Skip to main content
Erschienen in: Diseases of the Colon & Rectum 9/2007

01.09.2007 | Current Status

Radiation-Induced Sequelae Affecting the Continence Organ: Incidence, Pathogenesis, and Treatment

verfasst von: Sven Petersen, M.D., Ph.D., Johannes Jongen, M.D., Cordula Petersen, M.D., Ph.D., Marco Sailer, M.D., Ph.D.

Erschienen in: Diseases of the Colon & Rectum | Ausgabe 9/2007

Einloggen, um Zugang zu erhalten

Introduction

Incontinence is a late complication that causes symptoms years after radiation treatment and is difficult to deal with; it poses a particular challenge for care-providing physicians.

Review

This review looks at our current knowledge of the incidence, symptoms, and treatment of fecal incontinence induced by radiation treatment. An approximate estimation based on retrospective data suggests an incidence of fecal incontinence of up to one-third of patients. The mechanism that causes incontinence are changes in anal resting tone, squeeze pressure, and rectal volume or rectal compliance. The other associated aspects of incontinence include such further disorders as proctitis, colitis, and other disturbances involving the lower digestive tract. The therapeutic options mainly comprise the treatment of associated aspects, such as proctitis or diarrhea.

Conclusion

Surgical treatment should be the absolute exception. If the creation of a stoma is being considered, a resective procedure offering freedom from symptoms seems to be the more advantageous option.
Literatur
1.
Zurück zum Zitat Talcott, JA, Manola, J, Clark, JA, et al. 2003Time course and predictors of symptoms after primary prostate cancer therapyJ Clin Oncol2139793986PubMedCrossRef Talcott, JA, Manola, J, Clark, JA,  et al. 2003Time course and predictors of symptoms after primary prostate cancer therapyJ Clin Oncol2139793986PubMedCrossRef
2.
Zurück zum Zitat Fox, JC, Fletcher, JG, Zinsmeister, AR, et al. 2006Effect of aging on anorectal and pelvic floor functions in femalesDis Colon Rectum4917261735PubMedCrossRef Fox, JC, Fletcher, JG, Zinsmeister, AR,  et al. 2006Effect of aging on anorectal and pelvic floor functions in femalesDis Colon Rectum4917261735PubMedCrossRef
3.
Zurück zum Zitat Schellhammer, PF, Jordan, GH, el-Mahdi, AM 1986Pelvic complications after interstitial and external beam irradiation of urologic and gynecologic malignancyWorld J Surg10259268PubMedCrossRef Schellhammer, PF, Jordan, GH, el-Mahdi, AM 1986Pelvic complications after interstitial and external beam irradiation of urologic and gynecologic malignancyWorld J Surg10259268PubMedCrossRef
4.
Zurück zum Zitat Hamilton, AS, Stanford, JL, Gilliland, FD, et al. 2001Health outcomes after external-beam radiation therapy for clinically localized prostate cancer: results from the Prostate Cancer Outcomes StudyJ Clin Oncol1925172526PubMed Hamilton, AS, Stanford, JL, Gilliland, FD,  et al. 2001Health outcomes after external-beam radiation therapy for clinically localized prostate cancer: results from the Prostate Cancer Outcomes StudyJ Clin Oncol1925172526PubMed
5.
Zurück zum Zitat Jongen, J 2005Langzeitfolgen beachtenDtsch Arztebl102679680 Jongen, J 2005Langzeitfolgen beachtenDtsch Arztebl102679680
6.
Zurück zum Zitat Herrmann, T, Petersen, S, Hellmich, G, Baumann, M, Ludwig, K 1999Delayed toxicity of brief preoperative irradiation and risk-adjusted postoperative radiotherapy of operative rectal carcinoma. Results of a randomized prospective study [in German]Strahlenther Onkol175430436PubMedCrossRef Herrmann, T, Petersen, S, Hellmich, G, Baumann, M, Ludwig, K 1999Delayed toxicity of brief preoperative irradiation and risk-adjusted postoperative radiotherapy of operative rectal carcinoma. Results of a randomized prospective study [in German]Strahlenther Onkol175430436PubMedCrossRef
7.
