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Hu B, Zou Q, Xian Z, Su D, Liu C, Lu L, Luo M, Chen Z, Cai K, Gao H, Peng H, Cao W, Ren D. OUP accepted manuscript. Gastroenterol Rep (Oxf) 2022; 10:goac007. [PMID: 35198217 PMCID: PMC8859360 DOI: 10.1093/gastro/goac007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 12/01/2021] [Accepted: 12/02/2021] [Indexed: 11/14/2022] Open
Abstract
Background External rectal prolapse is a relatively rare disease, in which male patients account for a minority. The selection of abdominal repair or perineal repair for male patients has rarely been investigated. Methods Fifty-one male patients receiving abdominal repair (laparoscopic ventral rectopexy) or perineal repair (Delorme or Altemeier procedures) at the Sixth Affiliated Hospital of Sun Yat-sen University (Guangzhou, China) between March 2013 and September 2019 were retrospectively analysed. We compared the recurrence, complication rate, post-operative defecation disorder, length of stay, and quality of life between the abdominal and perineal groups. Results Of the 51 patients, 45 had a complete follow-up, with a median of 48.5 months (range, 22.8–101.8 months). A total of 35 patients were under age 40 years. The complication rate associated with abdominal repair was less than that associated with perineal repair (0% vs 20.7%, P = 0.031) and the recurrence rate was also lower (9.5% vs 41.7%, P = 0.018). Multivariate analysis showed that perineal repair (odds ratio, 9.827; 95% confidence interval, 1.296–74.50; P = 0.027) might be a risk factor for recurrence. Moreover, only perineal repair significantly improved post-operative constipation status (preoperative vs post-operative, 72.4% vs 25.0%, P = 0.001). There was no reported mortality in either of the groups. No patient's sexual function was affected by the surgery. Conclusions Both surgical approaches were safe in men. Compared with perineal repair, the complication rate and recurrence rate for abdominal repair were lower. However, perineal repair was better able to correct constipation.
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Affiliation(s)
- Bang Hu
- Department of Colorectal and Anal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P. R. China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, Guangdong Institute of Gastroenterology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P. R. China
| | - Qi Zou
- Department of Colorectal and Anal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P. R. China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, Guangdong Institute of Gastroenterology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P. R. China
| | - Zhenyu Xian
- Department of Colorectal and Anal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P. R. China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, Guangdong Institute of Gastroenterology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P. R. China
| | - Dan Su
- Department of Colorectal and Anal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P. R. China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, Guangdong Institute of Gastroenterology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P. R. China
| | - Chao Liu
- Department of Digestive Center, PanYu Central Hospital, Guangzhou, Guangdong, P. R. China
| | - Li Lu
- Department of Colorectal and Anal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P. R. China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, Guangdong Institute of Gastroenterology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P. R. China
| | - Minyi Luo
- Department of Colorectal and Anal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P. R. China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, Guangdong Institute of Gastroenterology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P. R. China
| | - Zixu Chen
- Department of Microbiology, Zhongshan School of Medicine, Key Laboratory for Tropical Diseases Control of the Ministry of Education, Sun Yat-sen University, Guangzhou, Guangdong, P. R. China
| | - Keyu Cai
- Department of Colorectal and Anal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P. R. China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, Guangdong Institute of Gastroenterology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P. R. China
| | - Han Gao
- Department of Colorectal and Anal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P. R. China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, Guangdong Institute of Gastroenterology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P. R. China
| | - Hui Peng
- Department of Colorectal and Anal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P. R. China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, Guangdong Institute of Gastroenterology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P. R. China
| | - Wuteng Cao
- Department of Radiology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P. R. China
| | - Donglin Ren
- Department of Colorectal and Anal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P. R. China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, Guangdong Institute of Gastroenterology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P. R. China
- Corresponding author. Department of Colorectal and Anal Surgery, The Sixth Affiliated Hospital of Sun Yat-sen University, 26 Yuancun Erheng Road, Guangzhou, Guangdong 510655, P. R. China. Tel: +86-020-38254005;
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Lakhoo J, Khatri G, Elsayed RF, Chernyak V, Olpin J, Steiner A, Tammisetti VS, Sundaram KM, Arora SS. MRI of the Male Pelvic Floor. Radiographics 2019; 39:2003-2022. [PMID: 31697623 DOI: 10.1148/rg.2019190064] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The pelvic floor is a complex structure that supports the pelvic organs and provides resting tone and voluntary control of the urethral and anal sphincters. Dysfunction of or injury to the pelvic floor can lead to gastrointestinal, urinary, and sexual dysfunction. The prevalence of pelvic floor disorders is much lower in men than in women, and because of this, the majority of the published literature pertaining to MRI of the pelvic floor is oriented toward evaluation of the female pelvic floor. The male pelvic floor has sex-specific differences in anatomy and pathophysiologic disorders. Despite these differences, static and dynamic MRI features of these disorders, specifically gastrointestinal disorders, are similar in both sexes. MRI and MR defecography can be used to evaluate anorectal disorders related to the pelvic floor. MRI can also be used after prostatectomy to help predict the risk of postsurgical incontinence, to evaluate postsurgical function by using dynamic voiding MR cystourethrography, and subsequently, to assess causes of incontinence treatment failure. Increased tone of the pelvic musculature in men secondary to chronic pain can lead to sexual dysfunction. This article reviews normal male pelvic floor anatomy and how it differs from the female pelvis; MRI techniques for imaging the male pelvis; and urinary, gastrointestinal, and sexual conditions related to abnormalities of pelvic floor structures in men.Online supplemental material is available for this article.©RSNA, 2019.
