Long-Term Outcome of Transcutaneous Posterior Tibial Nerve Stimulation in the Treatment of Functional Non-Retentive Fecal Incontinence in Children.

BACKGROUND: Functional non-retentive fecal incontinence (FNRFI) is a psychologically upsetting and embarrassing issue and affects children's quality of life negatively. AIM OF THIS STUDY: Evaluation of the short and long-term effect of Bilateral transcutaneous posterior tibial nerve stimulation (BTPTNS) in the treatment of FNRFI in children and its impact on the quality of life (QoL). Methodology: The current randomized controlled study included 94 Children with FNRFI who were randomly allocated into two equal groups. Group A received BTPTNS and Group B Received Sham BTPTNS. Follow-up was planned for 24 months for manometric findings, incontinence score, Incontinence episodes, and the QoL. RESULTS: The incontinence score was significantly decreases in Group A more than what was reported in Group B at 6, 12, 24 months follow up . In group A 53.2% of the included children who received BTPTNS showed a decrease in the incontinence episodes more than 75% and among them, 23.4% were fully continent. All the QoL domains were significantly improved in Group A after 6, 12, and 24 months when compared with Group B. CONCLUSION: BTPTNS can be a good modality in the treatment of FNRFI with favorable long-term maintenance of its effect together with a remarkable positive impact on all domains of QoL.

Size of urogenital hiatus as a potential risk factor for emptying disorders after pelvic prolapse repair.

PURPOSE: We correlated urogenital hiatus size and levator ani contraction strength with early postoperative emptying disorders. We also determined whether postoperative emptying disorders could be predicted before anti-incontinence procedures and pelvic organ prolapse repair. MATERIALS AND METHODS: We retrospectively reviewed the charts of 225 consecutive patients after surgery for pelvic organ prolapse and/or stress urinary incontinence. Urogenital hiatus size was evaluated using pelvic organ prolapse quantification. Levator contraction strength was determined by the Oxford 0 to 5 classification scale. Emptying disorders were defined as post-void residual urine volume greater than 100 ml 48 hours postoperatively and/or discharge home with a Foley catheter or on intermittent self-catheterization. RESULTS: Median patient age, post-void residual urine volume and urogenital hiatus size were significantly related to levator contraction strength (each p <0.05). Univariate logistic regression analysis revealed a significant association of urogenital hiatus size (p = 0.001), post-void residual urine volume (p = 0.005) and levator contraction strength (p = 0.001) with emptying disorder status. Multivariate logistic regression analysis showed that levator contraction strength (p = 0.001) and post-void residual urine (p = 0.01) were independent predictors of emptying disorders. CONCLUSIONS: A wide urogenital hiatus, decreased levator ani contraction strength, increasing age and increased post-void residual urine correlated with an increased chance of early postoperative emptying disorders. The most independent predictors of early emptying disorders were decreased levator contraction strength and increased post-void residual urine.

Balance and Fall Risk Assessment in Community-Dwelling Older Adults after Recovery from COVID-19: A Cross-Sectional Study.

BACKGROUND: SARS-CoV-2 atypical symptoms in older persons include falls, confusion, dizziness, and unusual weariness. Falls and their consequences are among the most prevalent causes of disability among older adults, significantly lowering quality of life and resulting in the loss of independence as well as impaired psychosocial functioning. The study purpose was to examine the impact of the SARS-CoV-2 infectious disease on balance in community-dwelling older adults. METHODS: Sixty-four older adults aged ≥ 60 years from both sexes, 31 treated for SARS-CoV-2 infection and 33 matched normal controls participated in the study. The Biodex Stability System (BSS) and Berg Balance Scale (BBS) were used for evaluation of balance and fall risk. The correlation between the Biodex overall stability index and the Berg Balance Scale score was investigated. RESULTS: When compared to controls, the SARS-CoV-2 group had significantly higher values of the Biodex overall stability index (OSI) (p = 0.011), anterior-posterior stability index (APSI) (p = 0.013), mediolateral stability index (MLSI) (p = 0.018), and fall risk index (FRI) (p = 0.008), as well as statistically lower scores on the Berg balance scale (p = 0.003). A moderate negative correlation was found between the two assessment tools in the SARS-CoV-2 group. CONCLUSION: Balance impairment and an increased risk of falling are among the outcomes of SARS-CoV-2 in community-dwelling older adults.

