Complete Emptying Research Articles

Esophageal tortuosity in achalasia: increased length-to-height ratio predicts inferior symptom relief and esophageal emptying following myotomy.

Current classification of achalasia does not account for variability in esophageal tortuosity. The esophageal length-to-height ratio (LHR) was developed to objectively quantify tortuosity, based on the premise that the esophagus must elongate to become tortuous. Hence, we assess the relationship of esophageal tortuosity, measured by LHR, to preoperative patient characteristics and post-myotomy outcomes, including longitudinal symptom relief and esophageal emptying. From 01/2014 to 01/2020, 420 eligible adult patients underwent myotomy for achalasia at our institution, 216 (51%) Heller myotomy and 204 (49%) per-oral endoscopic myotomy. LHR was measured on pre- and first postoperative timed barium esophagram (TBE), with larger values signifying greater tortuosity. Variable predictiveness and risk-adjusted longitudinal estimates of symptom relief (Eckardt score ≤ 3) and complete emptying, in relation to LHR and manometric subtype, were estimated. Median [15th, 85th percentile] preoperative LHR was 1.04 [1.01, 1.10]. Preoperative esophageal width > 3cm and age > 68years were most predictive of increased LHR. Increased LHR corresponded with decreases in longitudinal postoperative symptom relief and complete esophageal emptying, with a 4% difference in symptom relief and 20% difference in complete emptying, as LHR increased from 1.0 to 1.16. After adjusting for patient factors, including LHR, manometric subtype was less predictive of symptom relief, with estimated symptom relief occurring in 4% fewer patients with Type III achalasia, compared to Types I and II. Overall, LHR decreased following myotomy in patients with an initially tortuous esophagus. Length-to-height ratio was the only variable highly predictive of both longitudinal post-myotomy symptom relief and complete esophageal emptying, whereas manometric subtype was less predictive. These findings highlight the importance of tortuosity in the treatment of patients with achalasia, suggesting that inclusion of esophageal morphology in future iterations of achalasia classification is warranted.

Increased pulsation ratio in rear quarters reduces machine-on time and milking on empty teats

Dairy cows usually store more milk in rear than in front quarters. At conventional machine milking this leads to an earlier cessation of milk flow in front than in rear quarters and hence unavoidable milking on empty front teats. We tested the hypothesis that an increased pulsation ratio in rear quarters reduces both milking on empty front teats and machine-on time. We have also tested if the different amplitude of cyclic vacuum fluctuations during milking with simultaneous vs. alternate pulsation within front and rear quarters, respectively, impacts milking characteristics. Ten Holstein dairy cows were milked twice daily at 14-h and 10-h milking intervals. Pulsation ratio in front quarters was 65:35, but was either set at 65:35, 70:30, 75:25 or 80:20 in rear quarters. Whole udder milk flow, claw vacuum, and mouthpiece chamber vacuum of all 4 quarters were recorded during milking. Teat tissue thickness of all 4 teats was measured with a cutimeter at 5 and 30 min after cluster detachment. Total milk yield did not differ among treatments, indicating complete udder emptying. The time of quarter milk flow (tQMF) of front quarters did not differ among treatments but decreased with increasing pulsation ratio in rear quarters. In addition, the faster milking of rear quarters at higher pulsation ratio caused higher peak and average milk flow rates, a shorter duration of milk flow decline, and a reduced machine-on time. The increased milk flow at a higher pulsation ratio did not cause a significant reduction of the claw vacuum at the used sample size. Teat tissue thickness did not significantly differ among treatments, likely because milking on empty teats did almost not occur in the rear quarters, and treatment settings did not differ in front quarters. Simultaneous pulsation caused higher amplitudes of cyclic vacuum fluctuation than alternate pulsation. However, milking characteristics did not differ between simultaneous and alternate pulsation. In conclusion, an increased pulsation ratio in rear quarters reduces machine-on time, increases milking performance, and reduces the time of milking on empty teats in front quarters, without an increased impact on teat tissue thickness.

