a Single-Center Study
by Tao-Tao Zhang, Yan-Bing Huang, Yu-Yan He, Fan Chen, Jian-Bin Ying, Shou-Qing Sun, Qing-Shuang Zhao and Jun-Jie Jing
Children 2024, 11(12), 1504; https://doi.org/10.3390/children11121504 - 10 Dec 2024
Viewed by 1615
Abstract
Background: Anorectal malformations (ARMs) are often associated with tethered cord syndrome (TCS). This study focused on children with ARM to explore the risk factors for the co-occurrence of TCS and to investigate the impact of untethering surgery on anorectal function among these children. [...] Read more.
Background: Anorectal malformations (ARMs) are often associated with tethered cord syndrome (TCS). This study focused on children with ARM to explore the risk factors for the co-occurrence of TCS and to investigate the impact of untethering surgery on anorectal function among these children. Methods: A retrospective analysis was conducted on 130 children with ARM treated at Fujian Provincial Children’s Hospital (Fujian Hospital of Shanghai Children’s Medical Center) from May 2021 to January 2024. A total of 114 children were included in the study on the basis of the inclusion and exclusion criteria. The patients were divided into two groups according to the presence of TCS: the ARM group (n = 83) and the ARM+TCS group (n = 31). to explore the risk factors for the co-occurrence of ARM and TCS. All children diagnosed with TCS underwent untethering surgery regardless of symptoms. Anorectal function was compared between the ARM and ARM+TCS groups. Results: In the multivariate analysis, intermediate or high-type ARM increased the risk of children with ARM having TCS, with an OR of 3.572, 95% CI from 1.355 to 9.418, and p = 0.010. Additionally, the presence of other malformations also increased the risk of children with ARM having TCS (p = 0.026). When the ARM+TCS group was compared with the ARM group, children with low-type ARM in the ARM+TCS group exhibited a significant improvement in constipation following untethering surgery (p = 0.043). However, when children with intermediate or high-type ARM were compared, the anorectal function of the children in both groups was comparable. Conclusions: Intermediate or high-type ARM and the presence of other malformations are risk factors for the co-occurrence of TCS in children with ARM. In children with low-type ARM, those with TCS and ARM showed significant improvement in constipation after untethering surgery compared with those with ARM without TCS. We recommend that children with relevant conditions actively undergo untethering surgery. Full article
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10 pages, 578 KB  
Article
Sarcopenia in Women with Anorectal Dysfunctions—A Female Sarcopelvic Study
by Ana Margarida Duarte da Silva Vieira, Sandra Pais, Viviana Martins, Barbara Castelo and Miguel Mascarenhas Saraiva
J. Clin. Med. 2024, 13(23), 7273; https://doi.org/10.3390/jcm13237273 - 29 Nov 2024
Cited by 1 | Viewed by 969
Abstract
Background: Anorectal dysfunctions (ARDs) include fecal incontinence (FI) and functional defecation disorders (FDDs). The pelvic floor muscles play a central role in the physiology of continence and defecation. We aimed to investigate the prevalence of sarcopenia in a female group with anorectal dysfunctions [...] Read more.
