Prostate cancer and health-related quality of life: a review of the literature.
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With the established effectiveness of diverse treatments for prostate cancer, identification of the physical and psychosocial consequences of the disease and various treatments becomes critical. We review the literature on the effects of prostate cancer and its treatment on health-related quality of life (HRQoL). Studies show that prostate cancer and its treatment affect both disease-specific HRQoL (i.e. urinary, sexual, and bowel function) as well as general HRQoL (i.e. energy/vitality, performance in physical and social roles). Yet, these effects appear to differ across stage of disease and type of treatment. We outline evidence from three sources: (1) studies that compare men with the disease with an age-matched sample of men without the disease, (2) studies that assess men with the disease across time, and (3) cross-sectional studies that highlight predictors of HRQoL. Future research directions are discussed. (+info)
Quality of life after radical prostatectomy or watchful waiting.
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BACKGROUND: We evaluated symptoms and self-assessments of quality of life in men with localized prostate cancer who participated in a randomized comparison between radical prostatectomy and watchful waiting. METHODS: Between 1989 and 1999, a group of Swedish urologists randomly assigned men with localized prostate cancer to radical prostatectomy or watchful waiting. In this follow-up study, we obtained information from 326 of 376 eligible men (87 percent) concerning certain symptoms, symptom-induced distress, well-being, and the subjective assessment of quality of life by means of a mailed questionnaire. RESULTS: Erectile dysfunction (80 percent vs. 45 percent) and urinary leakage (49 percent vs. 21 percent) were more common after radical prostatectomy, whereas urinary obstruction (e.g., 28 percent vs. 44 percent for weak urinary stream) was less common. Bowel function, the prevalence of anxiety, the prevalence of depression, well-being, and the subjective quality of life were similar in the two groups. CONCLUSIONS: The assignment of patients to watchful waiting or radical prostatectomy entails different risks of erectile dysfunction, urinary leakage, and urinary obstruction, but on average, the choice has little if any influence on well-being or the subjective quality of life after a mean follow-up of four years. (+info)
Optic neuromyelitis syndrome in Brazilian patients.
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OBJECTIVES: To report the clinical features and outcome of 24 Brazilian patients with optic neuromyelitis syndrome (ONM); discuss the underlying pathological events associated with the ONM syndrome; review the nosological situation of ONM in the group of inflammatory and demyelinating diseases of the central nervous system. PATIENTS AND METHODS: Patients with ONM treated at the Hospital da Lagoa, Rio de Janeiro were studied. Demographic, clinical, magnetic resonance imaging, cerebrospinal fluid, and pathological data were analysed. RESULTS: The study consisted of 20 women, four men of whom 10 were white and 14 Afro-Brazilians. Clinical course was recurrent in 22 cases and monophasic in two. Neurological manifestations at inclusion were: sensory impairment (66%), bilateral (41.6%) or unilateral blindness (20.8%), paraplegia or quadriplegia (37.5%). The EDSS was moderate/severe in 70.8%. The underlying pathological events were respectively pulmonary tuberculosis and upper respiratory infection in the two monophasic cases; in the 22 recurrent ONM patients: pulmonary tuberculosis (3), neurocysticercosis (1), polyarteritis nodosa (1), antinuclear antibody and rheumatoid factor (1), antiphospholipid antibody primary syndrome (1), diabetes mellitus (1), hypothyroidism (1), and amenorrhea-galactorrhea (4). Normal cerebrospinal fluid was found in 52% and an inflammatory profile in 48%. Only four recurrent ONM white patients had brain and spinal cord magnetic resonance imaging and cerebrospinal fluid findings compatible with the diagnosis of multiple sclerosis. Large lesions were seen in 62% of spinal magnetic resonance images. Six of 12 recurrent ONM Afro-Brazilian died. There were no statistical differences in the demographic data of the two ethnic groups. Afro-Brazilians were significantly more severely impaired and had a higher mortality rate than the white patients. CONCLUSION: These cases were classified as follows: two monophasic acute disseminated encephalomyelitis; one recurrent disseminated encephalomyelitis; three recurrent ONM associated with Hughes syndrome, autoantibodies and polyarteritis nodosa; six recurrent ONM with endocrinopathies; and finally, four multiple sclerosis cases. The remaining cases were not associated with any other condition. It would seem clear that ONM is a syndrome rather than a single disease. (+info)
Anterior anal sphincter repair: results in a district general hospital.
