Purpose We used MAPP data to identify participants with urological chronic pelvic pain syndromes only or a chronic functional nonurological associated somatic syndrome in addition to urological ...chronic pelvic pain syndromes. We characterized these 2 subgroups and explored them using 3 criteria, including 1) MAPP eligibility criteria, 2) self-reported medical history or 3) RICE criteria. Materials and Methods Self-reported cross-sectional data were collected on men and women with urological chronic pelvic pain syndromes, including predominant symptoms, symptom duration and severity, nonurological associated somatic syndrome symptoms and psychosocial factors. Results Of 424 participants with urological chronic pelvic pain syndromes 162 (38%) had a nonurological associated somatic syndrome, including irritable bowel syndrome in 93 (22%), fibromyalgia in 15 (4%), chronic fatigue syndrome in 13 (3%) and multiple syndromes in 41 (10%). Of 233 females 103 (44%) had a nonurological associated somatic syndrome compared to 59 of 191 males (31%) (p = 0.006). Participants with a nonurological associated somatic syndrome had more severe urological symptoms and more frequent depression and anxiety. Of 424 participants 228 (54%) met RICE criteria. Of 228 RICE positive participants 108 (47%) had a nonurological associated somatic syndrome compared to 54 of 203 RICE negative patients (28%) with a nonurological associated somatic syndrome (p <0.001). Conclusions Nonurological associated somatic syndromes represent important clinical characteristics of urological chronic pelvic pain syndromes. Participants with a nonurological associated somatic syndrome have more severe symptoms, longer duration and higher rates of depression and anxiety. RICE positive patients are more likely to have a nonurological associated somatic syndrome and more severe symptoms. Because nonurological associated somatic syndromes are more common in women, future studies must account for this potential confounding factor in urological chronic pelvic pain syndromes.
The thin mucus or glycosaminoglycan layer of the bladder may be implicated in the pathogenesis of interstitial cystitis. We developed a specific anti-mucus, antisera stabilization technique to study ...the ultrastructural morphological appearance of the layer, and have used this technique to compare the surface morphology of 10 control and 10 interstitial cystitis patients. The electron micrographs demonstrate the ultrastructural characteristics of the pathological changes seen in interstitial cystitis but they did not show any significant difference in the morphological appearance of the mucus or glycosaminoglycan layer between the 2 groups.
Background:
Tissue expansion in the lower extremity is controversial, with studies reporting complication rates as high as 83%. Few studies have looked at tissue expansion prior to orthopaedic ...correction of severe foot and ankle deformities, and those available are restricted to clubfoot in the pediatric population. Here, we report the largest case series on the use of tissue expanders for the reconstruction of severe foot and ankle deformity and the only report in adults.
Methods:
This is a retrospective chart review of the senior author’s practice over a 16-year study period. All patients over 18 years of age who underwent tissue expansion prior to definitive orthopaedic correction of a severe foot and ankle deformity were included. Patient demographics, etiology of deformity, rate of expansion, and complications were recorded. Major complications were defined as those which required surgical intervention. Data were analyzed using descriptive statistics.
Results:
Nineteen cases were performed on 16 patients. Our overall complication rate was 31.6% (6/19), with major complications occurring in 21.1% (4/19) of cases, and minor complications occurring in 10.5% (2/19) of cases. Despite this, 94.7% (18/19) of cases went on to receive definitive orthopaedic correction after tissue expansion. No demographic parameters were associated with occurrence of complications.
Conclusions:
This represents the largest report on lower extremity tissue expansion for severe foot and ankle deformity correction. While we observed complications in 31.6% of patients, 94.7% of cases went on to receive definitive orthopaedic correction with successful primary closure.
Chronic prostatitis/chronic pelvic pain syndrome remains an enigmatic medical condition. Creation of the National Institutes of Health-funded Chronic Prostatitis Collaborative Research Network ...(CPCRN) has stimulated a renewed interest in research on and clinical aspects of chronic prostatitis/chronic pelvic pain syndrome. Landmark publications of the CPCRN document a decade of progress. Insights from these CPCRN studies have improved our management of chronic prostatitis/chronic pelvic pain syndrome and offer hope for continued progress.
Purpose: This study was designed to determine what questions health-care professionals think should be addressed with curable prostate cancer patients before treatment decisions are made.
Method: A ...survey was distributed to radiation oncologists, urologists, medical oncologists, nurses and radiation therapy technologists (RTTs) involved in treating prostate cancer patients. Participants were asked to judge the importance of addressing each of 78 questions (essential/important/no opinion/avoid) with a described hypothetical patient prior to the treatment decision. Eighty participants were later selected at random for a retest.
