Outcomes and efficacy of magnetic resonance imaging-compatible sacral nerve stimulator for management of fecal incontinence: A multi-institutional study

BACKGROUND Fecal incontinence(FI)is an involuntary passage of fecal matter which can have a significant impact on a patient’s quality of life.Many modalities of treatment exist for FI.Sacral nerve stimulation is a well-established treatment for FI.Given the increased need of magnetic resonance imaging(MRI)for diagnostics,the In-terStim which was previously used in sacral nerve stimulation was limited by MRI incompatibility.Medtronic MRI-compatible InterStim was approved by the United States Food and Drug Administration in August 2020 and has been widely used.AIM To evaluate the efficacy,outcomes and complications of the MRI-compatible InterStim.METHODS Data of patients who underwent MRI-compatible Medtronic InterStim placement at UPMC Williamsport,University of Minnesota,Advocate Lutheran General Hospital,and University of Wisconsin-Madison was pooled and analyzed.Patient demographics,clinical features,surgical techniques,complications,and outcomes were analyzed.Strengthening the Reporting of Observational studies in Epidemiology(STROBE)cross-sectional reporting guidelines were used.RESULTS Seventy-three patients had the InterStim implanted.The mean age was 63.29±12.2 years.Fifty-seven(78.1%)patients were females and forty-two(57.5%)patients had diabetes.In addition to incontinence,overlapping symptoms included diarrhea(23.3%),fecal urgency(58.9%),and urinary incontinence(28.8%).Fifteen(20.5%)patients underwent Peripheral Nerve Evaluation before proceeding to definite implant placement.Thirty-two(43.8%)patients underwent rechargeable InterStim placement.Three(4.1%)patients needed removal of the implant.Migration of the external lead connection was observed in 7(9.6%)patients after the stage I procedure.The explanation for one patient was due to infection.Seven(9.6%)patients had other complications like nerve pain,hematoma,infection,lead fracture,and bleeding.The mean follow-up was 6.62±3.5 mo.Sixty-eight(93.2%)patients reported significant improvement of symptoms on follow-up evaluation.CONCLUSION This study shows promising results with significant symptom improvement,good efficacy and good patient outcomes with low complication rates while using MRI compatible InterStim for FI.Further long-term follow-up and future studies with a larger patient population is recommended.

Garg incontinence scores: New scoring system on the horizon to evaluate fecal incontinence. Will it make a difference?

The main aim of this opinion review is to comment on the recent article published by Garg et al in the World Journal of Gastroenterology 2023;29:4593–4603.The authors in the published article developed a new scoring system,Garg incon-tinence scores(GIS),for fecal incontinence(FI).FI is a chronic debilitating disease that has a severe negative impact on the quality of life of the patients.Rome IV criteria define FI as multiple episodes of solid or liquid stool passed into the clothes at least twice a month.The associated social stigmatization often leads to significant under-reporting of the condition,which further impairs management.An important point is that the complexity and vagueness of the disease make it difficult for the patients to properly define and report the magnitude of the problem to their physicians.Due to this,the management becomes even more difficult.This issue is resolved up to a considerable extent by a scoring ques-tionnaire.There were several scoring systems in use for the last three decades.The prominent of them were the Cleveland Clinic scoring system or the Wexner scoring system,St.Marks Hospital or Vaizey’s scores,and the FI severity index.However,there were several shortcomings in these scoring systems.In the opinion review,we tried to analyze the strength of GIS and compare it to the existing scoring systems.The main pitfalls in the existing scoring systems were that most of them gave equal weightage to different types of FI(solid,liquid,flatus,etc.),were not comprehensive,and took only the surgeon’s perception of FI into view.In GIS,almost all shortcomings of previous scoring systems had been addressed:different weights were assigned to different types of FI by a robust statistical methodology;the scoring system was made comprehensive by including all types of FI that were previously omitted(urge,stress and mucus FI)and gave priority to patients’rather than the physicians’perceptions while developing the scoring system.Due to this,GIS indeed looked like a paradigm shift in the evaluation of FI.However,it is too early to conclude this,as GIS needs to be validated for accuracy and simplicity in future studies.

