93 research outputs found
KIRURĆ KO LIJEÄENJE STRES URINARNE INKONTINENCIJE, FEKALNE INKONTINENCIJE I VAGINALNOG PROLAPSA NOVOM OPERACIJOM »URETRO-ANO-VAGINOPLASTIKA«
We put forward a novel concept explaining the mechanism of micturition and the factors that control urinary continence. Also, we describe the mechanism of defecation and the factors that control stool continence and prevent fecal incontinence. A weak internal urethral sphincter (IUS) will not withstand sudden rise of intra-abdominal pressure and urine will leak. The weakness of the IUS is mostly due to traumatic rupture of its wall as a result of the huge vaginal distension that happens during prolonged, difficult and multiple frequent labors. So, surgical correction is by exposing that rupture and mending its walls. Also the marked vaginal distension which occurs in labor will cause lacerations in the internal anal sphincter (IAS) which is intimately related to the posterior vaginal wall. The torn weak IAS will cause fecal incontinence (FI). Exposing the torn IAS and mending the torn walls will restore the sphincter strength and fecal continence. Vaginal prolapse occurs as a result of vaginal wall weakness, redundancy and flabbiness subsequent to its marked stretching of its walls during vaginal deliveries. Overlapping the vaginal flaps both in the anterior and posterior vaginal wall, such repair will strengthen the vaginal walls, as if we put a collagenous mesh but instead this is an autologus collagenous mesh. We innovated an operation called »urethro-ano-vagino-plasty« to surgically treat urinary incontinence, fecal incontinence and and vaginal prolapse. Objectives. To describe this novel operation, and assess its results for a follow up period of 24 months. Methods. 134 patients with SUI and FI were assessed. Urethro-ano-vaginoplasty was done, and the results were assessed immediately and for 24 months follow up. Results. 121 (90.3%) gained urinary and fecal continence and remained continent in the follow up period. Conclusion. The internal anal sphincter (IAS) is a collageno-muscular tissue cylinder that surrounds the anal canal innervated by alpha-sympathetic nerve supply from the hypogastric nerves. It is surrounded in its lower part by the EAS which is a striated muscle innervated by the pudendal nerve. Its damage during childbirth causes fecal incontinence and mending the torn walls restores fecal continence.Predstavljena je nova koncepcija o mehanizmu mokrenja i Äimbenicima koji reguliraju mokraÄnu kontinenciju. TakoÄer, opisan je mehanizam defekacije te Äimbenici koji kontroliraju kontinenciju stolice i sprjeÄavaju fekalnu inkontinenciju. Slab unutarnji uretralni sfinkter (IUS) se ne moĆŸe suprostaviti naglom porastu intraabdominalnog tlaka te Äe mokraÄa bjeĆŸati. Slabost IUS-a je veÄinom posljedica ozljede njegove stijenke zbog silnog vaginalna ĆĄirenja koje se zbiva tijekom produljenih, teĆĄlih i uÄestalih raÄanja. KirurĆĄka korekcija se sastoji u nalaĆŸenju prsnuÄa i opskrbi njegove stijenke. Vaginalno ĆĄirenje tijekom poroda uzrokuje prsnuÄe unutarnjeg analnog sfinktera (IAS), koji je intimno povezan sa straĆŸnjom vaginalnom stijenkom. Oslabljeni i prsnuti IAS uzrokuje fekalnu inkontinenciju (FI). Prikaz prsnutog IAS-a i ĆĄivanje njegovih razderanih stijenki uspostavit Äe snagu sfinktera i fekalnu kontinenciju. Vaginalni prolaps nastaje kao posljedica slabosti i mlohavosti vaginalne stijenke te njene proĆĄirenosti, zbog istezanja tijekom vaginalnog raÄanja. Preklapanjem vaginalnih reĆŸanja prednje i straĆŸnje stijenke ojaÄava se stijenka, umjesto umjetne mreĆŸice postavljamo vlastitu autolognu kolagenu mreĆŸicu. Izumjeli smo za korekciju urinarne i fekalne inkontinencije te vaginalna prolapsa novu operaciju i nazcvali je »uretro-ano-vagino-plastika«. Cilj rada je opisati novu operaciju i prosuditi njen uspjeh nakon 24 mjeseca. Metoda. Operirane su 134 bolesnice sa stres urinarnom inkontinencijom i fekalnom inkontinencijom. Rezultati. 