Bladder dysfunction following stroke: An updated review on diagnosis and management

Bladder dysfunction represents a frequent and important clinical problem in stroke patients. The aim of this narrative review was to explore the currently available information regarding the diagnosis and management of bladder dysfunction following stroke. The most common symptoms of bladder dysfunction following stroke are urinary incontinence, urgency, increased frequency, and difficulty voiding. Medical history, including voiding diary, physical examination, and urodynamic studies are useful in establishing diagnosis. Bladder pressure in stroke patients with detrusor overactivity is rarely high enough to damage the upper urinary tract. In neurogenic bladder, however, there is always a risk for transmission of intravesical pressure to the upper tract. In incontinent patients, urodynamic studies can reveal bladder hyper- or hyporeflexia, detrusor overactivity with impaired contractility or detrusor-sphincter dyssynergia, or even no abnormalities at all. With stroke patients with urinary dysfunction, establishing a proper diagnosis is of paramount importance to start appropriate treatment, prevent upper tract damage, maintain continence, and ensure complete emptying. After diagnosis, an individually tailored treatment plan is mandatory, including behavioral techniques, lifestyle interventions, and anticholinergic medication. Other therapeutic choices include alternative drugs, intradetrusor injection of botulinum toxin, and spinal neuromodulation. A bladder rehabilitation program is essential for improving post-stroke lower urinary symptoms and depends on the patient’s awareness, cooperation, and independence. Bladder dysfunction after stroke, as a strong prognostic factor of disability, exerts an enormous impact on health and economy. Therefore, every single effort toward a proper diagnosis and effective rehabilitation is crucial.

Fictional Realization of History as a Drama of Consciousness in the Novels Ugursuz and Karabeg by Nedžad Ibrišimović

New historicism establishes that the historiographical discourse is essentially narrative, that historiography necessarily behaves like a story. The problem boils down to the relationship between fiction and faction, to the narrative functioning of historiographical material. Novelistic prose can solve this relationship by being loyal or by undermining the idea of logical coherence in the narration, formal plot, time sequence and psychological explanation. Reality is, therefore, a semantic landfill that requires selection and formulation, be it through history or history, and in that process narrative/discursiveness, mimeticity, and rhetoric cannot be avoided. In the novels Ugursuz and Karabeg Ibrišimović sees the content of the past as a landfill of floating stories that write history as a story. At the same time, the story is freed from the unequivocal context of historiographical understanding and interpretation, and gives itself to endless interpretability, multiplied possibilities of interpretation offered by the literary context. With this, the meaning of the facts is checked by moving them from the historiographical context to the literary one, and also to the parabolic form, which is characterized by narrative disguise and complexity, paradoxicality, ambiguity and absurdity. In Ugursuz, the state of complete value emptiness opens the way for the heroes to transfer reality into the illusion of their own power, which is encouraging, and thus appropriated paves the way for an alienated self-image. With alienated emotional states, their sick needs and their sick actions are also alienated. In Karabeg, the angel inhabits the thoughts and hearts of the heroes and witnesses their danger in the conflicts of their own reason and emotions, thus revealing their slavish relationship towards higher goals or, on the other hand, towards the determination to follow their own destiny/nature.

Giggle Incontinence: An Interesting Case Report

Introduction: Giggle incontinence (GI) is a socially embarrassing problem characterized by involuntary and complete bladder emptying in response to laughter. Case Presentation: Here, we report a rare case of giggle incontinence in a 15 years old girl. Physical examination, laboratories, and imaging studies were all negative. Our patient was treated successfully with 10 mg PO methylphenidate for one year. Follow-up for more than one year showed a complete resolution of symptoms. Discussion: To our knowledge, there is no a standard plan for treatment such case. Giggle incontinence can be difficult to recognize, as embarrassment can prevent disclosure of symptoms, and it is difficult to treat. Many reports showed a good response to methylphenidate. Conclusion: Giggle incontinence is a rare condition which it can be seen in childhood. Methylphenidate drug is considered an option for treatment.