Long-Term Effect of Hyperbaric Oxygen Therapy on Gait and Functional Balance Skills in Cerebral Palsy Children-A Randomized Clinical Trial.

This study aimed to explore the long-term effects of hyperbaric oxygen therapy on spatiotemporal gait parameters and functional balance in children with cerebral palsy. Thirty-nine children with hemiplegic cerebral palsy were randomly allocated to one of two groups: control or study. The children in both groups received traditional physical therapy three times per week for six months. In addition, the children in the study group received hyperbaric oxygen therapy five times/week for eight weeks. The GAITRite system and pediatric balance scale were used to assess spatiotemporal gait parameters and functional balance at baseline, post-intervention, and six months after the cessation of hyperbaric oxygen therapy. Post-intervention means of all measured parameters were significantly higher than pre-intervention means, but only for the study group (p < 0.05). However, both groups' means at the six-month follow up were significantly greater than those at pre-intervention (p < 0.05). At the post-intervention and follow-up evaluations, comparisons between groups revealed a statistically significant difference in all measured parameters for the study group against the control group (p < 0.05). It can be concluded that adding hyperbaric oxygen therapy to physical therapy rehabilitation could be effective in improving spatiotemporal gait parameters and functional balance in children with cerebral palsy.

Virtual reality as a pain distractor during physical rehabilitation in pediatric burns.

The purpose of this study was to determine the immediate effect of adding Virtual reality (VR) to conventional burn rehabilitation program on pain and range of motion (ROM) in children with burn injuries during rehabilitation sessions after burn. METHODS: Twenty-two pediatric children (13 boys & 9 girls) with burn injuries and inpatient hospitalization participated in this study. Their age ranged from 9 to 16 years old with 2nd degree deep partial thickness burn of TBSA (10%-25%). They were randomly classified into study and control groups of equal numbers; control group receive passive ROM and stretch exercises, and study group receive the same treatment of the control group in addition to VR training. children in the study group wear the Oculus Rift DK2 as a means for VR and they allowed to choose the favorite video they would like to view before starting the study. The children feel like they are actually in a game. The pain was measured using VAS and the maximum range-of-motion of the joints using electronic digital goniometer before and immediately after the rehabilitation session. RESULTS: There was a significant decrease in pain intensity and increase of ROM after application of VR in the study group and a significant difference between groups after treatment for pain and ROM p < 0.05. CONCLUSION: Based on the current findings adding VR to the rehabilitation program of pediatric burn victims had an immediate effect on decreasing pain and increase ROM.

Quantitative Assessment of Sensory Integration and Balance in Children with Autism Spectrum Disorders: Cross-Sectional Study.

Postural stability is dependent on the interpretation of external inputs acquired by sensory information processes, such as visual, vestibular, and proprioceptive systems, in order to accomplish neuromuscular control, balance maintenance, and appropriate motor response. A defect in any of these systems, or in the integration of information given by these systems, might threaten their capacity to maintain balance. Therefore, the purpose of this study was to investigate the sensory integration and balance using the Biodex balance system (BBS) in children with autism spectrum disorder (ASD) during the static posture. Seventy-four children from both sexes, 38 with ASD matched with 36 typically developed (TD) children as a control group, were included in the study. Using the Biodex balance system, the postural sway was evaluated through the modified Clinical Test of Sensory Integration and Balance (m-CTSIB) during quiet standing. In this test, four different situations were considered from standing position: eyes open/firm surface, eyes closed/firm surface, eyes open/foam surface, and eyes closed/foam surface. ASD children showed a significant increase in postural sway under all tested conditions when compared to the TD children group, especially for the conditions in which visual and somatosensory inputs were disrupted (p-value < 0.05). These results provide evidence that postural stability decreased in ASD children. Under static postural challenges, the current study's findings imply that children diagnosed with ASD have postural control deficiencies, especially for the conditions in which visual and somatosensory input was disrupted. Further research must be conducted to find the best balance training program for ASD cases using the Biodex balance system and considering its impact on motor skills.

