Impact of Staged Rehabilitation Training on Urinary Incontinence Recovery After Radical Prostatectomy: A Retrospective Analysis.

To evaluate urinary incontinence using the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF), daily pad use, and 24-h pad weight test before and after radical prostatectomy (RP) chronologically, and the correlation between them. ICIQ-SF and questions on daily pad use provided subjective, and 24-h pad weight test for objective evaluation. In total, 258 cases were recruited. The continence rate at 12 months after RP was 67% for no pad use, 87% for security 1 pad/day, and 94% for 1 pad/day. The median ICIQ-SF total score before and at 1, 3, 6, and 12 months after RP was 0, 10, 7, 5, and 4, respectively. Incontinence patterns differed when comparing ICIQ-SF results pre- and post-RP. Significant correlation existed between the ICIQ-SF total score, 24-h pad weight test, and daily pad use; however, point distribution on each scatter plot varied widely. Comparing results before and at 12 months after RP revealed complete recovery for 35% of patients from the ICIQ-SF total score, 67% from daily pad use, and 64% from the 24-h pad weight test. A combination of all 3 showed a recovery of preoperative levels in 29% of patients. ICIQ-SF was effective and convenient for evaluating UI, including the pattern of UI, after RP. Significant correlation, but wide variations, among ICIQ-SF, daily pad use, and the 24-h pad weight test existed. The best evaluation method would be the one that can compare UI status pre- and post-RP using the ICIQ-SF and 24-h pad weight test.

To assess the effect of nurse-led cardiac rehabilitation programs on improving the quality of life of elderly patients with coronary artery disease (CAD). This single-center retrospective cohort study included elderly CAD patients hospitalized and followed at our hospital from June 2022 to June 2024. Based on receipt of a nurse-led rehabilitation program, patients were assigned to a rehabilitation or conventional group. Propensity score matching (1:1 nearest neighbor) was performed using variables including age, gender, major comorbidities (hypertension, diabetes, and hyperlipidemia), body mass index, smoking status, NYHA class, left ventricular ejection fraction, history of percutaneous coronary intervention/coronary artery bypass grafting, and baseline medication use. The program comprised individualized assessment and goal setting before discharge, plus remote support, and self-management training after discharge. Primary outcome was the SF-36 quality of life score; secondary outcomes were Generalized Anxiety Disorder-7, Patient Health Questionnaire-9, and Six-Minute Walk Test. Assessments were at discharge, 3 months, and 6 months. After matching, baseline characteristics were balanced between the 2 groups. There were no significant differences between the rehabilitation group and the conventional group in age (71.6 ± 6.4 vs 72.1 ± 6.1 years), gender (male 61.3% vs 64.5%), comorbidity of hypertension (72.6% vs 75.8%), and percutaneous coronary intervention ratio (50.0% vs 48.4%) (all P > .05). At 6 months of follow-up, the rehabilitation group showed a significant improvement in SF-36 total score (from 58.2 ± 7.4–75.6 ± 5.8), which was better than the conventional group (from 57.6 ± 6.9–65.2 ± 6.5) (interaction P = .023). The most significant improvements were observed in physical function and social function (interaction P = .017 and 0.026, respectively). The physical function score in the rehabilitation group at 6 months was 78.9 ± 6.2, significantly higher than the conventional group’s score of 68.5 ± 6.9. The Generalized Anxiety Disorder-7 score in the rehabilitation group decreased from a median of 7 at discharge to 3 at 6 months (IQR 2–5), while the conventional group remained at 6 (IQR 4–8), with a significant difference (P < .01). A similar trend was observed in Patient Health Questionnaire-9 scores. The 6-minute walking distance also showed greater improvement in the rehabilitation group (from 298.5 ± 45.2–385.7 ± 38.4 m, P < .001). Nurse-led cardiac rehabilitation significantly improves quality of life, reduces anxiety and depression, and enhances functional capacity in elderly CAD patients, supporting its broader clinical application.