Urinary catheterization and techniques for preventing hematuria: integrative review

Objective: Analyze and synthesize the available scientific evidence on urinary catheterization and techniques used to prevent hematuria in bladder emptying and acute and chronic urinary retention in adults and the elderly. Methods: This integrative review was carried out in the PubMed, LILACS, Embase, Cochrane, Web of Science, and Scopus databases. Hand searching was used in the reference lists of included studies. An unlimited period was used to review the studies published in Portuguese, English, French, German, and Spanish. The PICOS strategy was applied to develop the research question and the Joanna Briggs Institute (JBI) instrument was used to assess the methodological quality of studies. Results: Eleven studies were included, with a total of 659 patients. Urinary retention occurred mainly in men and the main cause was benign prostatic hyperplasia. Rapid and gradual decompressions were the techniques used for bladder decompression by urinary catheterization, and hematuria and hypotension were the main complications regardless of the technique. The results showed that there was no significant difference between the two techniques in terms of the outcome of hematuria prevention. Conclusion: Gradual bladder emptying does not prevent hematuria compared to rapid and complete emptying. Case reports describe clinical conditions that deserve attention when hematuria occurs after urinary catheterization and the respective implications in the treatment of patients. We highlight the importance of nursing in identifying and preventing the diagnosis of Urinary Retention to avoid subsequent interventions and clinical complications, including post-catheterization hematuria.

Giggle incontinence: a scoping review.

Giggle incontinence (GI) is poorly described, defined, and understood. It is considered a bladder storage disorder in which laughter causes an uncontrollable episode of urinary incontinence that cannot be stopped until the bladder is completely emptied. It has been confused with stress urinary incontinence and overactive bladder. A thorough analysis of 26 articles on the subject of "giggle incontinence" and associated terms was performed, including all articles since the phrase first appeared. To date, 351 GI cases have been reported. It occurs mainly in women (69.5%) at 5 years of age, with a prevalence ranging from 8.4 to 16.2 years (average age of 12.4 years), and some cases have a family history of the disease (13-16.7%). This review discusses the historical background, current understanding, and challenges related to GI. It primarily affects females after the age of 5 years, causing complete bladder emptying during uncontrollable laughter. The exact cause is unknown, but hypotheses suggest involvement of the central nervous system. Diagnosis relies on clinical history, physical tests, and urine frequency evaluation. Management involves urotherapy techniques, biofeedback, and methylphenidate. Understanding GI will aid in developing more effective management techniques. IMPACT: Highlights limited awareness among healthcare professionals about giggle incontinence as a distinct condition, emphasizing the need for standardized diagnostic criteria and assessment tools. Addresses insufficient understanding of the underlying mechanisms and contributing factors, providing valuable insights for better diagnosis and treatment. Emphasizes the importance of patient education and support, calling for improved resources and counseling. Urges further research and evidence-based guidelines to enhance treatment strategies.

Prediction of early bladder outcomes after spinal cord injury: The HALT score.

Neurogenic bladder (NB) is a prevalent and debilitating consequence of spinal cord injury (SCI). Indeed, the accurate prognostication of early bladder outcomes is crucial for patient counseling, rehabilitation goal setting, and personalized intervention planning. A retrospective exploratory analysis was conducted on a cohort of consecutive SCI patients admitted to a rehabilitation facility in China from May 2016 to December 2022. Demographic, clinical, and electrophysiological data were collected within 40 days post-SCI, with bladder outcomes assessed at 3 months following SCI onset. The present study enrolled 202 SCI patients with a mean age of 40.3 ± 12.3 years. At 3 months post-SCI, 79 participants exhibited complete bladder emptying. Least absolute shrinkage and selection operator (LASSO) and multivariate logistic regression analyses identified the H-reflex of the soleus muscle, the American Spinal Injury Association Lower Extremity Motor Score (ASIA-LEMS), and the time from lesion to rehabilitation facility (TLRF) as significant independent predictors for bladder emptying. A scoring system named HALT was developed, yielding a strong discriminatory performance with an area under the receiver operating characteristics curve (aROC) of 0.878 (95% CI: 0.823-0.933). A simplified model utilizing only the H-reflex exhibited excellent discriminatory ability with an aROC of 0.824 (95% CI: 0.766-0.881). Both models demonstrated good calibration via the Hosmer-Lemeshow test and favorable clinical net benefits through decision curve analysis (DCA). In comparison to ASIA-LEMS, both the HALT score and H-reflex showed superior predictive accuracy for bladder outcome. Notably, in individuals with incomplete injuries, the HALT score (aROC = 0.973, 95% CI: 0.940-1.000) and the H-reflex (aROC = 0.888, 95% CI: 0.807-0.970) displayed enhanced performance. Two reliable models, the HALT score and the H-reflex, were developed to predict bladder outcomes as early as 3 months after SCI onset. Importantly, this study provides hitherto undocumented evidence regarding the predictive significance of the soleus H-reflex in relation to bladder outcomes in SCI patients.

