Efficacy of prednisone for severe refractory ulcerative interstitial cystitis

PURPOSE: We know that bladder inflammation has been noted in some patients with interstitial cystitis (IC). Studies with corticotherapy were performed about 50 years ago. Since that time few studies have been done with corticotherapy. We evaluated the efficacy of prednisone in patients with chronic severe IC with Hunner's ulcers unresponsive to first line therapies. MATERIALS AND METHODS: A prospective study was performed on 14 patients with evidence of ulcerative IC between 1998 and 2003. The patients received 25 mg of prednisone daily for 1 to 2 months and the dose was then tapered to the minimum required for relief of symptoms. Efficacy was evaluated with the O'Leary symptom and problem index and a 6-point pain scale. RESULTS: Of the 14 patients 9 (64%) were still using prednisone at the end of the study with an average followup of 16 months. In these 9 patients a 38% reduction (p <0.005) in the total score of the O'Leary index was observed. Pain was decreased by 88% (p = 0.0001). There were 5 patients who dropped out of the study due to lack of improvement or side effects. Overall results for the whole cohort included a reduction of 22% (p <0.02) of the total score of O'Leary index and a 69% improvement in pain control (p <0.001). CONCLUSIONS: These results suggest that a trial of prednisone should be considered in patients with severe ulcerative IC otherwise unresponsive to conventional treatment. Improvement in pain control was particularly impressive in this group of patients.     

Prevalence of temporomandibular disorders in fibromyalgia and failed back syndrome patients: a blinded prospective comparison study.

OBJECTIVES: The objective of this study was to determine the prevalence of temporomandibular disorders (TMD) and evaluate psychosocial domains in patients with fibromyalgia (FM) compared with patients with failed back syndrome (FBS). STUDY DESIGN: The study included 51 (32 FM and 19 FBS) adult patients who were administered orofacial pain and psychological questionnaires before a clinical examination. Presence of TMD was diagnosed according to the Research Diagnostic Criteria for TMD. RESULTS: Fifty-three percent of the FM patients reported having face pain compared with 11% of the FBS patients. Of those FM patients who reported face pain, 71% fulfilled the criteria for a diagnosable TMD. FM patients had significantly higher subscale scores for somatization, obsessive-compulsive, medication used for sleep, and fatigue compared with FBS patients. Eighty-seven percent of the FM patients reported a stressful event and 42.3% had symptoms indicating posttraumatic stress disorder. CONCLUSION: The high prevalence of TMD and psychosocial dysfunction among FM patients suggests wide-reaching dysregulation of autonomic and hypothalamic-pituitary-adrenal axis functions.     

Sexual dysfunction in female subjects with fibromyalgia

PURPOSE: We investigated sexual function in females with fibromyalgia (FM) and evaluate whether coexistent major depression (MD) has an additional negative effect on sexual function. MATERIALS AND METHODS: A total of 100 female subjects were enrolled in the study, including 40 with FM only, 27 with FM plus MD and 33 healthy volunteers as a control group. The diagnosis of MD was made according to Structured Clinical Interview for Diagnostic and Statistical Manual-IV interview and the Hamilton Depression Rate Scale was used to grade depression. Widespread pain and quality of life were assessed with the Lattinen Pain Scale and Fibromyalgia Impact Questionnaire, respectively. The Female Sexual Function Index (FSFI) was used to assess sexual dysfunction. RESULTS: All subjects were comparable in age, occupation and education. Mean FSFI total score +/- SD was significantly decreased in the FM and FM plus MD groups compared with that in healthy controls (21.83 +/- 5.84 and 22.43 +/- 7.0 vs 28.10 +/- 6.52, respectively, p = 0.001). However, the FSFI score was not significantly different between patients with FM only and FM plus MD (p >0.05). Correlation analysis revealed a negative moderate correlation between total Lattinen pain score and FSFI score in the FM only and FM plus MD groups (r = -0.366, p = 0.047 and r = -0.403, p = 0.018, respectively). FSFI score did not correlate with FIQ and HDRS scores (p >0.05). CONCLUSIONS: This study demonstrates that female patients with FM have distinct sexual dysfunction compared with healthy controls and coexistent MD has no additional negative effect on sexual function. Thus, female subjects with FM should be evaluated in terms of sexual function to provide better quality of life.     

