BACKGROUND/AIMS: The Anopress device is a new portable manometry system. The aim of this study is to formulate normative data using this new device by recording the anorectal function of asymptomatic subjects. Patient comfort was also assessed. METHODS: Anorectal function was assessed in asymptomatic volunteers using the Anopress. All volunteers were examined in a standardized way in accordance with the study protocol. Normative values for the Anopress were obtained from the recorded data and patient comfort was assessed using a visual analogue scale. RESULTS: We recruited 153 healthy volunteers. Eighty were female (23 parous; median age 39.5 [interquartile range {IQR}, 28.75–53.00]) and 73 were male (median age 40.5 [IQR, 29.00–52.25]). For the female cohort, the following normal range (2.5–97.5 percentile) values were recorded across the whole anal canal: resting pressure 40.0–103.0 mmHg; squeeze increment 35.0–140.6 mmHg; endurance 1.3–9.0 seconds; involuntary squeeze 41.1–120.8 mmHg; and strain pressure 22.1–77.9 mmHg. Similarly, the following male normal range (2.5–97.5 percentile) values were recorded across the whole anal canal: resting pressure 38.3–99.6 mmHg; squeeze increment 42.5–154.8 mmHg; involuntary squeeze 40.0–123.6 mmHg; endurance 2.0–10.0 seconds; and strain pressure 11.0–72.1 mmHg. The median visual analogue scale scores for discomfort during the measurement was 0.0 (IQR, 0.00–0.00). CONCLUSIONS: Normative values for the Anopress device have been calculated by this study. The Anopress appears to be a safe and well tolerated way of measuring pressures from the entire anal canal. Further comparisons with other standard and commonly used manometry tests are, however, required to verify its reliability.
Anal Canal ; Cohort Studies ; Female ; Healthy Volunteers ; Humans ; Male ; Manometry ; Physiology ; Reference Values ; Volunteers

PURPOSE: The aim was to evaluate the discriminating accuracy of anorectal manometry (ARM) between nonconstipated (NC) subjects and functionally constipated (FC) subjects, and between FC subjects with and without functional defecation disorder (FDD). METHODS: Among female patients who visited anorectal physiology unit, those who could be grouped to following categories were included; FC group with FDD (+FDD subgroup), or without FDD (−FDD subgroup) and NC group. ARM was performed and interpreted not only with absolute pressure values, but also pattern classification and quantification of pressure changes in the rectum and anus during attempted defecation. RESULTS: There were 76 subjects in NC group and 75 in FC group. Among FC group, 63 subjects were in −FDD subgroup and 12 in +FDD subgroup. In pattern classification of pressure changes, type 0, as ‘normal’ response, was only slightly more prevalent in NC group than in FC group. When all ‘abnormal’ types (types 1–5) were considered together as positive findings, the sensitivity and specificity of pattern classification in diagnosing FC among all subjects were 89.3% and 22.7%. Those values in diagnosing FDD among FC group were 91.7% and 11.1%. Manometric defecation index (MDI) as a quantification parameter was significantly different between −FDD and +FDD subgroups. Other conventional absolute pressures were mostly comparable between the groups. CONCLUSION: Among all parameters of ARM, MDI was useful to diagnose FDD in FC patients. Other parameters including the pattern classification were questionable in their ability to diagnose FDD.
Anal Canal ; Arm ; Classification ; Constipation ; Defecation* ; Female ; Humans ; Manometry* ; Physiology ; Rectum ; Sensitivity and Specificity

OBJECTIVETo investigate the risk factors of postoperative urinary retention after rectal cancer surgery.

METHODSClinical data of 133 patients with rectal cancer undergoing radical surgery from January 2013 to September 2014 in the General Hospital of the PLA Rocket Force were retrospectively analyzed. Time to the first removal of urinary catheter, incidence of postoperative urinary retention, and time to re-insert indwelling catheter were recorded. Risk factors of urinary retention were analyzed.

