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Acta Obstet Gynecol Scand. 1997 Mar;76(3):266-70.
Anorectal manometry in women with urinary stress incontinence.

Kjolhede P, Hallbook O, Ryden G, Sjodahl R.

Department of Obstetrics and Gynecology, Faculty of Health Sciences, University Hospital, Linkoping, Sweden.

OBJECTIVE: The aims of this prospective study were to determine the bowel function and the anal sphincter function in women with urinary stress incontinence by means of anorectal manometry and to look for manometric variables which could predict the development of surgery demanding genital prolapse after Burch colposuspension. SUBJECTS: During 1991-1992 twenty-one women with urodynamically proven genuine stress urinary incontinence were consecutively operated upon with the Burch colposuspension. No concomitant prolapse repair surgery was performed. Forty-four healthy subjects without anorectal disorders were used as controls. METHODS: All subjects were investigated with anorectal manometry using a microtransducer catheter. A standardized questionnaire concerning bowel function was answered at interview. The manometry and interview were performed preoperatively and one year after the Burch colposuspension. RESULTS: According to the preoperative questionnaire, fecal incontinence was found in 62%, constipation in 38% and straining at defecation in 71%. There were no significant differences in any of the manometric parameters between the preoperative and the one-year postoperative assessment. The patients with prolapse operations after the colposuspension (n = 6) had a significantly lower anal squeeze pressure area (p = 0.029) preoperatively compared to the control subjects. The patients without prolapse surgery (n = 15) did not differ in manometric parameters from the control subjects. CONCLUSION: Bowel dysfunction is common in women with stress urinary incontinence. The women with low anal squeeze pressure area preoperatively are at risk for the development of genital prolapse after Burch colposuspension.

Laxative online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9093143&dopt=Abstract constipation laxative [PubMed - index

J Pediatr Surg. 1997 Mar;32(3):462-8.
The tethered spinal cord in patients with anorectal malformations.

Levitt MA, Patel M, Rodriguez G, Gaylin DS, Pena A.

Department of Surgery, Long Island Jewish Medical Center, New Hyde Park, NY, USA.

The aims of this study were to find the prevalence of tethered cord in patients with anorectal malformations; to determine if the presence of tethered cord relates to the severity of the anorectal defect, and to certain symptoms, signs, radiologic findings, and associated anomalies; and finally to determine whether tethered cord impacted on a patient's functional prognosis and whether surgical untethering improved the patient. The authors studied 934 patients with anorectal malformations, 111 of whom had magnetic resonance imaging (MRI) of the spine. We compared patients with and without tethered cord by using parametric and nonparametric statistical tests. Tethered cord occurred in 24% of the patients. The prevalence varied according to the type of anorectal defect from 43% in the complex group to 11% in patients with rectovestibular fistula. Patients with tethered cord had a lateral sacral ratio lower than that of patients without tethered cord (0.410 versus 0.702). Tethered cord was present in 90% of patients with myelodysplasia, 60% of patients with a presacral mass, 57% of patients with sacral hemivertebrae, and 56% of patients with a single kidney. The greater number of associated anomalies a patient had, the greater the risk of having tethered cord (P < .05 for all differences). The authors noted differences between patients with and without tethered cord in the presence of voluntary bowel movements (46% versus 70%), fecal soiling (91% versus 63%), constipation (21% versus 43%), and urinary incontinence (86% versus 42%). The data indicate that patients with tethered cord have a worse functional prognosis than patients without tethered cord. However, the incontinence in our patients was also predictable based on the type of anorectal defect and

Dis Colon Rectum. 1997 Jan;40(1):79-83.
Variation in pudendal nerve terminal motor latency according to disease.

Pfeifer J, Salanga VD, Agachan F, Weiss EG, Wexner SD.

Department of Colorectal Surgery, Cleveland Clinic Florida, Fort Lauderdale 33309, USA.

PURPOSE: The aims of this study were first to establish whether any difference among pudendal nerve terminal motor latency (PNTML) values exists relative to diagnosis, second to determine whether left and right latencies are similar, and third to assess any correlation between age and neuropathy. Latency was elicited three times on each side, and an average latency was recorded as a result. MATERIALS AND METHODS: Between June 1989 and April 1995, 1,026 patients (775 females and 251 males) underwent PNTML study. These patients were divided into four groups according to diagnosis: Group I, fecal incontinence; Group II, chronic constipation; Group III, idiopathic rectal pain; Group IV, rectal prolapse. Overall mean age was 61.5 (range, 6-95) years. Student's t-test was used to calculate statistical differences. Patients were then analyzed according to age and gender. Correlation was calculated with the nonparametric Mann-Whitney U test. RESULTS: Unilateral or bilateral prolongation of PNTML was noted in 90 patients (21.2 percent) in Group I, 80 (20.4 percent) in Group II, 22 (18.1 percent) in Group III, and 38 (42.6 percent) in Group IV. Average PNTML on the left side was 1.88 ms in Group I, 1.94 ms in Group II, 1.98 ms in Group III, and 2.12 ms in Group IV. Average PNTML on the right side was 1.85 ms in Group I, 1.94 ms in Group II, 1.99 ms in Group III, and 2.07 ms in Group IV. The only statistically significant differences in PNTML were between Groups I and IV (left, P < 0.005; right, < 0.05) and between females and males (P < 0.0001). CONCLUSION: There is no statistically significant difference between latencies of left and right pudendal nerves. Similarly, there are no statistically significant differences among patients with fe

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