Pelvic Dysfunction Research Articles

Pelvic floor status during pregnancy as a predictor of pelvic dysfunction and birth outcome

This literature review presents an analysis of a number of studies that examined the association between pelvic floor health during pregnancy and the development of pelvic dysfunction and birth outcomes. These studies consistently demonstrated that changes in pelvic floor structure and function during pregnancy are associated with an increased risk of developing pelvic disorders such as urinary incontinence and pelvic organ prolapse. Besides, certain pelvic floor characteristics, such as muscle strength, tone, and stretching ability, have been identified as potential predictors of pelvic floor dysfunction during pregnancy and prolonged second-stage labor. The data collected suggest that pelvic floor assessment during pregnancy may provide valuable prognostic information about birth outcomes. Understanding these relationships may lead to improved prenatal care strategies and interventions to optimize pelvic floor function and reduce the incidence of adverse birth outcomes. Further research is required to clarify the specific parameters for evaluating pelvic floor changes that are most indicative of pelvic organ dysfunction and adverse birth outcomes, as well as to assess the efficacy of preventive interventions.

Screening for Incidence and Effect of Pelvic Floor Dysfunction in College-Aged Athletes.

Pelvic floor dysfunction (PFD) occurs when muscles of the pelvic floor become weakened, impaired, or experience tension leading to a variety of complications. Due to the reactive nature and high demands of many sports, athletes are at increased susceptibility and of particular interest concerning PFD. The purpose of this study was to explore the prevalence of PFD among college-aged athletes, assess how PFD impacted athletic performance, and identify contributing factors for increased likelihood of PFD in athletes. Cross-Sectional Study. All fully active LVC NCAA Division 3 athletes were recruited for screening for PFD using the Cozean Pelvic Dysfunction Screening Protocol and were surveyed on their self-knowledge of PFD. Athletes who scored ≥ 3 on this tool completed an additional survey, created by the investigators, to identify the impact PFD had on their athletic performance and personal life and were then randomly assigned to one of three investigators to undergo a noninvasive coccygeal assessment to determine underactive, overactive, or normal pelvic floor muscle (PFM) activity. Fifty-three Division III male and female athletes between the ages of 18-25 years old participated in the study. Statistically significant differences were found between Cozean scores and demographic factors of age (p \<0.001), gender (p \<0.05), self-knowledge of PFD (p \<0.001), and sport (p \<0.001) among all participants that contributed to the increased likelihood of PFD. Thirteen athletes scored ≥ 3 on the Cozean with the 92.3% experiencing under/over active PFM activity and the majority indicating that PFD significantly impacted their athletic performance and quality of life. The results indicate that older female NCAA Division III college athletes who participate in swimming and who possess self-knowledge of PFD are more likely to experience PFD. Additionally, these athletes are likely to encounter a significant impact on their athletic performance and quality of life. These results provide preliminary evidence on the need of PFD awareness and assessment among college athletes. Level 3b.

A New Diagnostic Tool for the Assessment of Pelvic Dysfunction in MR Defecography

Pelvic floor dysfunction is characterized by incomplete fecal defecation, negatively affecting the quality of life. Magnetic resonance defecography (MRD) is a useful examination that is ionizing radiation-free and easily reproducible, and provides anatomical and functional details that are obtainable through multiplanar and dynamic examinations. The study aims to detect pathology using MRD in patients with suspected pelvic floor dysfunction and determine its cause. MRD was performed on 79 individuals. Dynamic images were obtained at rest, straining, and during defecation. Pelvic hiatus mediolateral diameters were compared between groups. The defecation phase provided more accurate results than the straining phase for determining the existence and severity of pathology significantly. The defecation phase is the most accurate phase for identifying the existence and severity of pathology, as the pelvic hiatus mediolateral diameter is thought to be an important factor in triggering pelvic dysfunction.

Investigating the role of the pelvic floor muscles in sexual function and sexual response: a systematic review and meta-analysis.