Background: Anorectal dysfunctions (ARDs) include fecal incontinence (FI) and functional defecation disorders (FDDs). The pelvic floor muscles play a central role in the physiology of continence and defecation. We aimed to investigate the prevalence of sarcopenia in a female group with anorectal dysfunctions and compare them with a healthy female age-matched group. As secondary objectives, the relationship between anorectal dysfunction outcomes and sarcopenia was analyzed. Methods: We conducted a single-center cross-sectional, interventional, controlled, and double-blind study involving female adults admitted to an ARD outpatient clinic assessed for FI and/or FDD. A control group was also included of age-matched women without ARD. Sarcopenia was evaluated in the entire cohort, according to the latest criteria. Statistical analysis was performed using SPSS software v.29, considering a confidence interval of 95%. Results: A total of 130 participants were included, equally divided by the two groups. The median age was 64 years. Both groups were also similar regarding body mass index (BMI), physical activity index values, and dietary patterns. Among the 130 investigated women, there were no cases of confirmed sarcopenia or severe sarcopenia, but 15 women (11.5%) had probable sarcopenia or dynapenia. The case group had significantly more probable sarcopenia than women in the control group (14 (21.5%) vs. 1 (1.5%), p < 0.001). The presence of relevant comorbidities, such as irritable bowel syndrome (IBS), urinary incontinence (UI), and meat dietary pattern (MDP), was a risk factor for probable sarcopenia. The binomial logistic regression analysis showed that probable sarcopenia (OR 3.9; CI 1.1–14.1, p = 0.039) was associated with a worse treatment response. Conclusions: Probable sarcopenia or dynapenia was significantly more prevalent in women with ARD and was a predictive factor of a worse treatment response, regardless of the ARD severity. Concomitant UI, MDP, IBS, and psychiatric conditions were significantly associated with dynapenia. The inclusion of the evaluation of sarcopenia in these patients should be considered. Full article
(This article belongs to the Section Obstetrics & Gynecology)
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16 pages, 1795 KB  
Article
Functional Assessment of Anal Sphincter with Transperineal Ultrasound and Its Relationship to Anal Continence
by Yaman Degirmenci, Joscha Steetskamp, Roxana Schwab, Annette Hasenburg, Markus Schepers, Ina Shehaj and Christine Skala
Diagnostics 2024, 14(23), 2614; https://doi.org/10.3390/diagnostics14232614 - 21 Nov 2024
Cited by 1 | Viewed by 1267
Abstract
Background/Objectives: Anal incontinence is linked to pelvic floor dysfunction. Diagnosis involves assessing both the function and structure of the anorectal unit. Although transperineal ultrasound has gained attention as a less invasive option, its effectiveness as a diagnostic tool for evaluating the relationship between [...] Read more.
Background/Objectives: Anal incontinence is linked to pelvic floor dysfunction. Diagnosis involves assessing both the function and structure of the anorectal unit. Although transperineal ultrasound has gained attention as a less invasive option, its effectiveness as a diagnostic tool for evaluating the relationship between structure and function is still debated. This study aimed to explore the relationship between quantitative measurements of anal sphincter and pelvic floor structures as well as the subjective symptoms and objective assessments of sphincter function regarding anal incontinence. Methods: 50 women with pelvic floor dysfunction were recruited for the study. The severity of anal incontinence was assessed using the CACP score. Ultrasound imaging was employed to measure anal sphincter area, while sphincter pressures were evaluated through manometry. The relationships between variables were analyzed using Pearson’s and Spearman’s correlation tests. Results: The mean anal sphincter area was 5.51 cm2 at rest and 4.06 cm2 during maximal contraction. Resting anal sphincter pressure had an average of 46.29 mmHg, and contraction pressure averaged 103.25 mmHg. No significant correlation was found between the anal sphincter area and pressure at rest (r = 0.018) or during contraction (r = −0.210). However, a moderate correlation was observed between the change in sphincter pressure and area during contraction (r = 0.312). The CACP score showed no significant correlation with the sphincter area at rest (r = −0.084) but was weakly correlated during contraction (r = −0.270). Conclusions: Conventional diagnostic tools for evaluating anal incontinence can be uncomfortable and are not always readily available. Perineal sonography presents a promising, less invasive alternative for dynamic assessment of the anal sphincter. Full article
(This article belongs to the Special Issue Current Challenges and Perspectives of Ultrasound, 2nd Edition)
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19 pages, 4560 KB  
Review
Is Collaborative Care the Future of Medicine? Lessons Learned from the Care of Children with Colorectal Conditions
by Julie M. Choueiki, Stephen Sales, Susan Callicott, David Ashman, Katherine Worst, Andrea Badillo, Briony K. Varda, Allison Mayhew, Thomas O. Xu and Marc A. Levitt
Children 2024, 11(5), 570; https://doi.org/10.3390/children11050570 - 9 May 2024
Cited by 3 | Viewed by 1931
Abstract
The treatment of patients with colorectal disorders requires care from a wide variety of medical and surgical specialties over the course of their lifetime. This is ideally handled by a collaborative center which facilitates the assessment and development of patient care among multiple [...] Read more.