Comparison of the effect of chest tube diameter on drainage rate and tube performance in patients with pleural effusion. A cross-sectional study.

Chest tube insertion is one of the essential procedures that is performed for patients suffering from pneumothorax or pleural effusion. Choosing the best chest tube size, with maximum emptying and minimum discomfort and side effects, is one of the most important factors in patient care, while the best tube size is highly a matter of debate. In this investigation, we aimed to assess the difference between the groups with different chest tube sizes regarding the time needed for drainage, the necessity of additional invasive procedures, or pain severity. In this cross-sectional study, patients with pleural effusion, were entered into the study. patients were randomly divided into two groups based on their chest tube size: size 28 and size 32. Then, the duration of complete effusion emptying and the duration of the chest tube insertion was evaluated. According to this study, 26 (65.0%) participants were male. The duration for complete evacuation of pleural effusion varied from 3 to 10 days. The average duration of chest tube retention in the group of patients with chest tube sized 28 and 32 were 5.82, and 5.91 days, respectively; The average pain intensity in the group of patients with chest tube sized 28 and 32 were 6.71 ±1.02 and 6.48 ±1.21 units, respectively. There was no significant difference in how long the chest tube needed to stay in place to fully drain the pleural effusion. They also didn't differ significantly in the need for additional invasive procedures such as VATS, and secondary chest tube insertion. There was no notable difference for pain severity and the need for painkillers in the two groups of patients.

Hysteroscopy-assisted suction curettage for early pregnancy loss: does it reduce retained products of conception and postoperative intrauterine adhesions?

To describe the feasibility of hysteroscopy-assisted suction curettage for early pregnancy loss and to investigate whether it reduces the rates of retained products of conception (RPOC) and intrauterine adhesions (IUA). Prospective single-arm cohort study. University-affiliated Department of Obstetrics and Gynecology. Women admitted for surgical evacuation of early pregnancy loss were invited to participate in the study. Vaginal misoprostol was administered for cervical ripening preoperatively. Under general anesthesia, a diagnostic hysteroscopy was performed to identify the pregnancy's implantation wall, followed by ultrasound-guided suction and curettage directed to the implantation wall, and then diagnostic hysteroscopy to verify complete uterine cavity emptying. Postoperative IUA were evaluated by follow-up office hysteroscopy. Identification of the pregnancy's implantation wall on hysteroscopy, and intra-, and postoperative complications associated with the procedure. The evaluation of postoperative IUA was limited due to the COVID-19 pandemic-related restrictions on elective procedures. Forty patients were included in the study group. Their mean age was 34.0 ± 6.6years, and their mean gestational age was 8.9 ± 1.6weeks. The implantation wall was clearly visualized on hysteroscopy in 33 out of 40 cases (82.5%). The mean operative time was 17.2 ± 8.8min, and no intraoperative complications occurred. Suspected RPOC were diagnosed intraoperatively by hysteroscopy and removed in 4 cases, and the histologic examination confirmed the presence of RPOC in three of them. Follow-up office hysteroscopy was performed in nine women: mild IUA was diagnosed in one case and a normal cavity was confirmed in eight cases. A new pregnancy was reported at the time of follow-up in 15 cases, while 12 women declined to attend the follow-up hysteroscopy and four were lost to follow-up. Hysteroscopy-assisted suction curettage for early pregnancy loss is a safe, short, and inexpensive procedure, which allows the identification of the pregnancy's wall in most cases and may reduce the rates of RPOC.