LACK OF ASSOCIATION OF PROSTATE CARCINOMA NUCLEAR GRADING WITH PROSTATE SPECIFIC ANTIGEN RECURRENCE AFTER RADICAL PROSTATECTOMY

Pelvic floor muscle training for patients having radical prostatectomy promotes contraction of these muscles in anticipation of activities that may provoke urine leakage. The aims of this study were: to determine the contribution of the individual activities comprising a standardised 1-hour pad test (1HPT) to overall urine leakage early after radical prostatectomy; and to investigate relationships between the 1HPT, 24-hour pad test (24HPT) and the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) early after radical prostatectomy. A prospective analysis of patients having radical prostatectomy and receiving pelvic floor muscle training (n = 33). Participants completed the 1HPT, 24HPT and ICIQ-SF at 3 and 6 weeks postoperatively. Participants wore a separate, pre-weighed continence pad for each of the seven activities comprising the 1HPT; pads were weighed separately and together to calculate activity-related and overall urine leakage. Walking at a comfortable speed and drinking while sitting were the two activities contributing most to overall urine leakage, albeit these activities also comprised 75% of 1HPT time. All component activities contributed a minimum 7 ± 5% of overall urine leakage. There were significant and strong to very strong correlations between all of the 1HPT, 24HPT, and ICIQ-SF at 3 weeks postoperatively. There were significant decreases in 24HPT (P = 0.032) and ICIQ-SF (P = 0.001) but no significant change in 1HPT from 3 to 6 weeks postoperatively. Pelvic floor muscle training should include contraction of these muscles in sedentary and walking postures. The 1HPT correlates well with the 24HPT, but may not be sensitive to early postoperative improvements in urinary leakage.

Postprostatectomy Established Stress Urinary Incontinence Treated With Duloxetine

Objective: To explore the effect of exercise prescription based on a progressive mode in treating elderly patients with lower limb dysfunction after deep burns. Methods: A randomized controlled trial was conducted. From January 2021 to January 2023, 60 elderly patients with lower limb dysfunction after deep burns who met the inclusion criteria were admitted to the First Affiliated Hospital of Air Force Medical University. The patients were divided into conventional rehabilitation group (30 cases, 17 males and 13 females, aged (65±3) years) and combined rehabilitation group (30 cases, 16 males and 14 females, aged (64±3) years) according to the random number table. For patients in both groups, the red-light treatment was started after the lower limb wounds healed or when the total area of scattered residual wounds was less than 1% of the total body surface area. After 2 weeks of red-light treatment, the patients in conventional rehabilitation group were given conventional rehabilitation treatments, including joint stretching, resistance, and balance training; in addition to conventional rehabilitation treatments, the patients in combined rehabilitation group were given exercise prescription training based on a progressive mode three times a week, mainly including dumbbell press, Bobath ball horizontal support, and high-level pulldown trainings. The training time for patients in both groups was 12 weeks. Before training (after 2 weeks of red-light treatment) and after 12 weeks of training, the upper limb and lower limb motor functions of the patients were evaluated using the simple Fugl-Meyer scale, the physical fitness of patients was evaluated using the simple physical fitness scale, and the patient's risk of falling was evaluated by the time consumed for the timed up and go test. The adverse events of patients that occurred during training were recorded. After 12 weeks of training, a self-designed satisfaction survey was conducted to investigate patients' satisfaction with the training effect. Data were statistically analyzed with independent sample t test, paired sample t test, Mann-Whitney U test, Wilcoxon signed rank test, and chi-square test. Results: Before training, the scores of upper limb and lower limb motor functions of patients between the two groups were similar (P>0.05). After 12 weeks of training, the scores of upper limb motor function of patients in conventional rehabilitation group and combined rehabilitation group were significantly higher than those before training (with t values of -11.42 and -13.67, respectively, P<0.05), but there was no statistically significant difference between the two groups (P>0.05). The score of lower limb motor function of patients in combined rehabilitation group was 28.9±2.6, which was significantly higher than 26.3±2.6 in conventional rehabilitation group (t=-3.90, P<0.05), and the scores of lower limb motor function of patients in conventional rehabilitation group and combined rehabilitation group were significantly higher than those before training (with t values of -4.14 and -6.94, respectively, P<0.05). Before training, the individual and total scores of physical fitness of patients between the two groups were similar (P>0.05). After 12 weeks of training, the balance ability score, walking speed score, chair sitting score, and total score of physical fitness of patients in conventional rehabilitation group and combined rehabilitation group were significantly increased compared with those before training (with Z values of -4.38, -3.55, -3.88, -4.65, -4.58, -4.68, -4.42, and -4.48, respectively, P<0.05), and the balance ability score, walking speed score, chair sitting score, and total score of physical fitness of patients in combined rehabilitation group were significantly increased compared with those in conventional rehabilitation group (with Z values of -3.93, -3.41, -3.19, and -5.33, P<0.05). Before training, the time consumed for the timed up and go test for patient's risk of falling in the two groups was close (P>0.05). After 12 weeks of training, the time consumed for the timed up and go test for patient's risk of falling in combined rehabilitation group was (28.0±2.1) s, which was significantly shorter than (30.5±1.8) s in conventional rehabilitation group (t=4.94, P<0.05). Moreover, the time consumed for the timed up and go test for patient's risk of falling in both conventional rehabilitation group and combined rehabilitation group was significantly shorter than that before training (with t values of 14.80 and 15.86, respectively, P<0.05). During the training period, no adverse events such as muscle tissue strain, edema, or falling occurred in any patient. After 12 weeks of training, the satisfaction score of patients with the training effect in combined rehabilitation group was 13.5±1.2, which was significantly higher than 8.5±1.4 in conventional rehabilitation group (t=21.78, P<0.05). Conclusions: The exercise prescription training based on a progressive mode can significantly promote the recovery of lower limb motor function and physical fitness of elderly patients with lower limb dysfunction after deep burns, and effectively reduce the patient's risk of falling without causing adverse events during the training period, resulting in patient's high satisfaction with the training effect.

