Priapism, a symptom of claudication of the cauda equina in spinal stenosis.

Priapism is defined as a persistent penile erection in the absence of sexual arousal. This symptom has been documented in patients with spinal stenosis although it is considered a rare finding. The European Association of Urology guidelines on priapism [Salonia et al., 2014] list cauda equina syndrome and spinal stenosis as causative factors for ischemic priapism although the literature describing this phenomenon appears sparse. Priapism can be a rare symptom of lumbar spine stenosis/transient cauda equina compression. This presentation is complex and believed to be a parasympathetic mediated autonomic disorder. This article discusses the relationship between spinal stenosis, cauda equina syndrome and priapism using available literature. Greater awareness of this clinical finding may help clinicians in their clinical decision making. In patients with suspected cauda equina syndrome, subjective enquiry regarding the symptom priapism may add to the patients overall clinical picture.

Osteoarthritis and obesity; conservative management, multi-morbidity, surgery and the implications of restricted access to knee or hip replacement: a literature review.

BACKGROUND: Osteoarthritis is a significant health issue for many over the age of 65. Obesity is an accepted risk factor for the development of OA. Weight loss and exercise are fundamental evidence based conservative management strategies. Obese patients with OA are, however, at increased risk of requiring surgical intervention. BMI as a measure of obesity, is being used by many commissioners in the UK as an eligibility criterion for surgery. Many patients with end stage arthritis now find themselves unable to have joint replacement surgery because of their weight. OBJECTIVE: This evidence informed review provides focus on those with obesity and OA, considering management strategies in this group. The additional impact of multi-morbidity on this cohort is considered. The available literature concerning those requiring surgery but who are denied joint replacement surgery because of their weight is explored. DESIGN: A non-systematic literature review was undertaken to facilitate analysis of this subject. The manuscript uses the SANRA criteria as a framework of quality assurance. CONCLUSIONS: Osteoarthritis and associated obesity is a significant public health issue. Patients need greater support in maximising their conservative management options, including the promotion and facilitation of weight loss and exercise, possibly combined; a multi-professional responsibility for all healthcare workers, including those in the nursing profession. A greater research emphasis should be placed on investigating and developing enhanced care frameworks for this large cohort of patients, especially supporting those who are denied surgery because of their weight.