Diagnostic tools for fecal incontinence: Scoring systems are the crucial first step

The main aim of this editorial is to comment on the recent article published by Garg et al in the World Journal of Gastroenterology 2023;29:4593-4603.This original research presents a new scoring system for fecal incontinence.Fecal incontinence is a chronic disease with a severe impact on the quality of life of the patients.Substantial social stigmatization often leads to significant underreporting of the condition even during visits to a specialist and could lead to further misman-agement or non-existent management of the disease.An important fact is that patients are often unable to describe their condition when not asked precisely defined questions.This problem is partially resolved by scoring questionnaires.Several scoring systems are commonly used;however,each of them has their shortcomings.For example,the absence of different kinds of leakage besides flatus and stool could further lead to underscoring the incontinence severity.Therefore,there has long been a call for a more precise scoring system.The correct identification of the presence and severity of fecal incontinence is paramount for further diagnostic approach and for choosing the appropriate therapy option.This editorial describes fecal incontinence,its effect on quality of life in general and further evaluates the diagnostic approach with a particular focus on symptom scoring systems and their implications for clinical practice.

Impact of applying the theory of human becoming and self-care deficit theory of nursing on insomnia in after stroke urinary incontinence patients

Objective:To determine the impact of applying the theory of human becoming and self-care deficit theory of nursing in overcoming insomnia in patients of urinary incontinence(UI)after stroke.Insomnia is a sleep disorder experienced by UI patients after stroke which can exacerbate problems related to brain damage and can complicate the recovery process.Methods:This study was a quasi-experimental conducted in 4 hospitals.Fifty-six patients were selected by convenience sampling and divided into 2 groups(the intervention and control group).Participants in the intervention group received“applying the theory of Human becoming and self-care deficit theory of nursing,”starting when the patient is about to go home from the hospital and continuing at the house.Measurement of insomnia is done using the Pittsburgh Sleep Quality Index(PSQI).Results:The mean insomnia scores of participants from both groups increased in the first and third measurements.The second and third insomnia measurements found a significant difference(P<0.001).This intervention decreased the average score of insomnia by 4.11 times in the second measurement and 5.82 times in the third measurement.The most important item that decreased in the third measurement of insomnia was sleep efficiency.Conclusions:Applying the theory of human becoming and self-care deficit theory of nursing in this study significantly decreased the insomnia score of post-stroke UI patients.It can be used as a guide for nurses,patients,and families in managing insomnia.In addition,the application of nursing theory in nursing practice can systematize nursing care plans and organize the knowledge of professionals into a conceptual framework,as well as provide effective guidance for nurses on what to do.

New objective scoring system to clinically assess fecal incontinence

BACKGROUND Several scoring systems are used to assess fecal incontinence(FI),among which,the most commonly used are Wexner and Vaizey’s scoring systems.However,there are significant lacunae in these scoring systems,due to which they are neither accurate nor comprehensive.AIM To develop a new scoring system for FI that is accurate,comprehensive,and easy to use.METHODS A pro forma was made in which six types of FI were included:solid,liquid,flatus,mucous,stress,and urge.The weight for each FI was determined by asking a group of patients and laypersons to give a disability score to each type of FI from 0 to 100(0-least,100-maximum disability).The disability was assessed on a modified EQ-5D+(EuroQol)description system,4D3L(4 dimensions and 3 levels)for each FI.The average score of each FI was calculated,divided by 10,and rounded off to determine the weight of each FI type.The scores for the three levels of frequency of each FI were assigned as never=0(No episode of FI ever),occasional=1(≤1 episode of FI/wk),and common=2(>1 episode of FI/wk),and was termed as frequency score.The score for each FI would be derived by multiplying the frequency score and the weight for that FI type.In the second phase of the study,a group of colorectal surgeons was asked to rank the six FI types in order of severity,and their ranking was compared with the patient and laypersons’rankings.RESULTS Fifty patients and 50 laypersons participated in the study.The weight was assigned to each FI(solid-8,liquid-8,urge-7,flatus-6,mucus-6,and stress-5),and an new scoring system was formulated.The maximum possible score was 80(total incontinence),and the least 0(no incontinence).The surgeons’ranking of FI severity did not correlate well with patients’and laypersons’rankings of FI,highlighting that surgeons and patients may perceive the severity of FI differently.CONCLUSION A new scoring system for FI was formulated,which was simple,logical,comprehensive,and easy to use,and eliminated previous shortcomings.Patients’and surgeons’perceptions of FI severity of FI did not correlate well.