Zurück zum Zitat Heemsbergen, WD, Hoogeman, MS, Hart, GA, Lebesque, JV, Koper, PC 2005Gastrointestinal toxicity and its relation to dose distributions in the anorectal region of prostate cancer patients treated with radiotherapyInt J Radiat Oncol Biol Phys6110111018PubMedCrossRef Heemsbergen, WD, Hoogeman, MS, Hart, GA, Lebesque, JV, Koper, PC 2005Gastrointestinal toxicity and its relation to dose distributions in the anorectal region of prostate cancer patients treated with radiotherapyInt J Radiat Oncol Biol Phys6110111018PubMedCrossRef
8.
Zurück zum Zitat Fokdal, L, Honore, H, Hoyer, M, Maase, H 2005Dose-volume histograms associated to long-term colorectal functions in patients receiving pelvic radiotherapyRadiother Oncol74203210PubMedCrossRef Fokdal, L, Honore, H, Hoyer, M, Maase, H 2005Dose-volume histograms associated to long-term colorectal functions in patients receiving pelvic radiotherapyRadiother Oncol74203210PubMedCrossRef
9.
Zurück zum Zitat Miller, DC, Sanda, MG, Dunn, RL, et al. 2005Long-term outcomes among localized prostate cancer survivors: health-related quality-of-life changes after radical prostatectomy, external radiation, and brachytherapyJ Clin Oncol2327722780PubMedCrossRef Miller, DC, Sanda, MG, Dunn, RL,  et al. 2005Long-term outcomes among localized prostate cancer survivors: health-related quality-of-life changes after radical prostatectomy, external radiation, and brachytherapyJ Clin Oncol2327722780PubMedCrossRef
10.
Zurück zum Zitat Morris, M, Eifel, PJ, Lu, J, et al. 1999Pelvic radiation with concurrent chemotherapy compared with pelvic and para-aortic radiation for high-risk cervical cancerN Engl J Med34011371143PubMedCrossRef Morris, M, Eifel, PJ, Lu, J,  et al. 1999Pelvic radiation with concurrent chemotherapy compared with pelvic and para-aortic radiation for high-risk cervical cancerN Engl J Med34011371143PubMedCrossRef
11.
Zurück zum Zitat Hayne, D, Vaizey, CJ, Boulos, PB 2001Anorectal injury following pelvic radiotherapyBr J Surg8810371048PubMedCrossRef Hayne, D, Vaizey, CJ, Boulos, PB 2001Anorectal injury following pelvic radiotherapyBr J Surg8810371048PubMedCrossRef
12.
Zurück zum Zitat Iwamoto, T, Nakahara, S, Mibu, R, et al. 1997Effect of radiotherapy on anorectal function in patients with cervical cancerDis Colon Rectum40693697PubMedCrossRef Iwamoto, T, Nakahara, S, Mibu, R,  et al. 1997Effect of radiotherapy on anorectal function in patients with cervical cancerDis Colon Rectum40693697PubMedCrossRef
13.
Zurück zum Zitat Birnbaum, EH, Myerson, RJ, Fry, RD, Kodner, IJ, Fleshman, JW 1994Chronic effects of pelvic radiation therapy on anorectal functionDis Colon Rectum37909915PubMedCrossRef Birnbaum, EH, Myerson, RJ, Fry, RD, Kodner, IJ, Fleshman, JW 1994Chronic effects of pelvic radiation therapy on anorectal functionDis Colon Rectum37909915PubMedCrossRef
14.
Zurück zum Zitat Kushwaha, RS, Hayne, D, Vaizey, CJ, et al. 2003Physiologic changes of the anorectum after pelvic radiotherapy for the treatment of prostate and bladder cancerDis Colon Rectum4611821188PubMedCrossRef Kushwaha, RS, Hayne, D, Vaizey, CJ,  et al. 2003Physiologic changes of the anorectum after pelvic radiotherapy for the treatment of prostate and bladder cancerDis Colon Rectum4611821188PubMedCrossRef
15.
Zurück zum Zitat Yeoh, EE, Holloway, RH, Fraser, RJ, et al. 2004Anorectal dysfunction increases with time following radiation therapy for carcinoma of the prostateAm J Gastroenterol99361369PubMedCrossRef Yeoh, EE, Holloway, RH, Fraser, RJ,  et al. 2004Anorectal dysfunction increases with time following radiation therapy for carcinoma of the prostateAm J Gastroenterol99361369PubMedCrossRef
16.
Zurück zum Zitat Herbolsheimer, M, Rotte, K 1997Cancer of the endometriumVahrson, HW eds. Radiation oncology of gynecological cancerSpringerNew York241296 Herbolsheimer, M, Rotte, K 1997Cancer of the endometriumVahrson, HW eds. Radiation oncology of gynecological cancerSpringerNew York241296
17.