121 bolesnica (90,3%) je opet postigla mokraÄnu i fekalnu kontinenciju i zadrĆŸala ih tijekom praÄenja. ZakljuÄak. Unutarnji analni sfinkter je kolegano-miĆĄiÄni tkivni cilindar, inerviran alfa-simpatiÄnim ĆŸivcima iz hipogastriÄkog pleksusa koji okruĆŸuje analni kanal. U donjem dijelu je okruĆŸen vanjskim sfinkterom koji je popreÄno-prugaste miĆĄiÄne graÄe i inerviran ograncima pudendalnog ĆŸivca. Njegovo oĆĄteÄenje tijekom raÄanja uzrokuje fekalnu inkontinenciju, a ĆĄivanje prsnute stijenke uspostavlja fekalnu kontinenciju
FEKALNA INKONTINENCIJA Nova koncepcija: Uloga unutarnjeg analnog sfinktera pri defekaciji i fekalnoj inkontinenciji
Introduction. Fecal incontinence is involuntary escape of stool, mucus and/or flatus.Its causes are: anal sphincter damage (childbirth trauma, surgical trauma.); constipation; diarrhea; rectocele; rectal prolapse and rarely congenital causes. Fecal material entering the rectum is evacuated by defecation during which: 1. The smooth muscles of the distal colon and rectum contract, propelling the feces into the anal canal; 2.The anal sphincter relaxes allowing defecation to occur. We put forward a recent concept on the patho-physiology of defecation.The mechanism of defecation has two stages: first stage: (in early childhood) before training; second stage is after training. The mother starts to teach her child how to control himself. This is gained by maintaining high alpha sympathetic tone at the internal anal sphincter (IAS) keeping it closed all the time till appropriate place and time are available. Wherever appropriate place is available and there is a desire, six neuromuscular actions will occur: 1) the person will lower the acquired high alpha sympathetic tone at the IAS relaxing it opening the anal canal; 2) through the voluntary nervous system (NS) he will widen the ano-rectal angle to bring the anal canal and the rectum on one axis. This is done through the pelvic floor muscles; 3) through, voluntary NS he will also relax the external anal sphincter (EAS); then synergistic actions between the voluntary and autonomic nervous system occur; 4) the abdominal and diaphragmatic muscles contract, increasing the intra- abdominal pressure and forcing the feces through the anal canal (via the voluntary NS); 5) the smooth muscles of the distal colon and rectum contract, propelling the feces into the anal canal (through the autonomic NS); 6) followed by sequential contractions of the three parts of the EAS (deep then superficial and then the subcutaneous parts) that will squeeze the anal canal propelling any residual contents.
Objectives. Imaging of the anal canal by 3-dimension ultrasound (3DUS) in normal women and women suffering from fecal incontinence and from rectocele, to compare the state of the IAS and EAS. Methods. 