Small Extracellular Vesicles Secreted by Peri-urethral Tissues Regulate Fibroblast Function and Contribute to the Pathogenesis of Female Stress Urinary Incontinence

Objective:This study aimed to explore the existence of small extracellular vesicles(sEVs)in peri-urethral tissues and the role of abnormal expression of sEVs in the pathogenesis of female stress urinary incontinence(SUI).Methods:sEVs were extracted from peri-urethral vaginal wall tissues using differential centrifugation and were observed by transmission electron microscopy(TEM).The number of sEVs and their protein contents were compared between SUI and control groups using nanoparticle tracking analysis(NTA)and bicinchoninic acid(BCA)protein assay.Fibroblasts were cultured separately with SUI(SsEVs group)and normal tissue sEVs(NsEVs group).Proliferation and migration of fibroblasts were compared between groups using CCK-8 and wound healing assays,respectively.Expression levels of collagenⅠandⅢwere compared among blank control(BC),NsEVs,and SsEVs groups using real-time PCR.Protein mass spectrometry was used to test the differentially expressed proteins contained in sEVs between groups.Results:sEVs were extracted and found under the electron microscope.There were significantly more sEVs extracted from the SUI group compared to the normal group.Fibroblasts showed increased proliferative and decreased migratory abilities,and expressed more collagen in the SsEVs group compared to the NsEVs and BC groups.Protein spectrum analysis demonstrated several differentially expressed targets,including components of microfibrils,elastin polymer,and anti-inflammatory factors.Conclusion:sEVs were detected in the peri-urethral tissues.SUI tissues expressed more sEVs than control.The abnormal expression of sEVs and their protein contents may contribute to the pathogenesis and progression of SUI.

The prevalence,associated factors,and impact of urinary incontinence in pregnant and postpartum women in Nanjing,China:A cross-sectional study

Objective:Urinary incontinence(UI)is highly prevalent in antenatal and postnatal women while the prevalence of UI varied largely from 3.84%to 38.65%.This study was to assess the prevalence of UI,the associated factors,and the impact of UI on daily life in pregnant and postpartum women in Nanjing,China.Methods:The prevalence of UI and the impact of UI on life were assessed by the validated Chinese version of International Consultation on Incontinence Questionnaire-urinary incontinence-short form and the validated Chinese version of urinary incontinence quality of life.The associated factors were estimated by using logistic regression analysis.Results:UI affected 37.80%of pregnant women and 16.41%of postpartum women of the study population.Among the pregnant participants,the prevalence rates of stress UI,urge UI,and mixed UI were 25.77%,4.47%,and 7.10%,respectively.Among the postpartum women,the prevalence rates of stress UI,urge UI,and mixed UI were 11.15%,1.92%,and 2.69%,respectively.In both pregnant women and postpartum women,vaginal delivery had significantly increased the odds of reporting UI(p=0.007,p=0.003,respectively).The impact of UI on daily life was significantly greater in postpartum women compared to pregnant women especially in social embarrassment(p=0.000).Conclusion:The prevalence rates of UI were high in pregnant women in Nanjing,China.Vaginal delivery significantly increased odds of reporting UI.UI has a great impact on pregnant and postpartum women’s life,especially in social embarrassment.

