The incidence of urethral stricture and bladder neck contracture with transurethral resection vs. holmium laser enucleation of prostate: A matched,dual-center study

IntroductionUrethral strictures (US) and bladder neck contracture (BNC) are common, long-term complications of transurethral prostate surgery. We aimed to compare transurethral resection of the prostate (TURP) and holmium laser enucleation of the prostate (HoLEP) regarding incidence of US or BNC and identify possible risk factors.MethodsA retrospective review of patients who underwent TURP and HoLEP with followup data of at least one year in two separate institutions was performed. The incidence of postoperative US or BNC in both groups was compared. Bivariate and multivariate analysis of risk factors in both cohorts with US or BNC were performed.ResultsThe study included 208 patients: 101 and 107 patients in the TURP and HoLEP arms, respectively. The two groups were matched for age and prostate size. Eight (7.92%) and five (4.72%) patients in the TURP and HoLEP arms, respectively, developed US (p=0.3423), while two (1.87%) patients in the HoLEP arm had BNC (p=0.2634). Of the eight patients with the US in the TURP arm, six (9.8%) had bipolar TURP, while two (5%) had monopolar TURP. Multivariate analysis showed that larger prostate volume (hazard ratio [HR] 1.22, 95% confidence interval [CI] 1.05, 1.41, p=0.0066) and longer operative time (HR 1.84, 95% CI 1.76, 1.93, p=0.0015) were associated with risk of US/BNC.ConclusionsThere is no significant difference between TURP and HoLEP regarding incidence of US or BNC, although there is a tendency towards a higher rate of US associated with bipolar TURP. Increased prostate volume and operative time are possible risk factors.

KEY MESSAGES

• We compared TURP and HoLEP regarding their incidence of US or BNC with matching patients for age and prostate volume and identified possible risk factors.
• The US incidence was comparable, although the incidence within the TURP arm was higher with bipolar than monopolar TURP.
• The BNC incidence was 1.87% in the HoLEP arm, while none of the patients in the TURP arm developed BNC (statistically insignificant).
• Multivariate analysis showed that larger prostate volume and longer operative time were associated with higher risk of US/BNC.

     

A scoping review of the use of visual aids in health education materials for persons with low-literacy levels

ObjectiveTo conduct a scoping review on the literature on visual aids in health education for persons with low-literacy.MethodsA scoping review methodology was employed. Pre-defined selection criteria identified 47 studies for inclusion. Data were extracted in relation to: (a) definitions of low-literacy and health literacy, (b) population studied, (c) research country, (d) consent procedures, (e) visual aids used, (f) development of visual aids, and (g) targeted outcomes.ResultsVisual aids developed with persons with low-literacy demonstrated statistically significant improvements in health literacy outcomes, with benefits in medication adherence and comprehension also reported. Pictograms and videos were the most effective visual aids. Only one study adapted consent procedures for low-literacy participants.DiscussionVisual aids in health education materials may benefit persons with low-literacy levels, but large gaps in the research base are evident. Experimental research in low- and middle-income countries, with a particular focus on consent for participants with low-literacy is needed.Practice implicationsVisual aid design needs to include stakeholders. Consent procedures and decision-making need to be specifically adapted for participants with low-literacy.     

Emergence and Distribution of Foot‐and‐Mouth Disease Virus Serotype A and O in Bangladesh

Foot‐and‐mouth disease (FMD) is endemic in Bangladesh and is predominantly due to FMDV serotype O. In 2012, FMD outbreaks were identified in five different districts of Bangladesh. Of 56 symptomatic cattle epithelial tissue samples, diagnostic PCR assay based on 5′‐URT detected 38 FMDV infections. Viral genotyping targeting VP1‐encoding region confirmed emergence of two distinct serotypes, A and O with an abundance of serotype A in Chittagong and Gazipur districts and serotype O in Pabna and Faridpur. Only single lineage of both A and O was retrieved from samples of five different regions. Sequencing and phylogenetic analysis of VP1 sequences revealed that serotype O sequences were closely related to the Ind 2001 sublineage of Middle East–South Asia (ME‐SA) topotype that was previously circulating in Bangladesh, and serotype A sequences belonging to the genotype VII that was dominant in India during the last decade. The results suggest that extensive cross‐border animal movement from neighbouring countries is the most likely source of FMDV serotypes in Bangladesh.     

Synchronous splenectomy during cholecystectomy for hereditary spherocytosis: Is it really necessary?

Background/Purpose

Expert guidelines recommend performing synchronous splenectomy in patients with mild hereditary spherocytosis (HS) and symptoms of gallstone disease. This recommendation has not been widely explored in the literature. The aim of this study is to determine if our data support expert opinion and if different practice patterns should exist.

Methods

This is an IRB-approved retrospective study. All HS patients under 18 years of age who underwent cholecystectomy for symptomatic gallstones at a single institution between 1981 and 2009 were identified. Patients who underwent cholecystectomy without concurrent splenectomy were reviewed retrospectively for future need for splenectomy and evidence of recurrent gallstone disease.

Results

Of the 32 patients identified, 27 underwent synchronous splenectomy. The remaining 5 patients underwent cholecystectomy without splenectomy and had a mean age of 9.4 years. One of the 5 patients eventually required splenectomy for left upper quadrant pain. None of the remaining 4 required hospitalization for symptoms related to hemolysis or hepatobiliary disease. Median follow-up is 15.6 years.

Conclusion

The need for splenectomy in patients with mild HS and symptomatic cholelithiasis should be assessed on a case by case basis. Our recommendation is to not perform synchronous splenectomy in conjunction with cholecystectomy for these patients if no indication for splenectomy exists.     

Burning sensation in the feet and glycosylated haemoglobin levels in Swedish- and non–Swedish-born primary healthcare patients

BackgroundA painful burning sensation in the feet is a common problem. The most common cause is small fibre neuropathy, a type of peripheral neuropathy that is often a consequence of diabetes and prediabetes.AimTo examine the association between a self-reported burning sensation in the feet and HbA1c levels in primary healthcare patients.MethodsThis study used data from patients in the 4D diabetes project in Swedish primary healthcare. The study population included 824 patients. Logistic regression was performed to study the association between the outcome and explanatory variables.ResultsA total of 24% of patients reported a burning sensation in the feet. This sensation was not associated with HbA1c levels. However, the probability of reporting a burning sensation was two times higher in non-Swedish-born than Swedish-born patients (OR, 2.31; 95% CI, 1.55–3.44) and higher in smokers than those who had never smoked, regardless of region of birth (OR, 1.69; 95% CI, 1.07?2.65).ConclusionsOur results do not support the hypothesis that a self-reported burning sensation in the feet is associated with HbA1c levels. Rather, they indicate a strong relationship between a burning sensation and region of birth, as well as between a burning sensation and smoking.     

Family Quality of Life of South African Families Raising Children with Autism Spectrum Disorder

This article describes the family quality of life among families who are raising a young child with autism spectrum disorder. Survey research was conducted with 180 families of children with autism spectrum disorder who were receiving disability-related services in the Gauteng province of South Africa. The principle measure used was the Beach Center Family Quality of Life Scale to assess five subdomains: family interaction, parenting, emotional well-being, material/physical well-being, and disability-related support. Results indicated that families felt the most satisfied with disability-related support and the least satisfied with the family’s emotional well-being. Family income, family type, and the severity level of autism were significantly associated with how satisfied families felt about their quality of life.