Pulmonary Function and Aerobic Capacity Responses to Equine Assisted Therapy in Adolescents with Idiopathic Scoliosis: A Randomized Controlled Trial.

BACKGROUND: Idiopathic scoliosis is a common spinal malalignment that negatively impacts the respiratory system and physical conditioning in adolescents. Equine-assisted therapy comprises therapeutic horseback riding that optimizes physical performance and mobility in a range of contexts. However, the influence of equine-assisted therapy on pulmonary function remains unclear. OBJECTIVE: To examine the impact of 10 weeks of hippotherapy combined with Schroth exercises on pulmonary function and aerobic capacity in adolescents with idiopathic scoliosis. METHODS: A randomized controlled trial including 45 patients, randomly assigned to experimental and control groups, was performed. Patients in the experimental group received 15 30-min sessions of hippotherapy over a period of 10 weeks. The 2 groups attended a 60-min session of Schroth exercises 3 times/week for 10 weeks. Pulmonary function and functional capacity were assessed before and after the intervention. RESULTS: Pre- and post-intervention variables (FVC, FEV1, FEV1/FVC, MVV and 6MWT) revealed significant improvement in both groups (p < 0.05). The improvement in the experimental group was significantly higher than in the control group (p < 0.05). CONCLUSION: The addition of hippotherapy to Schroth exercises resulted in improved pulmonary function and aerobic capacity in adolescents with idiopathic scoliosis.

Combination taping technique versus ankle foot orthosis on improving gait parameters in spastic cerebral palsy: A controlled randomized study.

BACKGROUND: One of the important goals in the treatment of spastic cerebral palsy is to maintain efficient and effective walking in order to be independent in activities and participate in society. OBJECTIVE: To compare the efficacy of foot combination taping of kinesio tape and athletic tape vs ankle foot orthosis in correcting spatiotemporal gait parameters in children with spastic diplegia. METHODS: Thirty-six children with spastic diplegia were randomly assigned into 3 groups; control, combination taping, and ankle foot orthosis groups. Children in the control group, in addition to those in both experimental groups, continued with conventional physical therapy, 1 h, 3 times per week for 4 weeks. Spatiotemporal gait parameters were assessed with the GAITRite system before and after the application of interventions. RESULTS: Significant increases in walking velocity, step length, stride length, right single support duration, and left single support duration of the ankle foot orthosis and combination taping groups than pre-intervention values. [AQ9] Moreover, the post--intervention values of the double support duration of the ankle foot orthosis and combination taping groups were significantly lower than pre-intervention values. There were no significant differences between the post-intervention values of the ankle foot orthosis and combination taping groups for all parameters. CONCLUSION: The results demonstrated that combination taping is an effective alternative technique to ankle foot orthosis to improve spatiotemporal parameters in children with spastic diplegic in combination with conventional physiotherapy.

Biofeedback versus bilateral transcutaneous posterior tibial nerve stimulation in the treatment of functional non-retentive fecal incontinence in children: A randomized controlled trial.

BACKGROUND: Biofeedback and transcutaneous posterior tibial nerve stimulation (TPTNS) can be used in treatment of Functional non-retentive fecal incontinence (FNRFI). Aim of this study was to evaluate the early effect of Biofeedback versus (TPTNS) and treatment by Kegal exercises and dietetic regulations in management of (FNRFI) in children. METHODOLOGY: The current prospective randomized controlled study included 93 children with FNRFI who were randomly allocated into the 3 groups. Group A (n = 28) were treated by dietetic regulation and Kegal exercises. Group B (n = 34) received biofeedback while group C (n = 31) received (TPTNS) for 3 months. Follow up using St' Mark's incontinence score and high resolution manometry was done at 3 and 6 months and compared to the initial records. RESULTS: There was statistically significant decrease in the incontinence score in Group B and C compared to Group A at 3 and 6 months (p ˂ 0.001). Resting and squeeze pressures showed significant increase group B and C (p ˂ 0.001). Patients in Group B and C showed significant decrease volume of balloon required for 1st sensation (p ˂ 0.001 and 0.034) respectively. CONCLUSION: Biofeedback is more effective than TPTNS, Kegal exercises and dietetic regulations in treatment of FNRFI in children for short term follow-up. LEVEL OF EVIDENCE: Level I. TYPE OF STUDY: Treatment Study.

