An allied health rehabilitation program for patients following surgery for abdomino-pelvic cancer: a feasibility and pilot clinical study.

PURPOSE: To investigate the feasibility of conducting a rehabilitation program for patients following surgery for abdomino-pelvic cancer. METHODS: A non-randomised controlled before-and-after study. Patients who had undergone surgery for stage I-III abdomino-pelvic cancer (colorectal, gynaecological or prostate cancer) were recruited. The rehabilitation group (n = 84) received an 8-week, bi-weekly education and exercise program conducted by a physiotherapist, exercise physiologist, health psychologist and dietician, supplemented by exercise diaries and telephone coaching sessions. The comparator group (n = 104) completed postal questionnaires only. Feasibility measures, functional exercise capacity, muscle strength, physical activity levels, pelvic floor symptoms, anxiety and depression, health-related quality of life (HRQoL) and self-efficacy were measured at baseline (time 1), immediately post-intervention (time 2) and at 6 months post-baseline (time 3) and compared within- and between-groups. RESULTS: The consent rate to the rehabilitation program was 24%. Eighty-one percent of the rehabilitation group attended 85-100% of 16 scheduled sessions. Overall satisfaction with the program was 96%. Functional exercise capacity, handgrip strength in males, bowel symptoms, physical activity levels, depression and HRQoL were significantly improved in the rehabilitation group (p < 0.05) at time 2. The improvements in all these outcomes were sustained at time 3. The rehabilitation group had significantly improved physical activity levels, depression and HRQoL compared with the comparator group at times 2 and 3 (p < 0.05). CONCLUSION: Recruitment to this oncology rehabilitation program was more difficult than expected; however, attendance and patient satisfaction were high. This program had positive effects on several important clinical outcomes in patients following abdomino-pelvic cancer treatment. TRIAL REGISTRATION: ANZCTR 12614000580673.

Microsurgical and nonmagnified subinguinal varicocelectomy for infertile men: a comparative study.

OBJECTIVE: To compare semen parameters, pregnancy, recurrence, and complication rates after microsurgical and nonmagnified subinguinal varicocelectomy for infertile men. DESIGN: Prospective, randomized study. SETTING: Ghodran General Hospital, Kingdom of Saudi Arabia. PATIENT(S): One hundred sixty-two infertile male patients with varicocele. INTERVENTION(S): Eighty-two patients were treated by microsurgical subinguinal varicocelectomy (MSSIV) (group I), whereas 80 patients were treated by conventional, nonmagnified subinguinal varicocelectomy (NMSIV) (group II). MAIN OUTCOME MEASURE(S): The patients were postoperatively evaluated by physical examination and semen analysis after 4 and 12 months. Pregnancy rate was monitored during the follow-up period. RESULT(S): Postoperatively, mean sperm count and motility improved significantly in both groups: 42.7% and 67.1% of the MSSIV group and 23.7% and 33.8% of the NMSIV group showed ≥50% improvement in sperm count and motility after 1 year. Patients having bilateral varicocele showed significantly better improvement of sperm count than those with unilateral varicocele after both MSSIV and NMSIV. The pregnancy rate at the end of the follow-up period reached 37.8% in the MSSIV group and 21.2% in the NMSIV group. The recurrence rate was zero in the MSSIV group and 11.3% in the NMSIV group. The rate of hydrocele formation was 1.2% in the MSSIV group and 8.7% in the NMSIV group. CONCLUSION(S): Microsurgical subinguinal varicocelectomy has a better improving effect on sperm count and motility, higher spontaneous pregnancy rates, and lower postoperative recurrence and hydrocele formation than conventional subinguinal varicocelectomy in infertile men.

The significance of microsurgical varicocelectomy in the treatment of subclinical varicocele.

OBJECTIVE: To assess the improvement of seminal characteristics and pregnancy rates after microsurgical varicocelectomy in men with subclinical varicocele. DESIGN: Retrospective study. SETTING: University infertility clinic. PATIENT(S): One hundred forty-three patients with a subclinical left-sided varicocele. INTERVENTION(S): Patients who agreed to microsurgical varicocelectomy (n = 25, surgery group), medical treatment with L-carnitine (n = 93 drug group), and those who did not agree to any treatment (n = 25, observation group) were enrolled. MAIN OUTCOME MEASURE(S): Semen characteristics were reevaluated twice 6 months after treatment. The natural pregnancy rates were estimated by telephone interview between 1 and 2 years after treatment. RESULT(S): In the surgery group, sperm counts improved significantly after microsurgical varicocelectomy. In the drug group, however, sperm parameters did not significantly improve after treatment. Natural pregnancy rates were 60.0% in the surgery group, 34.5% in the drug group, and 18.7% in the observation group. The natural pregnancy rate of the surgery group was higher than the other groups, and there were statistically significant differences among the three groups. CONCLUSION(S): Surgical treatment is the best option for management of subclinical varicocele.

Técnica de Mathieu para la corrección del hipospadias distal en niños / Mathieu technique for correction of distal hypospadias in children

Introducción: el hipospadias es una alteración en la formación de la uretra en la que el meato urinario queda en una posición anormal en la parte ventral del pene. Se presenta en uno de cada 300 nacidos vivos, la localización distal es la más frecuente (70 por ciento). Para su corrección quirúrgica existen diversas técnicas basadas en la utilización de colgajos. Material y método: se incluyeron los casos de hipospadias distal, operados de febrero de 1979 a febrero de 1997, mediante la técnica de Mathieu, considerando como variables el tipo de hipospadias, tratamiento hormonal, complicaciones y tratamiento antibiótico, así como resultado funcional y estético. Resultados: se incluyó en el estudio un total de 61 pacientes, 44 con hipospadias subcoronal (72.1 por ciento), 14 con hipospadias coronal (22.9 por ciento) y tres con hipospadias glandular (4.9 por ciento). Se identificaron nueve casos de estenosis. De las estenosis, (83.1 por ciento) fue en la base y el restante entre la base y el meato. Hubo 18 casos con fístulas, cuatro en hipospadias coronal (80 por ciento en la base) y 14 en los casos subcoronales (43 por ciento en la base). Se observaron tres casos de divertículo, todos en los casos subcoronales. Se obtuvieron buenos resultados estéticos y funcionales en más de 90 por ciento. En el análisis se encontró una frecuencia mayor de fístulas que en otras series (29 por ciento). La técnica de Mathieu representa una excelente opción para los pacientes con hipospadias distal, dado su alto porcentaje de buenos resultados estéticos y funcionales aun con las complicaciones presentadas.

Case consultation: ablatio penis.

In male infants, traumatic ablation of the penis, with or without loss of the testicles may occur as a sequel to mutilatory violence, accidental injury, or circumcision error. Post-traumatically, one program of case management is surgical sex reassignment to live as a girl, with female hormonal therapy at the age of puberty. The other program is genital reconstructive surgery to live as a boy, with male hormonal therapy at puberty if the testicles are missing. In both programs, the long term outcome is less than perfect and is contingent on intervening variables that include societal ideology; surgical technology; juvenile and adolescent timing and frequency of hospital admissions construed by the child as nosocomial abuse; development of body image; health and sex education; fertility versus sterility; coitus and orgasm; possible lesbian orientation if living as a girl; and long-term cost accounting, including the psychic cost of being a pawn in possible malpractice litigation on whose disability a very large fortune in compensation may devolve. There is, as yet, no unanimously endorsed set of guidelines for the treatment of genital trauma and mutilation in infancy, and no provision for a statistical depository for outcome data.