Open radical retropubic prostatectomy gives favourable surgical and functional outcomes after transurethral resection of the prostate

OBJECTIVES

To assess the peri‐ and postoperative outcome of patients treated with open radical retropubic prostatectomy (RRP) for prostate cancer and who had previously undergone transurethral resection of the prostate (TURP).

PATIENTS AND METHODS

Prospectively collected data from a consecutive series of 1760 patients who had RRP between July 2003 and June 2007 at our institution were used to retrospectively match 62 cases (with previous TURP) with the same number of controls (without previous TURP). Matching variables were patient age, body mass index, prostate volume, preoperative total prostate‐specific antigen (PSA) level, Gleason score, pathological stage, and intraoperative nerve‐sparing procedure. Complete 1‐year follow‐up data were available for all patients. All collected data on surgery and perioperative complications were analysed. Functional outcome data at the 1‐year follow‐up were evaluated by applying an institutional questionnaire. Sexual function was assessed using the abbreviated International Index of Erectile Function‐5 questionnaire, and urinary control was evaluated by defining complete urinary control as no pad usage.

RESULTS

The rate of complete urinary control rate in cases and controls was similar (81% vs 82%). When nerves were spared, 60% (15/25) of patients in either group were capable of sexual intercourse. The overall positive surgical margin rate was insignificantly higher in cases (19% vs 13, P > 0.05). After 1 year of follow‐up the biochemical recurrence rate (PSA >0.04 ng/mL) did not differ significantly in patients who had RRP after TURP vs RRP alone (six of 62, 10%, vs five of 62, 8%; P = 0.77).

CONCLUSIONS

RRP for prostate cancer in patients who have had previous TURP does not result in a higher perioperative complication rate, or a worse functional outcome.     

The 7‐year outcome of the tension‐free vaginal tape procedure for treating female stress urinary incontinence

OBJECTIVE

To evaluate the long‐term results and predictive risk factors for efficacy after the tension‐free vaginal tape (TVT) procedure for treating female stress urinary incontinence (SUI).

PATIENTS AND METHODS

Inall, 306 women (mean age 50.7 years, sd 8.7) who had a TVT procedure for SUI were selected and followed ≥7 years (mean 92.3 months, range 84–110) after surgery. We analysed the long‐term results, the variables predictive of cure rates, and patient satisfaction.

RESULTS

The overall 7‐year cure rate was 84.6%, with a satisfaction rate of 69.3%. The cure rates were lower in patients with high‐grade SUI (50% in grade III, 82.8% in grade II and 90.7% in grade I; P < 0.001). On multivariate analysis, there were no independent risk factors related to cure rate, and urgency was the only factor independently associated with patient satisfaction (P = 0.008; odds ratio 2.47). Seventy‐one patients (23.2%) had complications at the 1‐month follow‐up after surgery, but only eight (2.6%) had complications at the 7‐year follow‐up, including mesh exposure in six and de novo urgency in two.

CONCLUSION

The absence of long‐term adverse events associated with the TVT procedure, and high subjective and objective 7‐year success rates with no independent predictive factors affecting the long‐term cure rate, make the TVT procedure a recommendable surgical treatment for female SUI.     

运动贴布联合神经肌肉电刺激对脑卒中后亚急性期足下垂患者步行障碍的影响

目的:观察运动贴布(肌内效贴)联合神经肌肉电刺激对脑卒中后亚急性期患者足下垂所致步行障碍的临床疗效。方法:采用随机数字表法将符合纳入标准的60例脑卒中患者分为运动贴布组(KT组)、神经肌肉电刺激组(NMES组)、联合组,每组各20例。三组患者均接受常规康复训练(2次/d,40min/次),KT组在此基础上增加运动贴布治疗(1次/d);NMES组在此基础上增加神经肌肉电刺激治疗(1次/d,20min/次);联合组则在常规康复训练基础上接受运动贴布联合神经肌肉电刺激治疗。以上各组每周连续治疗5天,持续4周。于治疗结束前后分别采用主动关节活动度(AROM)、10m步行能力测试(10mWT)、起立-行走即时测试(TUGT)、生理耗能指数(PCI)对三组患者疗效进行评定。结果:三组患者在治疗前的各项评定指标比较均无显著性意义(P>0.05)。治疗后,三组患者各项评分均优于治疗前且各组内比较均有显著性意义(P<0.01),其中,联合组各项评分均优于KT组和NMES组,组间比较有显著性意义(P<0.01),KT组与NMES组各项指标组间比较无显著性意义(P>0.05)结论:运...     

