Publication: La neuromodulación en el tratamiento de la incontinencia anal
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2017-09-19
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Universidad Complutense de Madrid
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Abstract
El manejo terapéutico de la incontinencia anal es uno de los problemas más complejos de la coloproctología y siempre debe ser individualizado en función de las peculiaridades de cada paciente. La variedad de los factores implicados exige un análisis meticuloso. A diferencia de lo que ocurre en otras patologías, el objetivo no siempre es la curación, sino mejorar la calidad de vida lo máximo posible. La esfinteroplastia hasta hace poco era la opción quirúrgica principal para pacientes con lesiones esfintéricas y cuya eficacia terapéutica oscila entre el 50-60%, alcanzando el 70% en manos expertas. El problema se ha planteado siempre en tres tipos de pacientes en los que han fracasado las medidas higiénicas, dietéticas y farmacológicas: Pacientes con integridad esfinteriana de cualquier etiología, como complemento a una esfinteroplastia previa debilitada por el paso del tiempo y pacientes con lesiones esfinterianas mínimas. En los últimos años, como resultado del desarrollo de la neurofisiología defecatoria, han aparecido nuevas opciones terapéuticas para la incontinencia fecal. Así, la Neuromodulación, con eficacia clínica demostrada en la incontinencia urinaria, surge como una terapia útil y en continuo desarrollo, siendo en la actualidad uno de los pilares fundamentales del tratamiento de esta patología. El elevado coste social y económico que supone este problema, nos ha hecho considerar de gran interés analizar los resultados de este tratamiento. Existe una forma de aplicación periférica (Neuromodulación del nervio Tibial Posterior) y otra central (Neuromodulación de Raíces Sacras)...
The therapeutical management of anal incontinence is one of the most complex problems in coloproctology and it must always be personalized in function of the particularities of every patient.The variety of the implicates factors requires a meticulous analysis. As opposed to what happens in other pathologies, the objective is not always the complete recovery, but improve the quality of life as much as possible. The sphincteroplasty was until very recently the principal surgery option for patients with sphincter lesions and whose therapeutical effectiveness fluctuates between 50% to 60%, reaching the 70% for the most highly qualified professionals.The problem has always been considered in the three patient types in which the hygiene, diatetic and pharmacological measures have failed: Patients with sphincter integrity of any etiology, as a complement of a previous sphincteroplasty debilitated due to the past of time and patients with minimal sphincter lesions. In recent years, as a result of the defecation neurophysiology development, many new therapeutical options have appeared in order to control the faecal incontinence.In this way, the neuromodulation, with demonstrated clinical efficacy in urinary incontinence emerges as a usefull therapy in continuous progress, been at the moment one of the fundamental foundations for the treatment of this pathology. The high economical and social cost that this problem means, has made us consider of great interest to analyze the results of this treatment...
The therapeutical management of anal incontinence is one of the most complex problems in coloproctology and it must always be personalized in function of the particularities of every patient.The variety of the implicates factors requires a meticulous analysis. As opposed to what happens in other pathologies, the objective is not always the complete recovery, but improve the quality of life as much as possible. The sphincteroplasty was until very recently the principal surgery option for patients with sphincter lesions and whose therapeutical effectiveness fluctuates between 50% to 60%, reaching the 70% for the most highly qualified professionals.The problem has always been considered in the three patient types in which the hygiene, diatetic and pharmacological measures have failed: Patients with sphincter integrity of any etiology, as a complement of a previous sphincteroplasty debilitated due to the past of time and patients with minimal sphincter lesions. In recent years, as a result of the defecation neurophysiology development, many new therapeutical options have appeared in order to control the faecal incontinence.In this way, the neuromodulation, with demonstrated clinical efficacy in urinary incontinence emerges as a usefull therapy in continuous progress, been at the moment one of the fundamental foundations for the treatment of this pathology. The high economical and social cost that this problem means, has made us consider of great interest to analyze the results of this treatment...
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Tesis inédita de la Universidad Complutense de Madrid, Facultad de Medicina, Departamento de Cirugía, leída el 22-01-2016