Rectal Prolapse Clinical Trial
Official title:
Pathologic and Functional Assessment of Rectal Prolapse in Young Patients
Patients aging less than 45 years with rectal prolapse will undergo full pathologic and functional assessment to determine the underlying etiology.
Full clinical assessment of the patients will be conducted by history taking querying the
type and duration of symptoms, associated medical conditions, history of previous surgery
for rectal prolapse, and presence of fecal incontinence which will be graded by Wexner
continence score. In addition, patients will undergo thorough general and local examination
to determine the type of rectal prolapse (internal or external) and the condition of the
anal sphincters and pelvic floor muscles.
Functional assessment of the anorectal region will be done by anal manometry to measure the
resting and squeeze anal pressures, rectal sensation and compliance; endorectal
ultrasonography to assess the integrity of the anal sphincters; and pudendal nerve terminal
motor latency (PNTML) to exclude pudendal neuropathy.
Random biopsies (2-4 in number) will be taken from the pelvic floor muscles, external anal
sphincter, and the lateral supportive ligaments of the rectum during surgical treatment of
rectal prolapse whether via the abdominal or perineal approach. Tissue samples will be
preserved in formalin solution and will be sent for histopathological examination. Tissue
samples will be subjected to immunohistochemistry to calculate the ratio between collagen
type I and type III, and to reveal any myopathic or degenerative changes. Additionally,
schistosomal affection of the pelvic floor muscles will be detected by immunohistochemistry
examination for the ova of schistosomal mansoni.
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Observational Model: Cohort, Time Perspective: Prospective
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