Zurück zum Zitat Sedgwick, DM, Howard, GC, Ferguson, A 1994Pathogenesis of acute radiation injury to the rectum. A prospective study in patientsInt J Colorectal Dis92330PubMedCrossRef Sedgwick, DM, Howard, GC, Ferguson, A 1994Pathogenesis of acute radiation injury to the rectum. A prospective study in patientsInt J Colorectal Dis92330PubMedCrossRef
18.
Zurück zum Zitat Yeoh, EK, Russo, A, Botten, R, et al. 1998Acute effects of therapeutic irradiation for prostatic carcinoma on anorectal functionGut43123127PubMedCrossRef Yeoh, EK, Russo, A, Botten, R,  et al. 1998Acute effects of therapeutic irradiation for prostatic carcinoma on anorectal functionGut43123127PubMedCrossRef
19.
Zurück zum Zitat Gervaz, P, Hennig, R, Buechler, M, et al. 2003Long-term expression of fibrogenic cytokines in radiation-induced damage to the internal anal sphincterSwiss Surg9193197PubMedCrossRef Gervaz, P, Hennig, R, Buechler, M,  et al. 2003Long-term expression of fibrogenic cytokines in radiation-induced damage to the internal anal sphincterSwiss Surg9193197PubMedCrossRef
20.
Zurück zum Zitat Berndtsson, I, Lennernas, B, Hulten, L 2002Anorectal function after modern conformal radiation therapy for prostate cancer: a pilot studyTech Coloproctol6101104PubMedCrossRef Berndtsson, I, Lennernas, B, Hulten, L 2002Anorectal function after modern conformal radiation therapy for prostate cancer: a pilot studyTech Coloproctol6101104PubMedCrossRef
21.
Zurück zum Zitat Varma, JS, Smith, AN, Busuttil, A 1986Function of the anal sphincters after chronic radiation injuryGut27528533PubMedCrossRef Varma, JS, Smith, AN, Busuttil, A 1986Function of the anal sphincters after chronic radiation injuryGut27528533PubMedCrossRef
22.
Zurück zum Zitat Iglicki, F, Coffin, B, Ille, O, et al. 1996Fecal incontinence after pelvic radiotherapy: evidences for a lumbosacral plexopathy. Report of a caseDis Colon Rectum39465467PubMedCrossRef Iglicki, F, Coffin, B, Ille, O,  et al. 1996Fecal incontinence after pelvic radiotherapy: evidences for a lumbosacral plexopathy. Report of a caseDis Colon Rectum39465467PubMedCrossRef
23.
Zurück zum Zitat Georgiou, A, Grigsby, PW, Perez, CA 1993Radiation induced lumbosacral plexopathy in gynecologic tumors: clinical findings and dosimetric analysisInt J Radiat Oncol Biol Phys26479482PubMed Georgiou, A, Grigsby, PW, Perez, CA 1993Radiation induced lumbosacral plexopathy in gynecologic tumors: clinical findings and dosimetric analysisInt J Radiat Oncol Biol Phys26479482PubMed
24.
Zurück zum Zitat Stryker, JA, Sommerville, K, Perez, R, Velkley, DE 1990Sacral plexus injury after radiotherapy for carcinoma of cervixCancer6614881492PubMedCrossRef Stryker, JA, Sommerville, K, Perez, R, Velkley, DE 1990Sacral plexus injury after radiotherapy for carcinoma of cervixCancer6614881492PubMedCrossRef
25.
Zurück zum Zitat Silva, GM, Berho, M, Wexner, SD, et al. 2003Histologic analysis of the irradiated anal sphincterDis Colon Rectum4614921497PubMedCrossRef Silva, GM, Berho, M, Wexner, SD,  et al. 2003Histologic analysis of the irradiated anal sphincterDis Colon Rectum4614921497PubMedCrossRef
27.
Zurück zum Zitat Bock, JU, Jongen, J 1996Diagnostic and therapeutic procedures in fecal incontinence in general practice of the surgically educated proctologist [in German]Zentralbl Chir121659664PubMed Bock, JU, Jongen, J 1996Diagnostic and therapeutic procedures in fecal incontinence in general practice of the surgically educated proctologist [in German]Zentralbl Chir121659664PubMed
28.
Zurück zum Zitat Baxter, NN, Tepper, JE, Durham, SB, Rothenberger, DA, Virnig, BA 2005Increased risk of rectal cancer after prostate radiation: a population-based studyGastroenterology128819824PubMedCrossRef Baxter, NN, Tepper, JE, Durham, SB, Rothenberger, DA, Virnig, BA 2005Increased risk of rectal cancer after prostate radiation: a population-based studyGastroenterology128819824PubMedCrossRef
29.
