Risk factors for the postoperative bladder neck contracture in patients with small-volume prostatic hyperplasia.

OBJECTIVE: This study was to explore the risk factors for postoperative bladder neck contracture (BNC) after transurethral operation of prostate in patients with small-volume prostatic obstruction. METHODS: Clinicopathologic data at our center from February 2016 to January 2020 were retrospectively collected and analyzed. Clinicopathological characteristics between patients with and without BNC were compared. Multivariate logistic regression was used to determine the risk factors for postoperative BNC. RESULTS: There were a total of 39 patients (8.53%) with postoperative BNC. Multivariate logistic regression analysis demonstrated that preoperative bladder neck diameter (BND), intravesical prostatic protrusion (IPP), surgical methods (transurethral resection of prostate (TURP)/anatomical endoscopic enucleation of the prostate (AEEP)), and postoperative urinary tract infection (UTI) were independent risk factors for postoperative BNC in patients with small-volume prostatic obstruction (P < 0.05). The incidence of postoperative BNC in patients undergoing AEEP was significantly decreased compared with those undergoing TURP. The optimal cut-off value of preoperative IPP was 6.10 mm while the optimal cut-off value of preoperative BND was 2.52 cm. CONCLUSIONS: Larger preoperative bladder neck and higher preoperative IPP lead to decreased incidence of postoperative BNC in patients with small-volume prostatic obstruction. Active management of postoperative UTI could effectively prevent the occurrence of postoperative BNC. Compared with TURP, complete AEEP would contribute to reduce BNC in patients with small-volume prostatic obstruction.

[Predictors of bladder neck contracture after transurethral procedure on the prostate].

The development and widespread implementation of modern endourological procedures for the treatment of benign prostatic hyperplasia (BPH) has led to a significant reduction in postoperative complications, but these interventions are associated to an increase of bladder neck contracture (BNC) rate. Various data on the frequency, pathogenesis, and risk factors for the development of BNC after endourological interventions are presented in the literature review. The prevalence of BNC after transurethral procedures depending on the type of energy used reaches up to 10%. Risk factors of BNC included the presence of chronic prostatitis and urinary tract infections, as well as small volume BPH. The age, cardiovascular diseases, type 2 diabetes, obesity, and a long-term smoking are considered as additional risk factors. A detailed study of the risk factors for BNC will further minimize BNC rate after transurethral procedures, thus improving the quality of life of patients.

Analysis of risk factors of bladder neck contracture following transurethral surgery of prostate.

BACKGROUNDS: The aim of the present study was to investigate the perioperative parameters associated with bladder neck contracture (BNC) after transurethral surgery of the prostate and to compare the incidence of BNC after transurethral resection of the prostate (TURP) or Thulium vaporesection (resection group) versus Thulium vapoenucleation or enucleation of the prostate (enucleation group). METHODS: Between March 2008 and March 2020, 2363 patients received TURP and 1656 patients received transurethral surgery of the prostate with Thulium laser (ThuP) at Mackay Memorial Hospital. A total of 62 patients developed BNC. These BNC patients were age-and operation-matched to 124 randomly sampled TURP/ThuP controls without BNC. A 1:1 propensity score matching model was used to evaluate the difference in incidence of BNC. RESULTS: Our study demonstrated that a greater proportion of BNC patients had history of cerebrovascular accidents (11/62 vs. 7/124, p = 0.009), coronary artery disease (14/48 vs. 16/108, p = 0.03), chronic kidney disease (14/62 vs. 11/124, p = 0.01), and two or more comorbidities (29/62 vs. 27/124, p = 0.001) compared with NBNC patients. Multivariate analysis showed that smaller prostate volume (OR 0.96 (0.94-0.99), p = 0.008) and recatherization (OR 5.6 (1.02-30.6), p = 0.047) were significantly associated with BNC. A ROC curve predicted that a prostate volume < 42.9 cm3 was associated with a notably higher rate of BNC. The propensity score matching model reported there was no difference in incidence between resection and enucleation groups. CONCLUSION: This study demonstrated that incidence of BNC was the same in different surgical techniques and that low prostate volume, recatherization and ≥ 2 comorbidities were positively correlated with the development of BNC after TURP or ThuP.