The pelvic floor muscles (PFMs) have been suggested to play a key role in sexual function and response in women. However, syntheses of the evidence thus far have been limited to interventional studies in women with pelvic pain or pelvic floor disorders, and these studies have failed to fully capture the involvement of the PFMs in a broader population. We sought to appraise the evidence regarding the role of the PFMs in sexual function/response in women without pelvic pain or pelvic floor disorders. More specifically, we examined the following: (1) effects of treatment modalities targeting the PFMs on sexual function/response, (2) associations between PFM function and sexual function/response, and (3) differences in PFM function between women with and those without sexual dysfunction. We searched for all available studies in eight electronic databases. We included interventional studies evaluating the effects of PFM modalities on sexual outcomes, as well as observational studies investigating the association between PFM function and sexual outcomes or the differences in PFM function in women with and those without sexual dysfunction. The quality of each study was assessed using the Mixed Methods Appraisal Tool. Estimates were pooled using random-effects meta-analyses whenever possible, or a narrative synthesis of the results was provided. The main outcomes were sexual function (based on a questionnaire)/sexual response (based on physiological test), and PFM function (assessment of the PFM parameters such as strength and tone based on various methods). A total of 33 studies were selected, including 14 interventional and 19 observational studies, most of which (31/33) were deemed of moderate or high quality. Ten out of 14 interventional studies in women with and without sexual dysfunctions showed that PFM modalities had a significant effect on sexual function. Regarding the observational studies, a meta-analysis revealed a significant moderate association between PFM strength and sexual function (r = 0.41; 95% CI, 0.08-066). Of the 7 observational studies performed to assess sexual response, all showed that the PFMs were involved in arousal or orgasm. Conflicting results were found in the 3 studies that evaluated differences in PFM function in women with and those without sexual dysfunction. Our results highlight the contribution of the PFMs in sexual function/response. One strength of this review is the inclusion of a broad range of study designs and outcomes, allowing a thorough synthesis of evidence. However, interpretations of these data should consider risk of bias in the studies, small sample sizes, and the absence of control/comparison groups. The findings of this review support the involvement of the PFMs in sexual function/response in women without pelvic pain or pelvic dysfunction. Well-designed studies should be performed to further investigate PFM modalities as part of the management of sexual dysfunction.

Lifelong LUTS: Understanding the bladder's role and implications across transition phases, a comprehensive review.

Lower urinary tract symptoms (LUTSs) are a diverse array of urinary and pelvic dysfunctions that can emerge from childhood, extend through adulthood, and persist into older age. This narrative review aims to provide a comprehensive perspective on the continuum of LUTS and shed light on the underlying mechanisms and clinical implications that span across the lower urinary tract. A panel of five experts from Belgium, the Netherlands, India, Denmark, and the United States participated in an intensive research to explore and pinpoint existing insights into the lifelong concept of LUTS, particularly at the pelvic level. The experts reviewed the existing literature and held a webinar to discuss their findings. Childhood LUTS can persist, resolve, or progress into bladder underactivity, dysfunctional voiding, or pain syndromes. The Lifelong character can be explained by pelvic organ cross-talk facilitated through complex neurological and nonneurological interactions. At the molecular level, the role of vasopressin receptors in the bladder's modulation and their potential relevance to therapeutic strategies for LUTS are explored. Frailty emerges as a parallel concept to lifelong LUTS, with a complex and synergistic relationship. Frailty, not solely an age-related condition, accentuates LUTS severity with insufficient evidence regarding the effectiveness and safety profile of the available therapeutic modalities. Understanding lifelong LUTSs offers insights into genetic, anatomical, neurological, and molecular mechanisms. Further research could identify predictive biomarkers, elucidate the role of clinically translatable elements in pelvic cross-talk, and uncover molecular signatures for personalized management.