Tumor cell hypoxia and the hypoxia-response signaling system as a target for prostate cancer therapy.

The accumulation of cancerous cells within a growing prostate tumor can deprive them of adequate vascular support. Without this support, the affected tumor cells become hypoxic, a condition that is usually unfavorable for the further growth and survival of eukaryotic cells. Mammalian cells, however, have the ability of responding to a hypoxic environment by activating a "hypoxia-response" signaling system. Ultimately, this signaling system upregulates the expression of a network of gene products that increase the propensity of the cell to survive even in this adverse environment. With increasing evidence that hypoxia and an activated hypoxia-response signaling system can influence progression (via increased angiogenic propensity and apoptotic resistance) and the therapeutic responsiveness of prostate cancer cells, this review will examine the concept of targeting hypoxia or the hypoxia-response system of prostate tumor cells as a means to suppress prostate tumor progression and metastasis or perhaps even as a means for eliminating prostate tumors in advanced prostate cancer patients.

Comparison of health-related quality of life and prostate-associated symptoms after primary and salvage cryotherapy for prostate cancer.

PURPOSE: Recent advances in cryosurgery of the prostate have led to the ability to treat tumors successfully with decreased morbidity. The patients' perspectives of this relatively new technique, however, have not yet been addressed. The purpose of this study was to compare health related quality of life (QoL) as well as prostate-associated symptoms in patients after primary and salvage cryoablation for clinically localized prostate cancer using a self-administered questionnaire. METHODS: A total of 131 consecutive patients who underwent cryoablation of the prostate between 1997 and 2001 were included in this confidential mailing study. The patients were either (a) patients with localized prostate cancer with contraindications for radical surgery, including patients refusing other forms of therapy, or (b) had locally recurrent prostate cancer after failure of radiation therapy. All patients received 3 months of neoadjuvant androgen deprivation therapy prior to cryosurgery and were surgically treated by the same surgeon using an argon-based system. We used the EORTC QLQ-C30, a commonly used, multidimensional instrument together with a supplementing, prostate-cancer-specific module. RESULTS: Eighty-one of the 131 patients (response rate 62%) returned the questionnaires. The two groups were comparable regarding age (mean age 72.8 vs 70.1 for the primary and the salvage group, respectively; p=0.22). The overall QoL scores were high in both groups. Primary cryotherapy patients fared significantly better regarding physical (p=0.005) and social (p=0.024) functioning compared with salvage cryotherapy patients. The most prominent prostate-related symptom in both patient groups was sexual dysfunction, followed by urinary symptoms, which were significantly more severe in the salvage group (p=0.001). Incontinence rates were 5.9 and 10% in the primary and the salvage group, respectively. Severe erectile dysfunction was reported in 86 and 90% of the primary and the salvage group, respectively. CONCLUSIONS: The present study demonstrates that, in selected patients, cryotherapy is a treatment option which has a functional outcome comparable to traditionally used prostate cancer treatments. More information regarding QoL is necessary for appropriate patient counseling and individual decision-making in the presence of various treatment alternatives.

Human hormone-refractory prostate cancers can harbor mutations in the O(2)-dependent degradation domain of hypoxia inducible factor-1alpha (HIF-1alpha).

