Pudendal nerve testing does not contribute to surgical decision making following anorectal testing in patients with faecal incontinence
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 i...
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| Veröffentlicht in: | International journal of colorectal disease 2016-08, Vol.31 (8), p.1437-1442 |
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| container_title | International journal of colorectal disease |
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| creator | Cooper, Edward A. De-Loyde, Katie J. Young, Christopher J. Shepherd, Heather L. Wright, Caroline |
| description | 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
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| doi_str_mv | 10.1007/s00384-016-2617-3 |
| format | Article |
| fullrecord | <record><control><sourceid>gale_proqu</sourceid><recordid>TN_cdi_proquest_miscellaneous_1808669043</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><galeid>A714488809</galeid><sourcerecordid>A714488809</sourcerecordid><originalsourceid>FETCH-LOGICAL-c472t-bfafeae5fba8f3ea08e156aa07c71f505690785a02d591aaf14adb6e70232d3c3</originalsourceid><addsrcrecordid>eNqNkstu1TAQhi0EoofCA7BBkdiwSbGd-JJlVXGTKsEC1tbEGR9cEvtgO1Q8Aa-No9NyE0jIC3s83_yasX9CHjN6xihVzzOlne5bymTLJVNtd4fsWN_xlnHJ75IdZWpo2SD0CXmQ8xWtsVT9fXLCFddyUHpHvr1bJwwTzE3A9AWbgrn4sG-miLkJsTQ2hpL8uJaai01e097bSk9offYxNAt82ngX5zlebycIMaEtlbnV8qE5QPEYSm6uffnYOMBNw4dN3AcMFh-Sew7mjI9u9lPy4eWL9xev28u3r95cnF-2tle8tKMDh4DCjaBdh0A1MiEBqLKKOUGFHKjSAiifxMAAHOthGiUqyjs-dbY7Jc-OuocUP6-1QbP4bHGeIWBcs2GaallF-u5_UNFrJcWGPv0DvYprCnWQSjHGZP0P8ZPaw4zGBxdLAruJmnPF-l5rTYdKnf2FqmvCxdcHQ-fr_W8F7FhgU8w5oTOH5BdIXw2jZvOJOfrEVJ-YzSdma_jJTcPruOD0o-LWGBXgRyDXVNhj-mWif6p-B2_8yU4</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1811162625</pqid></control><display><type>article</type><title>Pudendal nerve testing does not contribute to surgical decision making following anorectal testing in patients with faecal incontinence</title><source>MEDLINE</source><source>SpringerLink Journals - AutoHoldings</source><creator>Cooper, Edward A. ; De-Loyde, Katie J. ; Young, Christopher J. ; Shepherd, Heather L. ; Wright, Caroline</creator><creatorcontrib>Cooper, Edward A. ; De-Loyde, Katie J. ; Young, Christopher J. ; Shepherd, Heather L. ; Wright, Caroline</creatorcontrib><description>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.</description><identifier>ISSN: 0179-1958</identifier><identifier>EISSN: 1432-1262</identifier><identifier>DOI: 10.1007/s00384-016-2617-3</identifier><identifier>PMID: 27286978</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Biofeedback training ; Care and treatment ; Clinical Decision-Making ; Decision-making ; Fecal Incontinence - physiopathology ; Fecal Incontinence - surgery ; Female ; Gastroenterology ; Hepatology ; Humans ; Incontinence ; Internal Medicine ; Male ; Medical research ; Medicine ; Medicine & Public Health ; Medicine, Experimental ; Middle Aged ; Original Article ; Physiological aspects ; Proctology ; Pudendal Nerve - physiopathology ; Pudendal Nerve - surgery ; Surgeons ; Surgery</subject><ispartof>International journal of colorectal disease, 2016-08, Vol.31 (8), p.1437-1442</ispartof><rights>Springer-Verlag Berlin Heidelberg 2016</rights><rights>COPYRIGHT 2016 Springer</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c472t-bfafeae5fba8f3ea08e156aa07c71f505690785a02d591aaf14adb6e70232d3c3</citedby><cites>FETCH-LOGICAL-c472t-bfafeae5fba8f3ea08e156aa07c71f505690785a02d591aaf14adb6e70232d3c3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00384-016-2617-3$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00384-016-2617-3$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,780,784,27922,27923,41486,42555,51317</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27286978$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Cooper, Edward A.</creatorcontrib><creatorcontrib>De-Loyde, Katie J.</creatorcontrib><creatorcontrib>Young, Christopher J.</creatorcontrib><creatorcontrib>Shepherd, Heather L.</creatorcontrib><creatorcontrib>Wright, Caroline</creatorcontrib><title>Pudendal nerve testing does not contribute to surgical decision making following anorectal testing in patients with faecal incontinence</title><title>International journal of colorectal disease</title><addtitle>Int J Colorectal Dis</addtitle><addtitle>Int J Colorectal Dis</addtitle><description>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.