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OBJECTIVE: Previous series have evaluated the overlapping anterior anal sphincter repair, but with short-term follow-up and a wide range of results. We assessed our results of the anterior sphincter repair in patients with faecal incontinence. PATIENTS AND METHODS: This was a retrospective study of 20 patients who underwent an anterior anal sphincter repair between October 1994 and July 1999. In 12 of the patients, a polypropylene mesh was inserted in the repair to act as re-inforcement. Pre-operatively, all patients had an anterior anal sphincter defect diagnosed with endo-anal ultrasound. Clinical evaluation included the patient's assessment of improvement and the Cleveland Clinic Continence Score before and after surgery. Manometric studies were performed pre-operatively and a median time of 11.5 mouths postoperatively. RESULTS: At a median follow-up of 13 months (range, 3-61 months), 16 out of 20 (80%) patients said that surgery had improved their symptoms. There was a significant improvement in the continence score from 14 (range, 4-15) before operation to 7 (range, 0-15) after operation (P < 0.01). There were no significant differences in mean anal sphincter length, mean resting and maximum squeeze anal canal pressures before and after surgery. Similar results were obtained in patients with and without mesh re-inforcement. CONCLUSIONS: In our institution, the overlapping anterior anal sphincter repair is successful in relieving symptoms in patients with faecal incontinence due to an anterior sphincter defect. This improvement, however, is not associated with any significant changes in anorectal manometric parameters. (+info)
Sacral nerve stimulation for faecal incontinence due to systemic sclerosis.
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BACKGROUND: Faecal incontinence occurs in over one third of patients with systemic sclerosis. The aetiology is multifactorial. Conventional treatment is often unsuccessful. Sacral nerve stimulation is a new effective treatment for resistant faecal incontinence. AIMS: To evaluate sacral nerve stimulation in patients with systemic sclerosis. PATIENTS: Five women, median age 61 years (30-71), with scleroderma associated faecal incontinence were evaluated. All had failed maximal conventional treatment. Median number of preoperative weekly episodes of incontinence was 15 (7-25), median duration of incontinence was five years (5-9), and scleroderma 13 years (4-29). METHODS: All patients were screened with temporary stimulation. Those who benefited underwent permanent implantation. At baseline and after stimulation a bowel diary, the SF-36 quality of life assessment, endoanal ultrasound, and anorectal physiology were performed. RESULTS: Four patients were continent at a median follow up of 24 months (6-60). One patient failed temporary stimulation and was not permanently implanted. The weekly episodes of incontinence decreased from 15, 11, 23, and 7 to 0. Urgency resolved (median time to defer <1 minute (0-1) v 12.5 minutes (5-15)). Quality of life, especially social function, improved. Endoanal ultrasound showed an atrophic internal anal sphincter (median width 1.0 mm (0-1.6)). Anorectal physiology showed an increase in median resting pressure (37 pre v 65 cm H(2)O post) and squeeze pressure (89 v 105 cm H(2)O). Stimulation produced enhanced rectal sensitivity to distension. There were no major complications. CONCLUSIONS: Sacral nerve stimulation is a safe and effective treatment for resistant faecal incontinence secondary to scleroderma. The benefit is maintained in the medium term. (+info)
Aging and neural control of the GI tract: IV. Clinical and physiological aspects of gastrointestinal motility and aging.
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The gastrointestinal motility changes that occur as a function of age are reviewed herein. Careful attention must be given in any review of aging phenomena to exclude, or at least be cognizant of, the many comorbid conditions that can alter physiological functioning in older adults. The dramatic increase in life expectancy over the past 10-15 years demands that clinicians be aware of the various physiological and clinically relevant changes that occur with age. Gastrointestinal motility changes associated with age are relatively subtle, and in many instances only conflicting data exist. As the older adult population increases, and as the control of disease is improved, much more work needs to be done to understand the true effects of aging on gastrointestinal functioning. (+info)
Artificial anal sphincter in severe fecal incontinence: outcome of prospective experience with 37 patients in one institution.