Quality of Life in Patients With Localized Prostate Cancer: High-Dose Rate Brachytherapy Versus Laparoscopic Prostatectomy

In our institution, a unique sling technique is performed for urinary incontinence after radical prostatectomy. However, in cases of severe urinary incontinence or in the medium to long term, the therapeutic effect may be insufficient. Therefore, a urethral sling technique that provides stronger compression of the bulbar urethra was developed, and its effectiveness was compared with the conventional technique. Seventeen cases of conventional sling surgery and 16 cases of improved sling surgery were included. The number of pads used per day, safety pad rate, and International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF) were evaluated before and after surgery, and a retrospective comparison was made between the two groups. Furthermore, patients were divided into those who used ≤ 4 pads per day before surgery and those who used ≥ 5 pads per day, and the difference between the two groups was examined. We also examined changes over time between groups. Compared with the conventional group, the improved group showed significant improvement in the number of pads per day, safety pad rate, and ICIQ-SF 18 months after surgery. In the group with ≤ 4 preoperative pads, the improved group showed significant improvement in all safety pad rates except at 1 and 12 months after surgery. There were no significant differences in all items between the two groups when the number of preoperative pads was ≥ 5. The improved urethral sling technique appeared to contribute to improving moderate urinary incontinence by adding a simple procedure, especially for patients using ≤ 4 pads per day.

IntroductionNo standard definition for urinary continence after radical prostatectomy exists, and there are discrepancies in continence rates reported in the literature, as well as rates reported by physicians and patients. Therefore, we used two tools, a validated questionnaire and daily pad use, to identify the criteria that best reflects patients’ perceptions of continence recovery.Material and methodsThis is a prospective study of 74 patients who underwent nerve-sparing laparoscopic radical prostatectomy. Continence was assessed monthly for 3 months following catheter removal using the International Consultation on Incontinence Questionnaire Short Form (ICIQ-UI SF) and by recording the number of pads the patients used on a daily basis. According to daily pad use, patients were categorized as either dry (no-pads), socially continent (0–1 pad) or incontinent (≥2 pads).ResultsSeventy-four patients were enrolled with a mean age of 64.3 (±5.6) years. There were no significant differences in continence rates using scores from the International Consultation on Incontinence Questionnaire- Short Form (ICIQ-UI SF) or no-pad use (29.7% vs 32.4%, 45.9% vs 48.6% and 54.1% vs. 54.1%, at the 1-, 2- and 3-month follow-ups, respectively). However, the number of socially continent patients was significantly higher (59.5%, 70.3% and 81.1%, at the 1-, 2- and 3-month follow-ups, respectively [p <0.001]).ConclusionsThe totally dry definition better reflected patients’ perceptions rather than the socially continent definition for the evaluation of continence recovery following laparoscopic radical prostatectomy. To avoid discrepancies, we recommend the use of a validated questionnaire as well as the no-pad definition to standardize the reporting of post radical prostatectomy continence rates.

