Advanced Management Protocol of Transanal Irrigation in Order to Improve the Outcome of Pediatric Patients with Fecal Incontinence

Background: Transanal irrigation (TAI) is employed for children with fecal incontinence, but it can present several problems which require a study of their outcomes among different pathologies and without a tailored work up. The aim of our study was to evaluate the effectiveness of an advanced protocol in order to tailor TAI, prevent complications, and evaluate outcomes. Methods: We included 70 patients (14 anorectal malformation, 12 Hirschsprung’s disease, 24 neurological impairment, 20 functional incontinence) submitted to a comprehensive protocol with Peristeen®: fecal score, volumetric enema, rectal ultrasound, anorectal 3D manometry, and diary for testing and parameter adjustment. Results: Among the patients, 62.9% needed adaptations to the parameters, mainly volume of irrigated water and number of puffs of balloon. These adaptations were positively correlated with pre-treatment manometric and enema data. In each group, the improvement of score was statistically significant in all cases (p 0.000); the main factor influencing the efficacy was the rate of sphincter anomalies. The ARM group had slower improvement than other groups, whereas functional patients had the best response. Conclusions: Our results showed that TAI should not be standardized for all patients, because each one has different peculiarities; evaluation of patients before TAI with rectal ultrasound, enema, and manometry allowed us to tailor the treatment, highlighting different outcomes among various pathologies, thus improving the efficacy

Effect of different manipulations on serum PSA in patients with benign prostatic hyperplasia.

Objectives: To evaluate the effect of different urological manipulations on the serum PSA level in patients with benign prostatic hyperplasia. Study Design: Quasi-experimental study. Setting: Department of Urology, Nawaz Sharif Social Security Hospital, Lahore. Period: January 2018 to December 2018. Material & Methods: A series of 60 patients were included in the study who fulfill the inclusion criteria. All the patients were above 50 years of age and presented with symptoms of benign prostatic hyperplasia. These patients were divided into four groups equally. In group A digital rectal examination, in group B transurethral resection of prostate, in group C Foley’s catheterization and in group D Trans rectal ultrasound guided prostatic biopsy was done. Pre-manipulation and post-manipulation blood samples for serum PSA were taken after 30 minutes, 72 hours and one week. Results: Trans urethral resection of prostate, Foley's catheterization and trans rectal ultrasound guided prostatic biopsy caused a statistically significant rise in serum PSA level (p < 0.05) while digital rectal examination did not raise serum PSA level significantly. Conclusion: Different manipulations do cause alteration in the serum PSA level which may change the management plan.

Use of colour Doppler to eliminate rectal bleeding from trans-rectal ultrasound-guided biopsy of the prostate

Bleeding is one of the complications of trans-rectal ultrasound (TRUS)-guided biopsy of the prostate. Urethral bleeding could be prevented by avoiding the trajectory on the urethra. However, rectal bleeding is difficult to predict because the peri-prostatic, intra-prostatic and rectal vessels cannot be seen on an ordinary ultrasound scan. Use of colour Doppler to map out the vessels cognitively before injection of local anaesthesia prevents puncture of the vessels, which is a key cause of rectal bleeding. Level of evidence: Not applicable.