Non-hodgkin-lymphoma of low malignancy (immunocytoma) and arthritis of the glenohumeral joint

AIM: Oligo- or monarthritis is reported as an uncommon complication of both acute and chronic leukemia. Childhood leukemias are complicated more frequently by leukemic arthritis (LA) than adult cases. LA occurs rather in acute than in chronic leukemia and can present at any stage of the disease. Proposed pathogenic mechanisms of arthritis in leukemia are leukemic infiltration of synovial tissue and resulting periosteal and capsular inflammation. As the primary manifestation of chronic lymphocytic leukemia (CLL) and immunocytoma (IC), LA is extremely rare. In such cases osteoarthritis may then be misdiagnosed as the source of joint disease. METHOD: We report a case of glenohumeral arthritis with complete rotator cuff tear and humeral head migration in an 88-year-old patient. Surgery exposed joint effusion, synovitis and chondromalacia with glenohumeral joint destruction. RESULTS: Histopathological examination revealed an articular chondrocalcinosis and bone marrow infiltration by an immunocytoma (B-cell non-Hodgkin lymphoma of low malignancy). CONCLUSION: Although LA is an uncommon complication in CLL and IC, it may be considered in elderly patients with lymphocytosis and arthritis.     

Initial results of salvage laparoscopic radical prostatectomy after radiation failure

PURPOSE: We evaluated the feasibility of laparoscopic radical prostatectomy for recurrence after irradiation. MATERIALS AND METHODS: Since 2000, 7 patients with biological failure after irradiation (5 external beam radiation and 2 brachytherapy), and no metastasis on computerized tomography and bone scan underwent a transperitoneal laparoscopic radical prostatectomy according to the Montsouris technique. The left index finger was placed in the rectum to control the prostatorectal dissection. We call this procedure "finger assisted laparoscopy." RESULTS: Average operating time was 190 minutes (range 170 to 210), average blood loss was 387 cc (range 50 to 1,100) and no patient was transfused. Bladder catheter was removed after an average of 13 days because of the slower tissue healing after irradiation. No death or intraoperative complication occurred. There was no conversion to open surgery. Average postoperative stay was 6.4 days. Average followup was 11.2 months. Of the 7 patients 5 are continent (no pad day or night) and 2 have stress incontinence. All patients are impotent. No patient had urethral stenosis or lymphocele. Prostate specific antigen is lower than 0.1 ng/ml in 5 patients and higher in 2. CONCLUSIONS: Laparoscopic salvage radical prostatectomy after irradiation is feasible with no more morbidity than an open procedure. A longer followup is mandatory to evaluate its usefulness.     

Relationship among symptoms,mood, and personality traits in patients with interstitial cystitis/bladder pain syndrome

ObjectiveWe have proposed an analysis of personality traits to classify patients with interstitial cystitis/bladder pain syndrome (IC/BPS) to determine the association between symptoms, mood, and personality traits in IC/BPS patients.Materials and methodsA total of 57 patients (7 males and 50 females) diagnosed according to the National Institute of Diabetes and Digestive and Kidney Diseases criteria were recruited from December 2005 to June 2006. All of these patients were newly diagnosed cases of IC/BPS, and the evaluation was made during the admission after hydrodistension. This study used the O'Leary–Sant Symptom Index and Problem Index (interstitial cystitis system index and interstitial cystitis problem index) to record the clinical symptoms of all IC/BPS patients. Basic Personality Inventory and Back Anxiety Inventory were used to analyze personality traits and mood status.ResultsIC/BPS patients have personality traits of depression and hypochondriasis, and show moderate anxiety mood. The duration of the symptoms is longer in depressive IC/BPS patients. Significant positive correlations were found among pain and anxiety mood, symptoms and interpersonal problems, and problem index and depression, respectively. Patients with severe anxiety mood status have abnormal personality traits such as depression, anxiety, self-depreciation, and others.ConclusionsIC/BPS patients frequently exhibit several mental health disorders and negative personality traits. Therefore, in addition to targeting the bladder pathological condition, psychological intervention focusing on personality traits and anxiety mood status should be provided to improve quality of life of IC/BPS patients.     

Silent compartment syndrome complicating total knee arthroplasty: continuous epidural anesthesia masked the pain

Posterior dislocation is an uncommon complication of total knee arthroplasty (TKA) using a posterior stabilized total knee prosthesis, and it usually results from flexion instability. Acute posterior dislocation of a posterior stabilized prosthesis complicated by compartment syndrome of the leg has not previously been reported in the literature. We report a 62-year-old woman with posterior dislocation of her posterior stabilized TKA when her knee was in extension. It was further complicated by compartment syndrome with severe muscle necrosis. The diagnosis of compartment syndrome was delayed, partly because of continuous epidural anesthesia that completely abolished the pain and partly because of the low index of suspicion, as compartment syndrome is not well recognized as a possible complication of TKA. This case report strongly emphasizes that continuous epidural anesthesia is contraindicated in the case of complicated TKA because important clinical cues to neurovascular complications could be masked.     