The effect of methylphenidate for giggle incontinence in children.

Giggle incontinence (GI) is a rare form of urinary incontinence that occurs during or immediately after laughing due to involuntary and complete bladder emptying. Few studies in the literature report that methylphenidate can be effective in treatment of this condition. The aim of this study is to characterize children with GI and evaluate their response to methylphenidate, as well as describe treatment duration, dosage of methylphenidate, relapse rates after discontinuation of medication, and side effects. Medical records and 48-hfrequency-volume charts from children treated with methylphenidate for GI in the period January 2011-July 2021 were retrospectively analyzed. Eighteen children were diagnosed with GI and fulfilled inclusion criteria. Fifteen patients were included in analysis, as 3 out of 18 children decided not to take the methylphenidate that was prescribed. In total, 14 out of the 15 GI patients treated with methylphenidate experienced clinical effect. All patients included in the study had methylphenidate prescribed in a dose range of 5-20 mg daily. Treatment duration ranged from 30 to 1001 days, with a median of 152 days (IQR 114, 243.5). Ten children experienced complete response and two of those reported symptom relapse after discontinuation of the methylphenidate. Only mild and short-lasting side effects were reported by two patients. Our study demonstrates that methylphenidate is an effective treatment in children diagnosed with GI. Side effects are mild and uncommon.

Каменеутворення в аугментованому сечовому міхурі в дитячому віці: сучасний стан проблеми

Purpose - to analyze the current state of the problem patients’ treatment with stones in the augmented bladder and recommend optimal approaches for their elimination, based on the literature data. Augmentation cystoplasty is a surgical procedure used in adults and children with refractory bladder dysfunction, including, in particular, small bladder capacity, in whom conservative treatment has failed. The leading pediatric pathologies for which enterocystoplasty performed are neuropathic bladder and bladder exstrophy. The article examines the complications that arise, and the possibilities and advantages of endoscopic techniques in children compared to open surgery in view of compromised tissues due to congenital defects and previous surgical interventions. The cause of the main postoperative complications, such as metabolic disorders, hematuria syndrome, calculi formation, mucus formation, enteric fistulae, bladder rupture, intestinal obstruction and the development of malignant neoplasms, are mainly related to the use of gastrointestinal tract tissues in the bladder. As an example of modern surgical and minimally invasive methods application, considered the case of treatment of a child with urinary bladder exstrophy, in which later stones were formed. Conclusions. The stones formation in an augmented bladder is a fairly common problem, difficult to prevent and effectively treat. Timely complete bladder emptying and adequate treatment of bladder infections are the keys to preventing the formation of stones in an augmented bladder. Modern minimally invasive technologies make it possible to effectively, minimally traumatical and safely treat patients with calculi of various localizations of the urinary system, as well as patients who have previously undergone complex plastic surgery. The research was carried out in accordance with the principles of the Helsinki Declaration. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors.

Effectiveness of Manual Vacuum Aspiration in the Management of Miscarriage and Retained Products of Conception

