Testing the factor structure of the Family Quality of Life Survey - 2006.

BACKGROUND: Although the Family Quality of Life Survey - 2006 (FQOLS-2006) is being used in research, there is little evidence to support its hypothesised domain structure. The purpose of this study was to test the domain structure of the survey using confirmatory factor analysis. METHOD: Samples from Australia, Canada, Nigeria and the USA were analysed using structural equation modelling. The data from Australia, Canada and the USA were combined on the assumption that these countries are similar, at least to some degree, in economic development, language and culture. The Nigerian data were analysed on its own. The analysis was undertaken in two phases. First, the hypothesis that each of nine domains of the FQOLS-2006 is a unidimensional construct that can reliably measure the dimensions Importance, Stability, Opportunities, Attainment, Stability and Satisfaction was tested. Second, the hypothesis that family quality of life (FQoL) is a single latent construct represented by the nine domains measured in the FQOLS-2006 was tested. RESULTS: In the first phase of the analysis, the Importance dimension was dropped because of skewness and lack of variance. The Stability dimension did not fit well within the individual domain model in both the Nigerian and the combined three countries' data. When Importance and Stability were excluded, the individual domain models showede good or acceptable fit when error variances of some dimensions were allowed to correlate. In the second phase of the analysis, the overall model, FQoL, represented by the nine domains of the FQOLS-2006 showed good fit in both data sets. CONCLUSIONS: The conceptual model of the FQOLS-2006 was supported with some qualifications. Each domain on the survey can be reliably measured by four dimensions Opportunities, Initiative, Attainment and Satisfaction. The dimensions of Importance and Stability, however, did not fit. Data reported on these dimensions from past and current studies should be interpreted with caution. The construct of FQoL is also reliably measured by the domains of the FQOLS-2006. Further research into the psychometric properties of the survey, particularly from a cross-cultural perspective, is needed.

Family quality of life among families with a member who has an intellectual disability: an exploratory examination of key domains and dimensions of the revised FQOL Survey.

BACKGROUND: The Family Quality of Life Survey (FQOLS-2006) was developed as the result of increased interest in family quality of life (FQOL) among families with a member who has an intellectual disability (ID). The instrument includes nine life domains and six dimensions reflecting the main areas and characteristics of FQOL. The aim of the current study was to provide a descriptive analysis of the domains and dimensions of the survey and to explore their relationship to one another and to global satisfaction. METHOD: A convenience sample of 35 participants with a family member who had ID completed the FQOLS-2006 in a large urban centre in Canada. The data were analysed using descriptive analyses. RESULTS: The findings showed that although participants differentiated between different domains and dimensions, as reflected in their variability, stability was also found. For example, support from others was rated lowest across most dimensions, while family relationships and health of the family were generally rated higher. CONCLUSIONS: The findings strengthen the importance of examining both the overall perception of FQOL as well as the perceptions in individual life domains. Moreover, they highlight the need to examine each life domain according to its various dimensions. In sum, the results call for further examination of the FQOLS-2006 as a useful tool for assessing FQOL and for implementing services based on it.

Ultrasonography in evaluation of mechanical problems of inflatable penile prosthesis.

A simple noninvasive and relatively inexpensive new technique utilizing real time sector ultrasonography for evaluation of mechanical failure in inflatable penile prosthesis is presented.

Use of infra-pubic incision for insertion of Mentor Mark II inflatable penile prosthesis.

This study reports the experience with 35 men who were implanted with a GFS Mark II inflatable penile prosthesis. The advantages of using the connectorless prosthesis with a reservoir/pump are reviewed.

Ureteroileal anastomosis: new antirefluxing technique.

A case report of a new surgical technique of antirefluxing ureteroileal anastomosis is described. Also reviewed are previous antirefluxing ureterointestinal anastomoses.

Iatrogenic chordee following insertion of inflatable penile prosthesis.