RESULTSOf 133 patients, 70 were males and 63 were females, with a median age of 62 (20-79) years old. Distance from tumor lower margin to anal verge were ≤5 cm in 58 patients, >5 cm to 10 cm in 41 patients, and >10 cm to 15 cm in 34 patients. The postoperative TNM stage was recorded in 35 patients with stage I(, 34 with stage II(, 59 with stage III( and 5 with stage IIII(. Surgical procedures included anterior resection (AR) for 92 patients, abdominoperineal resection (APR) for 25 patients and intersphincteric resection (ISR) for 16 patients. Laparoscopic approach was performed in 89 patients compared with open operation in 44 patients. Time to the first removal of urinary catheter was 2-7 days after operation (median, 5 days) and 36 (27.1%) patients developed urinary retention. All the 36 patients achieved spontaneous voiding by re-inserting urinary catheter for 2-28 days (median, 6 days). Univariate analysis showed that elderly (>65 years) and laparoscopic approach had significantly higher incidence of urinary retention [37.5%(21/56) vs. 19.5%(15/77), χ=5.333, P=0.021; 34.8%(31/89) vs. 11.4%(5/44), χ=8.214, P=0.004; respectively]. Multivariate logistic analysis demonstrated that old age(OR=3.949, 95%CI:1.622 to 9.612, P=0.002), laparoscopic approach (OR=5.665, 95%CI:1.908 to 16.822, P=0.002), and abdominoperineal resection (OR=3.443, 95%CI:1.199 to 9.887, P=0.022) were independent risk factors of urinary retention after rectal cancer surgery.

CONCLUSIONSPatients undergoing rectal cancer surgery have a high risk of postoperative urinary retention. More attention should be paid to the old patients, especially those undergoing laparoscopic procedure or abdominoperineal resection, to prevent postoperative urinary retention and urinary dysfunction.

Adult ; Age Factors ; Aged ; Anal Canal ; surgery ; Colon, Sigmoid ; surgery ; Digestive System Surgical Procedures ; adverse effects ; methods ; statistics & numerical data ; Factor Analysis, Statistical ; Female ; Humans ; Laparoscopy ; adverse effects ; statistics & numerical data ; Male ; Middle Aged ; Postoperative Complications ; epidemiology ; Rectal Neoplasms ; classification ; surgery ; Rectum ; surgery ; Retrospective Studies ; Risk Factors ; Urinary Catheterization ; statistics & numerical data ; Urinary Retention ; epidemiology ; Urination ; physiology

OBJECTIVETo investigate the risk factors of low anterior resection syndrome (LARS) after anal sphincter preserving surgery (SPS) for rectal cancer patients.

METHODSClinicopathological and follow-up data of rectal cancer patients who underwent SPS from January 2010 to June 2014 in Department of Gastroenterological Surgery, Peking University People's Hospital, were retrospectively analyzed. Patients receiving permanent colostomy and local resection were excluded. Meanwhile, during October 2014 and March 2015, the enrolled patients were asked to fill out a specially designed questionnaire for LARS through face-to-face interview or telephone inquiry, according to the chronological order of operation. Based on the score of questionnaire, patients were divided into three groups: 0-20 points: non LARS; 21-29: minor LARS; 30-42: major LARS. The demographic and clinicopathologic features were compared among groups and the risk factors of major LARS were tested by logistic regression analysis.

RESULTSA total of 100 patients (61 males, 39 females) completed the bowel function survey, with an average age of 66.2(41-86) years, 33 patients <60 years versus 67 patients ≥60 years. No significant difference was observed in age distribution (P=0.204). Interval from operation to first follow-up was more than 1 year in 70 patients, and the median follow-up was 23 months. Thirty-seven patients were non LARS, 18 were minor LARS and 45 were major LARS. No significant differences in clinicopathological data (all P>0.05) were observed among three groups except radiotherapy history (P=0.025), tumor location(P=0.000) and distance from anastomotic site to anal verge(P=0.008). After comparison of non LARS group combined with minor LARS group versus major LARS, re-analysis of risk factors showed that radiotherapy history (RR=5.608, 95%CI:1.457 to 21.584, P=0.006), distance from tumor lower margin to anal verge (RR=0.125, 95%CI:0.042 to 0.372, P=0.000), distance from anastomotic site to anal verge (RR=0.255, 95%CI:0.098 to 0.665, P=0.004) and preventive ileostomy history(RR=3.643, 95%CI:1.058 to 12.548, P=0.032) were associated with major LARS. One potential risk factor detected in combined analysis was female (RR=2.138, 95%CI: 0.944 to 4.844, P=0.078). Multivariate analysis revealed that female (RR=2.654, 95%CI: 1.005 to 7.014, P=0.049), radiotherapy history (RR=10.422, 95%CI:2.394 to 45.368, P=0.002) and distance from tumor lower margin to anal verge ≤7 cm (RR=8.935, 95%CI:2.827 to 28.243, P=0.000) were independent risk factors of major LARS.

