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Carmen L A M Vleggeertlankamp - One of the best experts on this subject based on the ideXlab platform.
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the long term outcome of micturition Defecation and sexual function after spinal surgery for cauda equina syndrome
PLOS ONE, 2017Co-Authors: Nina S. Korse, Anna Veldma, Wilco C Peul, Carmen L A M VleggeertlankampAbstract:Background Cauda equina syndrome (CES) is a rare neurologic complication of lumbar herniated disc for which emergency surgical decompression should be undertaken. Despite the common belief that the restoration of functions that are affected by CES can take several years postoperatively, follow up seldom exceeds the first year after surgery. Long term outcome of especially micturition, Defecation and sexual function—which are by definition affected in CES—are unknown. The aim of this study is to evaluate 1) postoperative long term outcome of micturition, Defecation and sexual function in CES patients 2) attitude of patients towards received hospital care with regard to (recovery of) these functions. Methods CES patients were selected by screening the records of all patients operated on lumbar herniated disc in our university hospital between 1995–2010. A questionnaire was sent to the selected CES patients evaluating current complaints of micturition, Defecation and sexual function and attitude towards delivered care with focus on micturition, Defecation and sexual function. Results Thirty-seven of 66 eligible CES patients were included (response rate 71%, inclusion rate 56%). Median time after surgery was 13.8 years (range 5.8–21.8 years). Dysfunction at follow up was highly prevalent: 38% micturition dysfunction, 43% Defecation dysfunction and 54% sexual dysfunction. Younger age at presentation was associated with sexual dysfunction at follow up: for every year younger at presentation, odds ratio for sexual dysfunction at follow up was 1.11 (p = 0.035). Other associations with outcome were not identified. Two-third of the CES patients wished their neurosurgeon had given them more prognostic information about micturition, Defecation and sexual function. Conclusion The presented data demonstrate that dysfunction of micturition, Defecation and sexual function are still highly prevalent in a large number of CES patients even years postoperatively. These alarming follow up data probably have a devastating effect on personal perceived quality of life, which should be studied in more detail. CES patients communicate a clear demand for more prognostic information. The presented figures enable clinicians to inform their CES patients more realistically about long term postoperative outcome of micturition, Defecation and sexual function after surgical intervention.
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cauda equina syndrome presentation outcome and predictors with focus on micturition Defecation and sexual dysfunction
European Spine Journal, 2017Co-Authors: Nina S. Korse, J A Pijpers, E W Van Zwe, Henk W Elzevie, Carmen L A M VleggeertlankampAbstract:Even though micturition, Defecation, and sexual function are substantially affected in cauda equina syndrome (CES), data on outcome are scarce. Medical files of patients operated on lumbar herniated disc were screened for CES and retrospectively analyzed for baseline characteristics, outcome of micturition, Defecation, and sexual function and possible predictors. Seventy-five CES patients (52% men) were included with a mean age of 44 years. L5–S1 was the most common affected level. Duration of CES complaints at presentation was, on average, 84 h (median 48 h). Prevalence of symptoms at presentation: sciatica (97%), altered sensation of the saddle area (93%), micturition dysfunction (92%), and Defecation dysfunction (74%). Only 26 patients were asked about sexual dysfunction of whom 25 patients experienced dysfunction. Female gender was associated with more Defecation dysfunction at presentation than male gender (OR 4.11; p = 0.039). All patients underwent decompressive surgery. Two post-operative follow-up (FU) moments took place after a mean of 75 h and 63 days. Outcomes at second FU moment: micturition dysfunction 48%, Defecation dysfunction 42%, sexual dysfunction 53%, sciatica 48%, and altered sensation of the saddle area 57%. A shorter time to decompression was associated with more sciatica at FU 1 (p = 0.042) which effect had disappeared at FU 2. This study is unique in (1) displaying the presenting features in a large cohort of CES patients, (2) demonstrating that recovery after decompression is slow and far from complete in the majority of patients with regard to micturition, Defecation, and sexual function and (3) evaluating predictors for outcome.
Vera Loeningbaucke - One of the best experts on this subject based on the ideXlab platform.
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biofeedback treatment for chronic constipation and encopresis in childhood long term outcome
Pediatrics, 1995Co-Authors: Vera LoeningbauckeAbstract:Objective. Abnormal Defecation dynamics often are present in children with chronic constipation and encopresis. Patients who learned normal Defecation dynamics with biofeedback treatment had improved short-term outcome. The aim of our research was to evaluate if biofeedback treatment improved long-term outcome. Design. One hundred twenty-nine children with constipation, encopresis, and abnormal Defecation dynamics were treated conventionally ; 63 of them received additional biofeedback training directed towards teaching normal Defecation dynamics. Results. At follow-up (4.1 ± 1.5 years), 86% of conventionally treated patients and 87% of biofeedback-treated patients had improvement in encopresis ; 62% of conventionally treated patients, 50% of successful biofeedback-treated patients, and 23% of unsuccessful biofeedback-treated patients had recovered from chronic constipation and encopresis. Recovery rates were similar for conventionally treated patients and biofeedback-treated patients who learned normal Defecation dynamics (P >.2) but significantly lower for unsuccessful biofeedback-treated patients (P <.02). Length of follow-up was significantly related to recovery (P <.01). Conclusion. Learning normal Defecation dynamics with biofeedback training did not increase long-term recovery rates in children with chronic constipation, encopresis, and abnormal Defecation dynamics above those achieved with conventional treatment alone.