Objective: To assess the efficacy of manual vacuum aspiration (MVA) in terms of complications and complete uterine evacuation of the product of conception. Study design: Descriptive cross-sectional study. Place and duration: Department of Obstetrics and Gynecology, Bilawal Medical College, DHQ Hospital Kotri and CDF Hospital Hyderabad, from April 2020 to March 2021. Patient and method: All the patients with gestational of <14 weeks, and the diagnosis of missed miscarriage, blighted ovum, partial miscarriage, or RPOCs, who were undergone MVA was carried out. Primary outcome measures were efficacy and secondary outcome measures were to assess prevalence of complications including pain and cramps, infection and bleeding. Effectiveness was considered in terms of complete or incomplete evacuation. All the information was documented via a self-made study proforma. Results: A total of 83 patients were scheduled to undergo MVA. Majority of the cases 41.0% were presented with gestation age of 9 to 12 weeks. Most of the cases 56.6% had incomplete miscarriage, 31.3% were with missed miscarriage and 12.0% women had RPOCs. Mild to moderate pain and cramps were present in 91.60% of the cases, while only 6.0% of the cases had bleeding, and infection developed in 2 cases. According to effectiveness, complete evacuation was achieved in 81.9% of the cases. Conclusion: MVA is effective in the complete emptying of the uterine cavity and has high rates of acceptability and satisfaction. It reduces the waiting time for surgery, hospital stays, and GA complications. It is gradually gaining acceptability as a standard surgical procedure for safe early pregnancy termination. Keywords: Efficacy, safety, MVA, uterine evacuation, conception

Apical Aneurysms and Mid–Left Ventricular Obstruction in Hypertrophic Cardiomyopathy

BackgroundApical left ventricular (LV) aneurysms in hypertrophic cardiomyopathy (HCM) are associated with adverse outcomes. The reported frequency of mid-LV obstruction has varied from 36% to 90%. ObjectivesThe authors sought to ascertain the frequency of mid-LV obstruction in HCM apical aneurysms. MethodsThe authors analyzed echocardiographic and cardiac magnetic resonance examinations of patients with aneurysms from 3 dedicated programs and compared them with 63 normal controls and 47 controls with apical-mid HCM who did not have aneurysms (22 with increased LV systolic velocities). ResultsThere were 108 patients with a mean age of 57.4 ± 13.5 years; 40 (37%) were women. A total of 103 aneurysm patients (95%) had mid-LV obstruction with mid-LV complete systolic emptying. Of the patients with obstruction, 84% had a midsystolic Doppler signal void, a marker of complete flow cessation, but only 19% had Doppler systolic gradients ≥30 mm Hg. Five patients (5%) had relative hypokinesia in mid-LV without obstruction. Aneurysm size is not bimodal but appears distributed by power law, with large aneurysms decidedly less common. Comparing mid-LV obstruction aneurysm patients with all control groups, the short-axis (SAX) systolic areas were smaller (P < 0.007), the percent SAX area change was greater (P < 0.005), the papillary muscle (PM) areas were larger (P < 0.003), and the diastolic PM areas/SAX diastolic areas were greater (P < 0.005). Patients with aneurysms had 22% greater SAX PM areas compared with those with elevated LV velocities but no aneurysms (median: 3.00 cm2 [IQR: 2.38-3.70 cm2] vs 2.45 [IQR: 1.81-2.95 cm2]; P = 0.004). Complete emptying occurs circumferentially around central PMs that contribute to obstruction. Late gadolinium enhancement was always brightest and the most transmural apical of, or at the level of, complete emptying. ConclusionsThe great majority (95%) of patients in the continuum of apical aneurysms have associated mid-LV obstruction. Further research to investigate obstruction as a contributing cause to apical aneurysms is warranted.

Assessing nitrogen dynamics model and the role of artificial lagoon in effluent loading of shrimp farms in Gomishan wetland, southern Caspian Sea

Shrimp farming increases the nutrients, especially nitrogen in the water resources reducing water quality. This study was conducted to evaluate the nitrogen dynamics in white shrimp (Litopenaeus vannamei) farms and the role of artificial lagoon (24 ha) in reducing nitrogen levels in Gomishan coastal wetland, the eastern Caspian Sea. The results indicated that at the end of the 4-month breeding period, the amounts of nitrogen and phosphorus introduced into Gomishan wetland were calculated as to 220.157 and 39 tons, respectively in a breeding area covering 830 hectares. Nitrogen values (based on nitrate) calculated based on the relationship between the basin and the discharge of the outlet channel of the site at the time of complete emptying of the farms, were calculated to be approximately 121.8 tons per breeding time that it had an important role in eliminating about 45% of nutrient pollution and reducing the concentration of dissolved nitrogen. Moreover, nitrogen isotopic trace was observed in shrimp samples, in similar levels in the samples of both shrimp pond and lagoon, which emphasizes the role of feeding from natural food, especially benthic fauna. Overall, due to the decline of Caspian Sea water level, Gomishan coastal wetland is drying, and the output of shrimp farms is currenly the only source supplying water for the wetland. Hence, appropriate management strategies could minimize the amounts of nutrients into the natural water whilst aiding wetland’s survaival.