Tortícolis congénita: incidencia y actuación fisioterápica en neonatos con contractura en el esternocleidomastoideo / Congenital torticollis: Incidence and physiotherapeutic performance in newborns with contracture of sternocleidomastoid

Con el objeto de diferenciar casos de Tortícolis congénita por hematoma o por contractura en el ECM, tanto en su evaluación como en su tratamiento, hemos realizado este estudio en una muestra de 45 neonatos de una Zona Básica de Atención Primaria de Badajoz durante el primer año de vida. Se pretende demostrar la importancia en todos los casos del tratamiento precoz y seguimiento, precedido de una buena evaluación.Antes de iniciar el método de tratamiento realizamos una evaluación del desarrollo psicomotor del niño teniendo en cuenta la Actividad Refleja y los Hitos en las Etapas del Desarrollo. Destacar además la valoración de la musculatura tónica del cuello, tronco y extremidades para así hacer un tratamiento más diferenciado. La metodología empleada ha sido Tratamiento Neurodesarrollante de Bobath, y Reequilibración Tónica, así como enseñanza a los padres de medidas paleativas durante este primer año de vida. Los resultados más significativos han sido una mayor incidencia de contractura que de hematoma, más incidencia en niños que en niñas, mejores resultados obtenidos cuanto antes nos fueron derivados, siendo la edad media de derivación de 2,5 meses, así como mayor presencia de plagiocefalia como patología asociada (AU)

[Complications in the hemiplegic patient in the first year after the stroke]. / Complicaciones en el paciente hemipléjico durante el primer año tras el ictus.

INTRODUCTION: After a cerebrovascular accident (CVA) a hemiplegic patient is at risk from numerous complications after leaving hospital. OBJECTIVE: To analyze the frequency of occurrence of the commonest complications characteristic of the hemiplegic syndrome, during the first year after the stroke. PATIENTS AND METHODS: We evaluated 73 hemiplegic patients admitted to the rehabilitation department for treatment after a stroke. At each medical consultation, on admission and three, six and twelve months after the CVA, the complications 'belonging' to the hemiplegic syndrome were evaluated. These included contractures, painful shoulder, sympathetic-reflex dystrophy, fractures and thalamic pain. RESULTS: During the first year of the illness 81% of the patients had some type of complication. A painful shoulder was the commonest complication, seen in 40% of the patients, followed by contractures (23%). Sympathetic-reflex dystrophy of the paretic arm occurred in 11 patients (15%). CONCLUSION: The commonest complication in patients during the first year after their stroke are painful shoulder and contractures.

Epidemiology. The incidence and management of joint contracture in India.

An epidemiologic study in India showed that 50% of the severely disabled (1.8% of the total population) had locomotor disorders. There is a considerable difference in the incidence of disability and disease in rural and urban populations. The deformities from poliomyelitis are encountered predominantly in the rural areas (53.5%). The incidence in urban areas is only 1%. After poliomyelitis, the pathomechanics of deformity are prominent in the lower limbs. In a developing country, the management of contractures differs considerably from treatment in economically advanced nations. The use of postural exercises with body weight is well illustrated by certain Yoga postures such as paschimottansana or ushtrasana and is a prescribed treatment.

The influence of vitamin E on capsule formation and contracture around silicone implants.

An attempt was made to determine if the tissue response to surgical trauma and foreign body stimulus (silicone implants) could be altered using vitamin E in rats. The animals were divided into four groups: Group A served as controls, Group B were treated by intramuscular vitamin E, Group C were treated topically with vitamin E around the prosthesis, and Group D were treated topically with croton oil around the prosthesis. The animals in each group were killed at 2 week, 1 month, and 3 months intervals. The intraprosthetic pressure in each prosthesis was recorded using a strain gauge transducer. The capsules were then removed and examined histologically using a light microscope and the thickness of pseudocapsules was measured with an ocular micrometer. In Group B significantly thinner pseudocapsules were observed at 2 weeks, but there was no comparable difference either in thickness or degree of contracture (as measured by intraprosthetic pressures) between Groups A and B at 2 months and 3 months. In Group C, the pseudocapsules were significantly thicker at all tested periods and showed noticeable contracture at 3 months. In group D the pseudocapsules were thickest and cellular infiltrate more marked than in the other groups.