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The use of PTQ anal bulking injections

The use of PTQ anal bulking injections. Kirsty Cattle Pelvic floor clinical fellow. Introduction to treatment of faecal incontinence. Heterogenous condition, multiple treatments available, often disappointing results Conservative: Alteration of stool consistency, physiotherapy, biofeedback

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The use of PTQ anal bulking injections

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  1. The use of PTQ anal bulking injections Kirsty Cattle Pelvic floor clinical fellow

  2. Introduction to treatment of faecal incontinence • Heterogenous condition, multiple treatments available, often disappointing results • Conservative: • Alteration of stool consistency, physiotherapy, biofeedback • Surgical: • Anterior sphincter repair, postanal repair, stimulated graciloplasty, artificial bowel sphincter • Sacral nerve stimulation, anal bulking injections

  3. images • Authors: • Professor Yik-Hong Ho: • Head of surgery, school of Medicine, James Cook University, Townsville, Queensland, Australia • Journal: • British Journal of Surgery: • Impact factor 4.921

  4. Introduction & aim • Problem: • Serving a large rural area, long waiting list for biofeedback, only one colorectal surgeon • Aim: • to document the outcomes, in the short and medium term, from a large case series of patients with faecal incontinence and IAS dysfunction who received PTQ implants over a 4-year interval

  5. Methods • Identification of patients • IAS defects or dysfunction, either alone or in combination • Those unfit for surgery or opted for PTQ • Surgical method • Assessment of results • Anorectal physiology, standard symptom assessment tools, QoL • At baseline and 6 weeks • Statistical method

  6. Results • 74 patients • 28 (14.5 – 42) months follow up • At 6 weeks follow up: • 70 (95%) improved, 42 (57%) cured • At December 2008 follow up: • 40 of the 42 “cured” patients remain fully continent • Further 12 now “cured”

  7. Symptom scores & QoL • Both improved at 6 weeks and Dec 2008 • Satisfaction with procedure • Improve with time in those achieving complete continence • High, but do not improve in those with remaining incontinence

  8. Anal manometry • Significant rise in resting pressure, more so in those achieving continence • EAUS • Implants not intact in 10 of 70 patients • Further 2 had late migration of implants

  9. Complications • Required antidiarrhoeal medication (n=2) • Constipation (n=1) • Infection (n=1) • Anal irritation or discomfort (n=3) • Superficial mucosal ulceration (n=1)

  10. Risk factors predictive of poor outcome: • Pudendal neuropathy • Previous sphincter repair • Previous or subsequent biofeedback therapy • Migrated implants on EAUS • Female sex

  11. Discussion • Comparison with other studies of PTQ: • They claim better results and longer follow up • Improved anal manometry • Rate of implant migration: • Improved during study period • Study design • Cost implications • Alternatives

  12. Conclusion • Effective • Safe • Careful patient selection • Meticulous surgical technique

  13. Critique • Poor scientific technique, but pragmatic approach in their setting • Surprising improvement in continence scores

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