CONCLUSIONSLARS is a significant problem in most rectal cancer patients after SPS. The risk of major LARS increases on condition of radiotherapy, low tumor position and female. When dealing with these patients, preventive measures should be taken into consideration during SPS.

Adult ; Aged ; Aged, 80 and over ; Anal Canal ; pathology ; surgery ; Anastomosis, Surgical ; adverse effects ; Colon ; surgery ; Defecation ; physiology ; Factor Analysis, Statistical ; Female ; Follow-Up Studies ; Humans ; Long Term Adverse Effects ; epidemiology ; Male ; Middle Aged ; Radiotherapy ; adverse effects ; Rectal Neoplasms ; complications ; pathology ; surgery ; Rectum ; physiopathology ; surgery ; Retrospective Studies ; Risk Assessment ; methods ; Risk Factors ; Sex Factors ; Surveys and Questionnaires ; Syndrome

OBJECTIVETo investigate the clinical efficacy and safety of modified stapled transanal rectal resection (STARR) combined with perioperative pelvic floor biofeedback therapy (POPFBFT) in treating obstructed defecation syndrome (ODS).

METHODSThirty female ODS patients underwent modified STARR (resection and suture was performed in rectocele with one staple) combined with POPFBFT in Department of Colorectal and Anal Surgery, The First Hospital of Jilin university from October 2013 to March 2015. Before the modified STARR, patients received a course of POPFBFT (20 min/time, 2 times/d, 10 times as a course), and another 2 courses were carried out in clinic after discharge. Efficacy evaluation included general conditions of patients, morbidity of postoperative complication, overall subjective satisfaction (excellent: without any symptoms; good: 1 to 2 times of laxatives per month and without the need of any other auxiliary defecation; fairly good: more than 3 times of laxatives per month ; poor: with no improvement; excellent, good, fairly good are defined as effective), Longo ODS score (range 0 to 40 points, the higher the score, the more severe the symptoms), gastrointestinal quality of life index(GIQLI)(range 0 to 144 points, the lower the score, the more severe the symptoms), anorectal manometry and defecography examination. The follow-up lasted 12 months after operation (ended at April 2016).

RESULTSAverage age of 30 patients was 57(46 to 72) years and Longo ODS score of every patient was ≥9 before operation. The modified STARR was completed successfully in all the 30 patients with average operation time of 25 (18 to 34) min and average hospital stay of 6(4 to 9) d. Postoperative complications included pain(20%, 6/30), urinary retention (16.7%, 5/30), anorectal heaviness (6.7%, 2/30), and fecal urgency(26.7%, 8/30). Anaorectal heaviness and fecal urgency disappeared within 3 months. No severe complications, such as postoperative bleeding, infection, rectovaginal fistula, anastomotic dehiscence and anal incontinence were observed. The effective rate of overall subjective satisfaction was 93.3%(28/30) during the follow-up of 12 months. There was no significant difference in Longo ODS score between pre- POPFBFT and pre-operation (pre- POPFBFT: 32.95±3.22, pre-operation: 32.85±3.62, t=1.472, P=0.163). Compared with pre-POPFBFT, Longo ODS score at 1 week after operation decreased (t=4.306, P=0.000), moreover, score at 1 month after operation was lower than that at 1 week (13.05±7.49 vs. 15.00±7.17, t=7.322, P=0.000), while no significant differences were found among 1, 3, 6, 12 months after operation (F=2.111, P=0.107). Likewise, there was no significant difference in GIQLI score between pre-POPFBFT and pre-operation (pre-POPFBFT: 79.39±17.14, pre-operation: 76.65±17.56, t=1.735, P=0.096). Compared with the pre-POPFBFT, GIQLI score at 1 week after operation increased (t=4.714, P=0.000), moreover, GIQLI score at 1 month after operation was higher than that at 1 week (102.26±19.24 vs 91.31±21.35, t=5.628, P=0.000), while no significant differences were found among 1, 3, 6, 12 months after operation(F=1.211, P=0.313). In comparison with pre- POPFBFT, parameters of defecography examination at 12 months after operation showed obvious improvement: the rectocele decreased from (34.1±0.4) mm to (3.1±0.3) mm (t=6.847, P=0.000), anorectal angle during defecation increased from (123.8±6.7)degree to (134.7±8.5)degree, enlargement of anorectal angle during defecation increased from (29.1±3.5)degree to (37.1±5.3)degree, while no significant differences in descend of perineum, anorectal angles at rest as well as parameters of anorectal manometry were found (all P>0.05).