Lumbar sympathetic block for pain relief in two patients with interstitial cystitis

BACKGROUND AND OBJECTIVES: Interstitial cystitis (IC) is characterized clinically by lower abdominal pain, pain during urination, and increased frequency of urination. Treatment of the symptoms in IC remains challenging. We report effective treatment using lumbar sympathetic block for 2 patients with IC. CASE REPORT: A 63-year-old and 78-year-old woman were diagnosed with IC. Medical therapy with nonsteroidal anti-inflammatory drugs (NSAID), anticholinergics, and hydrodistention of the bladder failed to improve their symptoms. Subsequently, a continuous lumbar epidural block using 1% mepivacaine was used in these patients. A transient reduction of the symptoms in both patients was achieved. A lumbar sympathetic block with a neurolytic agent produced almost complete, and long-lasting relief of their symptoms. CONCLUSION: Lumbar sympathetic block using a neurolytic agent produced long-lasting pain relief in 2 patients with IC. Reg Anesth Pain Med 2001;26:271-273.     

Hyperbaric oxygen for the treatment of interstitial cystitis: long-term results of a prospective pilot study

OBJECTIVE: We conducted a prospective pilot study to assess the safety and efficacy of hyperbaric oxygen (HBO) for the treatment of interstitial cystitis (IC). METHODS: Six patients underwent 30 sessions of 100% oxygen inhalation in a hyperbaric chamber and were followed up over 15 months. The measures of efficacy were changes in pain and urgency (visual analog scales), alteration in the patient's assessment of overall change in his well-being (Patient Global Assessment Form), and changes in frequency and functional bladder capacity (48-hours voiding log). Evaluation of symptom severity regarding pain and voiding problems was done using the O'Leary-Sant index. RESULTS: Four patients rated the therapeutic result as either excellent or good and assessed their well-being after HBO treatment as improved. Two patients showed only short-term amelioration of some of their symptoms. At 12 months follow-up the baseline functional bladder capacity increased from 37-161 ml (range) to 160-200 ml in the responder group. The 24-hour voiding frequency decreased from 15-27 to 6-11 voids per day, a pain scale improvement from 20-97 mm at baseline to 3-30 mm at 12 months follow-up and an urgency scale improvement from 53-92 mm to 3-40 mm, respectively was observed at 12 month follow-up. The symptom and pain index score decreased from 23-35 at baseline to 3-17 at 12 months follow-up. CONCLUSION: HBO appears to be effective to treat IC patients. Treatment was well tolerated and resulted in a sustained decrease of pelvic pain and urgency, improvement of voiding patterns and increase of functional bladder capacity for at least 12 months.     

Challenging abdominal wall defects.

BACKGROUND: We propose a simple algorithm for management of patients with challenging abdominal fascial defects. METHODS: The medical records of 64 patients with complicated abdominal wall defects representing a consecutive series by a single surgeon over a 4-year period were reviewed. Group I patients presented with massive fascial defects and closed wounds. They were reconstructed with autogenous tissue using either the separation of parts (SOP) procedure or free tensor fascia lata (TFL) grafts. Group 2 patients had fascial defects with open wounds. Wound closure was first accomplished with either STSG or primary skin closure over viscera. These patients, now "converted" into patients with closed wounds, were reconstructed months later as in group 1. RESULTS: Average defect size was 320 cm2. Wound closure was achieved in one procedure in all patients with open wounds. Time to discharge after this procedure averaged 9 days. The only morbidity of wound closure was skin graft donor site pain. Average time from temporary staged closure with skin grafts to definitive closure with autogenous tissue was 5 months. Repair of closed fascial defects with autogenous tissue was performed in 51 patients. Average time to discharge after autogenous tissue repair was 6.6 days. Recurrence of hernia was noted in 2 (3.9%) patients with an average follow-up of 24 months. CONCLUSIONS: Treatment of challenging abdominal wall defects can be accomplished simply and safely utilizing the above surgical algorithm. Open wounds are converted into closed wounds and fascial defects are repaired with autogenous tissue. This treatment plan has proved to be effective in a wide variety of situations.     