Non-Ablative Transvaginal Radiofrequency in the Treatment of Stress Urinary Incontinence: Review of the Literature

Background: Urinary incontinence is defined as the involuntary loss of urine, which can affect up to 45% of women after menopause. Radiofrequency is a non-invasive procedure that involves the application of an electromagnetic wave that through heat generation promotes neocollagenesis and neoeslatinogenesis in the vaginal epithelium. This energy-based technology has been studied as a potential alternative for the treatment of genitourinary syndrome of menopause and urinary incontinence. Objective: To review the recent literature (from 2020 to June 2022) on the use of transvaginal radiofrequency in the treatment of stress urinary incontinence, by searching articles at databases of Capes, PubMed Cochrane and Scielo. Methods: The descriptor terms “Urinary Incontinence/therapy” [Majr] AND “Urinary Incontinence, Stress/therapy” [Majr] AND RADIOFREQUENCY-Search Results-PubMed, [“woman” OR “women”] AND [“urinary incontinence” OR “stress urinary incontinence”] AND Radiofrequency were used, with a filter for the period 2020 to 2022. Conclusion: The studies evaluated in this review demonstrated significant results of radiofrequency in the resolution or reduction of complaints of women with urinary incontinence, especially stress urinary incontinence, but most of these studies presented a low methodological quality. There is, therefore, a lack of studies with longer follow-ups, evaluation of cost-effectiveness, randomized clinical trials with objective outcomes and the use of validated questionnaires with international acceptance.

The Psycho-Social Impact of Urinary Incontinence on the Quality of Life among Kuwaiti Women with Type 2 Diabetes Mellitus

This study was conducted to determine the psycho-social impact of urinary incontinence (UI) on the quality of life of 250 Kuwaiti women with type 2 diabetic mellitus (DM). A survey method, using a 33-item 5-point Likert scale Arabic questionnaire adapted from the King’s Health Questionnaire (KHQ), was employed for data collection from February to May, 2014 while all the participants were receiving treatment for UI at a specialized urology center in Kuwait. Participants with UI and a co-morbidity of type 2 DM and obesity were 20 to 65 years old. Results showed the following variables were statistically significant for frequency of urine leak: Age was (χ2 = 36.877, df = 3, P ≤ 0.000). Parity showed nulliparous women reported less urine leak compared to parous women: Chi-square was (χ2 = 24.83, df = 12, P ≤ 0.016). Type 2 DM for more than 3 years duration had the highest incidence of several leaks per day. BMI of above 25 kg/m2 caused daily urine leak: Chi-square (χ2 = 17.912, df = 9, P ≤ 0.036). Participants’ self reports of good general health were those who leaked urine either 2 - 3 times weekly or occasionally. Finally, the impact of incontinence on their lifestyle was reported as extreme by 128 (51.2%), and 6 (2.4%) reported little or no impact on their quality of life: Chi-square was (χ2 = 52.392, df = 18, P ≤ 0.000). In conclusion, this study showed a clear correlation between UI and reduced quality of life. Midwives are well positioned to correct the myth that UI is an inevitable byproduct of childbearing. Midwives should explain to all pregnant women how childbirth can be a risk factor and provide anticipatory guidance by teaching preventive measures like pelvic floor exercises before and after delivery. Family members should assist sufferers in coping with their challenges by dispelling any form of stigmatization, joining them in practicing pelvic floor exercises, and encouraging, empathizing and supporting them emotionally.

Effect of Comprehensive Nursing Intervention in Patients with Urinary Incontinence After Radical Prostatectomy

Objective:To explore and analyze the clinical effect of comprehensive nursing intervention in patients with urinary incontinence after radical prostatectomy.Methods:84 patients with urinary incontinence after radical prostatectomy admitted to the Urology Department between May 2021 and May 2023 were included in this study.The patients were divided into a comprehensive group and a control group,with 42 cases in each group through a double-blind mechanism.The comprehensive group received comprehensive nursing care,and the control group received primary nursing care.The duration of indwelling urinary catheters and urinary incontinence;psychological performance and living conditions were compared between the two groups.Results:The duration of the indwelling urinary catheter and urinary incontinence of the patients in the comprehensive group were significantly shorter than that in the control group(P<0.05).Before nursing,there was no statistically significant difference in the anxiety,depression,and other psychological manifestations between the two groups(P>0.05);after nursing,the comprehensive group’s anxiety,depression,and other psychological manifestations of the comprehensive group were significantly lower than those of the control group(P<0.05).Before nursing,there was no statistically significant difference in the physical function,mental state,emotional state,and physical recovery of the patients between both groups(P>0.05);after nursing,the physical function,mental state,emotional state,physical recovery of the patients in the comprehensive group were significantly better than those of the control group.Besides,the living conditions of the patients in the comprehensive group were also significantly better than the control group’s(P<0.05).Conclusion:Comprehensive nursing intervention can effectively improve symptoms of urinary incontinence after radical prostatectomy,reduce inner pressure,and improve living standards.