The treatment of patients with colorectal disorders requires care from a wide variety of medical and surgical specialties over the course of their lifetime. This is ideally handled by a collaborative center which facilitates the assessment and development of patient care among multiple specialties which can enhance the quality and implementation of treatment plans, improve communication among different specialties, decrease morbidity, and improve patient satisfaction and outcomes. This collaborative approach can serve as a model for other parts of medicine requiring a similar multi-disciplinary and integrated method of care delivery. We describe the process, as well as the lessons learned in developing such a program. Full article
(This article belongs to the Special Issue Recent Advances in Pediatric Colorectal Surgery)
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14 pages, 213 KB  
Article
“Take It One Dilation at a Time”: Caregiver Perspectives of Postoperative Anal Dilations in Pediatric Patients with Colorectal Conditions
by Lea A. Wehrli, Merlin Ariefdjohan, Jill Ketzer, Kristina Matkins, Luis De la Torre, Andrea Bischoff and Laura Judd-Glossy
Behav. Sci. 2024, 14(5), 379; https://doi.org/10.3390/bs14050379 - 30 Apr 2024
Cited by 2 | Viewed by 1632
Abstract
Background: Postoperative anal dilations (PAD) are the standard of care for patients after a posterior sagittal anorectoplasty (PSARP) for anorectal malformation (ARM) or a transanal pull-through (TP) procedure for Hirschsprung disease (HD). This study assessed the psychosocial impact of PAD among caregivers of [...] Read more.
Background: Postoperative anal dilations (PAD) are the standard of care for patients after a posterior sagittal anorectoplasty (PSARP) for anorectal malformation (ARM) or a transanal pull-through (TP) procedure for Hirschsprung disease (HD). This study assessed the psychosocial impact of PAD among caregivers of children with ARM or HD, which may inform postoperative care strategies. Methods: Caregivers of patients with ARM and HD who underwent PSARP or TP within five years participated in the online survey. Questions included demographics, patient and caregiver experiences with PAD, and baseline psychosocial functioning. Quantitative results were reported descriptively, while qualitative responses were summarized as major themes. Results: The survey indicated a response rate of 26% caregivers, with most being female (91%) and biological mothers (85%). Patients were mostly male (65%), born with ARM (74%), and were five months old on average when PAD began. Caregivers reported that during PAD, children experienced distress (56%), pain (44%), and fear (41%), while a third noted no negative reactions. Over time, their child’s ability to cope with PAD got easier (38%) or stayed the same (41%). Caregivers reported worry/anxiety (88%), guilt (71%), stress (62%), and frustration (35%), noting that additional coping strategies to manage the emotional and logistical challenges of daily PAD would be helpful. Conclusion: Although PAD is necessary, it can be highly stressful for the patients and their caregivers. Key findings emphasized the need for additional coping strategies and highlighted the importance of integrating psychosocial support into the postoperative care regimen. Full article
(This article belongs to the Section Child and Adolescent Psychiatry)
14 pages, 7158 KB  
Article
Design and Material Characterization of an Inflatable Vaginal Dilator
by Po-Han Chen, Yu Ming Li, Karcher Morris, Milan T. Makale, Jyoti Mayadev and Frank E. Talke
Materials 2024, 17(5), 1050; https://doi.org/10.3390/ma17051050 - 24 Feb 2024
Cited by 1 | Viewed by 2866
Abstract
There are more than 13,000 new cases of cervical cancer each year in the United States and approximately 245,000 survivors. External beam radiation and brachytherapy are the front-line treatment modalities, and 60% of patients develop vaginal damage and constriction, i.e., stenosis of the [...] Read more.
There are more than 13,000 new cases of cervical cancer each year in the United States and approximately 245,000 survivors. External beam radiation and brachytherapy are the front-line treatment modalities, and 60% of patients develop vaginal damage and constriction, i.e., stenosis of the vaginal vault, greatly impeding sexual function. The incidence of vaginal stenosis (VS) following radiotherapy (RT) for anorectal cancer is 80%. VS causes serious quality of life (QoL) and psychological issues, and while standard treatment using self-administered plastic dilators is effective, acceptance and compliance are often insufficient. Based on published patient preferences, we have pursued the design of a soft inflatable dilator for treating radiotherapy-induced vaginal stenosis (VS). The critical component of the novel device is the dilator balloon wall material, which must be compliant yet able to exert therapeutic lateral force levels. We selected a commercially available silicone elastomer and characterized its stress–strain characteristics and hyperelastic properties. These parameters were quantified using uniaxial tensile testing and digital image correlation (DIC). Dilator inflation versus internal pressure was modeled and experimentally validated in order to characterize design parameters, particularly the dilator wall thickness. Our data suggest that an inflatable silicone elastomer-based vaginal dilator warrants further development in the context of a commercially available, well-tolerated, and effective device for the graded, controlled clinical management of radiotherapy-induced VS. Full article
(This article belongs to the Special Issue Advances in Biomaterials: Synthesis, Characteristics and Applications)
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12 pages, 2297 KB  
Article
Rectal Sensory and Compliance Testing: A Method Comparison Study between High-Resolution Anorectal Manometry and Barostat Investigations
by Lucian Marinica Grando, Jonas Halfvarson and Michiel van Nieuwenhoven
Diagnostics 2024, 14(4), 351; https://doi.org/10.3390/diagnostics14040351 - 6 Feb 2024
Viewed by 2254
Abstract
Abnormal visceral perception and motor function are often observed in patients with fecal incontinence, evacuation disorders and irritable bowel syndrome. The international anorectal physiology working group has proposed a standardization for anorectal function assessment, where rectal sensitivity testing is performed using an elastic [...] Read more.