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modulation of abnormal Defecation dynamics by biofeedback treatment in chronically constipated children with encopresis
The Journal of Pediatrics, 1990Co-Authors: Vera LoeningbauckeAbstract:To determine whether outcome in chronically constipated and encopretic children with abnormal Defecation dynamics could be improved with biofeedback training, we randomly assigned patients, 5 to 16 years of age, to receive conventional treatment alone (n=19) or conventional plus biofeedback treatment (n=22) and evaluated physiologic outcome at 7 months and clinical outcome at 7 and 12 months. Eighty-six percent of patients learned normal Defecation dynamics with up to six biofeedback sessions. At 7 months, 13% of conventionally treated and 77% of biofeedback-treated patients had normal Defecation dynamics ( p p p p
Nina S. Korse - One of the best experts on this subject based on the ideXlab platform.
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the long term outcome of micturition Defecation and sexual function after spinal surgery for cauda equina syndrome
PLOS ONE, 2017Co-Authors: Nina S. Korse, Anna Veldma, Wilco C Peul, Carmen L A M VleggeertlankampAbstract:Background Cauda equina syndrome (CES) is a rare neurologic complication of lumbar herniated disc for which emergency surgical decompression should be undertaken. Despite the common belief that the restoration of functions that are affected by CES can take several years postoperatively, follow up seldom exceeds the first year after surgery. Long term outcome of especially micturition, Defecation and sexual function—which are by definition affected in CES—are unknown. The aim of this study is to evaluate 1) postoperative long term outcome of micturition, Defecation and sexual function in CES patients 2) attitude of patients towards received hospital care with regard to (recovery of) these functions. Methods CES patients were selected by screening the records of all patients operated on lumbar herniated disc in our university hospital between 1995–2010. A questionnaire was sent to the selected CES patients evaluating current complaints of micturition, Defecation and sexual function and attitude towards delivered care with focus on micturition, Defecation and sexual function. Results Thirty-seven of 66 eligible CES patients were included (response rate 71%, inclusion rate 56%). Median time after surgery was 13.8 years (range 5.8–21.8 years). Dysfunction at follow up was highly prevalent: 38% micturition dysfunction, 43% Defecation dysfunction and 54% sexual dysfunction. Younger age at presentation was associated with sexual dysfunction at follow up: for every year younger at presentation, odds ratio for sexual dysfunction at follow up was 1.11 (p = 0.035). Other associations with outcome were not identified. Two-third of the CES patients wished their neurosurgeon had given them more prognostic information about micturition, Defecation and sexual function. Conclusion The presented data demonstrate that dysfunction of micturition, Defecation and sexual function are still highly prevalent in a large number of CES patients even years postoperatively. These alarming follow up data probably have a devastating effect on personal perceived quality of life, which should be studied in more detail. CES patients communicate a clear demand for more prognostic information. The presented figures enable clinicians to inform their CES patients more realistically about long term postoperative outcome of micturition, Defecation and sexual function after surgical intervention.
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cauda equina syndrome presentation outcome and predictors with focus on micturition Defecation and sexual dysfunction
European Spine Journal, 2017Co-Authors: Nina S. Korse, J A Pijpers, E W Van Zwe, Henk W Elzevie, Carmen L A M VleggeertlankampAbstract:Even though micturition, Defecation, and sexual function are substantially affected in cauda equina syndrome (CES), data on outcome are scarce. Medical files of patients operated on lumbar herniated disc were screened for CES and retrospectively analyzed for baseline characteristics, outcome of micturition, Defecation, and sexual function and possible predictors. Seventy-five CES patients (52% men) were included with a mean age of 44 years. L5–S1 was the most common affected level. Duration of CES complaints at presentation was, on average, 84 h (median 48 h). Prevalence of symptoms at presentation: sciatica (97%), altered sensation of the saddle area (93%), micturition dysfunction (92%), and Defecation dysfunction (74%). Only 26 patients were asked about sexual dysfunction of whom 25 patients experienced dysfunction. Female gender was associated with more Defecation dysfunction at presentation than male gender (OR 4.11; p = 0.039). All patients underwent decompressive surgery. Two post-operative follow-up (FU) moments took place after a mean of 75 h and 63 days. Outcomes at second FU moment: micturition dysfunction 48%, Defecation dysfunction 42%, sexual dysfunction 53%, sciatica 48%, and altered sensation of the saddle area 57%. A shorter time to decompression was associated with more sciatica at FU 1 (p = 0.042) which effect had disappeared at FU 2. This study is unique in (1) displaying the presenting features in a large cohort of CES patients, (2) demonstrating that recovery after decompression is slow and far from complete in the majority of patients with regard to micturition, Defecation, and sexual function and (3) evaluating predictors for outcome.