Chordee deformity is a rare complication following insertion of the inflatable penile prosthesis through a penoscrotal incision. The deformity occurs as a result of failure to inflate and deflate the device and to maintain the penis against the abdomen in the immediate postoperative period. When this occurs it can be corrected by incision of the fibrous scar and replacement with synthetic graft material.

Use of standard contraceptive diaphragm in management of stress urinary incontinence.

The management of stress urinary incontinence (SUI) consists of either surgical intervention and/or pharmacologic manipulation. Twelve patients with SUI were evaluated for management by the use of a fitted standard contraceptive diaphragm. Complete resolution of SUI was achieved in 11 of 12 patients (91%). Two of the 12 patients achieved continence but withdrew from the study because of associated discomfort from the diaphragm, therefore, complete resolution of SUI was achieved in 9 of 12 patients (75%).

Experimental evaluation of bladder closure techniques.

Two methods of bladder closure have been evaluated in dogs. A conventional two-layer closure including the mucosa and a single layer running horizontal mattress extramucosal closure have been compared. Observations including adequacy of healing, strength of scar, degree of inflammatory reaction, dna degree of bladder adhesions have been made. The extramucosal running horizontal mattress closure appears to approach the ideal bladder closure.

Ureteral replacements.

The clinical necessities of replacing all or part of the diseased or destroyed ureter have plagued surgeons for many years. In the past seventy years more than 100 surgical techniques have been described for ureteral replacement. Methods of replacement have fallen into four categories; nonbiologic substitutes, pedicle grafts, free grafts, and implantation and diversion. This review discusses the history and present status, and presents a look to the future in the surgery of ureteral replacement.

Blood urea nitrogen and serum creatinine. Physiology and interpretations.

Any elevations in levels of blood urea nitrogen and/or serum creatinine do not necessarily indicate structural renal disease. Conversely, blood urea nitrogen or serum creatinine values, which appear to be within the range of normal, do not by themselves rule out significant reduction in glomerular filtration rate. Any interpretation of the blood levels of these two substances must be done with the awareness that a variety of extrarenal factors can affect them. The blood urea nitrogen to serum creatinine ratio can be a valuable tool in the determination or renal functional and structural integrity.

Anterior urethral valves.

Two cases of anterior urethral valves are reported, one occuring in a child with renal osteodystrophy and the second being the first recorded case of anterior urethral valves in an adult. These 2 cases represent the thirteenth and fourteenth cases of anterior urethral valves reported in the literature.

Horseshoe kidney with multicystic dysplasia associated with ureterocele.

This is a case report of a horseshoe kidney one side of which contains a multicystic dysplastic element associated with a ureterocele. The surgical management and embryologic basis are reviewed.

New method for management of detrusor instability: transdermal scopolamine.

We report on the results of a pilot study using transdermal scopolamine in the management of detrusor instability (DI). Numerous agents have been used for the management of DI, however, many are associated with poor patient compliance and significant side effects. We have successfully used transdermal scopolamine on 3 patients with DI with good subjective and objective results.

Renal vein thrombosis in renal cell carcinoma. Proteinuria as diagnostic sign.

In 4 patients with hypernephroma and extension of the tumor thrombus into the renal vein, there has been a significant degree of proteinuria. We believe that the proteinuria in association with a renal mass suggests a tumor thrombus in the renal vein and warrants the preoperative inferior venacavogram. After a larger number of patients have been studied, it may become clear that patients who do not have proteinuria do not have renal vein or vena caval involvement. If this proves to be the case, these patients may be selectively spared inferior venacavography. For the present time in patients with hypernephroma, we can only recommend that the index of suspicion for renal vein involvement with tumor thrombus should remain high if the patient has significant proteinuria.

Clinical experience with Mentor Alpha I inflatable penile prosthesis. Report on 333 cases.