Contemporary diagnostics and treatment options for female stress urinary incontinence

Stress urinary incontinence is not a deadly disease,but for the large population of women suffering from it,it is a very important issue.Especially in the continuously aging population all over the world,there is more and more need for treatment of this serious medical condition.Treatment of female stress urinary incontinence exists already for ages.In the 20th century invasive treatments like Burch colposuspension and pubovaginal slings were the mainstay of surgical treatments.The introduction of the midurethral sling made the procedure less invasive and accessible for more caregivers.Luckily there are many options available and the field is developing quickly.In recent years many new medical devices have been developed,that increase the number of treatment options available and make it possible to find a suitable solution for the individual patient based on subjective and objective results and the chances of complications.This manuscript provides an introduction to the therapeutical options that are available nowadays for female stress urinary incontinence.

Female Stress Urinary Incontinence Treatment by Forming an Uretro-Vesical Angle with or without Mesh

Objective: To evaluate, in a comprehensive way, mesh and mesh free SUI treatment results obtained in a single center. The present study addresses the efficacy and safety of a novel surgical technique. Material & Methods: Adult female SUI patients, 184 in total, were divided within a sequential manner into two groups to be treated for SUI either with or without mesh insertion during a surgical intervention. In this novel procedure, a vertical vaginal incision from the urethra towards the bladder bottom is made and closed transversely. After the intervention the patients revisited the clinic at the 6th month. Results: 81 patients in mesh and 83 in the mesh free group completed the 2-year follow up. Based on the pad tests conducted at the end of 24-month follow up, 82% of the patients in the mesh free group and 85% in the mesh group were considered as successful if the pad test resulted with ≤2 gram. Cystocele of Grade I or II was also treated in 69 patients within the same single surgical procedure. Conclusion: The surgical outcomes of the mesh and mesh-free group were almost the same. However, though the cure rate of the mesh group was higher, it was not statistically significant. Adverse events were more frequent in the mesh group due to mesh presence.

Ten-Year Outcomes of Transobturator Mid-Urethral Sling for Treatment of Stress Urinary Incontinence in Hong Kong Chinese Women with or without Reconstructive Pelvic Floor Surgery

Objective: To evaluate the outcomes of transobturator mid-urethral sling (TO-MUS) with or without reconstructive pelvic floor surgery (RPFS) in Chinese women with stress urinary incontinence (SUI) after 10 years. Methods: This was a prospective observational study on Chinese women undergoing the insertion of TO-MUS with or without RPFS. All patients were assessed at 1-year and 10-year by urodynamic study (UDS). Objective cure was defined as the absence of urine leakage during provocative maneuvers on filling cystometry. Data regarding subjective outcome (patient perception), quality of life changes (Urogenital Distress Inventory-short form (UDI-6), Incontinence Impact Questionnaire-short form (IIQ-7)) and adverse events were also collected. Results: Of 104 eligible patients, 99 patients completed the 10-year evaluation. 57 patients (57.6%) underwent TO-MUS only and 42 patients (42.4%) underwent TO-MUS with concomitant RPFS. At 10-year follow-up, the overall objective cure rate was 86.9% and overall subjective cure rate was 80.8%. In TO-MUS only group, the objective and subjective cure rates at 10-year were 84.2% and 78.9% respectively. In TO-MUS with RPFS group, the objective and subjective cure rates at 10-year were 90.5% and 83.3% respectively. Compared TO-MUS only group with TO-MUS with RPFS group, there were no statistically significant differences in objective cure rate (84.2% vs. 90.5%, p = 0.55) and subjective cure rate (78.9% vs. 83.3%, p = 0.58). Conclusion: TO-MUS is an effective treatment for SUI in Hong Kong Chinese women. Concomitant RPFS during the procedure of TO-MUS does not affect the success.

