The surgical treatment of anal fistulas requires identification of the course of the primary and secondary tracts and their relation with the
sphincteric musculature in order to properly manage the fistula and drain any present abscess.
Urinary stress incontinence due to intrinsic
sphincteric deficiency: experience with fat and collagen periurethal injections.
Dynamic urethrocystoscopy was performed on each patient in dorsal lithotomy position under local anesthesia (lidocaine gel) to evaluate the functionality of
sphincteric urethra and to exclude urethral stricture disease or bladder neck sclerosis.
There was significant infiltration of both gluteal and
sphincteric muscles precluding complete excision.
Nicholls discussed fistulae plug, re-routing, LIFT- ligation of inter
sphincteric fistulae track.
Bladder/urethral function is about volume management, yet the
sphincteric mechanism is not tolerant of very high volumes, even in "normal" patients.
This is owing to poor peristalsis,
sphincteric action, and narrow diameter of cricopharynx.
Management of bleeding not only prolongs operative time and may injure the NVB and
sphincteric fibers using coagulation.
Some authors recommend no therapy for asymptomatic cases.11 However incontinence obstructive symptoms double micturation recurrent infection and cosmetic concerns are among indications for surgery.12 Treatment options for UD include follow-up without a specific therapy urethral dilatation perineal urethrostomy urethrourethrostomy and surgical operations such as urethroplasty surgery using buccal mucosal or tubularized grafts.13 In cases where reconstructive surgery is planned a cystoscopy should definitely be performed to assess functional urethra and
sphincteric mechanism.
Myers, "Male urethral
sphincteric anatomy and radical prostatectomy," Urologic Clinics of North America, vol.
The recommendation for complete excision, however, has to be balanced with consideration of preserving vocal fold phonatory and
sphincteric function.
The cardia surrounds the esophageal orifice; the fundus lies above the level of a horizontal line drawn through the esophageal (cardiac) orifice; the body lies below this line; and the pyloric part is the funnel-shaped region that leads into the pylorus, the distal, narrow
sphincteric region between the stomach and duodenum.
Several studies support this classification (Malouff & Lanyon, 1985; Vythilingum et al., 2002); however, Marks (1987) suggested that paruresis be classified as a specific phobia (
sphincteric phobia).
Most cases of incontinence are a result of intraoperative damage to the native urinary
sphincteric mechanisms (11), particularly the intrinsic sphincter component.
When performing CTC a large range of insufflation volumes are encountered from patient to patient due to the difference in length and width of an individual's colon, the severity of ileocaecal reflux, and losses due to mucosal resorption and
sphincteric incompetence.