Late Complication of Orthotopic T-Pouch Ileal Neobladder Diversion

A 69-year-old female with history of squamous cell carcinoma of the bladder who underwent anterior pelvic exenteration with an orthotopic T-pouch ileal neobladder 20 years ago was referred to the urology clinic because of worsening renal function. At time of urologic evaluation, the patient was voiding volitionally with a low post-void residual. Despite complete bladder emptying and a fluoroscopic cystogram demonstrating no evidence of reflux, she was recommended by her local urologist to perform clean intermittent catheterization 4-5 times/day, but her renal function continued to deteriorate. Laboratory evaluation revealed a decline in estimated glomerular filtration rate to 29 ml/min/1.73m2 from a baseline of 50 ml/min/1.73m2. A non-contrast computed tomography scan is shown below (Figure) and demonstrated bilateral hydroureteronephrosis and a dilated afferent limb (arrow) of the T-pouch despite a decompressed neobladder (asterisk).

Long-Term Surveillance and Management of Urological Complications in Chronic Spinal Cord-Injured Patients.

Bladder dysfunction is a common complication after chronic spinal cord injury (SCI). Patients may experience renal function loss, urinary tract infection (UTI), urolithiasis, bladder cancer, and even life-threatening events such as severe sepsis or renal failure. Suitable patient care may prevent UTI and urinary incontinence, decrease medication use, and preserve renal function. As the primary goal is to preserve renal function, management should be focused on facilitating bladder drainage, the avoidance of UTI, and the maintenance of a low intravesical pressure for continence and complete bladder emptying. Currently, several bladder management options are available to SCI patients: (1) reflex voiding; (2) clean intermittent catheterization; (3) indwelling catheterization. The target organ may be the bladder or the bladder outlet. The purposes of intervention include the following: (1) increasing bladder capacity and/or decreasing intravesical pressure; (2) increasing bladder outlet resistance; (3) decreasing bladder outlet resistance; (4) producing detrusor contractility; (5) urinary diversion. Different bladder management methods and interventions may have different results depending on the patient's lower urinary tract dysfunction. This review aims to report the current management options for long-term bladder dysfunction in chronic SCI patients. Furthermore, we summarize the most suitable care plans for improving the clinical outcome of SCI patients.

7736 Transcatheter Drainage and Ethanol Sclerotherapy for Treatment of Symptomatic Endometriomas: A Case Series

<h3>Study Objective</h3> To investigate the efficacy of ethanol sclerotherapy for endometriomas as either pre-operative adjuvant therapy to facilitate minimally invasive surgery or as definitive treatment. <h3>Design</h3> This is a case series of 15 patients treated from 2010-2022 who presented with endometriomas causing bulk symptoms and pain. We reviewed pre-procedure imaging, surgical history, procedural findings, post-procedure treatment course and symptom changes, and most recent interval imaging if available. <h3>Setting</h3> Multidisciplinary academic complex gynecology center with multimodal imaging guidance. <h3>Patients or Participants</h3> Patient age range was 21-61 years. Five patients had a history of surgical resection for endometriomas. All patients had endometriomas diagnosed with CT or MR and associated symptoms including bulk and pain. <h3>Interventions</h3> Patients underwent image-guided transabdominal, transvaginal, or transgluteal catheter drainage of their endometriomas. The endometrioma was completely evacuated and contrast study was performed to determine cavity volume (for ethanol injection) and complete emptying of the cavity. Ethanol 100% was instilled two times with a dwell time of 5-7 minutes each and then evacuated. The median total volume of alcohol instilled was 100 cc (range 55-600 cc). The drain was usually left in place; patients returned at 24-96 hours for repeat contrast study and a third ethanol injection followed by catheter removal. <h3>Measurements and Main Results</h3> The median volume of endometriotic material drained was 200 cc (range 30-2000 cc). All patients reported symptomatic improvement immediately following the procedure. Interval imaging was available for 11 patients (interval length range 32-837 days) with an average reduction in volume of 83.5% (range 53.2%-100%). 6 patients underwent subsequent surgery for endometriomas. There was one complication – secondary infection requiring repeat drainage. <h3>Conclusion</h3> Ethanol sclerotherapy is an effective treatment for improving endometrioma symptoms and can delay or obviate the need for surgery. It should continue to be studied on a larger scale to ascertain its optimal role in endometrioma treatment.