CONCLUSIONModified STARR combined with POPFBFT is safe and effective for ODS patients.

Aged ; Anal Canal ; surgery ; Biofeedback, Psychology ; physiology ; Constipation ; rehabilitation ; surgery ; Defecation ; Defecography ; Digestive System Surgical Procedures ; methods ; rehabilitation ; Female ; Humans ; Length of Stay ; Middle Aged ; Operative Time ; Pain, Postoperative ; etiology ; Pelvic Floor ; physiology ; Postoperative Complications ; Quality of Life ; Rectocele ; Surgical Stapling ; Suture Techniques ; Treatment Outcome ; Urinary Retention ; etiology

High-resolution anorectal manometry (HR-ARM) and high-definition anorectal manometry (HD-ARM) catheters have closely spaced water-perfused or solid state circumferentially-oriented pressure sensors that provide much better spatiotemporal pressurization than non-high resolution catheters. This is a comprehensive review of HR-ARM and HD-ARM anorectal manometry catheter systems, the methods for conducting, analyzing, and interpreting HR-ARM and HD-ARM, and a comparison of HR-ARM with non-high resolution anorectal manometry. Compared to non-high resolution techniques, HR-ARM and HD-ARM studies take less time and are easier to interpret. However, HR-ARM and HD-ARM catheters are more expensive and fragile and have a shorter lifespan. Further studies are needed to refine our understanding of normal values and to rigorously evaluate the incremental clinical utility of HR-ARM or HD-ARM compared to non-high resolution manometry.
Anal Canal ; Catheters ; Constipation ; Fecal Incontinence ; Manometry* ; Physiology ; Reference Values

BACKGROUNDNerve-sparing radical hysterectomy (NSRH) was developed in an attempt to minimize complications after radical hysterectomy. Since 2008, a modified NSRH-nerve plane-sparing radical hysterectomy (NPSRH) has been developed at the Cancer Hospital, Chinese Academy of Medical Sciences. The aim of this study was to investigate the role of NPSRH in improving postoperative pelvic visceral dysfunctions.

METHODSEighty-three patients with International Federation of Gynecology and Obstetrics (FIGO) stage IB1-IIA2 cervical cancer received NPSRH (the study group) from January 2008 to October 2012. One hundred and sixty-six patients who underwent conventional radical hysterectomy (CRH) were randomly selected as the control group. Age, pathological type and stage were matched between the two groups. The safety of surgery was assessed by duration of operation and blood transfusion rate. Postoperative short-term bladder function was analyzed by duration of catheterization. Long-term bladder, anorectal and sexual function were evaluated with questionnaires.

RESULTSSeventy-eight patients (94.0%) in the NPSRH group and one hundred and sixty patients (96.4%) in the CRH group completed the study. Median follow-up time was 31.9 months and 31.0 months respectively (P = 0.708). There was no significant difference between the two groups in terms of age, body mass index, FIGO stage, pathologic type, preoperative and postoperative therapy (P > 0.05). The blood transfusion rate shared no difference between two groups (P = 0.364). The operation time in the NPSRH group was significantly longer than CRH group (P < 0.01). But the duration of catheterization and hospitalization in the NPSRH group was significantly reduced compared with CRH group (P < 0.01). In addition, the incidence of long-term urinary frequency, urinary incontinence, urinary retention, straining to void, constipation and diarrhea was significantly lower in the NPSRH group (P < 0.05). However, there was no significant difference regarding sexual function (P > 0.05).

CONCLUSIONSThe current evidence indicated that NPSRH improved long-term bladder function compared to CRH. Moreover, it may improve long-term anorectal function as well.