Objective: To explore the effects of resistance training with elastic band at home on muscle function and walking ability of severely burned children. Methods: A prospective non-randomized controlled study was conducted. From January 2022 to April 2023, 40 children with severe burns who met the inclusion criteria were admitted to Tongren Hospital of Wuhan University & Wuhan Third Hospital. According to the willingness of the children or their families, the children were assigned to conventional rehabilitation group and combined rehabilitation group. During the study, 8 children dropped out of the study, 17 children were finally included in the conventional rehabilitation group with 6 males and 11 females, aged (8.5±2.4) years, and 15 children were included in the combined rehabilitation group with 5 males and 10 females, aged (9.6±2.5) years. The children in the 2 groups received conventional burn rehabilitation treatment in the hospital, including active and passive activity training, scar massage, and pressure therapy. The children in combined rehabilitation group received resistance training with elastic band of 3 to 5 times per week after discharge, and the children in conventional rehabilitation group received daily activity ability training after discharge. Before home rehabilitation training (1 week before discharge) and 12 weeks after home rehabilitation training, the grip strength was measured using a handheld grip dynamometer, the muscle strengths of the upper and lower limbs were measured using a portable dynamometer for muscle strength, lean body mass was measured by bioelectrical impedance measuring instrument, and the 6-min walking distance was measured. Data were statistically analyzed with independent sample t test, paired sample t test, Mann-Whitney U test, or Fisher's exact probability test. Results: After 12 weeks of home rehabilitation training, the grip strengths of children in combined rehabilitation group and conventional rehabilitation group were (15±4) and (11±4) kg, respectively, which were significantly higher than (10±4) and (9±4) kg before home rehabilitation training (with t values of -9.99 and -11.89, respectively, P values all <0.05); the grip strength of children in combined rehabilitation group was significantly higher than that in conventional rehabilitation group (t=3.24, P<0.05). After 12 weeks of home rehabilitation training, the muscle strengths of upper and lower limbs of children in combined rehabilitation group (with t values of -11.39 and -3.40, respectively, P<0.05) and the muscle strengths of upper and lower limbs of children in conventional rehabilitation group (with t values of -7.59 and -6.69, respectively, P<0.05) were significantly higher than those before home rehabilitation training, and the muscle strengths of upper and lower limbs of children in combined rehabilitation group were significantly higher than those in conventional rehabilitation group (with t values of 3.80 and 7.87, respectively, P<0.05). After 12 weeks of home rehabilitation training, the lean body mass of children in combined rehabilitation group was significantly higher than that before home rehabilitation training (t=0.21, P<0.05). After 12 weeks of home rehabilitation training, the 6-min walking distances of children in conventional rehabilitation group and combined rehabilitation group were significantly longer than those before home rehabilitation training (with t values of -5.33 and -3.40, respectively, P<0.05), and the 6-min walking distance of children in combined rehabilitation group was significantly longer than that in conventional rehabilitation group (t=3.81, P<0.05). Conclusions: Conventional burn rehabilitation treatment in hospital and home resistance training with elastic band for 12 weeks after discharge can significantly improve the muscle function and walking ability of severely burned children.

Objectives The prognostic importance of perineural invasion (PNI) in prostate cancer (PC) has been postulated by some authors. Few studies have investigated the risk factors associated with PNI. The aim of this study was to identify factors associated with PNI in PC. Patients and methods The study group of 113 patients diagnosed with PC during the period 2005–2010 consisted of 66 who underwent radical prostatectomy (RP) and 66 who did not. Each group was further divided into those with and without PNI. The association between clinicopathological parameters and PNI in prostate biopsy (Pbx) and RP specimens was investigated using t -test and logistic regression analysis. Discordance in PNI prevalence and PNI up-migration between Pbx and RP specimens were also studied. Results In patients who did not undergo RP, Pbx Gleason score (GS) ≥ 7 was a significant predictor for the presence of PNI. In patients who underwent RP, Pbx GS > 7 increased the risk of PNI in Pbx and RP samples, while a high RP GS predicted PNI in the RP specimen. The discordance rate for PNI in Pbx and RP specimens was 27.3%. Up-migration to a PNI positive cancer between Pbx and RP specimens was seen in 45.5% of cases and RP GS was the only factor associated with PNI up-migration. Conclusion The association of PNI with a high GS and the high rate of discordance between Pbx and RP specimens indicate that in patients with a high GS on Pbx, the pathologist should look more carefully for PNI, and the surgeon should be aware of sampling errors and the unreliability of Pbx specimens in detecting PNI.