Perceptions and barriers that influence the ability to provide appropriate incontinence care in nursing home residents: Statements from nursing staff

Urinary incontinence is a common medical condition among nursing home residents. Urinary incontinence in older people has a multifactorial etiology and is therefore more difficult to assess and treat than urinary incontinence in younger people. Previous research has shown that incontinence care in nursing home residents often is inadequate and little systematized. The aim of this study was to identify perceptions and barriers that influence the ability of the nursing staff to provide appropriate incontinence care. This was a qualitative study using focus-group methodology. Data were collected from three focus-group interviews with 15 members of the nursing staff from six different units in a nursing home. The focus-group interviews were recorded on tape, transcribed verbatim and analyzed according to qualitative content analysis. Three topics and eight categories were identified. The first topic, Perceptions and barriers associated with residents, consisted of one category: “physical and cognitive problems”. The second topic, Perceptions and barriers associated with nursing staff, consisted of three categories: “lack of knowledge”, “attitudes and beliefs” and “lack of accessibility”. The third topic, Perceptions and barriers associated with organizational culture, consisted of four categories: “rigid routines”, “lack of resource”, “lack of documentation” and “lack of leadership”. The findings from this study show that there are many barriers that might influence the possibilities of nursing staff to provide appropriate incontinence care to residents in nursing homes. However, it can nevertheless seem like opinions and the attitude of nursing staff, together with a lack of knowledge about UI, are the most important barriers to provide appropriate incontinence care.

Prevalence and Risk Factors of Stress Urinary Incontinence Among Perimenopausal Women and Its Influence on Daily Life in Women with Sexual Desire Problem

The prevalence of,and related factors to,stress urinary incontinence (SUI) among perimenopausal Chinese women and its impact on daily life among those women with sexual desire problem in Hubei province were investigated.In this study,1519 perimenopausal women aged 40 to 65 years were selected from three urban communities in the Wuhan area,and two impoverished,mountainous communities in Hubei province,and followed from April to October 2014.Detailed information about demographic characteristics,menstruation,pregnancy,sexual life and chronic diseases was collected.A cross-sectional survey was carried out following information collection by Chi-square test and multiple logistic regression analysis.Univariate and multivariate logistic regression analysis demonstrated that the potential factors associated with developing SUI were old age (OR=3.4,95% CI:1.92-6.04),vaginal delivery (OR=0.623,95% CI:0.45-0.87),low income (OR=0.063,95% CI:0.40-0.92),atrophic vaginitis (OR=1.4,95% CI:1.03-1.80),pelvic organ prolapse (OR=2.81,95% CI:1.36-5.80),chronic pelvic pain (OR=2.17,95% CI:1.90-4.03),constipation (OR=1.44,95% CI:1.07-1.93) and incontinence of feces (OR=3.32,95% CI:2.03-5.43).Moreover,the ratio of SUI (33.2%) was higher than the ratio of urgency urinary incontinence (24.1 %) or the ratio of mixed urinary incontinence (17.4%),and SUI had a greater impact on daily life among women with decreased sexual desire.In conclusion,SUI is a common disorder affecting over one third of the women surveyed,and has a severe impact on the daily life of perimenopausal women with declined sexual desire.Age,mode of delivery,and monthly income are major risk factors involved in the development of SUI.

Fecal incontinence - Challenges and solutions

Fecal incontinence is not a diagnosis but a frequent and debilitating common final pathway symptom resulting from numerous different causes. Incontinence not only impacts the patient&#x02019;s self-esteem and quality of life but may result in significant secondary morbidity, disability, and cost. Treatment is difficult without any panacea and an individualized approach should be chosen that frequently combines different modalities. Several new technologies have been developed and their specific roles will have to be defined. The scope of this review is outline the evaluation and treatment of patients with fecal incontinence.