A referral center's experience with transitional cell carcinoma misdiagnosed as interstitial cystitis

PURPOSE: There has been a recent trend to diagnose interstitial cystitis (IC) in a noninvasive way using a potassium sensitivity test, and a pelvic pain, urgency and frequency questionnaire. The concern is that significant pathology causing the bladder symptoms may be missed, such as transitional cell carcinoma. We present our experience with patients "labeled" as having IC who truly had cancer as the cause of irritative symptoms. MATERIALS AND METHODS: A retrospective review of patient records at our IC center was performed from 1998 to 2002. A total of 600 patients were seen at that time with the diagnosis of interstitial cystitis. RESULTS: Six patients (1%) previously diagnosed as having IC were found to have transitional cell carcinoma as the cause of symptoms, 4 of whom (67%) had no hematuria. Mean time from the diagnosis of IC to diagnosis of transitional cell carcinoma was 29.8 months. Irritative bladder symptoms resolved after identifying and treating the malignancy. CONCLUSIONS: Patients with irritative voiding symptoms require a thorough evaluation which may include cystoscopy, cytology and upper tract imaging. Hematuria was not a good predictor of cancer in our series. In the era before widespread use of minimally invasive means to diagnose IC (ie potassium sensitivity test, pelvic pain, urgency and frequency questionnaire) 1% of patients who were considered to have IC actually had transitional cell cancer as the cause of symptoms. One would expect that this number would increase if the criteria to diagnose IC and initiate treatment were oversimplified. Interstitial cystitis remains a diagnosis of exclusion.     

Osteopathic manipulative treatment in conjunction with medication relieves pain associated with fibromyalgia syndrome: results of a randomized clinical pilot project

Osteopathic physicians caring for patients with fibromyalgia syndrome (FM) often use osteopathic manipulative treatment (OMT) in conjunction with other forms of standard medical care. Despite a growing body of evidence on the efficacy of manual therapy for the treatment of selected acute musculoskeletal conditions, the role of OMT in treating patients with chronic conditions such as FM remains largely unknown. Twenty-four female patients meeting American College of Rheumatology criteria for FM were randomly assigned to one of four treatment groups: (1) manipulation group, (2) manipulation and teaching group, (3) moist heat group, and (4) control group, which received no additional treatment other than current medication. Participants' pain perceptions were assessed by use of pain thresholds measured at each of 10 bilateral tender points using a 9-kg dolorimeter, the Chronic Pain Experience Inventory, and the Present Pain Intensity Rating Scale. Patients' affective response to treatment was assessed using the Self-Evaluation Questionnaire. Activities of daily living were assessed using the Stanford Arthritis Center Disability and Discomfort Scales: Health Assessment Questionnaire. Depression was assessed using the Center for Epidemiological Studies Depression Scale. Significant findings between the four treatment groups on measures of pain threshold, perceived pain, attitude toward treatment, activities of daily living, and perceived functional ability were found. All of these findings favored use of OMT. This study found OMT combined with standard medical care was more efficacious in treating FM than standard care alone. These findings need to be replicated to determine if cost savings are incurred when treatments for FM incorporate nonpharmacologic approaches such as OMT.     

A prospective, randomized, placebo controlled, double-blind study of amitriptyline for the treatment of interstitial cystitis

PURPOSE: We conducted a prospective study to examine the safety and efficacy of the tricyclic antidepressant amitriptyline in patients with interstitial cystitis (IC). MATERIALS AND METHODS: The study comprised 44 women and 6 men who all met the symptom criteria of the National Institute of Diabetes, Digestive and Kidney Diseases for IC. The patients were randomly assigned to amitriptyline or placebo. Patients were prospectively treated for 4 months with a self-titration protocol that allowed them to escalate drug dosage in 25 mg increments in 1 week-intervals (maximum dosage 100 mg). The change from baseline in the O'Leary-Sant IC symptom and problem index was the primary outcome parameter. Changes in functional bladder capacity and frequency (48-hour voiding log), and intensity of pain and urgency (visual analog scales) were chosen as secondary outcome parameters. RESULTS: Two patients (1 on amitriptyline, 1 on placebo) dropped out of the study due to side effects. Thus, the data of 48 patients (24 patients in each group) were available for evaluation. Mean symptom score decreased from 26.9 to 18.5 in the amitriptyline group compared with 27.6 to 24.1 in the placebo group (p = 0.005). Pain and urgency intensity improved statistically significantly in the amitriptyline group compared with the placebo group (p <0.001). The frequency and functional bladder capacity improved to a much greater degree in the amitriptyline group but the differences were not statistically significant (p = 0.063, p = 0.083). Anticholinergic side effects were reported by all except 2 patients in the amitriptyline group (92%) and by 5 patients in the placebo group (21%). Mouth dryness was the most frequent side effect reported in the amitriptyline group (79%). CONCLUSIONS: Amitriptyline therapy for 4 months is safe and effective for treating IC. A statistically significant change in the symptom score and statistically significant improvement of pain and urgency intensity compared with placebo were observed. Anticholinergic side effects constitute the major drawback of amitriptyline treatment for IC.     