40 patients with FI were assessed clinically and by imaging using 3DUS, and also 10 normal women not suffering from fecal incontinence (FI) as a control. Results. The anal canal is closed in normal women, with intact IAS. In women suffering from FI the anal canal is wide and open with torn IAS. Conclusion. The internal anal sphincter (IAS) is a collageno-muscular tissue cylinder that surrounds the anal canal innervated by alpha-sympathetic nerve supply from the hypogastric nerves. It is surrounded in its lower part by the EAS which is a striated muscle innervated by the pudendal nerve. Its damage during childbirth causes fecal incontinence, and mending its torn wall restores fecal continence.Uvod. Fekalna inkontinencija (insuficijencija stolice) znaÄi nevoljno bjeĆŸanje stolice, sluzi i/ili vjetrova. Uzroci su: oĆĄteÄenje sfinktera (pri raÄanju djeteta, kirurĆĄka trauma), zatvor stolice, proljev; rektokela, ispadanje rektuma, rijetko priroÄeno ispadanje. Stolica ulazi u zavrĆĄno crijevo te iz njega izlazi na sljedeÄi naÄin: 1. Glatki miĆĄiÄi donjeg i zavrĆĄnog dijela debelog crijeva se steĆŸu, potiskujuÄi feces u analni kanal; 2. Analni sfinkter olabavi i omoguÄi da uslijedi defekacija. Predstavljamo svjeĆŸe shvaÄanje o patofiziologiji defekacije. Mehanizam ima dva razdobkja: prvo razdoblje je rano djetinstvo, bez poduke; drugo razdoblje je nakon poduke. Majka poduÄava svoje dijete kako se kontrolirati. To se postiĆŸe visokim alfa simpatiÄkim tonusom unutarnjeg analnog sfinktera, drĆŸeÄi ga zatvorenim sve dok se ne ukaĆŸe odgovarajuÄe mjesto i vrijeme. Kad se naÄe odgovarajuÄe mjesto, i ako postoji ĆŸelja, poÄinje ĆĄest sinergistiÄkih neuromuskularnih aktivnosti: 1) osoba Äe sniziti postojeÄi visoki alfa simpatiÄki tonus unutarnjeg analnoga sfinktera i time otvoriti analni kanal; 2) pomoÄu voljnog ĆŸivÄanog sustava smanjit Äe ano-rektalni kut i dovesti ih u istu osovinu; to postiĆŸe pomoÄu miĆĄiÄa dna zdjelice: 3) voljnim ĆŸivÄanim sustavom takoÄer Äe omlohaviti vanjski analni sfinkter; tada nastupa sinergistiÄna djelatnost voljnog i autonomnog ĆŸivÄevlja; 4) trbuĆĄni i dijafragmalni miĆĄiÄi se steĆŸu, poveÄavaju intraabdominalni tlak te potiskuju feces kroz analni kanal; 5) steĆŸu se glatki miĆĄiÄi debelog crijeva i rektuma te potiskuju feces u analni kanal (autonomnim ĆŸivÄevljem); 6) slijede segmentalna stezanja sva tri dijela vanjskog sfinktera (dubokog, povrĆĄnog pa potkoĆŸnog), koja Äe iz analnog kanala istisnuti sve zaostatke.
Svrha rada. Trodimenzionalnim ultrazvukom prikazati analni kanal u zdravih ĆŸena te u onih koje pate od fekalne inkontinencije i rektokele, usporediti njihov unutraĆĄnji i vanjski analni sfinkter. Metode. Analizirano je kliniÄki i 3DUZ-om 40 pacijentica s fekalnom inkompetencijom i usporeÄeno s 10 zdravih ĆŸena. Rezultat. Analni kanal je u zdravih ĆŸena zatvoren, njihov unutrapnji sfinkter je neoĆĄteÄen. U ĆŸena s fekalnom inkompetencijom analni kanal je ĆĄirok i otvoren te s razderanim sfinkterom. ZakljuÄak. Unutarnji analni sfinkter je kolageno-miĆĄiÄno tkivo oblika cilindra koje okruĆŸuje analni kanal, inerviran je alfa-simpatiÄkim ĆŸivcima iz hipogastriÄkog pleksusa. Unutarnji sfinkter je okruĆŸen donjim dijelom vanjskog analnog sfinktera, koji je graÄen od prugastog miĆĄiÄja inerviranog pudendalnim ĆŸivcem. Njegovo oĆĄteÄenje tijekom raÄanja uzrokuje fekalnu inkontinenciju. Prepravak njegove razderane stijenke uspostavlja fekalnu kontinenciju
KIRURĆ KO LIJEÄENJE STRES URINARNE INKONTINENCIJE, FEKALNE INKONTINENCIJE I VAGINALNOG PROLAPSA NOVOM OPERACIJOM »URETRO-ANO-VAGINOPLASTIKA«
We put forward a novel concept explaining the mechanism of micturition and the factors that control urinary continence. Also, we describe the mechanism of defecation and the factors that control stool continence and prevent fecal incontinence. A weak internal urethral sphincter (IUS) will not withstand sudden rise of intra-abdominal pressure and urine will leak. The weakness of the IUS is mostly due to traumatic rupture of its wall as a result of the huge vaginal distension that happens during prolonged, difficult and multiple frequent labors. So, surgical