Zurück zum Zitat Jung, H, Svoboda, V, Alberti, W, Herrmann, T 2005Spätnebenwirkungen nach Strahlentherapie des ProstatakarzinomsExp Strahlenther klin Strahlenbiol146770 Jung, H, Svoboda, V, Alberti, W, Herrmann, T 2005Spätnebenwirkungen nach Strahlentherapie des ProstatakarzinomsExp Strahlenther klin Strahlenbiol146770
30.
Zurück zum Zitat Bentzen, SM, Overgaard, J 1994Patient-to-patient variability in the expression of radiation-induced normal tissue injurySemin Radiat Oncol46880PubMedCrossRef Bentzen, SM, Overgaard, J 1994Patient-to-patient variability in the expression of radiation-induced normal tissue injurySemin Radiat Oncol46880PubMedCrossRef
31.
Zurück zum Zitat Peeters, ST, Hoogeman, MS, Heemsbergen, WD, et al. 2006Rectal bleeding, fecal incontinence, and high stool frequency after conformal radiotherapy for prostate cancer: normal tissue complication probability modelingInt J Radiat Oncol Biol Phys661119PubMedCrossRef Peeters, ST, Hoogeman, MS, Heemsbergen, WD,  et al. 2006Rectal bleeding, fecal incontinence, and high stool frequency after conformal radiotherapy for prostate cancer: normal tissue complication probability modelingInt J Radiat Oncol Biol Phys661119PubMedCrossRef
32.
Zurück zum Zitat Cox, JD, Byhardt, RW, Wilson, JF, et al. 1986Complications of radiation therapy and factors in their preventionWorld J Surg10171188PubMedCrossRef Cox, JD, Byhardt, RW, Wilson, JF,  et al. 1986Complications of radiation therapy and factors in their preventionWorld J Surg10171188PubMedCrossRef
33.
Zurück zum Zitat Parikh, S, Hughes, C, Salvati, EP, et al. 2003Treatment of hemorrhagic radiation proctitis with 4 percent formalinDis Colon Rectum46596600PubMedCrossRef Parikh, S, Hughes, C, Salvati, EP,  et al. 2003Treatment of hemorrhagic radiation proctitis with 4 percent formalinDis Colon Rectum46596600PubMedCrossRef
34.
Zurück zum Zitat Zbar, AP, Bernstein, S, Greaves, N, Iniss, M, Shenoy, RK 2005The utilization of intraluminal formalin for intractable rectal haemorrhage in advanced rectal cancer: a case reportTech Coloproctol94951PubMedCrossRef Zbar, AP, Bernstein, S, Greaves, N, Iniss, M, Shenoy, RK 2005The utilization of intraluminal formalin for intractable rectal haemorrhage in advanced rectal cancer: a case reportTech Coloproctol94951PubMedCrossRef
35.
Zurück zum Zitat Regueiro, MD 2004Diagnosis and treatment of ulcerative proctitisJ Clin Gastroenterol38733740PubMedCrossRef Regueiro, MD 2004Diagnosis and treatment of ulcerative proctitisJ Clin Gastroenterol38733740PubMedCrossRef
36.
Zurück zum Zitat Johnston, MJ, Robertson, GM, Frizelle, FA 2003Management of late complications of pelvic radiation in the rectum and anus: a reviewDis Colon Rectum46247259PubMedCrossRef Johnston, MJ, Robertson, GM, Frizelle, FA 2003Management of late complications of pelvic radiation in the rectum and anus: a reviewDis Colon Rectum46247259PubMedCrossRef
37.
Zurück zum Zitat Pruitt, R, Hanson, J, Safdi, M, et al. 2002Balsalazide is superior to mesalamine in the time to improvement of signs and symptoms of acute mild-to-moderate ulcerative colitisAm J Gastroenterol9730783086PubMedCrossRef Pruitt, R, Hanson, J, Safdi, M,  et al. 2002Balsalazide is superior to mesalamine in the time to improvement of signs and symptoms of acute mild-to-moderate ulcerative colitisAm J Gastroenterol9730783086PubMedCrossRef
38.
Zurück zum Zitat Ehrenpreis, ED, Jani, A, Levitsky, J, Ahn, J, Hong, J 2005A prospective, randomized, double-blind, placebo-controlled trial of retinol palmitate (vitamin A) for symptomatic chronic radiation proctopathyDis Colon Rectum4818PubMedCrossRef Ehrenpreis, ED, Jani, A, Levitsky, J, Ahn, J, Hong, J 2005A prospective, randomized, double-blind, placebo-controlled trial of retinol palmitate (vitamin A) for symptomatic chronic radiation proctopathyDis Colon Rectum4818PubMedCrossRef
39.