Kinesio Taping? is not better than placebo in reducing pain and disability in patients with chronic non-specific low back pain: a randomized controlled trial

Background:

Kinesio Taping ^® has been widely used in clinical practice. However, it is unknown whether this type of tape is more effective than placebo taping in patients with chronic lower back pain.

Objective:

To compare the effectiveness of Kinesio Taping ^® in patients with chronic non-specific low back pain against a placebo tape and a control group.

Method:

This is a 3-arm, randomized controlled trial with a blinded assessor. Sixty patients with chronic non-specific low back pain were randomized into one of the three groups: Kinesio Taping ^® group (n=20), Micropore^® (placebo) group (n=20) and control group (n=20). Patients allocated to both the Kinesio Taping ^® group and the placebo group used the different types of tape for a period of 48 hours. The control group did not receive any intervention. The outcomes measured were pain intensity (measured by an 11-point numerical rating scale) and disability (measured by the 24-item Roland Morris Disability Questionnaire). A blinded assessor measured the outcomes at baseline, 48 hours and 7 days after randomization.

Results:

After 48 hours, there was a statistically significant difference between the Kinesio Taping ^® group versus the control group (mean between-group difference = -3.1 points, 95% CI=-5.2 to -1.1, p=0.003), but no difference when compared to the placebo group (mean between-group difference= 1.9 points, 95% CI=-0.2 to 3.9, p=0.08). For the other outcomes no differences were observed.

Conclusions:

The Kinesio Taping ^® is not better than placebo (Micropore^®) in patients with chronic low back pain.     

平片无张力疝修补术治疗腹股沟疝的临床效果和安全性分析

目的：观察平片无张力疝修补治疗腹股沟疝的临床效果及安全性。方法选取本院2008年3月~2013年3月收治的51例腹股沟疝患者,按不同疝修补手术治疗方案分为对照组(24例)和研究组(27例),对照组行疝环充填式无张力疝修补术治疗,研究组行平片无张力疝修补术治疗,比较两种修补术的临床疗效及安全性。结果研究组治疗总有效率为85.18%,明显高于对照组的58.33%,差异有统计学意义(P<0.05);研究组不良反应发生率为7.41%,低于对照组的33.33%,差异有统计学意义(字2=3.8980,P<0.05)。结论平片无张力疝修补治疗腹股沟疝效果优于传统疝环充填式无张力疝修补术,安全性高,值得临床推广应用。     

治疗女性压力性尿失禁手术吊带松紧不同调整方法的探讨

目的:探讨经阴道尿道中段悬吊术治疗女性压力性尿失禁吊带松紧不同调整方法的效果及并发症发生情况.方法:回顾性分析2003年8月～2005年12月收治的399例单纯压力性尿失禁(Stress urmary incontinence,SUI)患者临床资料,其中行经耻骨后通路的经阴道无张力尿道中段悬吊术(Tension free vaginal tape,TVT)4例,经阴道悬吊成形术(Intravaginal slingplasty,IVS)126例,童式前路悬吊手术150例,经闭孔通路的阴道无张力尿道中段悬吊术(TVT-O)58例,改良TVT-O手术61例.对吊带松紧的调整分别采用诱发试验法、组织剪法、尿道棒法和艾利斯钳法,观察各种吊带松紧调整方法的效果及并发症.结果:采用诱发试验法128例,基本无效(偏松)2例(2/128),效果满意124例(124/128),尿潴留(偏紧)2例(2/128);组织剪法98例,基本无效2例(2/98),效果满意93例(93/98),尿潴留3例(3/98);尿道棒法96例,基本无效4例(4/96),效果满意87例(87/96),尿潴留5例(5/96);艾利斯钳法77例,基本无效5例(5/77),效果满意66例(66/77),尿潴留6例(6/77)例.总偏松发生率3.3%(13/399),偏紧发生率4.0%(16/399).四组中以诱发试验法并发症发生例数最低,艾利斯钳法最高,但经统计学处理,四组间差异无统计学意义(P＞0.05).结论:TVT是治疗压力性尿失禁非常有效的手术治疗方法,治疗效果的关键在于吊带调整的松紧程度.诱发试验法、组织剪法、尿道棒法和艾利斯钳法均为临床实用的有效调整吊带松紧的手段,其中诱发试验法对初学者较易掌握,并有可靠的治疗效果和很低的并发症发生率.在此方法基础上积累一定经验后采用其他方法可提高手术效率.     

