“Sexuality” is a comprehensive concept and has been used as a synonym for everything related to sex. However, in the healthcare domain, a definition of sexuality that enables diagnosis and facilitates support of individuals with dysfunction is needed. “Individual sexual characteristics and the interaction between sexual partners” is proposed as the definition of “sexuality” to be used in the healthcare domain to distinguish it from definitions of “sexual dysfunction and sex” that are clearly defined based on sexual reactions.
Regarding sexuality for ostomates, their relationship with their partner is more important than the sexual dysfunction itself. A satisfied and happy state, namely “well-being”, for ostomates includes not only satisfaction with sexual activity, but also communication and physical contact with their partner. Therefore, the goal of support for ostomates in sexuality is considered to be their subjective sexual well-being.
For actual support, therapeutic communication aimed at improving issues related to sexuality is effective. It is recommended that healthcare professionals make the most of their therapeutic communication techniques to help ostomates improve their interactions with their partners and achieve their subjective sexual well-being.

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A parastomal hernia (PSH) is the most common complication after stoma creation, occurring in more than half of patients two years after surgery. Obesity is a major risk factor for the development of a PSH, and its incidence is expected to increase in the future. Although no surgical technique is strongly recommended to prevent PSH development, the creation of a stoma through a retroperitoneal route and prophylactic mesh placement at the time of stoma construction have been considered potentially effective.
Most PSH cases remain asymptomatic and are managed conservatively; however, surgical intervention is absolutely indicated in emergency cases with acute irreducibility or strangulation. In contrast, symptoms such as pain, difficulty with stoma appliance adherence, and poor cosmesis constitute relative indications for surgery.
Primary fascial closure alone is not recommended due to its high recurrence rate, and meshbased repair techniques should be used. Common mesh repair approaches include the onlay method, retromuscular placement, and the intraperitoneal onlay mesh (IPOM) technique. Of the IPOM repairs, the keyhole and Sugarbaker techniques are the principal options. A metaanalysis of laparoscopic IPOM procedures reported recurrence rates of 24.1％ for the keyhole method and 9％ for the Sugarbaker method, indicating a significantly higher recurrence with the former. Thus, the laparoscopic keyhole technique is not currently recommended.

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Fecal incontinence (FI) is a distressing symptom that substantially impairs quality of life and requires management tailored to its cause and severity. Since the publication of the 2017 edition of the Japanese Practice Guidelines for Fecal Incontinence, awareness and clinical implementation have progressively expanded. The revised second edition was released in November 2024. This review outlines the current diagnosis and treatment for FI, with reference to key updates in the 2024 guidelines.
FI is defined as involuntary loss of feces through the anus, either unconsciously or against one's will. In Japan, its prevalence is approximately 4.0％ in adults aged 20–65 years and 7.5％ in those over 65. Contributing pathophysiological factors include stool consistency; the function of defecation-related musculature; anorectal sensory function; rectal pressure, capacity and compliance; colonic function; and cognitive and motor function.
FI symptoms are categorized into passive and urge incontinence. Diagnostic evaluation involves history-taking, digital anorectal examination, anorectal physiological testing, and endoanal ultrasonography.
Management strategies are classified into three tiers: initial treatment, specialized conservative therapy, and surgical intervention. A stepwise approach, commencing with the least invasive modality, is generally recommended.
Initial treatment comprises dietary and lifestyle modification, bowel habit training, skin care, adjustment of oral medications such as laxatives, and pharmacological therapy. Specialized conservative therapies include pelvic floor muscle training, biofeedback therapy, and transanal irrigation. Among surgical options, sacral neuromodulation and sphincteroplasty are regarded as first-line procedures, whereas gastrointestinal stoma creation is considered a second-line intervention. Anal sphincter restoration using regenerative medicine is an emerging area of ongoing research.

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Background: Patients with spina bifida usually have defecation disorders due to neurogenic bowel dysfunction (NBD) from birth. Transanal irrigation (TAI) enables independent bowel management and is expected to improve patients’ quality of life (QOL). There have been no Japanese reports of a case of spina bifida whose NBD was successfully managed by conversion from Malone antegrade continence enema (MACE) to TAI.
Case: A 16-year-old male patient with NBD due to spina bifida had undergone a navel appendicostomy for MACE at 11 years of age. After reasonable bowel management with MACE for 5 years, he was referred to our hospital to convert his bowel management from MACE to TAI with the Peristeen anal irrigation system, because he began being troubled with fecal incontinence to watery stool, abdominal pain, and mucus leakage from the navel appendicostomy on the day after MACE irrigation. The NBD score (best: 0-worst: 47), Cleveland Clinic Florida Fecal Incontinence Score (no incontinence: 0-worst incontinence:20), and the Fecal Incontinence Quality of Life Scale (worst: 1-best: 4.1) improved from 19, 13, and 3.2 with MACE to 10, 8, and 3.6 with TAI, respectively. A visual analogue scale to evaluate satisfaction with current bowel function and management (worst: 0-best: 10) also improved from 4.2 with MACE to 8.5 with TAI.
Conclusion: Although switching from TAI to MACE is a common practice, this case suggests that conversion from MACE to TAI can improve bowel dysfunction and QOL in patients with NBD due to spina bifida.

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Background: Surgery for generalized fecal peritonitis is highly susceptible to wound dehiscence due to surgical site infection (SSI). Because the management of such dehiscent wounds is often challenging, both local wound care and systemic management are important for its healing.
Case: A woman in her late 70s had a sigmoid end colostomy constructed in the left lower quadrant of the abdomen as surgery for sigmoid colon perforation caused by long-term constipation. Nine days later, another perforation occurred in the intraperitoneal part of the stomal limb, so that a transverse end colostomy was created in the left upper quadrant. On the 36th postoperative day (POD), SSI occurred, causing midline wound dehiscence near the stoma. Trafermin was sprayed on the dehiscent wound, and the wet-to-wet dressing method was performed. The refractory dehiscent wound had healed completely by POD 355 after the long-term intensive wound care, as well as systemic management including total parenteral nutrition, followed by oral dietary intake and antibiotic therapy. The wound care was performed not only by health care professionals (HCPs), but also by the patient herself.
Discussion: The standardized wound care method, appropriate nutritional management, and infection control are considered to be main factors promoting the healing of the dehiscent wound in the present case.
Conclusion: Even in a case of deep wound dehiscence extending into the abdominal cavity, complete wound healing was achieved by continuous long-term care through collaboration among HCPs and the patient.

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[in Japanese]

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