Zurück zum Zitat Benson, AB 3rd, Ajani, JA, Catalano, RB, et al. 2004Recommended guidelines for the treatment of cancer treatment-induced diarrheaJ Clin Oncol2229182926PubMedCrossRef Benson, AB 3rd, Ajani, JA, Catalano, RB,  et al. 2004Recommended guidelines for the treatment of cancer treatment-induced diarrheaJ Clin Oncol2229182926PubMedCrossRef
40.
Zurück zum Zitat Classen, J, Belka, C, Paulsen, F, et al. 1998Radiation-induced gastrointestinal toxicity. Pathophysiology, approaches to treatment and prophylaxisStrahlenther Onkol1748284PubMed Classen, J, Belka, C, Paulsen, F,  et al. 1998Radiation-induced gastrointestinal toxicity. Pathophysiology, approaches to treatment and prophylaxisStrahlenther Onkol1748284PubMed
41.
Zurück zum Zitat Musial, F, Enck, P, Kalveram, KT, Erckenbrecht, JF 1992The effect of loperamide on anorectal function in normal healthy menJ Clin Gastroenterol15321324PubMedCrossRef Musial, F, Enck, P, Kalveram, KT, Erckenbrecht, JF 1992The effect of loperamide on anorectal function in normal healthy menJ Clin Gastroenterol15321324PubMedCrossRef
42.
Zurück zum Zitat Zimmermann, F, Molls, M 2004ProstataBamberg, MMolls, MSack, H eds. Radioonkologie. Vol. 2W. Zuckerschwert VerlagMuenchen692719 Zimmermann, F, Molls, M 2004ProstataBamberg, MMolls, MSack, H eds. Radioonkologie. Vol. 2W. Zuckerschwert VerlagMuenchen692719
43.
Zurück zum Zitat Triadafilopoulos, G, Sarkisian, M 1990Dilatation of radiation-induced sigmoid stricture using sequential Savary-Guilliard dilators. A combined radiologic-endoscopic approachDis Colon Rectum3310651067PubMedCrossRef Triadafilopoulos, G, Sarkisian, M 1990Dilatation of radiation-induced sigmoid stricture using sequential Savary-Guilliard dilators. A combined radiologic-endoscopic approachDis Colon Rectum3310651067PubMedCrossRef
44.
Zurück zum Zitat Yates, MR 3rd, Baron, TH 1999Treatment of a radiation-induced sigmoid stricture with an expandable metal stentGastrointest Endosc50422426PubMedCrossRef Yates, MR 3rd, Baron, TH 1999Treatment of a radiation-induced sigmoid stricture with an expandable metal stentGastrointest Endosc50422426PubMedCrossRef
45.
Zurück zum Zitat Yegappan, M, Ho, YH, Nyam, D, et al. 1998The surgical management of colorectal complications from irradiation for carcinoma of the cervixAnn Acad Med Singapore27627630PubMed Yegappan, M, Ho, YH, Nyam, D,  et al. 1998The surgical management of colorectal complications from irradiation for carcinoma of the cervixAnn Acad Med Singapore27627630PubMed
46.
Zurück zum Zitat Luck, A, Chapuis, P, Sinclair, G, Hood, J 2001Endoscopic laser stricturotomy and balloon dilatation for benign colorectal stricturesANZ J Surg71594597PubMedCrossRef Luck, A, Chapuis, P, Sinclair, G, Hood, J 2001Endoscopic laser stricturotomy and balloon dilatation for benign colorectal stricturesANZ J Surg71594597PubMedCrossRef
47.
Zurück zum Zitat Mayer, R, Klemen, H, Quehenberger, F, et al. 2001Hyperbaric oxygen-an effective tool to treat radiation morbidity in prostate cancerRadiother Oncol61151156PubMedCrossRef Mayer, R, Klemen, H, Quehenberger, F,  et al. 2001Hyperbaric oxygen-an effective tool to treat radiation morbidity in prostate cancerRadiother Oncol61151156PubMedCrossRef
48.
Zurück zum Zitat Carl, UM, Peusch-Dreyer, D, Frieling, T, Schmitt, G, Hartmann, KA 1998Treatment of radiation proctitis with hyperbaric oxygen: what is the optimal number of HBO treatments?Strahlenther Onkol174482483PubMedCrossRef Carl, UM, Peusch-Dreyer, D, Frieling, T, Schmitt, G, Hartmann, KA 1998Treatment of radiation proctitis with hyperbaric oxygen: what is the optimal number of HBO treatments?Strahlenther Onkol174482483PubMedCrossRef
49.
Zurück zum Zitat Denton, AS, Andreyev, HJ, Forbes, A, Maher, EJ 2002Systematic review for non-surgical interventions for the management of late radiation proctitisBr J Cancer87134143PubMedCrossRef Denton, AS, Andreyev, HJ, Forbes, A, Maher, EJ 2002Systematic review for non-surgical interventions for the management of late radiation proctitisBr J Cancer87134143PubMedCrossRef
50.