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Affiliation(s)
- Janesh Lakhoo
- From the Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Medical Center North, 1161 21st Ave South, CCC1121, Nashville, TN 37232 (J.L., K.M.S., S.S.A.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (G.K.); Department of Radiology, Faculty of Medicine, Cairo University Hospitals, Cairo, Egypt (R.F.E.); Department of Radiology, Montefiore Medical Center, Bronx, NY (V.C.); Department of Radiology, University of Utah School of Medicine, Salt Lake City, Utah (J.O.); Department of Radiology, South Nassau Communities Hospital, Oceanside, NY (A.S.); and Department of Diagnostic and Interventional Radiology, University of Texas Health Science Center at Houston, Houston, Tex (V.S.T.)
| | - Gaurav Khatri
- From the Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Medical Center North, 1161 21st Ave South, CCC1121, Nashville, TN 37232 (J.L., K.M.S., S.S.A.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (G.K.); Department of Radiology, Faculty of Medicine, Cairo University Hospitals, Cairo, Egypt (R.F.E.); Department of Radiology, Montefiore Medical Center, Bronx, NY (V.C.); Department of Radiology, University of Utah School of Medicine, Salt Lake City, Utah (J.O.); Department of Radiology, South Nassau Communities Hospital, Oceanside, NY (A.S.); and Department of Diagnostic and Interventional Radiology, University of Texas Health Science Center at Houston, Houston, Tex (V.S.T.)
| | - Rania F Elsayed
- From the Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Medical Center North, 1161 21st Ave South, CCC1121, Nashville, TN 37232 (J.L., K.M.S., S.S.A.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (G.K.); Department of Radiology, Faculty of Medicine, Cairo University Hospitals, Cairo, Egypt (R.F.E.); Department of Radiology, Montefiore Medical Center, Bronx, NY (V.C.); Department of Radiology, University of Utah School of Medicine, Salt Lake City, Utah (J.O.); Department of Radiology, South Nassau Communities Hospital, Oceanside, NY (A.S.); and Department of Diagnostic and Interventional Radiology, University of Texas Health Science Center at Houston, Houston, Tex (V.S.T.)
| | - Victoria Chernyak
- From the Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Medical Center North, 1161 21st Ave South, CCC1121, Nashville, TN 37232 (J.L., K.M.S., S.S.A.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (G.K.); Department of Radiology, Faculty of Medicine, Cairo University Hospitals, Cairo, Egypt (R.F.E.); Department of Radiology, Montefiore Medical Center, Bronx, NY (V.C.); Department of Radiology, University of Utah School of Medicine, Salt Lake City, Utah (J.O.); Department of Radiology, South Nassau Communities Hospital, Oceanside, NY (A.S.); and Department of Diagnostic and Interventional Radiology, University of Texas Health Science Center at Houston, Houston, Tex (V.S.T.)
| | - Jeffrey Olpin
- From the Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Medical Center North, 1161 21st Ave South, CCC1121, Nashville, TN 37232 (J.L., K.M.S., S.S.A.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (G.K.); Department of Radiology, Faculty of Medicine, Cairo University Hospitals, Cairo, Egypt (R.F.E.); Department of Radiology, Montefiore Medical Center, Bronx, NY (V.C.); Department of Radiology, University of Utah School of Medicine, Salt Lake City, Utah (J.O.); Department of Radiology, South Nassau Communities Hospital, Oceanside, NY (A.S.); and Department of Diagnostic and Interventional Radiology, University of Texas Health Science Center at Houston, Houston, Tex (V.S.T.)
| | - Ari Steiner
- From the Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Medical Center North, 1161 21st Ave South, CCC1121, Nashville, TN 37232 (J.L., K.M.S., S.S.A.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (G.K.); Department of Radiology, Faculty of Medicine, Cairo University Hospitals, Cairo, Egypt (R.F.E.); Department of Radiology, Montefiore Medical Center, Bronx, NY (V.C.); Department of Radiology, University of Utah School of Medicine, Salt Lake City, Utah (J.O.); Department of Radiology, South Nassau Communities Hospital, Oceanside, NY (A.S.); and Department of Diagnostic and Interventional Radiology, University of Texas Health Science Center at Houston, Houston, Tex (V.S.T.)
