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Presse Med. 1990 Oct 13;19(33):1533-7.
[Simplified defecography technique. Description and results]

[Article in French]

Berretta O, Chaussade S, Coquet M, Couturier D, Bonnin A, Guerre J.

Service de Gastroenterologie, Hopital Cochin, Paris.

Defecography is a useful paraclinical examination to explore disturbances of continence or defecation. The purpose of this study was to present a simplified defecography technique and assess its validity in subjects without defecation problems (n = 10) and in patients complaining of idiopathic chronic constipation (n = 35). The anorectal angle at rest (RAA) and when straining at stool was not significantly different in constipated patients and in controls. Defecography often gave abnormal results. Anterior rectocele was found in almost 50 percent (17/35) of constipated patients and in 20 percent (2/10) of controls (P less than 0.05). None of the patients had posterior rectocele. Persistent imprint of the puborectal muscle during straining was present in 36 percent (9/35) of constipated patients and in 10 percent (1/10) of controls (NS). The imprint was not always associated with closure of the RAA between rest and straining; this closure was never found in controls but was observed in 6 out of 17 constipated patients (35 percent; P less than 0.05). Perineal descent (PD) varied from 0.6 to 3.7 cm (mean +/- s.e.m.: 2.0 +/- 0.63 cm) in controls, as against 0.6 to 7.9 cm (mean +/- s.e.m.: 2.7 +/- 0.45 cm) in constipated patients. In 24 percent of the constipated patients PD was greater than 3.7 cm (the maximum value recorded in controls). All constipated patients with closure of the RAA during defecation had a PD of less than 1 cm, thus confirming the concept of "pelvic floor muscle hypertonia". Disorders of rectal statics are more frequent in subjects with constipation, but their significance is varied. Some abnormalities could be the cause of constipation (e.g. anismus) and others its consequence (anterior rectal prolapse, anterior rectoc

Semin Pediatr Surg. 1995 Feb;4(1):35-47.
Anorectal malformations.

Pena A.

Department of Surgery, Schneider Children's Hospital, Long Island Jewish Medical Center, New Hyde Park, NY 11040, USA.

The posterior sagittal approach was used to treat 792 patients with anorectal malformations. From these, 387 cases were evaluated 6 months to 13 years later. Voluntary bowel movements were present in 74.3% of the entire series. When distributed by diagnosis, the percentages varied: 100% in patients with rectal atresia and perineal fistula; 93.2% in those with vestibular fistula; 80.9% in those with bulbar fistula; 71.1% in those with cloacas; 66.7% in those with prostatic fistula, and 15.8% in those with bladder-neck fistula. Soiling was present in 57% of all cases. Patients with voluntary bowel movements and no soiling were classified as totally continent; 40.8% of the series belong to this group. Distributed by diagnosis, it varied from 100% in cases with rectal atresia or perineal fistula, 65.9% in those with vestibular fistula, 34% in those with bulbar fistula, 31.6% in those with cloacas, 26.3% in those with prostatic fistula; none of the patients with vaginal fistula or bladder-neck fistula was totally continent. Constipation was detected in 43.1% of all patients, and was more frequent in those with simple defects. Urinary incontinence was found in 19% of patients with cloacas who had a common channel shorter than 3 cm, and in 68.8% of the patients who had longer common channels. Other patients suffered from urinary incontinence only when they had an absent sacrum or other severe bladder or urethral congenital defects. An accurate diagnosis and evaluation of the sacrum allows us to establish, with reasonable accuracy, functional prognosis in most children. Those with functional disorders must be treated properly medically, to improve their quality of life.

Laxative online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=7728507&dopt=Abstract constipation laxative colon cleansing

Arch Androl. 1995 Mar-Apr;34(2):83-94.
Pudendal artery syndrome with erectile dysfunction: treatment by pudendal canal decompression.

Shafik A.

Department of Surgery and Research, Faculty of Medicine, Cairo University, Egypt.

Pudendal artery syndrome (PAS) was studied in 10 patients with erectile dysfunction (ED). Ages ranged from 38 to 55 years. All had chronic constipation and straining at stool, absent nocturnal penile tumescence, low penobrachial pressure index (p < .01), low peak flow velocity (p < .001), and a diameter increase (p < .0001) upon duplex ultrasonography screening. Four of the 10 patients had perineal hypoesthesia, prolonged bulbocavernosus reflex (p < .05), and pudendal nerve terminal motor latency (p < .05), and weak anal reflex and EMG activity of the external anal sphincter. The levator EMG activity was reduced in all patients. Intracavernous papaverine injection induced partial erection after a period longer than normal. Selective pudendal arteriography showed narrowing or obstruction of the distal part of the internal pudendal artery (IPA) on both sides with poorly or non-visualized penile arteries. A generalized arterial disease was excluded and pudendal artery compression in the pudendal canal (PC) was suspected as causing ED. The narrow or obstructed part of the IPA corresponds to the part in the PC. Four of the 10 patients had manifestations of pudendal neuropathy in addition to IPA compression. Pudendal canal decompression (PCD) was performed through a perineal approach. ED improved in 8 of the 10 patients 3-6 months postoperatively. Two of the 4 patients who had pudendal arteriopathy combined with neuropathy did not improve. In conclusion, the 10 patients with ED had common clinical and investigative findings that constitute the pudendal artery syndrome. PCD effected improvement in 80% of the cases.

Laxative online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=7786092&dopt=Abstract constipation laxative colon cleansing

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