Zurück zum Zitat Bennett M, Feldmeier J, Hampson N, Smee R, Milross C. Hyperbaric oxygen therapy for late radiation tissue injury. Cochrane Database Syst Rev 2005;CD005005 Bennett M, Feldmeier J, Hampson N, Smee R, Milross C. Hyperbaric oxygen therapy for late radiation tissue injury. Cochrane Database Syst Rev 2005;CD005005
51.
Zurück zum Zitat Russell, JC, Welch, JP 1979Operative management of radiation injuries of the intestinal tractAm J Surg137433442PubMedCrossRef Russell, JC, Welch, JP 1979Operative management of radiation injuries of the intestinal tractAm J Surg137433442PubMedCrossRef
52.
Zurück zum Zitat Jao, SW, Beart, RW Jr, Gunderson, LL 1986Surgical treatment of radiation injuries of the colon and rectumAm J Surg151272277PubMedCrossRef Jao, SW, Beart, RW Jr, Gunderson, LL 1986Surgical treatment of radiation injuries of the colon and rectumAm J Surg151272277PubMedCrossRef
53.
Zurück zum Zitat Stuart, M, Failes, DG, Killingback, MJ, Luca, C 1980Irradiation injuries of the large intestineDis Colon Rectum239497PubMedCrossRef Stuart, M, Failes, DG, Killingback, MJ, Luca, C 1980Irradiation injuries of the large intestineDis Colon Rectum239497PubMedCrossRef
54.
Zurück zum Zitat Pricolo, VE, Shellito, PC 1994Surgery for radiation injury to the large intestine. Variables influencing outcomeDis Colon Rectum37675684PubMedCrossRef Pricolo, VE, Shellito, PC 1994Surgery for radiation injury to the large intestine. Variables influencing outcomeDis Colon Rectum37675684PubMedCrossRef
55.
Zurück zum Zitat Geisler, D, Marks, J, Marks, G 2004Laparoscopic colorectal surgery in the irradiated pelvisAm J Surg188267270PubMedCrossRef Geisler, D, Marks, J, Marks, G 2004Laparoscopic colorectal surgery in the irradiated pelvisAm J Surg188267270PubMedCrossRef
56.
Zurück zum Zitat Gazet, JC 1985Parks’ coloanal pull-through anastomosis for severe, complicated radiation proctitisDis Colon Rectum28110114PubMedCrossRef Gazet, JC 1985Parks’ coloanal pull-through anastomosis for severe, complicated radiation proctitisDis Colon Rectum28110114PubMedCrossRef
57.
Zurück zum Zitat Kimose, HH, Fischer, L, Spjeldnaes, N, Wara, P 1989Late radiation injury of the colon and rectum. Surgical management and outcomeDis Colon Rectum32684689PubMedCrossRef Kimose, HH, Fischer, L, Spjeldnaes, N, Wara, P 1989Late radiation injury of the colon and rectum. Surgical management and outcomeDis Colon Rectum32684689PubMedCrossRef
58.
Zurück zum Zitat Lucarotti, ME, Mountford, RA, Bartolo, DC 1991Surgical management of intestinal radiation injuryDis Colon Rectum34865869PubMedCrossRef Lucarotti, ME, Mountford, RA, Bartolo, DC 1991Surgical management of intestinal radiation injuryDis Colon Rectum34865869PubMedCrossRef
59.
Zurück zum Zitat Lehur, PA, Michot, F, Denis, P, et al. 1996Results of artificial sphincter in severe anal incontinence. Report of 14 consecutive implantationsDis Colon Rectum3913521355PubMedCrossRef Lehur, PA, Michot, F, Denis, P,  et al. 1996Results of artificial sphincter in severe anal incontinence. Report of 14 consecutive implantationsDis Colon Rectum3913521355PubMedCrossRef
60.
Zurück zum Zitat Michot, F, Costaglioli, B, Leroi, AM, Denis, P 2003Artificial anal sphincter in severe fecal incontinence: outcome of prospective experience with 37 patients in one institutionAnn Surg2375256PubMedCrossRef Michot, F, Costaglioli, B, Leroi, AM, Denis, P 2003Artificial anal sphincter in severe fecal incontinence: outcome of prospective experience with 37 patients in one institutionAnn Surg2375256PubMedCrossRef
Metadaten
Titel
Radiation-Induced Sequelae Affecting the Continence Organ: Incidence, Pathogenesis, and Treatment
verfasst von
Sven Petersen, M.D., Ph.D.
Johannes Jongen, M.D.
Cordula Petersen, M.D., Ph.D.
Marco Sailer, M.D., Ph.D.
Publikationsdatum
01.09.2007
Erschienen in
Diseases of the Colon & Rectum / Ausgabe 9/2007
Print ISSN: 0012-3706
Elektronische ISSN: 1530-0358
DOI
https://doi.org/10.1007/s10350-007-0296-4

