Edward A Cooper1,2, Katie J De-Loyde3, Christopher J Young4,5,6, Heather L Shepherd3, Caroline Wright4,5,3. 1. Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, NSW, Australia. edwardagcooper@gmail.com. 2. Sydney Medical School, The University of Sydney, Sydney, NSW, Australia. edwardagcooper@gmail.com. 3. Surgical Outcomes Research Centre (SOuRCe), Sydney Local Health District and Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia. 4. Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, NSW, Australia. 5. Sydney Medical School, The University of Sydney, Sydney, NSW, Australia. 6. The Institute of Academic Surgery, Royal Prince Alfred Hospital, Sydney, NSW, Australia.
Abstract
PURPOSE: Faecal incontinence (FI) is a debilitating condition, which affects approximately 2-17 % of the population. Clinical assessment, physiological testing and imaging are usually used to evaluate the pathophysiology and guide management of FI. By analysing patient characteristics, symptoms and investigative findings, the aim of this study was to identify which patient characteristics and investigations influence patient management. METHODS: Data was prospectively collected for all patients with FI presenting to a single surgeon at the Royal Prince Alfred Hospital, Sydney, between March 2002 and September 2013. Continuous data was analysed using the independent T-test. Categorical data was analysed using chi-square tests and logistic regression. RESULTS: Three hundred ninety-eight patients were reviewed; 96 % were female and the mean age was 57 years. Surgical intervention was recommended for 185 patients (47 %) should biofeedback fail. Independent predictors for surgical recommendation were prolapse (p < 0.001, adjusted OR = 4.9 [CI 2.9-8.2]), a functional sphincter length <1 cm (p = 0.032, OR = 1.7 [CI 1.1-2.8]), an external anal sphincter defect (p = 0.028, OR = 1.8 [CI 1.1-3.1]) and a Cleveland Clinic Incontinence Score ≥10 (p = 0.029, OR = 1.7 [CI 1.1-2.6]). CONCLUSION: Independent predictors of surgical recommendation included the presence of prolapse, a functional sphincter length <1 cm, an external anal sphincter defect and a Cleveland Clinic Incontinence Score ≥ 10. Pudendal neuropathy was not a predictor of surgical intervention, leading us to question the utility of this investigation.
PURPOSE: Faecal incontinence (FI) is a debilitating condition, which affects approximately 2-17 % of the population. Clinical assessment, physiological testing and imaging are usually used to evaluate the pathophysiology and guide management of FI. By analysing patient characteristics, symptoms and investigative findings, the aim of this study was to identify which patient characteristics and investigations influence patient management. METHODS: Data was prospectively collected for all patients with FI presenting to a single surgeon at the Royal Prince Alfred Hospital, Sydney, between March 2002 and September 2013. Continuous data was analysed using the independent T-test. Categorical data was analysed using chi-square tests and logistic regression. RESULTS: Three hundred ninety-eight patients were reviewed; 96 % were female and the mean age was 57 years. Surgical intervention was recommended for 185 patients (47 %) should biofeedback fail. Independent predictors for surgical recommendation were prolapse (p < 0.001, adjusted OR = 4.9 [CI 2.9-8.2]), a functional sphincter length <1 cm (p = 0.032, OR = 1.7 [CI 1.1-2.8]), an external anal sphincter defect (p = 0.028, OR = 1.8 [CI 1.1-3.1]) and a Cleveland Clinic Incontinence Score ≥10 (p = 0.029, OR = 1.7 [CI 1.1-2.6]). CONCLUSION: Independent predictors of surgical recommendation included the presence of prolapse, a functional sphincter length <1 cm, an external anal sphincter defect and a Cleveland Clinic Incontinence Score ≥ 10. Pudendal neuropathy was not a predictor of surgical intervention, leading us to question the utility of this investigation.
Authors: Rocco Ricciardi; Anders F Mellgren; Robert D Madoff; Nancy N Baxter; Richard E Karulf; Susan C Parker Journal: Dis Colon Rectum Date: 2006-06 Impact factor: 4.585
Authors: Y P Sangwan; J A Coller; R C Barrett; P L Roberts; J J Murray; L Rusin; D J Schoetz Journal: Dis Colon Rectum Date: 1996-06 Impact factor: 4.585
Authors: Luigi Brusciano; Claudio Gambardella; Bruno Roche; Salvatore Tolone; Roberto Maria Romano; Francesco Tuccillo; Gianmattia Del Genio; Gianmattia Terracciano; Giorgia Gualtieri; Ludovico Docimo Journal: Updates Surg Date: 2020-06-28