Anal Canal ; physiology ; Female ; Follow-Up Studies ; Humans ; Hysterectomy ; methods ; Rectum ; physiology ; Urinary Bladder ; physiology ; Uterine Cervical Neoplasms ; surgery

Successful assessing intestinal lumen content with ultrasound signals might lay a strong basis for the development of the artificial anal sphincter. In the present study, we utilized a modified MLU02-212 ultrasonic gas bubble detector to test the distal part of proximal colon in each rabbit, for the group of twenty healthy New Zealand rabbits. Voltage signals of solid, liquid, gas and empty content of the lumen were collected and compared. The results indicated that there were significant differences among the voltage signals in the 4 conditions (P = 0.000), respectively. Multiple comparison showed significant differences existed in any pair of the four conditions (P = 0.000). Three signal non-overlapping regions existed in these 4 conditions. Thus it seemed that ultrasound could be utilized to distinguish various contents inside the intestinal lumen and could act as "artificial sensory nerve".
Anal Canal ; innervation ; physiology ; Animals ; Artificial Organs ; Colon ; diagnostic imaging ; Enteric Nervous System ; physiology ; Fecal Incontinence ; surgery ; Female ; Gastrointestinal Contents ; Gastrointestinal Motility ; physiology ; Male ; Rabbits ; Sensory Receptor Cells ; physiology ; Ultrasonography

OBJECTIVETo study the expression of Wnt5a protein in the terminal rectum of children with anorectal malformation (ARM) and the possible association between Wnt5a and ARM.

METHODSSpecimens were obtained from 20 children with ARM, 7 children with acquired rectovestibular fistula and 6 children with non-gastrointestinal tract disease (control group). The expression of Wnt5a protein in the terminal rectum was determined by immunohistochemistry and Western blot.

RESULTSWnt5a was mainly expressed in the rectum of the myenteric nerve plexus, mucosal layer and submucosa in the control group. Compared with the control group, Wnt5a expression in the terminal rectum decreased significantly in the ARM group, and decreased more significantly in children with high ARM. The results of Western blot showed the expression of Wnt5a protein in the high, intermediate and low ARM groups were significantly lower than that in the acquired rectovestibular fistula and the control groups (P<0.01). The expression of Wnt5a protein in the high and the intermediate ARM groups were also lower than that in the low ARM group (P<0.01). There was no significant difference in the Wnt5a protein expression between the acquired rectovestibular fistula and the control groups.

CONCLUSIONSThe expression of Wnt5a in the termina1 rectum decreases in children with ARM, suggesting Wnt5a may play an important role in the development of ARM.

Anal Canal ; abnormalities ; Female ; Humans ; Immunohistochemistry ; Infant ; Male ; Proto-Oncogene Proteins ; analysis ; physiology ; Rectum ; abnormalities ; chemistry ; Wnt Proteins ; analysis ; physiology ; Wnt-5a Protein

Although bidets are widely used in Korea, its effects on anorectal pressures have not been studied in detail in terms of the water settings used. Twenty healthy volunteers were placed on a toilet equipped with a bidet, and anorectal pressures were measured with a manometry catheter inserted into the rectum and anal canal before and after using the bidet at different water forces (40, 80, 160, 200 mN), temperatures (24degrees C vs 38degrees C), and water jet widths (narrow vs wide). The pressure at anal high pressure zone decreased from 96.1 +/- 22.5 to 81.9 +/- 23.3 mmHg at water jet pressure of 40 mN and 38degrees C wide water jet (P < 0.001), from 94.3 +/- 22.4 to 80.0 +/- 24.1 mmHg at water jet pressure of 80 mN and 38degrees C narrow water jet (P < 0.001), and from 92.3 +/- 22.4 to 79.6 +/- 24.7 mmHg at a water jet pressure of 80 mN and 38degrees C wide water jet (P < 0.001). At other settings, no significant changes were observed. Our results indicate that, in addition to cleansing effect, bidet could be used to reduce anal resting pressure in the same manner as the traditional warm sitz bath under the conditions of low or medium water jet pressure, a warm water temperature, and a wide type water jet.
Adult ; Anal Canal/physiology ; Female ; Humans ; Male ; Manometry ; Pressure ; Rectum/*physiology ; Temperature ; *Toilet Facilities ; Water