Weitere Artikel der Ausgabe 9/2007

Diseases of the Colon & Rectum 9/2007 Zur Ausgabe

OriginalPaper

Selected Abstracts

Update Chirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

S3-Leitlinie „Diagnostik und Therapie des Karpaltunnelsyndroms“

Karpaltunnelsyndrom BDC Leitlinien Webinare
CME: 2 Punkte

Das Karpaltunnelsyndrom ist die häufigste Kompressionsneuropathie peripherer Nerven. Obwohl die Anamnese mit dem nächtlichen Einschlafen der Hand (Brachialgia parästhetica nocturna) sehr typisch ist, ist eine klinisch-neurologische Untersuchung und Elektroneurografie in manchen Fällen auch eine Neurosonografie erforderlich. Im Anfangsstadium sind konservative Maßnahmen (Handgelenksschiene, Ergotherapie) empfehlenswert. Bei nicht Ansprechen der konservativen Therapie oder Auftreten von neurologischen Ausfällen ist eine Dekompression des N. medianus am Karpaltunnel indiziert.

Prof. Dr. med. Gregor Antoniadis
Berufsverband der Deutschen Chirurgie e.V.

S2e-Leitlinie „Distale Radiusfraktur“

Radiusfraktur BDC Leitlinien Webinare
CME: 2 Punkte

Das Webinar beschäftigt sich mit Fragen und Antworten zu Diagnostik und Klassifikation sowie Möglichkeiten des Ausschlusses von Zusatzverletzungen. Die Referenten erläutern, welche Frakturen konservativ behandelt werden können und wie. Das Webinar beantwortet die Frage nach aktuellen operativen Therapiekonzepten: Welcher Zugang, welches Osteosynthesematerial? Auf was muss bei der Nachbehandlung der distalen Radiusfraktur geachtet werden?

PD Dr. med. Oliver Pieske
Dr. med. Benjamin Meyknecht
Berufsverband der Deutschen Chirurgie e.V.

S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“

Appendizitis BDC Leitlinien Webinare
CME: 2 Punkte

Inhalte des Webinars zur S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“ sind die Darstellung des Projektes und des Erstellungswegs zur S1-Leitlinie, die Erläuterung der klinischen Relevanz der Klassifikation EAES 2015, die wissenschaftliche Begründung der wichtigsten Empfehlungen und die Darstellung stadiengerechter Therapieoptionen.

Dr. med. Mihailo Andric
Berufsverband der Deutschen Chirurgie e.V.