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Transappendicular Continent Cystostomy Technique (Mitrofanoff Principle)
Published in Jacques Corcos, Gilles Karsenty, Thomas Kessler, David Ginsberg, Essentials of the Adult Neurogenic Bladder, 2020
A short tunnel usually causes stomal incontinence. Evaluation should be done thoroughly to exclude other causes, such as high reservoir pressure. Using a bulking agent can be tried with some success in the short term,20 but long-term data are lacking. The reported agent used is dextranomer/hyaluronic acid.20–23 If failed, surgical revision can be undertaken by either complete take-down and use of ileal segment, or alternatively leaving the existing channel and wrapping an additional detrusor muscle over the channel.24
Biofeedback, Relaxation Training, and Cognitive Behavior Modification
Published in Kevin W. Olden, Handbook of Functional Gastrointestinal Disorders, 2020
Ann L. Davidoff, William E. Whitehead
Bennett and Wilkinson (9) compared behavioral stress-management training alone with medical management in 24 newly diagnosed IBS patients. The behavioral intervention had three major components: education about normal variations in bowel function, stress-management training based on progressive relaxation exercises, and training in self-instruction techniques to cope with stress. Medical management consisted of a bulking agent, an anticholinergic, and a drug with both anxiolytic and antidepressant properties. Pain and diarrhea improved in both groups to a similar extent; psychological symptoms decreased significantly more in the relaxation group, however.
Energy balance and its regulation
Published in Geoffrey P. Webb, Nutrition, 2019
Alimentary signals are involved in signalling satiety at the end of a meal and signals indicating an absence of food in the gut may help signal the need to eat again. One can alter the energy density of the diets of laboratory rats by the use of an inert bulking agent (e.g. methylcellulose) or by the addition of energy-rich fat. Rats fed diluted diets are able to maintain their body weights and compensate for the dilution by increasing the volume of food they eat. However, long-term feeding with diets of high energy density causes obesity in rats, which suggests that overconcentration of the diet may reduce the effectiveness of feeding control mechanisms, so reducing the energy density of human diets may help to prevent excessive weight. The mechanisms regulating energy balance are generally more effective in preventing under- rather than overconsumption. The term thrifty phenotype has been used in relation to this idea. During our evolutionary history, having so-called thrifty genes that aided survival during periods of food shortage would have been a survival advantage but under conditions of abundant food supply and low need for physical activity they would become disadvantageous and predispose to obesity (discussed further in the next chapter).
Trends in the surgical management of vesicoureteral reflux in Finland in 2004–2014
Published in Scandinavian Journal of Urology, 2021
Liisi Ripatti, Hanna-Reeta Viljamaa, Tommi Kauko, Ville Kytö, Päivi Rautava, Jussi Sipilä, Niklas Pakkasjärvi
Data on the complication rate of ureteral reimplantation are scarce. Although a straightforward procedure, ureteral reimplantation still encompasses the opening of the bladder and thus possibly affects the bladder function. While bulking agent injections are fairly well tolerated with low complication rates, the efficacy remains lower than with reimplantation [8,10]. In this study, we limited complication detection to Clavien-Dindo grade IIIb due to the technical limitations of the register study. On the other hand, also the difference in the length of stay between the procedure groups reflects the associated post-operative morbidity of the operations. We showed that the risk for reoperations is 14% for injection therapy and 4% for open ureteral reimplantations. While reoperations are here graded the same, converting to an open operation must be regarded as a more serious complication than a renewed injection therapy. Still, any reoperation involves a significant burden on the families involved. Health-related quality of life was not investigated in this register-based study but has previously been analyzed [26–28]. The results have been somewhat controversial since some have reported successful endoscopic treatment of VUR to be associated with improved quality of life [26,28]. On the other hand, one study showed the good quality of life in both those treated with antimicrobial prophylaxis and ureteral reimplantation [27].
Faecal incontinence: a narrative review of clinic-based management for the general gynaecologist
Published in Journal of Obstetrics and Gynaecology, 2018
Kathryn S. Williams, Dara F. Shalom, Harvey A. Winkler
Supplementing a restricted diet with fibre can be beneficial for patients suffering from incontinence of liquid stool. Fibre acts as a bulking agent and can allow for increased rectal sensation as well as decreased ‘intestinal hurry’. It is recommended that the daily dose of fibre (including dietary and supplemental) not exceed 30 g (Costilla et al. 2013). Table 1 provides a list of readily available over the counter (OTC) options including: psyllium (Metamucil®), wheat dextrin (Benefiber®), methylcellulose (Citrucel®) and calcium polycarbophil (Fibercon®). While these supplements are beneficial, they may be associated with mild side effects. In a randomised controlled trial (RCT) of 16 g of supplemental fibre versus placebo symptoms of bloating, belching, flatus and fullness were 1–2 times higher in subjects taking the fibre (Bliss et al. 2011). If these symptoms are severe and bothersome, Rao (2014) recommend methylcellulose as a first-line bulking agent. Methylcellulose (Citrucel®) is resistant to fermentation by colonic microflora and less likely than other forms of fibre to cause bloating and exacerbate diarrhoea. Supplemental fibre in quantities of 1–2 tablespoons per day can improve stool consistency and be especially helpful in patients who have low-volume loose stool.
The potential role of gut microbiota and its modulators in the management of propionic and methylmalonic acidemia
Published in Expert Opinion on Orphan Drugs, 2018
Alberto Burlina, Sebastian Tims, Francjan van Spronsen, Wolfgang Sperl, Alessandro P. Burlina, Mirjam Kuhn, Jan Knol, Maryam Rakhshandehroo, Turgay Coşkun, Rani H Singh, Anita MacDonald
D-tagatose, manno-oligosaccharides [63,64], and arabinoxylan oligosaccharides [65] need to be synthesized and added as food additives. However, D-tagatose occurs naturally, but only in small amounts in fruits and dairy products. Polydextrose also needs to be synthesized, and is used widely as a bulking agent in several prepared foods [65]. Ispaghula husk is known only for medicinal use (softening of the stools) and can be easily avoided. Only inulin is naturally present in noticeable amounts in various flowering plants, such as chicory, Jerusalem artichokes, salsify, asparagus, and onions [66–69]. However, food preparations, such as boiling, might reduce the inulin content of these foods as inulin is soluble in hot water.