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OBJECTIVE: To evaluate the outcome of artificial anal sphincter implantation for severe fecal incontinence in 37 consecutive patients operated on in a single institution from 1993 through 2001. SUMMARY BACKGROUND DATA: Implantation of an artificial anal sphincter is proposed in severe fecal incontinence when local treatment is unsuitable or has failed. The results of this technique have not been determined yet, and its place among the various operative procedures is still debated. METHODS: Artificial anal sphincters were implanted in 37 patients from 1993 through 2001. All patients had complete fecal incontinence and had failed to respond to medical treatment. Median duration of incontinence was 16 years. The causes of incontinence were sphincter disruption (19 patients), hereditary malformations (2 patients), and neurologic disease (16 patients). Six patients had had previous surgery for fecal incontinence. Assessment was made by physical examination (anal continence, rectal emptying) and anorectal manometry. RESULTS: In the first 12 patients, six devices had to be removed (50%); the cause of failure was found in all cases, and this allowed contraindications to be defined. Among the next 25 patients, 23 had an uncomplicated postoperative follow-up, and 5 developed seven complications: control pump change (n = 3), balloon migration (n = 1), and major rectal emptying difficulties in patients with obstructive internal rectal procidentia (n = 2). The artificial anal sphincter had to be removed definitively in three cases, representing the failure rate of this technique in the authors' experience (12%); two other devices had to be removed temporarily and the patients are awaiting reimplantation. In this latter group of 25 patients, 80% have an activated sphincter: continence for liquid stool is normal in 78.9%, continence for gas in 63.1%. Seven patients have rectal emptying difficulties, minor in five and major in two. Manometric studies showed mean pressures of 110 and 37 cm H(2)O with closed and open sphincter, respectively, with a mean duration of artificial sphincter opening of 128 seconds. CONCLUSIONS: The long-term functional outcome of artificial anal sphincter implantation for severe fecal incontinence is satisfactory; adequate sphincter function is recovered and the definitive removal rate is low. Good results are directly related to careful patient selection and appropriate surgical and perioperative management after a learning curve of the surgical team. (+info)
New-onset fecal incontinence after stroke: prevalence, natural history, risk factors, and impact.
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BACKGROUND AND PURPOSE: Fecal incontinence (FI) is a common complication after stroke, yet epidemiological research into this distressing condition is limited. The purpose of this study was to describe the prevalence, natural history, associations, and impact of new-onset FI after stroke. METHODS: Stroke patients in the community-based South London Stroke Register (January 1995 to 2000) without preexisting FI were characterized regarding bowel continence at 7 to 10 days, 3 months, and 1 and 3 years after stroke. FI was defined as any degree of bowel leakage. RESULTS: Prevalence of poststroke FI was 30% (7 to 10 days), 11% (3 months), 11% (1 year), and 15% (3 years). One third of patients with FI at 3 months were continent by 1 year; conversely, 63% incontinent at 1 year had been continent at 3 months. Characteristics of 91 patients with FI and 755 without FI at 3 months were compared using multiple logistic regression. Acute stroke associations of neglect (adjusted odds ratio [OR], 1.9; 95% CI, 1.0 to 3.5) and initial urinary incontinence (OR, 6.2; 95% CI, 3.2 to 11.9) were no longer significant after adjustment for clinical factors at 3 months. Final independent associations were anticholinergic drug use (OR, 3.1; 95% CI, 1.1 to 10.2) and needing help with toilet use (OR, 3.5; 95% CI, 1.4 to 17.3). FI at 3 months increased the risk of long-term placement (28% vs 6%) and death within 1 year (20% vs 8%). CONCLUSIONS: New-onset FI in stroke survivors is common but may be transient. Modifiable risk factors for FI 3 months after stroke are constipating drug use and difficulty with toilet access, raising implications for developing treatment and prevention strategies. (+info)