Impact of fecal incontinence on quality of life

AIM:To explore the impact of fecal incontinence (FI) on quality of life (QOL) of patients attending urogynecology and colorectal clinics (CCs).METHODS:Cross-sectional study of 154 patients (27 male) with FI,who attended the clinics at a regional hospital in North Queensland,Australia in 2003 and 2004,and completed the Fecal Incontinence Quality of Life Scale (FIQL:1=very affected;4=not affected).RESULTS:More than 22% of patients had their QOL affected severely by FI.Patients reported that they had not previously been asked about FI by a medical practitioner nor did they voluntarily disclose its presence.The median FIQL scores for all participants were:lifestyle=3.24;coping=2.23;depression=2.42;and embarrassment=2.33.Increasing frequency of soiling had a negative effect on all four FIQL scales (P < 0.001) as did the quantity of soiling (P < 0.01).Female CC patients had poorer FIQL scores than urogynecology clinic patients for lifestyle (P=0.015),coping (P=0.004) and embarrassment (P=0.009),but not depression (P=0.062),despite having experienced FI for a shorter period.CONCLUSION:Failure to seek treatment for FI degrades the quality of patients' lives over time.FI assessment tools should incorporate the quantity of fecal loss.

Treatment strategies in obstructed defecation and fecal incontinence

Obstructed defecation （OD） and fecal incontinence （FI） are challenging clinical problems, which are commonly encountered in the practice of colorectal surgeons and gastroenterologists. These disorders sodally and psychologically distress patients and greatly impair their quality of life. The underlying anatomical and pathophysiological changes are complex, often incompletely understood and cannot always be determined. As a consequence, many medical, surgical, and behavioral approaches have been described, with no panacea. Over the past decade, advances in an understanding of these disorders together with rational and similar methods of evaluation in anorectal physiology laboratories （ARP）, radiology studies, and new surgical techniques have led to promising results. In this brief review, we discuss treatment strategies and recent updates on clinical and therapeutic aspects of obstructed defecation and fecal incontinence.

Stem cell therapy for faecal incontinence: Current state and future perspectives

Faecal continence is a complex function involving different organs and systems. Faecal incontinence is a common disorder with different pathogeneses, disabling consequences and high repercussions for quality of life. Current management modalities are not ideal, and the development of new treatments is needed. Since 2008, stem cell therapies have been validated, 36 publications have appeared(29 in preclinical models and seven in clinical settings), and six registered clinical trials are currently ongoing. Some publications have combined stem cells with bioengineering technologies. The aim of this review is to identify and summarise the existing published knowledge of stem cell utilization as a treatment for faecal incontinence. A narrative or descriptive review is presented. Preclinical studies have demonstrated that cellular therapy, mainly in the form of local injections of muscle-derived(muscle derived stem cells or myoblasts derived from them) or mesenchymal(bone-marrow-or adipose-derived) stem cells, is safe. Cellular therapy has also been shown to stimulate the repair of both acute and subacute anal sphincter injuries, and some encouraging functional results have been obtained. Stem cells combined with normal cells on bioengineered scaffolds have achieved the successful creation and implantation of intrinsically-innervated anal sphincter constructs. The clinical evidence, based on adipose-derived stem cells and myoblasts, is extremely limited yet has yielded some promising results, and appears to be safe. Further investigation in both animal models and clinical settings is necessary to drawing conclusions. Nevertheless, if the preliminary results are confirmed, stem cell therapy for faecal incontinence may well become a clinical reality in the near future.

Diagnostic approach to faecal incontinence:What test and when to perform?

Faecal incontinence(FI)is a debilitating common end result of several diseases affecting the quality of life and leading to patient disability,morbidity,and increased societal burden.Given the various causes of FI,it is important to assess and identify the underlying pathomechanisms.Several investigatory tools are available including high-resolution anorectal manometry,transrectal ultrasound,magnetic resonance imaging,and electromyography.This review article provides an overview on the causes and pathophysiology of FI and the author’s perspective of the stepwise investigation of patients with FI based on the available literature.Overall,high-resolution anorectal manometry should be the first investigatory tool for FI,followed by either transrectal ultrasound or magnetic resonance imaging for anal internal sphincter and external anal sphincter injury,respectively.