Urinary conduit formation using a retubularized bowel from continent urinary diversion or intestinal augmentations: ii. Does it have a role in patients with interstitial cystitis?

PURPOSE: Interstitial cystitis (IC) may require surgical treatment in a minority of patients in whom conservative treatment failed. This treatment includes enterocystoplasty (ECP), or continent or incontinent urinary diversion with or without cystourethrectomy. Patients with IC who underwent ECP or continent urinary diversion (CUD) occasionally have recurrent pain in the augmented bladder or continent pouch. In these patients a new ileal conduit is frequently constructed. Using part of the continent urinary diversion or bladder augmentation patch to make the ileal conduit has been reported. However, there may be some concern with performing the procedure in patients with IC because of the theoretical risk of continued pain in the converted ileal segment. We evaluated the role of conduit formation using retubularized bowel from ECP or CUD in patients with IC. MATERIALS AND METHODS: A total of 11 patients with a mean age of 45 years underwent conduit formation using the augmentation patch of ECP or part of the continent urinary reservoir. Patients were followed by history, physical examination, laboratory tests and urography. RESULTS: Followup was 20 to 80 months. One patient continued to have pelvic pain. None of the patients had residual pain in the conduit. One patient had intermittent pain in the conduit 32 months after conversion. Two patients had ureteral obstruction requiring ureteral reimplantation revision. No patient complained of new gastrointestinal problems. CONCLUSIONS: Retubularization of a previously used bowel segment from ECP or CUD to form a urinary conduit seems to be an acceptable alternative in patients with IC.     

Total knee arthroplasty without patellar resurfacing in isolated patellofemoral osteoarthritis

Thirty-one patients (33 knees) with symptomatic patellofemoral osteoarthritis and minimal tibiofemoral changes underwent LCS total knee arthroplasty without patellar resurfacing. Average age was 73 years (range, 58-89 years) with a female-to-male ratio of 5:1. Average follow-up was 20 months (range, 12-40 months). All except 4 patients had grade 3 or 4 patellofemoral osteoarthritis. Preoperatively, all patients had significant knee pain. Sleep disturbance was reported in 21 patients. All but 10 patients required walking aids. Average range of motion was 108 degrees (range, 80-125 degrees ). At latest review, 21 knees were pain-free, the remaining 12 knees being described as having only occasional knee pain. Two patients continued to have night pain. Average range of motion was 104 degrees (range, 70-135 degrees ). Lateral patellar tilt improved in all but 5 knees by an average of 7 degrees (range, 1-26 degrees ). Patellar congruency improved in all but 3 knees by an average of 18% (range, 3-63%). None of the patients to date have required revision surgery. Total knee arthroplasty without patellar resurfacing is an effective option in older patients with isolated patellofemoral osteoarthritis.     

间质性膀胱炎16例的诊断与治疗

目的探讨间质性膀胱炎(IC)的诊断和治疗方法。方法回顾分析16例IC患者的临床资料,患者主要表现为尿频、尿急、耻骨上疼痛和慢性盆腔疼痛,误诊为慢性膀胱炎、盆腔炎、子宫内膜异位症、膀胱结核及尿道综合征,经手术后病理或膀胱镜检查确诊,其中4例行尿流改道,2例行乙状结肠膀胱成形术,10例行药物治疗。结果4例患者行尿流改道治疗后盆腔疼痛完全消失。2例行膀胱成形术后仍有轻微会阴部不适,膀胱容量大于350 m l,分别随访24,33个月无复发。10例非手术治疗患者O′Leary-Sant间质性膀胱炎症状评分和IC问题评分分别由治疗前的(15.4±4.1)和(9.4±2.7)分,降至治疗后的(4.1±2.1)和(5.1±3.9)分。结论对IC的诊断和鉴别诊断应给予充分重视;及早诊断及多种措施联合治疗,可显著改善IC患者的症状,提高生活质量。     