Penile prostheses are a well-established form of therapy for erectile dysfunction. We report our experience with 333 cases using the Mentor Alpha I inflatable penile prosthesis. With a follow-up period of 15.4 months, there were 25 (7.5%) complications with 15 (4.5%) major complications that required reoperation. We also review the advantages and the procedures for implanting the penile prosthesis on an outpatient basis or a one-day hospital stay.

Prostaglandin E1 versus sex therapy in the management of psychogenic erectile dysfunction.

The treatment for psychogenic erectile dysfunction has been previously managed by non-medical methods consisting of counseling with a psychiatrist, psychologist or sex therapist. The success rate for treatment with counseling has not been uniformly successful. This paper compares the treatment of psychogenic erectile dysfunction using standard sex therapy and self-injection therapy using low-dose PGE1. Fifty men with psychogenic impotence were divided into two groups: standard sex therapy for twelve weeks or treatment using low-dose (2.5 - 5.0 microg) of PGE1. The results showed that men treated with low-dose PGE1 had a 47% improvement of obtaining an unaided erection compared to 58% improvement rate with sex therapy. 69% of patients in the PGE1 group were satisfied with their treatment compared to 75% receiving sex therapy. The frequency of intercourse reported in patient diaries for the two groups was similar (20.5 per month for PGE1 vs 20.0 per month for sex therapy. The reported duration of erection by patients receiving PGE1 therapy was longer than that reported by those receiving sex therapy (35 min vs 10 min). The comparison of the cost of treatment of the two treatment groups reveals that the sex therapy is approximately 25% more expensive than the PGE1 treatment. This pilot study demonstrates that the efficacy of PGE1 was numerically, though not statistically, less than sex therapy in the treatment of psychogenic impotence. The cost per positive outcome with PGE1 treatment is lower than that of sex therapy treatment making PGE1 more cost-effective.

A practical approach to the evaluation and treatment of erectile dysfunction. A private practitioner's viewpoint.

There are many changes occurring in the delivery of health care that are economically impacting our urology practices. Certainly, the days of being primarily prostate and TURP doctors are over. Incorporating an impotence component in our practices is an effective method of filling the void left by treating BPH. Treating impotence will not require any significant additional equipment or staff. Not only are there opportunities within our own practices, there are thousands of men suffering from impotence in our communities who need our help and our expertise. Finally, using the two-visit technique, most men can be evaluated and begin a treatment program that will result in a successful resolution to their sexual problem in a cost-effective fashion.

Treatment of impotence. 1. Nonsurgical methods.

Male sexual dysfunction is a problem that is quite prevalent in our society. Until recently, the only treatments for impotence were testosterone injection, sex therapy, and implantation of a penile prosthesis. These methods remain in use when appropriate. However, now that the pathophysiology of erection is better understood, the dopamine agonist, intracorporal injection, and the alpha 2-adrenergic receptor blocker have been added to the treatment list. Gadgets that artificially increase the blood supply to the penis are sometimes used. The withdrawal of drugs that affect sexual function may be sufficient.

Treatment of impotence. 2. Surgical methods.

Most patients with an organic or physical cause of their impotence can be helped, because noninvasive diagnostic testing to identify the disorder and specialized surgical techniques to repair it are available. Occlusion or leakage of the blood supply to the penis is treated with graft bypass, endarterectomy, transluminal balloon angioplasty, or vein ligation. Patients with persistent Peyronie's disease may require plaque excision and graft placement, and sometimes, a penile prosthesis. Different types of penile prostheses have been used successfully.

Urinary incontinence in women. Evaluation in the primary-care office.

Urinary incontinence in women is common and can be a significant social problem. The most common type is stress incontinence, caused by displacement of the bladder neck and urethra and experienced during activities that increase intraabdominal pressure. Other types are urge, overflow, and mixed incontinence. Diagnosis of the type and cause can usually be made using simple, cost-effective office procedures. Nonsurgical treatment is often successful and may consist of pharmacologic management, intermittent self-catheterization, Kegel exercises, and use of a mechanical device.