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Systematic Review of Animal Models Used in Research of Origins and Treatments of Fecal Incontinence

Evers, Judith Ph.D.1; Jones, James F. X. M.B., B.Ch., B.A.O., B.Sc., Ph.D.1; O’Connell, P. Ronan M.D., F.R.C.S.I., F.R.C.S.2

Diseases of the Colon & Rectum: June 2017 - Volume 60 - Issue 6 - p 614–626
doi: 10.1097/DCR.0000000000000841
Original Contributions: Pelvic Floor
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BACKGROUND: Fecal incontinence is a common disorder, but its pathophysiology is not completely understood.

OBJECTIVE: The aim of this review is to present animal models that have a place in the study of fecal incontinence.

DATA SOURCES: A literature review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines performed in August 2016 revealed 50 articles of interest. Search terms included fecal/faecal incontinence and animal model or specific species.

STUDY SELECTION: Articles not describing an animal model, in vitro studies, veterinary literature, reviews, and non-English articles were excluded.

MAIN OUTCOME MEASURES: The articles described models in rats (n = 31), dogs (n = 8), rabbits (n = 7), and pigs (n = 4).

RESULTS: Different fecal incontinence etiologies were modeled, including anal sphincter lesions (33 articles) ranging from a single anal sphincter cut to destruction of 50% of the anal sphincter by sharp dissection, electrocautery, or diathermy. Neuropathic fecal incontinence (12 articles) was achieved by complete or incomplete pudendal, pelvic, or inferior rectal nerve damage. Mixed fecal incontinence (5 articles) was modeled either by the inflation of pelvic balloons or an array of several lesions including nervous and muscular damage. Anal fistulas (2 articles), anal sphincter resection (3 articles), and diabetic neuropathy (2 articles) were studied to a lesser extent.

LIMITATIONS: Bias may have arisen from the authors’ own work on fecal incontinence and the absence of blinding to the origins of articles.

CONCLUSIONS: Validated animal models representing the main etiologies of fecal incontinence exist, but no animal model to date represents the whole pathophysiology of fecal incontinence. Therefore, the individual research questions still dictate the choice of model and species.

1 Department of Anatomy, University College Dublin School of Medicine, Dublin, Ireland

2 Section of Surgery and Surgical Specialties, University College Dublin School of Medicine and Centre for Colorectal Disease, St. Vincent’s University Hospital, Dublin, Ireland

See Tribute Video to Robert D. Madoff, M.D., at http://links.lww.com/DCR/A348.

Financial Disclosure: Dr Evers was funded by Medtronic Inc. Dr Jones has research agreements with and has received research funding and speaking honorarium from Medtronic Inc. Dr O’Connell has received research funding and speaker honorarium from Medtronic, speaker honorarium from Ethicon, and is on the advisory board of MSK.

Presented at the meeting of COST, Dublin, Ireland, November 18 to 19, 2016.

Correspondence: Judith Evers, Ph.D., Room C330, Health Science Building, UCD Belfield, Dublin 4, Ireland. E-mail: Judith.evers@ucd.ie

© 2017 The American Society of Colon and Rectal Surgeons