correction is by exposing that rupture and mending its walls. Also the marked vaginal distension which occurs in labor will cause lacerations in the internal anal sphincter (IAS) which is intimately related to the posterior vaginal wall. The torn weak IAS will cause fecal incontinence (FI). Exposing the torn IAS and mending the torn walls will restore the sphincter strength and fecal continence. Vaginal prolapse occurs as a result of vaginal wall weakness, redundancy and flabbiness subsequent to its marked stretching of its walls during vaginal deliveries. Overlapping the vaginal flaps both in the anterior and posterior vaginal wall, such repair will strengthen the vaginal walls, as if we put a collagenous mesh but instead this is an autologus collagenous mesh. We innovated an operation called »urethro-ano-vagino-plasty« to surgically treat urinary incontinence, fecal incontinence and and vaginal prolapse. Objectives. To describe this novel operation, and assess its results for a follow up period of 24 months. Methods. 134 patients with SUI and FI were assessed. Urethro-ano-vaginoplasty was done, and the results were assessed immediately and for 24 months follow up. Results. 121 (90.3%) gained urinary and fecal continence and remained continent in the follow up period. Conclusion. The internal anal sphincter (IAS) is a collageno-muscular tissue cylinder that surrounds the anal canal innervated by alpha-sympathetic nerve supply from the hypogastric nerves. It is surrounded in its lower part by the EAS which is a striated muscle innervated by the pudendal nerve. Its damage during childbirth causes fecal incontinence and mending the torn walls restores fecal continence.Predstavljena je nova koncepcija o mehanizmu mokrenja i Äimbenicima koji reguliraju mokraÄnu kontinenciju. TakoÄer, opisan je mehanizam defekacije te Äimbenici koji kontroliraju kontinenciju stolice i sprjeÄavaju fekalnu inkontinenciju. Slab unutarnji uretralni sfinkter (IUS) se ne moĆŸe suprostaviti naglom porastu intraabdominalnog tlaka te Äe mokraÄa bjeĆŸati. Slabost IUS-a je veÄinom posljedica ozljede njegove stijenke zbog silnog vaginalna ĆĄirenja koje se zbiva tijekom produljenih, teĆĄlih i uÄestalih raÄanja. KirurĆĄka korekcija se sastoji u nalaĆŸenju prsnuÄa i opskrbi njegove stijenke. Vaginalno ĆĄirenje tijekom poroda uzrokuje prsnuÄe unutarnjeg analnog sfinktera (IAS), koji je intimno povezan sa straĆŸnjom vaginalnom stijenkom. Oslabljeni i prsnuti IAS uzrokuje fekalnu inkontinenciju (FI). Prikaz prsnutog IAS-a i ĆĄivanje njegovih razderanih stijenki uspostavit Äe snagu sfinktera i fekalnu kontinenciju. Vaginalni prolaps nastaje kao posljedica slabosti i mlohavosti vaginalne stijenke te njene proĆĄirenosti, zbog istezanja tijekom vaginalnog raÄanja. Preklapanjem vaginalnih reĆŸanja prednje i straĆŸnje stijenke ojaÄava se stijenka, umjesto umjetne mreĆŸice postavljamo vlastitu autolognu kolagenu mreĆŸicu. Izumjeli smo za korekciju urinarne i fekalne inkontinencije te vaginalna prolapsa novu operaciju i nazcvali je »uretro-ano-vagino-plastika«. Cilj rada je opisati novu operaciju i prosuditi njen uspjeh nakon 24 mjeseca. Metoda. Operirane su 134 bolesnice sa stres urinarnom inkontinencijom i fekalnom inkontinencijom. Rezultati. 121 bolesnica (90,3%) je opet postigla mokraÄnu i fekalnu kontinenciju i zadrĆŸala ih tijekom praÄenja. ZakljuÄak. Unutarnji analni sfinkter je kolegano-miĆĄiÄni tkivni cilindar, inerviran alfa-simpatiÄnim ĆŸivcima iz hipogastriÄkog pleksusa koji okruĆŸuje analni kanal. U donjem dijelu je okruĆŸen vanjskim sfinkterom koji je popreÄno-prugaste miĆĄiÄne graÄe i inerviran ograncima pudendalnog ĆŸivca. Njegovo oĆĄteÄenje tijekom raÄanja uzrokuje fekalnu inkontinenciju, a ĆĄivanje prsnute stijenke uspostavlja fekalnu kontinenciju