PURPOSE: Androgen ablation, the preferred therapy for advanced prostate cancer, reduces blood flow and induces hypoxia in androgen-dependent tissues. Given the transient effectiveness of this therapy, we must consider whether a hypoxia-resistance mechanism might be involved in the development of therapeutic resistance by prostate cancer cells. The transcription factor protein, hypoxia-inducible factor 1alpha (HIF-1alpha), helps increase the expression of gene products that enable cells to survive conditions of hypoxic stress. Enhanced HIF-1alpha expression during hypoxia results from a drastic reduction of its degradation rate within a critical region of the protein referred to as the "oxygen-dependent degradation (ODD) domain". We sequenced HIF-1alpha cDNAs amplified from human prostate cancer cell lines and from hormone resistant prostate cancer specimens to determine whether prostate cancer cells might harbor mutations within the HIF-1alpha ODD domain. METHODS: HIF-1alpha cDNAs were RT-PCR amplified from three prostate cancer cell lines (LNCaP, PC-3, and DU145), from five different human hormone-resistant prostate cancers and one normal prostate, all microdissected, and were sequenced to determine whether the HIF-1alpha gene products were wildtype or mutant. One specimen containing a hormone-resistant prostate tumor that expressed a mutated HIF-1alpha cDNA was further microdissected into benign and tumorous regions and DNAs extracted from these regions were directly amplified by PCR and sequenced to determine whether the HIF-1alpha mutation was specific to the tumor. RESULTS: Although the HIF-1alpha cDNAs of all cell lines, the normal prostate, and three of the tumors were found to have a wildtype sequence, HIF-1alpha cDNAs amplified from two hormone-resistant tumors had nucleic acid substitutions that resulted in significant amino acid changes within the ODD domain of the HIF-1alpha protein. Analysis of the DNA extracted from a benign or tumorous region of one of these specimens showed that only the wildtype (nonmutated) form of the HIF-1alpha gene was amplified from the normal DNA whereas only the mutated form of the HIF-1alpha gene was amplified from the tumor. CONCLUSIONS: Some human hormone-refractory prostate cancers have mutations in a critical regulatory domain of the HIF-1alpha protein. We believe that these mutations might enable expression of this protein under inappropriate conditions and contribute to the development of therapeutic resistance by the cancer cells. This hypothesis is currently being tested.

Economic aspects of medical erectile dysfunction therapies.

The introduction of safe and effective oral therapies has changed the significance of erectile dysfunction (ED) forever. Seldom has a new drug changed the landscape of pharmacotherapy in so many ways as sildenafil (Viagra, Pfizer). This article highlights the various oral, intracavernosal and intraurethral therapies currently available for ED and evaluates the socio-economic impact of each method.

Regression of prostate cancer following administration of Genistein Combined Polysaccharide (GCP), a nutritional supplement: a case report.

PURPOSE: It has been reported that genistein, an isoflavone used in soybeans, has antiprostate cancer effects. Genistein Combined Polysaccharide (GCP trade mark; AMino Up, Sapporo, Japan), a nutritional supplement manufactured in Japan, is composed of genistein and a polysaccharide obtained from basidiomycetes (mycelia) that grows in a variety of mushrooms. METHODS: We report a case of a patient with a biopsy proven prostate cancer showing clinical and pathologic evidence of regression following administration of GCP. The patient was enrolled in an Institutional Review Board (IRB)-approved protocol and received GCP for 6 weeks prior to radical prostatectomy. RESULTS: The patient's prostate-specific antigen (PSA) decreased from an initial value of 19.7 to 4.2 ng/mL after 44 days of low-dose GCP. No cancer was identified in the radical prostatectomy specimen and no side effects were observed in this patient. CONCLUSION: This case suggests that GCP, which has shown potent inhibitory effects against prostate cancer in vitro, may have some potential activity in the treatment and prevention of prostate cancer.

Intracystic hemorrhage in a non-endometriotic mullerian vaginal cyst.

The commonest type of simple vaginal cyst is the Mullerian cyst. These are typically lined by columnar epithelium and contain serous or mucinous fluid. If blood is found in the cyst, the source is usually due to the presence of endometrial elements in the cyst wall. The cyst is then termed an endometriotic cyst. In this case report, we have described a woman with a symptomatic 3 cm upper vaginal cyst who underwent surgical excision of the cyst. The cyst cavity was found to be full of old dark blood and mucous, however the wall contained no endometrial tissue and was lined by columnar epithelium which stained positive for mucous with mucicarmine. No cause for the intracystic hemorrhage was identified. We conclude that intracystic hemorrhage can occur in a simple Mullerian vaginal cyst in the absence of endometrial components.