</description><subject>Biofeedback training</subject><subject>Care and treatment</subject><subject>Clinical Decision-Making</subject><subject>Decision-making</subject><subject>Fecal Incontinence - physiopathology</subject><subject>Fecal Incontinence - surgery</subject><subject>Female</subject><subject>Gastroenterology</subject><subject>Hepatology</subject><subject>Humans</subject><subject>Incontinence</subject><subject>Internal Medicine</subject><subject>Male</subject><subject>Medical research</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Medicine, Experimental</subject><subject>Middle Aged</subject><subject>Original Article</subject><subject>Physiological aspects</subject><subject>Proctology</subject><subject>Pudendal Nerve - physiopathology</subject><subject>Pudendal Nerve - surgery</subject><subject>Surgeons</subject><subject>Surgery</subject><issn>0179-1958</issn><issn>1432-1262</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNqNkstu1TAQhi0EoofCA7BBkdiwSbGd-JJlVXGTKsEC1tbEGR9cEvtgO1Q8Aa-No9NyE0jIC3s83_yasX9CHjN6xihVzzOlne5bymTLJVNtd4fsWN_xlnHJ75IdZWpo2SD0CXmQ8xWtsVT9fXLCFddyUHpHvr1bJwwTzE3A9AWbgrn4sG-miLkJsTQ2hpL8uJaai01e097bSk9offYxNAt82ngX5zlebycIMaEtlbnV8qE5QPEYSm6uffnYOMBNw4dN3AcMFh-Sew7mjI9u9lPy4eWL9xev28u3r95cnF-2tle8tKMDh4DCjaBdh0A1MiEBqLKKOUGFHKjSAiifxMAAHOthGiUqyjs-dbY7Jc-OuocUP6-1QbP4bHGeIWBcs2GaallF-u5_UNFrJcWGPv0DvYprCnWQSjHGZP0P8ZPaw4zGBxdLAruJmnPF-l5rTYdKnf2FqmvCxdcHQ-fr_W8F7FhgU8w5oTOH5BdIXw2jZvOJOfrEVJ-YzSdma_jJTcPruOD0o-LWGBXgRyDXVNhj-mWif6p-B2_8yU4</recordid><startdate>20160801</startdate><enddate>20160801</enddate><creator>Cooper, Edward A.</creator><creator>De-Loyde, Katie J.</creator><creator>Young, Christopher J.</creator><creator>Shepherd, Heather L.</creator><creator>Wright, Caroline</creator><general>Springer Berlin Heidelberg</general><general>Springer</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7T5</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>H94</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>7X8</scope></search><sort><creationdate>20160801</creationdate><title>Pudendal nerve testing does not contribute to surgical decision making following anorectal testing in patients with faecal incontinence</title><author>Cooper, Edward A. ; De-Loyde, Katie J. ; Young, Christopher J. ; Shepherd, Heather L. ; Wright, Caroline</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c472t-bfafeae5fba8f3ea08e156aa07c71f505690785a02d591aaf14adb6e70232d3c3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Biofeedback training</topic><topic>Care and treatment</topic><topic>Clinical Decision-Making</topic><topic>Decision-making</topic><topic>Fecal Incontinence - physiopathology</topic><topic>Fecal Incontinence - surgery</topic><topic>Female</topic><topic>Gastroenterology</topic><topic>Hepatology</topic><topic>Humans</topic><topic>Incontinence</topic><topic>Internal Medicine</topic><topic>Male</topic><topic>Medical research</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Medicine, Experimental</topic><topic>Middle Aged</topic><topic>Original Article</topic><topic>Physiological aspects</topic><topic>Proctology</topic><topic>Pudendal Nerve - physiopathology</topic><topic>Pudendal Nerve - surgery</topic><topic>Surgeons</topic><topic>Surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Cooper, Edward A.</creatorcontrib><creatorcontrib>De-Loyde, Katie J.</creatorcontrib><creatorcontrib>Young, Christopher J.</creatorcontrib><creatorcontrib>Shepherd, Heather L.</creatorcontrib><creatorcontrib>Wright, Caroline</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Immunology Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>MEDLINE - Academic</collection><jtitle>International journal of colorectal disease</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Cooper, Edward A.</au><au>De-Loyde, Katie J.</au><au>Young, Christopher J.</au><au>Shepherd, Heather L.</au><au>Wright, Caroline</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Pudendal nerve testing does not contribute to surgical decision making following anorectal testing in patients with faecal incontinence</atitle><jtitle>International journal of colorectal disease</jtitle><stitle>Int J Colorectal Dis</stitle><addtitle>Int J Colorectal Dis</addtitle><date>2016-08-01</date><risdate>2016</risdate><volume>31</volume><issue>8</issue><spage>1437</spage><epage>1442</epage><pages>1437-1442</pages><issn>0179-1958</issn><eissn>1432-1262</eissn><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.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>27286978</pmid><doi>10.1007/s00384-016-2617-3</doi><tpages>6</tpages></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0179-1958 |
| ispartof | International journal of colorectal disease, 2016-08, Vol.31 (8), p.1437-1442 |
| issn | 0179-1958 1432-1262 |
| language | eng |
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| source | MEDLINE; SpringerLink Journals - AutoHoldings |
| subjects | Biofeedback training Care and treatment Clinical Decision-Making Decision-making Fecal Incontinence - physiopathology Fecal Incontinence - surgery Female Gastroenterology Hepatology Humans Incontinence Internal Medicine Male Medical research Medicine Medicine & Public Health Medicine, Experimental Middle Aged Original Article Physiological aspects Proctology Pudendal Nerve - physiopathology Pudendal Nerve - surgery Surgeons Surgery |
| title | Pudendal nerve testing does not contribute to surgical decision making following anorectal testing in patients with faecal incontinence |
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