| | - Varaha S Tammisetti
- From the Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Medical Center North, 1161 21st Ave South, CCC1121, Nashville, TN 37232 (J.L., K.M.S., S.S.A.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (G.K.); Department of Radiology, Faculty of Medicine, Cairo University Hospitals, Cairo, Egypt (R.F.E.); Department of Radiology, Montefiore Medical Center, Bronx, NY (V.C.); Department of Radiology, University of Utah School of Medicine, Salt Lake City, Utah (J.O.); Department of Radiology, South Nassau Communities Hospital, Oceanside, NY (A.S.); and Department of Diagnostic and Interventional Radiology, University of Texas Health Science Center at Houston, Houston, Tex (V.S.T.)
| | - Karthik M Sundaram
- From the Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Medical Center North, 1161 21st Ave South, CCC1121, Nashville, TN 37232 (J.L., K.M.S., S.S.A.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (G.K.); Department of Radiology, Faculty of Medicine, Cairo University Hospitals, Cairo, Egypt (R.F.E.); Department of Radiology, Montefiore Medical Center, Bronx, NY (V.C.); Department of Radiology, University of Utah School of Medicine, Salt Lake City, Utah (J.O.); Department of Radiology, South Nassau Communities Hospital, Oceanside, NY (A.S.); and Department of Diagnostic and Interventional Radiology, University of Texas Health Science Center at Houston, Houston, Tex (V.S.T.)
| | - Sandeep S Arora
- From the Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Medical Center North, 1161 21st Ave South, CCC1121, Nashville, TN 37232 (J.L., K.M.S., S.S.A.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (G.K.); Department of Radiology, Faculty of Medicine, Cairo University Hospitals, Cairo, Egypt (R.F.E.); Department of Radiology, Montefiore Medical Center, Bronx, NY (V.C.); Department of Radiology, University of Utah School of Medicine, Salt Lake City, Utah (J.O.); Department of Radiology, South Nassau Communities Hospital, Oceanside, NY (A.S.); and Department of Diagnostic and Interventional Radiology, University of Texas Health Science Center at Houston, Houston, Tex (V.S.T.)
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Joshi HM, Gosselink MP, Smyth EA, Hompes R, Cunningham C, Lindsey I, Urban J, Jones OM. Expression of fibulin-5 in the skin of patients with rectal prolapse. Colorectal Dis 2015; 17:996-1001. [PMID: 25891043 DOI: 10.1111/codi.12972] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2014] [Accepted: 02/23/2015] [Indexed: 01/07/2023]
Abstract
AIM Components of connective tissue other than collagen have been found to be involved in patients with rectal prolapse. The organization of elastic fibres differs between controls and subsets of patients with rectal prolapse, and their importance for maintaining the structural and functional integrity of the pelvic floor has been demonstrated in transgenic mice, with animals which have a null mutation in fibulin-5 (Fbln5(i/i)) developing prolapse. This study aimed to compare fibulin-5 expression in the skin of patients with and without rectal prolapse. METHOD Between January 2013 and February 2014, skin specimens were obtained during surgery from 20 patients with rectal prolapse and from 21 without prolapse undergoing surgery for other indications. Fibroblasts from the skin were cultured and the level of fibulin-5 expression was determined on cultured fibroblasts, isolated from these specimens by quantitative real-time polymerase chain reaction. Immunohistochemistry was performed on fixed tissue specimens to assess fibulin-5 expression. RESULTS Fibulin-5 mRNA expression and fibulin-5 staining intensity were significantly lower in young male patients with rectal prolapse compared with age-matched controls [fibulin-5 mean ± SD mRNA relative units, 1.1 ± 0.41 vs 0.53 ± 0.22, P = 0.001; intensity score, median (range), 2 (0-3) vs 1 (0-3), P = 0.05]. There were no significant differences in the expression of fibulin-5 in women with rectal prolapse compared with controls. CONCLUSION Fibulin-5 may be implicated in the aetiology of rectal prolapse in a subgroup of young male patients.
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Affiliation(s)
- H M Joshi
- Oxford Pelvic Floor Centre, Oxford University Hospitals Trust, Oxford, UK.,Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, UK
| | - M P Gosselink
- Oxford Pelvic Floor Centre, Oxford University Hospitals Trust, Oxford, UK
| | - E A Smyth
- Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, UK
| | - R Hompes
- Oxford Pelvic Floor Centre, Oxford University Hospitals Trust, Oxford, UK
| | - C Cunningham
- Oxford Pelvic Floor Centre, Oxford University Hospitals Trust, Oxford, UK
| | - I Lindsey
- Oxford Pelvic Floor Centre, Oxford University Hospitals Trust, Oxford, UK
| | - J Urban
- Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, UK
| | - O M Jones
- Oxford Pelvic Floor Centre, Oxford University Hospitals Trust, Oxford, UK
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