PRIKAZ UNUTRAĆ NJEG SFINKTERA URETRE I VAGINE U ZDRAVIH ĆœENA I OBOLJELIH OD STRES INKONTINENCIJE MOKRAÄE I PROLAPSA VAGINE
Introduction. The internal urethral sphincter (IUS) is a cylinder formation that extends from the urinary bladder neck to the urogenital diaphragm. It is composed of a strong collagen sheet with muscle fibers that intermingle with the collagen in the middle of the cylinderâs thickness. The strong collagen sheet gives the IUS the high wall tension necessary to create the high urethral pressure. The muscle fibers, innervated by alpha sympathetic nerves (T10-L2) are responsible for closure and opening the urethra. Urinary continence depends on the presence of an intact and strong IUS and of an acquired behavior, gained by learning and training in early childhood, how to maintain a high alpha sympathetic tone at the IUS keeping it closed until there is a need. Normal vagina is a cylinder of collageno-elastic-muscular tissues. Its strong collagen sheet is responsible for keeping it in its normal upward position. Labors cause redundancy and weakness of the vaginal walls with subsequent prolapse and lacerations of the IUS which is intimately overlying the anterior vaginal wall resulting in stress urinary incontinence (SUI). Objectives. To image by 3D-US and MRI the IUS and the vagina; and to examine their histopathology. Methods. Histopathology as well as 3D-US and MR imaging are done. Results. Images show the IUS as a compact tissue cylinder that extends from the bladder neck to the urogenital diaphragm in continent women; IUS is torn in women with SUI. Conclusion. The anterior vaginal wall and the IUS are torn in patients with SUI and with vaginal prolapse. They are intact in continent women.Uvod. UnutraĆĄnji uretralni sfinkter (IUS) je cilindriÄnog oblika, proteĆŸe se od vrata mokraÄnog mjegura do urogenitalne dijafragme. Sastoji se od Ävrstog kolagenog sloja s miĆĄiÄnim vlaknima koja su izmijeĆĄana s kolagenom u sredini debljine cilindra. Jaki kolageni sloj daje IUS-u snaĆŸnu napetost stijenke potrebnu da stvori visoki intrauretralni tlak. MiĆĄiÄna vlakna, inervirana alfa simpatiÄnim ĆŸivcima (Th10-L2) su odgovorna za zatvaranje i otvaranje uretre. Kontinencija mokraÄe ovisi o postojanju intaktnog i jakog IUS-a te o steÄenom ponaĆĄanju, uÄeÄi i vjeĆŸbajuÄi u ranom djetinjstvu kako odrĆŸati visoki alfa simpatiÄki tonus IUS-a, drĆŸeÄi ga zatvorenim dok je potrebno. Normalna vagina je cilindriÄna cijev kolageno-elastiÄno-miĆĄiÄnog tkiva. Njen jaki kolageni sloj je odgovoran za njen uspravni poloĆŸaj. Porod uzrokuje suviĆĄak i slabost vaginalne stijenke s posljediÄnim prolapsom i laceracijom IUS-a, koji intimno prileĆŸi prednjoj vaginalnoj stijenci, ĆĄto rezultira stresnom mokraÄnom inkontinencijom (SUI). Cilj istraĆŸivanja. Prikazati trodimenzionalnim ultrazvukom (3D-UZ) i magnetskom rezonancijom (MR) te histopatoloĆĄkim pregledom intrauretralni sfinkter i vaginu. Metode. HistopatoloĆĄka tehnika te 3D-UZ i MR prikazi. Rezultati. Prikazi pokazuju IUS kao kompaktni tkivni cilindar koji se proteĆŸe od vrata mokraÄnog mjehura do urogenitalne dijafragme u kontinentnih ĆŸena; IUS je oĆĄteÄen u ĆŸena sa SUI. ZakljuÄak. Prednja vaginalna stijenka i IUS bivaju oĆĄteÄeni (prsnuti) u pacijentica sa SUI i s vaginalnim prolapsom. Oni su intaktni u kontinentnih ĆŸena
Infertility and the provision of infertility medical services in developing countries
developing countrie
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