Abscess formation after transobturator sling placement: a case report

New techniques of sling placement may be associated with infectious complications. Slings through the obturator foramen and thigh can lead to a significant abscess formation within the thigh adductor muscles. A large thigh abscess associated with a transobturator sling was diagnosed and treated. The authors report the evaluation and treatment of a unique infectious complication of transobturator slings.     

硅胶舒乐贴在新生儿光照疗法眼罩固定中的应用

目的观察硅胶舒乐贴在新生儿光照疗法(简称光疗)眼罩固定中的效果。方法选择130例接受光疗的新生儿,按接受光疗日期分组,单号为观察组68例,双号为对照组62例,对照组采用微孔通气型医用胶带固定眼罩,观察组采用3M硅胶舒乐贴固定眼罩。观察两组新生儿眼罩脱落、皮肤并发症和摘除眼罩时新生儿哭闹发生情况。结果观察组新生儿眼罩脱落次数,皮肤并发症和哭闹发生率低于对照组,两组比较,差异均有统计学意义(P0.05)。结论新生儿光疗时采用3M硅胶舒乐贴对眼罩进行固定,可降低新生儿皮肤损伤,提高固定效果。     

合并其他阴式手术的经闭孔尿道中段悬吊术治疗压力性尿失禁的疗效分析

目的探讨合并其他阴式手术的经闭孔尿道中段悬吊术（TVT—O）治疗压力性尿失禁（SUI）的近期疗效和影响因素。方法选取2006年12月至2012年5月南京军区福州总院收治的SUI患者184例,根据是否合并其他阴式手术将其分为联合TVT—O组（57例）和TVT—O组（127例）。分析两组患者的围手术期并发症及术后1年的疗效,并采用泌尿生殖道疾病相关问卷-6（UDI-6）和尿失禁影响程度相关问卷-7（ⅡQ-7）评估患者术后的生活质量。结果联合TVT—O组患者术中出血量、手术时间和尿管留置时间分别为（80．52±53．68）ml、（65．37±33．12）min和（75．31±47．84）h;TVT～O组分别为（16．26±11．72）ml、（17．45±8．92）min和（23．69±11．11）h,两组比较,差异均有统计学意义（P均〈0．05）;联合TVT—O组并发症发生率（14．04％,8／57）与TVT-O组（11．02％,14／127）比较,差异无统计学意义（P〉0．05）;联合TVT-O组与TVT-O组随访时间分别为（36．82±22．34）个月和（38．30±25．75）个月,联合TVT—O组治愈率（94．74％,54／57）与TVT-O组（97．64％,124／127）比较,差异无统计学意义（P〉0．05）;术后1年联合TVT-0组UDI-6和IIQ-7评分分别为（0．72±0．70）分和（0．74±0．69）分,TVT-O组分别为（0．69±0．72）分和（0．71±0．71）分,均较术前降低（P〈0．05）,但两组间比较,差异无统计学意义（P〉O．05）。结论TVT—O合并其他阴式手术虽然延长了尿管留置及术后住院时间,但并不影响TVT—O治疗SUI的近期疗效。     

From the Cover: Microstructured barbs on the North American porcupine quill enable easy tissue penetration and difficult removal

North American porcupines are well known for their specialized hairs, or quills that feature microscopic backward-facing deployable barbs that are used in self-defense. Herein we show that the natural quill’s geometry enables easy penetration and high tissue adhesion where the barbs specifically contribute to adhesion and unexpectedly, dramatically reduce the force required to penetrate tissue. Reduced penetration force is achieved by topography that appears to create stress concentrations along regions of the quill where the cross sectional diameter grows rapidly, facilitating cutting of the tissue. Barbs located near the first geometrical transition zone exhibit the most substantial impact on minimizing the force required for penetration. Barbs at the tip of the quill independently exhibit the greatest impact on tissue adhesion force and the cooperation between barbs in the 0–2 mm and 2–4 mm regions appears critical to enhance tissue adhesion force. The dual functions of barbs were reproduced with replica molded synthetic polyurethane quills. These findings should serve as the basis for the development of bio-inspired devices such as tissue adhesives or needles, trocars, and vascular tunnelers where minimizing the penetration force is important to prevent collateral damage.