Management of Third and Fourth-Degree Perineal Tears After Vaginal Birth. Guideline of the DGGG, OEGGG and SGGG (S2k-Level, AWMF Registry No. 015/079, December 2020).

This guideline provides recommendations for the diagnosis, treatment and follow-up care of 3rd and 4th degree perineal tears which occur during vaginal birth. The aim is to improve the management of 3rd and 4th degree perineal tears and reduce the immediate and long-term damage. The guideline is intended for midwives, obstetricians and physicians involved in caring for high-grade perineal tears.

Skeletal Muscle-Derived Cell Implantation for the Treatment of Fecal Incontinence: A Randomized, Placebo-Controlled Study.

Background And Aims: Fecal incontinence (FI) improvement following injection of autologous skeletal muscle-derived cells has been previously suggested. This study aimed to test the efficacy and safety of said cells through a multicenter, placebo-controlled study, to determine an appropriate cell dose, and to delineate the target patient population that can most benefit from cell therapy.

Methods: Patients experiencing FI for at least 6 months were randomized to receive a cell-free medium or low or high dose of cells.

Skeletal muscle-derived cell implantation for the treatment of sphincter-related faecal incontinence.

Background: In an earlier pilot study with 10 women, we investigated a new approach for therapy of faecal incontinence (FI) due to obstetric trauma, involving ultrasound-guided injection of autologous skeletal muscle-derived cells (SMDC) into the external anal sphincter (EAS), and observed significant improvement. In the current study, we tested this therapeutic approach in an extended patient group: male and female patients suffering from FI due to EAS damage and/or atrophy. Furthermore, feasibility of lower cell counts and cryo-preserved SMDC was assessed.

Ten-year follow-up after the tension-free vaginal tape procedure.

Objective: The current study aimed to evaluate objective and subjective results 10 years after the tension-free vaginal tape procedure.

Study Design: Two hundred ten patients who underwent a tension-free vaginal tape procedure at the 2 participating units between 1999 and 2001 were invited for follow-up. Evaluation at 10 years included history, clinical examination, cystoscopy, urodynamics, a cough stress test, and the Incontinence Outcome Questionnaire.

The natural history of clinically unrecognized anal sphincter tears over 10 years after first vaginal delivery.

Objective: To estimate the influence of clinically unrecognized anal sphincter injuries detected by endoanal ultrasonography 3 months after first vaginal delivery on symptoms of anal incontinence over the subsequent 10-year period.

Methods: One-hundred fifty-six consecutive primigravid women were recruited, anal endosonography performed, and bowel habit predelivery characterized by means of a validated 24-point questionnaire. After excluding four women with a clinically recognized sphincter tear after delivery and 18 who delivered by cesarean, these procedures were repeated 3 months postpartum.

The Incontinence Outcome Questionnaire: an instrument for assessing patient-reported outcomes after surgery for stress urinary incontinence.

The aim of this study is to develop and psychometrically test a questionnaire (Incontinence Outcome Questionnaire, IOQ) for assessing quality of life (QOL) after surgery for stress urinary incontinence that can be used as a single measurement after the intervention. A total of 171 patients who underwent the tension-free vaginal tape (TVT/TVT-O) operation for stress urinary incontinence completed the King s Health Questionnaire (KHQ), the Short Form-12 (SF-12) and the IOQ. The internal consistency, internal and external validity and responsiveness of the IOQ were tested.

Quality of life and continence 1 year after the tension-free vaginal tape operation.

Objective: The purpose of this study was to evaluate changes in condition-specific and generic quality of life (QOL) and continence rates 1 year after the tension-free vaginal tape (TVT) operation for stress urinary incontinence.

Study Design: A total of 99 patients undergoing the TVT operation underwent clinical and urodynamic assessment and completed the German language King's Health Questionnaire (KHQ) and the Short Form 36 (SF-36) before and 3 and 12 months after surgery. Overall, 72 TVTs were performed as isolated procedure and 27 in combination with other operations.

Assessment of the predictive value of a bowel symptom questionnaire in identifying perianal and anal sphincter trauma after vaginal delivery.

Purpose: The purpose of this study was to determine whether a postpartum bowel-habit questionnaire could reliably identify females who had sustained perineal and anal sphincter trauma after vaginal delivery.

Methods: A prospective cohort design was used to recruit 156 consecutive primigravid females, of whom 134 delivered vaginally without clinical evidence of a third-degree tear. These 134 females completed a specific anal continence questionnaire and underwent anal endosonography before and after delivery to identify those with postpartum deterioration in anal continence and to relate this to sonographic evidence of anoperineal trauma.

Influence of the subpubic arch angle on anal sphincter trauma and anal incontinence following childbirth.

Objective: To assess the relationship between the subpubic arch angle, anal sphincter and perineal trauma, and anal incontinence after childbirth in nulliparous women.

Design: Prospective cohort study.

Setting: University teaching hospital.

Female anal sphincter: age-related differences in asymptomatic volunteers with high-frequency endoanal US.

Purpose: To evaluate endoanal ultrasonographic (US) anatomy in a large group of nulliparous women by using a high-frequency 10-MHz transducer to define normal age-related differences in sphincter morphology.

Materials And Methods: One hundred fifty asymptomatic nulliparous women (mean age, 31 years; range, 19-80 years) underwent endoanal US with a high-frequency 10-MHz transducer. Anal canal structures were measured at high, middle, and low levels and were correlated with age by using the Pearson simple linear correlation coefficient.