Overview On Neurogenic Bowel Dysfunction in Pediatrics

Neurogenic bowel dysfunction (NBD) is fecal incontinence or constipation which is prevalent in kids with both congenital and acquired neurological disorders. NBD results from loss of normal sensory or motor control and may include both the upper and the lower gastrointestinal (GI) tract Constipation and fecal incontinence are frequent symptoms of neurogenic bowel dysfunction (NBD), which makes it a challenging condition to treat. Also, they have a major impact on quality of life and dignity. Bowel dysfunction is less studied compared to neurogenic bladder, generally prevelant in spina bifida, but practically as prevalent in other neurological conditions. Generally, the objective of neurogenic bowel management is to achieve complete emptying of the rectum on a systematic basis. This may be accomplished through with a multidimensional approach containing of conservative, medical and even surgical approaches. A modified Delphi procedure was used to construct a statement document. This paper discusses the various causes of paediatric NBD. Our aim is to enhance clinical management, numerous therapeutic techniques are given. Due to both the improved survival rate and better diagnosis, there are more children and teenagers with NBD. The number of children and adolescents with NBD is growing as a result of better diagnosis and a greater survival rat NBD can cause either faecal incontinence or constipation, or both, with a fair amount of predictability. However, each patient will experience NBD in a different way depending on a variety of underlying conditions and coexisting conditions. Due to the status of the affected child and caregivers, management of NBD should be individualized using a combined multidisciplinary therapy.

ERAS guidelines-driven upper gastrointestinal contrast study after esophagectomy can detect delayed gastric conduit emptying and improve outcomes

BackgroundDelayed gastric conduit emptying can occur after esophagectomy and has been shown to be associated with increased risk for postoperative complications. Application of a standardized clinical protocol after esophagectomy including an upper gastrointestinal contrast study has the potential to improve postoperative outcomes.MethodsProspective cohort including all patients operated with esophagectomy at two high-volume centers for esophageal surgery. The standardized clinical protocol included an upper gastrointestinal contrast study on day 2 or 3 after surgery. All images were compiled and evaluated for the purpose of the study. Clinical data was collected in IRB approved institutional databases at the participating centers.ResultsThe study included 119 patients treated with esophagectomy of whom 112 (94.1%) completed an upper gastrointestinal contrast study. The results showed that 8 (7.1%) patients had radiological delayed gastric conduit emptying defined as no emptying of contrast through the pylorus. Partial conduit emptying was seen in 34 (30.4%) patients, and 70 (62.5%) patients had complete conduit emptying. Complete or partial emptying was associated with significantly earlier nasogastric tube removal (3 vs. 6 days) and hospital discharge 8 vs. 17 days, P < 0.001). Radiological signs of delayed gastric conduit emptying were shown to be associated with increased risk of postoperative complications. There was, however, no association with severe postoperative complications according to Clavien–Dindo score, pulmonary complications, anastomotic leak or need for intensive care.ConclusionThe results of the study demonstrate that postoperative upper gastrointestinal contrast studies can be used to assess the level of emptying of the gastric conduit after esophagectomy. Application of upper gastrointestinal contrast study in the ERAS guidelines-driven standardized clinical pathway after esophagectomy has the potential to improve postoperative outcomes.