INTRODUCTION AND HYPOTHESIS: To study the correlation between transperineal ultrasound (TPUS) findings immediately after birth and postpartum anal incontinence (AI) and constipation. METHODS: This is a prospective cohort study in pregnant patients who delivered vaginally at term. Participants filled in questionnaires, including the St. Mark's Incontinence Score and the Patient Assessment of Constipation Symptoms, at inclusion and at 6-weeks postpartum follow-up. TPUS acquisitions were performed immediately after birth to detect anal sphincter and levator defects, the dimensions of the genital hiatus as well as the dimensions of rectovaginal septum defects. We report on the prevalence and severity of AI and constipation at the postpartum follow-up and ran regression models to quantify the association between the former and TPUS findings immediately after birth. We calculated that a minimum of 156 patients were required to detect potential predictors for AI (power = 80%; alpha = 0.05; f2 = 0.15). RESULTS: Of 182 consecutive participants, 109 (60%) reported AI and 78 (43%) constipation. There were 37 (20.3%) women with a levator avulsion, 83 (46%) with an external anal sphincter defect in one or more TUI-sections and 29 (16%) with a rectovaginal septum defect. On univariate regression, sphincter defects were associated with AI [OR = 1.94(1.28-2.94)]. On multivariate regression, levator avulsion was the only independent sonographic predictor of AI [aOR = 2.57(1.03-7.44)], whereas sphincter defects, dimensions of the genital hiatus or rectovaginal defects were not correlated with AI. We identified no factors associated with constipation. CONCLUSIONS: The presence of levator avulsion immediately after vaginal delivery predicts postpartum AI. Ultrasound appearance of the anal sphincter, genital hiatus and rectovaginal septum was not informative.

• Klíčová slova
• Anal incontinence, Constipation, Levator avulsion, OASI, Obstetric injury, Pelvic floor ultrasound,
• Publikační typ
• časopisecké články MeSH

INTRODUCTION AND HYPOTHESIS: Pregnancy and childbirth predispose to pelvic floor dysfunction (PFD), coinciding with functional and anatomical changes in the pelvic floor. To some extent, these can be assessed by transperineal ultrasound (TPUS), yet the correlation between ultrasound findings and symptoms has not been well elucidated. We hypothesised that pregnant women with PFD would show different findings at TPUS. METHODS: This is a planned secondary analysis of a prospective cohort study. Pregnant women were asked to fill out standardised questionnaires on PFD and undergo TPUS at 12-14 weeks and 28-32 weeks of gestation. We compared bladder neck descent, urethral rotation, retrovesical angle, pelvic organ descent, genital hiatus dimensions and the presence of anal sphincter defects between women with and those without PFD using t test and Fisher's exact test. Linear mixed-effects models were used to assess the correlation between TPUS findings and PFD severity. As this is a secondary subgroup analysis of participants who underwent TPUS, no sample size was determined upfront. RESULTS: At Valsalva, women with urinary incontinence had more pronounced bladder neck descent (p = 0.02) and urethral rotation (p < 0.01), as well as wider retrovesical angles (p = 0.04) and larger genital hiatus areas (p < 0.01). After controlling for age, BMI and parity, the retrovesical angle was the only persistent predictor of urinary incontinence. No correlation was observed between any TPUS marker and symptoms of either prolapse or anorectal dysfunction. CONCLUSIONS: In pregnant women, symptoms of urinary incontinence, but not of prolapse and anorectal dysfunction, are associated with differences in pelvic floor anatomy at TPUS.

• Klíčová slova
• Anal incontinence, Constipation, Gestation, Pelvic organ prolapse, Transperineal ultrasound, Urinary incontinence,
• MeSH
• anální kanál diagnostické zobrazování   MeSH
• dospělí MeSH
• inkontinence moči diagnostické zobrazování   MeSH
• komplikace těhotenství * diagnostické zobrazování   MeSH
• lidé MeSH
• onemocnění dna pánevního * diagnostické zobrazování   MeSH
• pánevní dno * diagnostické zobrazování   patofyziologie   MeSH
• prospektivní studie MeSH
• průzkumy a dotazníky MeSH
• těhotenství MeSH
• ultrasonografie MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• těhotenství MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