Abnormal visceral perception and motor function are often observed in patients with fecal incontinence, evacuation disorders and irritable bowel syndrome. The international anorectal physiology working group has proposed a standardization for anorectal function assessment, where rectal sensitivity testing is performed using an elastic balloon attached to a high-resolution anorectal manometry (HRAM) catheter. Rectal compliance, another component of rectal function evaluation, is a pressure–volume relationship that refers to the rectum’s ability to stretch and expand as it receives and holds fecal matter. There are no data available regarding the possibility of compliance testing using HRAM, although this is theoretically possible by correcting for the elastic balloon’s intrinsic properties. The gold standard for measurement of visceral sensitivity and compliance is the rectal barostat, according to the procedure described by the European COST action GENIEUR group. Data on the agreement between the two different procedures are scarce. Hence, we performed a comparative study of the HRAM and barostat investigations in 26 healthy individuals. We hypothesized that by inflating the balloon before the examination, rectal compliance can be measured with HRAM investigations, and we examined correlations and levels of agreement between the methods. Our results demonstrate that assessing rectal compliance with HRAM is technically possible; however, a strong correlation with the rectal barostat was only observed at the maximum tolerable volume (Spearman’s rho = 0.7, p = 0.02). We only found moderate correlations (Spearman’s rho = 0.562, p = 0.019) for compliance according to the barostat methodology and for rectal sensibility testing (Spearman’s rho = 0.57, p = 0.03 for maximum tolerable volume). Bland–Altman plots showed poor levels of agreement between the methods. We conclude that HRAM and the rectal barostat cannot be used interchangeably for compliance or sensitivity assessments. We suggest the development of a non-elastic balloon with a fixed size and shape to assess rectal sensory function and compliance in HRAM testing. Full article
(This article belongs to the Special Issue Image-Guided Diagnosis and Therapies for Pelvic Floor Disorders)
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10 pages, 668 KB  
Article
The Effect of Dexmedetomidine Sedation on Lower Gastrointestinal Motility in Children—Is It Suitable for Anorectal Manometry?
by Tal David Berger, Karina Lukovits, David Cavanaugh, Samuel Nurko and Keira Mason
J. Clin. Med. 2023, 12(23), 7494; https://doi.org/10.3390/jcm12237494 - 4 Dec 2023
Viewed by 1698
Abstract
Anorectal manometry is one of the most frequently performed gastrointestinal motility studies in children. It is an important study in diagnosing Hirschsprung disease (HD). These procedures can be uncomfortable, painful and emotionally distressing. Nitrous oxide or midazolam are the only pharmacologic options available, [...] Read more.
Anorectal manometry is one of the most frequently performed gastrointestinal motility studies in children. It is an important study in diagnosing Hirschsprung disease (HD). These procedures can be uncomfortable, painful and emotionally distressing. Nitrous oxide or midazolam are the only pharmacologic options available, as clinical experience suggests that they do not alter manometry readings. Our study was designed to determine whether Dexmedetomidine (DEX) could provide adequate sedation without disrupting anal and rectal pressure. The effect of DEX on anorectal function has never been studied in children. This prospective study recorded anorectal manometry (ARM) measurements prior to the administration of DEX and then repeated the measurements at 1 and 5 min after DEX. The main ARM measurements included resting intra-anal sphincter pressure (IASP) and the presence and characteristics of the recto-anal inhibitory reflex (RAIR). DEX was administered as a bolus followed by a continuous infusion. Twenty patients were included (60% female; mean age 10.8 ± 4.6 years). The RAIR became absent in 2/16 (12.5%) patients after DEX administration. DEX may alter physiologic ARM and IASP recordings necessary to diagnose gastrointestinal medical conditions. Full article
(This article belongs to the Section Anesthesiology)
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