Results: The overall response rate was 55% (284/518) on the initial survey and 56% (45/80) on the retest. The relative importance of the various questions was similar across groups (
r(76) ranged from 0.75 to 0.91, all
P<0.001). Despite the between-group similarity, opinions within each group varied widely. For example, among oncologists, the number of questions deemed essential by individual respondents ranged from five to 69, with >90% respondent agreement on only 15 of the 78 questions. The extent of agreement was similar in the other groups. The retest showed that essential and important responses were reasonably stable, i.e. 92% of questions judged essential at one time were judged either essential (58%) or important (34%) at the other time.
Conclusions: Although the relative importance of addressing the various questions appears similar across the professional groups involved in the care of prostate patients, within each profession there seems to be little agreement. The lack of agreement includes both how many questions are essential to address and whether or not most individual questions are essential.
To determine the prevalence, diagnostic patterns and management of lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH) in Canadian urology outpatient practice.
...Representative urologists were randomly selected from lists provided by the Canadian and Quebec Urological Associations. Each patient identified with a BPH diagnosis during a typical 2-consecutive-week period during April, May or June 2007 was asked to complete a corresponding International Prostate Symptom Score (IPSS) questionnaire. Each day, the participant urologist completed an outpatient log and a detailed programmed chart review to transcribe demographics, investigations and treatments associated with each BPH patient.
Eighty-six urologists were invited to participate. Thirty-eight (44.2%) agreed, and 27 of those (71.1%) submitted evaluable data for the audit. Of the 5616 patients seen in outpatient practice (average 208 per urologist), 4324 (77%) were male. A BPH diagnosis was identified in 19.6% of the men (n = 849; mean age 69.5, standard deviation SD 10, yr; age range 40-100 yr; mean duration of symptoms 4.8, SD 4.2, yr; mean IPSS score 12.3, SD 7.4; mean prostate specific antigen PSA 3.9, SD 3.9, ng/mL). Twenty-four percent of patients had prostates that were rated as large, 50% as medium and 26% as small. PSA level correlated positively with prostate volume. Twenty-two percent were initial consultations for LUTS and 78% were repeat visits. Diagnostic evaluation tended to follow those examinations and tests recommended by the Canadian BPH guidelines. Treatment choices tended to follow an evidence-based algorithm with respect to treatment choices for men in the various prostate-volume and PSA groups.
This prospective audit indicates that BPH remains a common condition managed by urologists in outpatient practice. Investigations and treatments confirm that Canadian urologists appear to be following Canadian BPH guidelines as well as the most recent evidence from the literature.
The lifetime co-morbidity of major psychiatric disorders among male alcoholics was examined with the structured Psychiatric Diagnostic Interview (PDI), which was administered to 928 patients ...undergoing alcoholism treatment at six Veterans Administration Medical Centers. Thirty-eight percent were positive for alcoholism only; 62% fulfilled inclusive lifetime diagnostic criteria for at least one other additional psychiatric syndrome. Thirty percent satisfied criteria for one additional syndrome; 16% for two additional syndromes; 12% for three; and 4% for four or more disorders in addition to alcoholism. Depression and antisocial personality were the most frequently identified co-occurring syndromes (36% and 24%, respectively) followed by drug abuse and mania (17% each). The additional psychiatric syndromes in this sample were clearly not randomly distributed; instead, certain disorders tended to cluster together such as: drug abuse and antisocial personality; mania and depression; depression and anxiety disorder; and schizophrenia and affective disorder. Implications for classification and treatment are discussed.
Abstract Objective This report examines the 4-year longitudinal association between histological prostate inflammation and CP/CPPS, development of new and progression of existing CP/CPPS, in the men ...randomized to placebo in the REDUCE population. Methods Uni- and multivariable analyses at multiple time points over 4 years were performed between acute and chronic inflammation detected on baseline biopsies and incidence of CPPS-like symptoms (defined as a positive response to CPSI question 1a perineal pain and/or question 2b ejaculatory pain, and a total pain subscore of at least 4) and progression of CP/CPPS (defined as an increase ≥ 4 points from baseline total CPSI score in patients with a baseline categorization of CP/CPPS). Results Acute and chronic inflammation was detected in 641 (15.6%) and 3216 (78.3%) of the 4109 men in the study. CP/CPPS symptom status was available for 2816 at baseline. A total of 317 of the 2150 men with no baseline CP/CPPS and follow-up data developed CP/CPPS – like symptoms. Acute and chronic inflammation was not associated with the incidence of CP/CPPS like symptoms (p> 0.1). After a median follow-up of 12.0 months, a total of 109 of the 145 men baseline CP/CPPS and follow-up data developed symptomatic progression. Chronic, but not acute, inflammations was significantly associated with a shorter time to CP/CPPS progression in both uni- or multivariable analyses (p=0.029 and 0.018 respectively). Conclusion Inflammation is not associated with an increased risk of developing CP/CPPS but chronic inflammation does predict risk of symptomatic progression in men who have identified CP/CPPS symptoms.
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