To compare the clinical therapeutic effect between electroacupuncture at "four points of sacral region" and transurethral Erbium laser in treatment of moderate to severe stress urinary incontinence after radical prostatectomy. A total of 68 patients of moderate to severe stress urinary incontinence after radical prostatectomy were divided into an electroacupuncture group (34 cases) and an Erbium laser group (34 cases, 3 cases dropped off) according to the settings. In the electroacupuncture group, electroacupuncture was applied at "four points of sacral region", i.e. points of 0.5 cun beside bilateral sacrococcygeal joints and bilateral Huiyang (BL 35), with continuous wave, 2 Hz in frequency, 60 min each time, once every other day, 3 times a week, 12 times as one course of treatment. In the Erbium laser group, transurethral Erbium laser technology was given, once every 4 weeks as one course of treatment. Both groups were treated for 5 courses. The scores of the International Consultation on Incontinence questionnaire-short form (ICI-Q-SF) and the incontinence quality of life questionnaire (I-QOL) were observed before treatment, after each course of treatment and in follow-up after 1 and 2 months of treatment completion, respectively, and the clinical efficacy was evaluated after treatment in the two groups. Compared with those before treatment, the ICI-Q-SF scores were decreased while the I-QOL scores were increased after 5 courses of treatment and in follow-up after 1, 2 months of treatment completion in the two groups (P<0.01). The ICI-Q-SF score in follow-up after 2 months of treatment completion were higher than that after 5 courses of treatment in the Erbium laser group (P<0.05). After 3, 4, 5 courses of treatment and in follow-up after 1 and 2 months of treatment completion, the ICI-Q-SF scores in the electroacupuncture group were lower than those in the Erbium laser group (P<0.05, P<0.01); after 2, 3, 4, 5 courses of treatment and in follow-up after 1 and 2 months of treatment completion, the I-QOL scores in the electroacupuncture group were higher than those in the Erbium laser group (P<0.01). The change ranges of ICI-Q-SF score and I-QOL score between before treatment and after each course of treatment in the electroacupuncture group were lager than those in the Erbium laser group (P<0.01, P<0.05). The total effective rate was 61.8% (21/34) in the electroacupuncture group, which was superior to 19.4 (6/31) in the Erbium laser group (P<0.01). Both electroacupuncture at "four points of sacral region" and transurethral Erbium laser can improve the clinical symptoms and the quality of life in patients of moderate to severe stress urinary incontinence after radical prostatectomy. The short-term efficacy and long-term efficacy of electroacupuncture are superior to the Erbium laser technology.

Study on the effect of rehabilitation intervention timing on symptom cluster relief after lumbar spine surgery: A retrospective cohort study.

Objective The aim of this study was to evaluate the effect of a perioperative pelvic floor muscle training program on urinary incontinence symptoms and the quality of life of patients after radical prostatectomy. Methods This single-center, parallel-group, randomized, controlled study was conducted with a total of 60 patients undergoing open radical prostatectomy in a training and research hospital in Turkey. Patients were randomly assigned to the pelvic floor muscle training group (n = 30) and the control group (n = 30). The data were collected by face-to-face and phone interviews following surgery at seven days after removal of the urethral catheter (baseline) and 3 months using the Patient Information Form, the International Consultation on Incontinence Questionnaire Short Form and the International Consultation on Incontinence Questionnaire for Male Lower Urinary Tract Symptoms. Descriptive statistics, Chi-square test, Independent-samples t-test, and paired-samples test were used to analyze the data. Primary and secondary endpoints were the differences between groups in terms of both scale scores after 3 months. Findings After 3 months, Incontinence Questionnaire Short Form scores (P < 0.001) and “voiding, incontinence, frequency, nocturia” symptoms scores (P < 0.001) were significantly lower in the pelvic floor muscle training group, and quality of life scores were higher than in the control group (P < 0.001). Conclusion According to this study, the perioperative pelvic floor muscle training program was effective on patients’ urinary incontinence symptoms and quality of life 3 months after radical prostatectomy. Evidence-based practices should be used for patients to alleviate common urinary symptoms and to accelerate the recovery of urinary continence.

To identify the definition for urinary continence (UC) after radical prostatectomy (RP) which reflects best patients' perception of quality of life (QoL). Continence was prospectively assessed in 634 patients, 12 months after RP using the International Consultation on Incontinence Questionnaire Short-Form (ICIQ-SF) and the number of pads employed in a 24-hour period (pad usage). We used the one-way ANOVA technique with posthoc pairwise comparisons according to Scheffé's method (homogeneous subsets) for assessing the degree of QoL deficit related to urinary incontinence (UI). The continence prevalence is 64.4%, 74.1%, 88.3%, and 35.8% using "0 pads," "1 safety pad," "1 pad," and "ICIQ score 0" definitions, respectively. Pad usage is moderately strongly associated with ICIQ 1, 2, and 3 (ρ = 0.744, 0.677, and 0.711, respectively; p < 0.001). Concordance between classical UC definitions is acceptable between "0 pads-ICIQ score 0" (K = 0.466), but poor for "1 safety pad" and "1 pad" (K = 0.326 and 0.137, respectively). Patients with "0 pad usage" have better QoL related to urine leakage than patients with "1 safety pad" or "1 pad" (1.41 vs. 2.44 and 3.11, respectively; p < 0.05). There were no significant differences found regarding QoL between patients with ICIQ score 0 and ICIQ score 2 (1.01 vs. 1.63; p = 0.63). Pad usage and the ICIQ-SF's answers provide useful information. We propose a combined definition (0 pads and ICIQ score ≤2) as it is the definition with the least impact on daily QoL.