Sergio W Larach - One of the best experts on this subject based on the ideXlab platform.
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stapled transanal rectal resection vs transvaginal rectocele repair for treatment of obstructive Defecation syndrome
Diseases of The Colon & Rectum, 2009Co-Authors: Marsha Harris, Andrea Ferrara, Joseph T Gallagher, Samuel Dejesus, Paul R Williamson, Sergio W LarachAbstract:PURPOSE:Stapled transanal rectal resection has been introduced as a new technology for the management of obstructive Defecation syndrome. In this study we observed the clinical outcomes for stapled transanal rectal resection as compared with transvaginal rectocele repair for obstructive Defecation s
Dominik Weishaupt - One of the best experts on this subject based on the ideXlab platform.
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assessment of obstructive Defecation by high resolution anorectal manometry compared with magnetic resonance defecography
Clinical Gastroenterology and Hepatology, 2015Co-Authors: Henriette Heinrich, Caecilia S Reiner, Dominik Weishaupt, Matthias Sauter, Mark Fox, Marcel Halama, Benjamin Misselwitz, Simon Buetikofer, Michael FriedAbstract:Background & Aims Patients with obstructive Defecation have abnormalities of anorectal function and/or structure. Conventional anorectal manometry (ARM) can identify abnormal function and behavior (dyssynergia); however, agreement between manometry and defecography is only fair. High-resolution (HR)-ARM may improve diagnostic agreement by differentiating pressure effects caused by dyssynergia and obstruction. We compared HR-ARM findings with magnetic resonance (MR) defecography in the clinical assessment of patients with symptoms of obstructive Defecation defined by Rome III criteria. Methods HR-ARM (Manoscan AR 360; Given Imaging, Yoqeam, Israel) assessed anal sphincter function and pressure during simulated Defecation. Abnormal manometric findings were classified according to the Rao system and compared with MR defecography as the reference standard. Results A total of 188 consecutive patients (155 women; age, 19–93 y) with obstructive Defecation underwent a full investigation. Compared with patients with dyssynergia on MR imaging (n = 66), patients with structural pathology (n = 87) had lower resting ( P P P Conclusions The diagnostic agreement between anorectal HR-ARM and MR defecography is high and pressure measurements accurately identify recto-anal dyssynergia and intra-anal outlet obstruction by structural pathology as causes of obstructive Defecation.
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mr defecography in patients with dyssynergic Defecation spectrum of imaging findings and diagnostic value
British Journal of Radiology, 2011Co-Authors: Caecilia S Reiner, R Tutuian, Alina Solopova, D Pohl, B Marincek, Dominik WeishauptAbstract:Objectives: We describe the spectrum of findings and the diagnostic value of MR defecography in patients referred with suspicion of dyssynergic Defecation. Methods: 48 patients (34 females, 14 males; mean age 48 years) with constipation and clinically suspected dyssynergic Defecation underwent MR defecography. Patients were divided into patients with dyssynergic Defecation (n518) and constipated patients without dyssynergic Defecation (control group, n530). MRIs were analysed for evacuation ability, time to initiate evacuation, time of evacuation, changes in the anorectal angle (ARA-change), presence of paradoxical sphincter contraction and presence of additional pelvic floor abnormalities. Sensitivity, specificity, positive and negative predictive values and accuracy for the diagnosis of dyssynergic Defecation were calculated. Results: The most frequent finding was impaired evacuation, which was seen in 100% of patients with dyssynergic Defecation and in 83% of the control group, yielding a sensitivity for MR defecography for the diagnosis of dyssynergic Defecation of 100% (95% confidence interval (CI) 97–100%), but a specificity of only 23% (95% CI 7–40%). A lower sensitivity (50%; 95% CI 24–76%) and a high specificity (97%; 95% CI 89–100%) were seen with abnormal ARA-change. The sensitivity of paradoxical sphincter contraction was relatively high (83%; 95% CI 63–100%). A combined analysis of abnormal ARA-change and paradoxical sphincter contraction allowed for the detection of 94% (95% CI 81–100%) of the patients with dyssynergic Defecation. Conclusion: MR defecography detects functional and structural abnormal findings in patients with clinically suspected dyssynergic Defecation. Impaired evacuation is seen in patients with functional constipation owing to other pelvic floor abnormalities than dyssynergic Defecation.