Outpatient adrenalectomy

PURPOSE: To our knowledge we report the initial experience with outpatient, same day laparoscopic adrenalectomy. MATERIALS AND METHODS: Nine select patients were entered into our ambulatory adrenalectomy protocol. Each patient fulfilled certain preoperative and postoperative inclusion criteria, including informed consent, age 70 years or older, body mass index 40 or less, adrenal tumor less than 5 cm., no pheochromocytoma, uncomplicated laparoscopic surgery that was completed by 12 p.m., perioperative hemodynamic stability and pain control by oral analgesics. RESULTS: All 9 patients successfully underwent outpatient laparoscopic adrenalectomy. Average patient age was 53 years and average adrenal tumor size was 2 cm. Mean surgical time was 2.3 hours and mean blood loss was 53 ml. The diagnosis was aldosteroma in 7 cases, enlarging adenoma in 1 and myelolipoma in 1. Average postoperative hospital stay was 416 minutes (range 300 to 570). Postoperative analgesia comprised 6 mg. morphine sulfate and 32 mg. ketorolac. The only complication was a local abscess requiring delayed drainage at 2 weeks. No other patient was rehospitalized for any reason. A followup questionnaire survey revealed excellent patient satisfaction. CONCLUSIONS: To our knowledge we report the initial series of outpatient laparoscopic excision of a solid organ, the adrenal gland. Ambulatory adrenalectomy is feasible and safe, and results in high patient satisfaction. However, ambulatory adrenalectomy should be restricted to highly select patients and performed by minimally invasive surgeons who have considerable experience with laparoscopic adrenal surgery.     

Results of resurfacing a native patella in patients with a painful total knee arthroplasty

Between 1990 and 2003, 24 patients (28 knees) who had a total knee arthroplasty (TKA) and underwent subsequent patella resurfacing without revision of the tibial or femoral components to alleviate pain were identified. Patient charts were reviewed retrospectively and patients were interviewed after average 2.9-year follow-up (range: 1-12 years) to assess function, pain, and satisfaction with the procedure. Average patient age at revision surgery was 68 years, and the average time from the index TKA was 9.8 years. Mean Knee Society function and pain scores were 68+/-28 and 45+/-16, respectively. Average preoperative range of motion was 102 degrees (range: 65 degrees-130 degrees), and average postoperative range of motion was 106 degrees (range: 65 degrees-130 degrees). Only 52% of patients would undergo revision surgery again given their current levels of pain and function. Revision of only the patella for patients with a painful TKA who did not undergo patella resurfacing at the initial surgery provides 52% satisfactory results. Surgeons should look for other causes of pain in this patient population and reconsider their indications for not resurfacing the patella in TKA.     

Sexual dysfunction in men with paraparesis in lumbar burst fractures

STUDY DESIGN: A retrospective follow-up study. OBJECTIVES: To review and analyze the sexual function of patients who have sustained lumbar fractures with incomplete paraparesis. SUMMARY OF BACKGROUND DATA: As a result of advances in surgical techniques, most patients with lumbar fractures have significant recovery of neurologic status. Because motor functions are important to patients, most of the studies have concentrated their analyses on motor recovery. Many patients who have almost completely recovered motor function, however, may have sexual dysfunction, especially men. METHODS: Forty-three patients with lumbar fractures that resulted in incomplete paraparesis were analyzed. American Spinal Injury Association motor index points were determined for each patient before and after surgery and used for comparison between American Spinal Injury Association motor index and international index of erectile function score. Eleven male patients who reported sexual dysfunction were evaluated by using Rigiscan. RESULTS: During the follow-up period, 42 patients showed neurologic recovery. Average improvement of American Spinal Injury Association motor score was 13. 1 and average international index of erectile function score was 45. Average improvement of American Spinal Injury Association motor score for patients who had not reported sexual dysfunction was 12.5, and average international index of erectile function score was 52. For 11 patients in the sexual dysfunction group, preoperative motor score was 28.0, and average improvement of score was 14.9. Nocturnal penile tumescence monitoring results were abnormal in four cases. Averaged international index of erectile function score was 15. There was a statistically significant difference between the sexually healthy and dysfunctional groups in international index of erectile function score (P < 0.05), whereas no difference was noted in American Spinal Injury Association motor score. CONCLUSIONS: Neurologic recovery after lumbar fractures was improved. Regardless of neurologic recovery, most patients reported some disability, usually caused by pain and occasionally sexual dysfunction. Impairment of sexual function was present in four patients (9.3%). Although these patients may preserve psychiatric erection potential, they usually experienced sexual problems.