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Fecal Incontinence, Physical Examination
Published in Han C. Kuijpers, Colorectal Physiology: Fecal Incontinence, 2019
Finally, after completion of the digital examination, the stool on the gloved finger should be checked for blood, mucus, pus, and color of the stool. Anoscopy should be performed after a digital examination. A search is made for swelling, masses, tumors, polyps, hypertrophied anal papillae, an internal opening of a fistula, fissures, and atypical ulcerations. When the anoscope is withdrawn, the patient should be asked to strain. By doing so, prolapsing hemorrhoids, incomplete mucosal prolapse, or rectoceles may be detected, which otherwise would have been missed.
Bleeding from the Colon and Rectum
Published in Peter Sagar, Andrew G. Hill, Charles H. Knowles, Stefan Post, Willem A. Bemelman, Patricia L. Roberts, Susan Galandiuk, John R.T. Monson, Michael R.B. Keighley, Norman S. Williams, Keighley & Williams’ Surgery of the Anus, Rectum and Colon, 2019
Charles B. Whitlow, Ben Hopkins
Anoscopy can be performed quickly using inexpensive disposable anoscopes with a self-contained light source. Whilst haemorrhoidal bleeding is rarely a cause for massive LGIB, it does account for a substantial portion of hospital admissions. Rubber-band ligation can be performed at this initial evaluation if a definite bleeding source is identified. Additionally, inflammation of the distal rectum or angioectasia from radiation can be detected by anoscopy. The presence of formed stool in the distal rectum without blood indicates an anal source, whilst the presence of dark liquid blood in the distal rectum generally indicates a proximal source. The obvious limitation of anoscopy is the inability to assess the proximal rectum.
Male infertility
Published in C. Yan Cheng, Spermatogenesis, 2018
Ryan Flannigan, Marc Goldstein
Involves using a rectal probe that serves as an electrode to deliver electrical stimulation to the prostate and seminal vesicles. The patient is positioned to right lateral decubitus. The patient is catheterized prior to the procedure using mineral oil as lubrication and the urine is drained. Twenty to 30 mL of sperm transport media (e.g., human tubal fluid [HTF] buffered with hydroxyethyl-piperazineethane-sulfonic acid buffer and plasmanate) is then instilled into the bladder. Anoscopy is performed to ensure that the rectal mucosa is healthy. The Seager Electroejaculator© probe is then inserted into the rectum and either a peaked sine wave or 1-second block paradigm is used with five stimulations, repeated up to six times. The probe temperature must be kept below 38 degrees Celsius and below 30-volts maximum. An assistant holds a sterile specimen cup in front of the meatus to collect the sample. Anoscopy is again performed at the end of the procedure. EEJ may be performed in a surgical theater for sensate patients and may be performed in either the office or surgical theater for patients not sensate below the waste. However, the physician must again monitor for autonomic dysreflexia (AD) in patients with SCI above T6 and have the ability to treat respected changes. Many physicians recommend pretreating >T6 SCI patients with nifedipine; a discussion with the anesthetist preoperatively is recommended. If AD does ensue, the stimulation should be withdrawn immediately.21
Management of non-obstetric traumatic vulvar haematoma: a retrospective review of 33 cases
Published in Journal of Obstetrics and Gynaecology, 2022
Mi Sun Kim, Hyun Jung Lee, Eunhui Joo, Sukho Kang, Mee-Hwa Lee, Hyeon Chul Kim
Different imaging modalities have been used to investigate the size, location, and extent of haematomas. Transperineal ultrasonography can provide an easy and objective bedside assessment of the extent of haematomas in greater detail (Sherer et al. 2006). CT and MRI are more complex and expensive imaging modalities, which allow for a more specific and detailed mapping of the vulvar haematoma with the capacity to exclude a possible retroperitoneal involvement and to detect the bleeding vessels (Guerriero et al. 2004). Further assessment by abdominal radiography, anoscopy, and sigmoidoscopy can also be indicated when the injury is above the hymen or the anal sphincter or when the impaling object reached the rectum or peritoneal cavity (Michala 2013). Selective arterial embolisation is also emerging as an alternative to surgical management when conservative treatment fails (Kunishima et al. 2008).
Screening for Squamous Cell Anal Cancer in HIV Positive Patients: A Five-Year Experience
Published in Journal of Investigative Surgery, 2018
Chiara Santorelli, Cosimo Alex Leo, Jonathan D. Hodgkinson, Franco Baldelli, Francesco Cantarella, Emanuel Cavazzoni
The anoscopy was performed using a high-resolution video proctoscope. The HR-VPS consists of a Proctostation THD© device (THD SPA, 2016; Correggio RE, Italy), which is a portable touch screen 16–9 connected to a high-resolution camera (Figure 3). The camera is wrapped in a disposable cover and connected with a disposable self-illuminating anoscope (Figure 4), which is equipped with side windows to perform biopsies and ablative treatments under visual control. The “patient management” software allows to include epidemiologic and clinical data in the patients' personal folder, which can be updated anytime. Each examination is recorded as a complete video associated with audio; the operator can also take pictures at all times. Contrary to what happens when using a colposcope adjusted for anoscopy, VPS with proctostation is performed in the Sims position as an ordinary anal examination, therefore patients need no bowel preparation. The operator inserts the anoscope with the aid of an introducer, which is then replaced by the camera. The operator then uses the tool with a single hand, observing the examination on the monitor (Figures 5 and 6). A pedal allows the operator to turn the recording on/off and to take pictures of areas of interest. Afterwards, acetic acid is introduced. If necessary, biopsies can be performed under visual control by introducing forceps through side windows without changing the position of or switching off the instrument. Once the examination is concluded, VPS is extracted and the disposable part is thrown away enTABLE 1 bloc.
Angiogenesis inhibitors and symptomatic anal ulcers in metastatic colorectal cancer patients**
Published in Acta Oncologica, 2018
Francesca Bergamo, Sara Lonardi, Beatrice Salmaso, Carmelo Lacognata, Francesca Battaglin, Francesco Cavallin, Luca Saadeh, Sabina Murgioni, Antonino Caruso, Camillo Aliberti, Vittorina Zagonel, Carlo Castoro, Marco Scarpa
Additionally, a proctologic endoscopic evaluation was performed when feasible, to obtain a direct visualization of the anal canal, the dentate line and the hemorrhoidal plexus. A standard disposable flute beak anoscope was used in most cases, but in the presence of anal canal stricture, we used a pediatric anoscope. The rectoscopy was usually performed with a standard rigid rectoscope but, as for anoscopy, it was sometimes necessary to use the pediatric instrument. Finally, the time between the beginning of first line treatment and the diagnosis of anal ulcer was calculated and reported for each patient.