INTRODUCTION AND HYPOTHESIS: The terminology for anorectal dysfunction in women has long been in need of a specific clinically-based Consensus Report. METHODS: This Report combines the input of members of the Standardization and Terminology Committees of two International Organizations, the International Urogynecological Association (IUGA) and the International Continence Society (ICS), assisted on Committee by experts in their fields to form a Joint IUGA/ICS Working Group on Female Anorectal Terminology. Appropriate core clinical categories and sub classifications were developed to give an alphanumeric coding to each definition. An extensive process of twenty rounds of internal and external review was developed to exhaustively examine each definition, with decision-making by collective opinion (consensus). RESULTS: A Terminology Report for anorectal dysfunction, encompassing over 130 separate definitions, has been developed. It is clinically based with the most common diagnoses defined. Clarity and user-friendliness have been key aims to make it interpretable by practitioners and trainees in all the different specialty groups involved in female pelvic floor dysfunction. Female-specific anorectal investigations and imaging (ultrasound, radiology and MRI) has been included whilst appropriate figures have been included to supplement and help clarify the text. Interval review (5-10 years) is anticipated to keep the document updated and as widely acceptable as possible. CONCLUSIONS: A consensus-based Terminology Report for female anorectal dysfunction terminology has been produced aimed at being a significant aid to clinical practice and a stimulus for research.

• Klíčová slova
• Anorectal, Fecal incontinence, Female pelvic floor, Female sexual dysfunction, Imaging, Terminology,
• MeSH
• gynekologie organizace a řízení   MeSH
• konsensus MeSH
• lidé MeSH
• mezinárodní agentury organizace a řízení   MeSH
• nemoci rekta klasifikace   MeSH
• onemocnění dna pánevního klasifikace   MeSH
• společnosti lékařské organizace a řízení   MeSH
• terminologie jako téma * MeSH
• urologie organizace a řízení   MeSH
• ženské urogenitální nemoci klasifikace   MeSH
• Check Tag
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

OBJECTIVES: Prucalopride is effective at alleviating symptoms of chronic constipation in women. The aim of this study was to assess the efficacy of 12 weeks of prucalopride treatment compared with placebo in men with chronic constipation. METHODS: This was a multicenter, stratified, randomized, parallel-group, double-blind, placebo-controlled, phase 3 study (ClinicalTrials.gov identifier: NCT01147926). The primary end point was the proportion of patients with a mean of three or more spontaneous complete bowel movements (SCBMs) per week across the treatment period. Efficacy end points were assessed using daily electronic diaries, global assessment of the severity of constipation and efficacy of treatment, and Patient Assessment of Constipation-Symptoms (PAC-SYM) and Patient Assessment of Constipation-Quality of Life (PAC-QOL) questionnaires. RESULTS: In total, 374 patients were enrolled in the study. Significantly more patients achieved a mean of three or more SCBMs per week in the prucalopride group (37.9%) than in the placebo group (17.7%, P<0.0001). The proportion of patients rating their constipation treatment as "quite a bit" to "extremely" effective at the final on-treatment visit was 46.7 and 30.4% in the prucalopride and placebo groups, respectively. The difference between treatment groups was statistically significant (P<0.0001). The proportion of patients with an improvement of at least 1 point in PAC-QOL satisfaction subscale score was 52.7 and 38.8% in the prucalopride and placebo groups, respectively (P=0.0035). Prucalopride had a good safety profile and was well tolerated. CONCLUSIONS: Prucalopride is effective, has a good safety profile, and is well tolerated for the treatment of men with chronic constipation.

• MeSH
• agonisté serotoninových receptorů 5-HT4 škodlivé účinky   terapeutické užití   MeSH
• benzofurany škodlivé účinky   terapeutické užití   MeSH
• bolesti břicha chemicky indukované   MeSH
• bolesti hlavy chemicky indukované   MeSH
• chorobopisy MeSH
• chronická nemoc MeSH
• defekace MeSH
• dospělí MeSH
• dvojitá slepá metoda MeSH
• kvalita života MeSH
• lidé středního věku MeSH
• lidé MeSH
• nauzea chemicky indukované   MeSH
• průjem chemicky indukované   MeSH
• průzkumy a dotazníky MeSH
• senioři MeSH
• stupeň závažnosti nemoci MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• Publikační typ
• časopisecké články MeSH
• klinické zkoušky, fáze III MeSH
• multicentrická studie MeSH
• práce podpořená grantem MeSH
• randomizované kontrolované studie MeSH
• Názvy látek
• agonisté serotoninových receptorů 5-HT4 MeSH
• benzofurany MeSH
• prucalopride MeSH Prohlížeč