Vulvar granular cell tumor.

Granular cell tumors are rare, usually benign, soft tissue neoplasms of neural origin. They occur more often in females than males, the peak age incidence is in the fourth through fifth decades. They can occur anywhere in the body with up to 15% situated in the vulva. The commonest presentation is as an asymptomatic mass. Microscopic findings are usually sufficient, but immunohistochemistry can also be helpful in confirming the diagnosis. The vulvar tumors are benign in 98% of cases with 2% reported as malignant. In this case report we describe a woman with a granular cell tumor confirmed by biopsy who underwent excision of the mass but with focal extension to the resection margin on microscopy. Our recommendation of re-excision was declined. Since it is not uncommon with these tumors to find groups of tumor cells extending beyond the macroscopic limits of growth, we conclude that it is advisable to have margins assessed intraoperatively by frozen section such that further excision can be performed for positive margins. Our patient has been followed for 18 mo without recurrence, should the tumor recur, re-excision, with frozen section control, is indicated. Recurrence rates are reported as 2%-8% with clear margins and 20% with positive margins.

Risk factors for mesh extrusion after prolapse surgery: a case-control study.

OBJECTIVES: To identify risk factors for mesh extrusion in women undergoing pelvic organ prolapse repair by abdominal sacral colpopexy (ASC) or vaginal mesh procedure (VMP). METHODS: A multicenter case-control study of patients who underwent ASC or VMP from 2006 to 2009 identified using diagnosis and procedure coding. Cases were defined as women who underwent eligible index procedure with synthetic mesh and had mesh visible through the vaginal epithelium at postoperative evaluation; controls were matched in an approximate 1:3 ratio by date and type of procedure. Two conditional logistic regression models were constructed to assess variables associated with mesh extrusion among women who underwent ASC and among women who underwent VMP. RESULTS: Eighty-four cases were identified (43 cases after ASC and 41 cases after VMP), and 252 patients were matched as controls (147 patients who underwent ASC and 105 patients who underwent VMP). Concomitant hysterectomy was positively associated with mesh extrusion) among women who underwent ASC (adjusted odds ratio, 3.18; 95% confidence interval, 1.27-7.93; P = 0.01) and VMP (adjusted odds ratio, 3.72, 95% confidence interval, 1.20-11.54; P = 0.02). Age, race, type of vaginal incision, menopausal status, medical comorbidities, and smoking were not significantly associated with extrusion in either group. CONCLUSIONS: Concomitant hysterectomy is a risk factor for mesh extrusion after ASC and VMPs. This information may be helpful during informed preoperative counseling and planning.

Selection of salvage cryotherapy patients.

Radiation therapy is a main form of therapy for patients with localized prostate cancer. Despite advances in delivering radiation beams to the gland, urologists will be faced with managing patients with rising prostate-specific antigen values and radiation-recurrent cancer. If the cancer is detected early, salvage therapy can be initiated. Recent modifications in the technique of salvage cryosurgery have led to the ability to eradicate these tumors with a decrease in morbidity. The management and selection of these patients, as well as the results of salvage cryoablation, are discussed in this article.

Transurethral resection of the prostate: the new old standard.

A literature search was performed for articles between June 2000 and July 2001 pertaining to transurethral resection of the prostate. Eight of the most interesting and/or groundbreaking articles, as deemed by the authors, were selected for review. Topics discussed include transurethral vaporization of the prostate, laser prostatectomy, preoperative finasteride, pelvic floor rehabilitation, the impact of the quantity of tissue removed, bladder infusion prior to catheter removal, and ethanol-glycine in assessment of the absorption of irrigation fluid.

Female sexual dysfunction: state of the art.

Female sexual dysfunction, a common, multifactorial, and often undertreated medical condition, attracted the attention of the medical community with the successful introduction of medical therapy for male erectile dysfunction. This review discusses the updated classification systems and definitions, epidemiologic aspects, and new pathophysiologic and therapeutic implications of this sexual disorder.