Application status and progress of intraoperative nerve monitoring in pelvic autonomic nerve preserving radical resection of rectal cancer

The current treatment strategy for rectal cancer is a comprehensive treatment centered on surgery. The application of total mesorectal excision (TME) has significantly reduced the local recurrence rate and improved the survival prognosis, but a series of pelvic organ dysfunction caused by pelvic autonomic nerve injury during the operation will reduce the postoperative quality of life of patients. Pelvic autonomic nerve preserving (PANP) radical proctectomy has emerged, but the biggest challenge in the implementation process of this technology is the accurate identification of nerves. A series of studies have shown that pelvic intraoperative autonomic monitoring (pIONM) can effectively assist surgeons to identify nerves, The purpose of this article is to introduce the function of pelvic autonomic nerve, the clinical manifestation of postoperative pelvic dysfunction and its relationship with nerve injury, the key points of implementing PANP, and the current situation and research progress of pIONM technology application.

Effectiveness of intraoperative monitoring of the bulbocavernosus reflex for predicting postoperative pelvic disorders in the surgical treatment of distal spine tumors

The study evaluated the diagnostic effectiveness of changes in the parameters of the bulbocavernous reflex during intraoperative neurophysiological monitoring in the surgical treatment of caudal spinal cord tumors. The study was performed during examinations and neurosurgical treatment of 58 patients suffering from intradural extramedullary and intramedullary tumors of the caudal spinal cord. In 23 (39.7%) patients, the tumors were localized at the level of the lower thoraciclumbar spine (Th11L1), and in 35 (60.3%) patients, they were at the level of the lumbosacral spine (L2S2). Pelvic organ dysfunction was assessed based on the extent of neurogenic bladder symptoms before surgery, 1014 days after surgery, and a year later. The bulbocavernous reflex was recorded in response to genital nerve stimulation, with a series of three pulses lasting 0.5 ms each, and the repetition rate of the series was 2 Hz. The intensity of the stimulation current was 75% of the maximum intensity. The bulbocavernous reflex was registered from the external anal sphincter muscles. During intraoperative monitoring, the bulbocavernous reflex remained stable in 49 patients. In this group, pelvic dysfunction was not observed immediately or 12 months after surgery. Persistent changes in motor response parameters were registered in nine patients; seven and eight cases of dysuric disorders were observed immediately after surgery and 12 months after surgery, respectively. Persistent changes in the bulbocavernous reflex during intraoperative monitoring were significantly more often associated with pelvic organ dysfunction immediately after surgery (2 = 36,323; p 0.001) and 12 months after surgery (2 = 32,284; p 0.001). The sensitivity and specificity of intraoperative monitoring of the bulbocavernous reflex in assessing the risk of pelvic dysfunction in the postoperative period were 96.1% and 100%, respectively. In general, postoperative pelvic organ dysfunction is a frequent cause of neurological complications following surgical treatment of caudal spine tumors. Therefore, during surgery, neurophysiological monitoring is implemented to control pelvic organ functions, including the registration of the bulbocavernous reflex.

(099) A Systematic Review Investigating the Involvement of the Pelvic Floor Muscles in Sexual Function and Sexual Response

Abstract Introduction The pelvic floor muscles (PFM) have been suggested to play a key role in sexual function and sexual response in women. However, current syntheses of the evidence have been limited to interventional studies investigating the effect of modalities targeting the PFM on sexual function in women with pelvic pain and pelvic floor disorders. The literature has therefore never been critically appraised while excluding these potential confounders, which prevents to fully capture and understand the involvement of the PFM in sexual function and sexual response. Objective To examine and synthesize the available evidence on: i) the effects of PFM training on sexual function in women without pelvic pain or pelvic disorders, ii) the association between PFM function and sexual function/response and iii) the differences in the PFM function between women with and without sexual dysfunctions. Methods Electronic databases including Medline, Cochrane, CENTRAL, CINAHL, Psycinfo, Sportdiscuss, AMED, Scopus and EMBASE were searched using a peer-reviewed search strategy. We also performed a hand search of the references of all relevant articles and a grey literature search. Main outcomes included sexual function (self-reported questionnaire), sexual response (physiological test) and PFM function (strength and tone assessed with various assessment tools). We included interventional studies (randomized controlled trials and non-randomized studies) investigating the effects of PFM training on sexual outcomes as well as observational studies examining the association between PFM function (strength and tone) and sexual outcomes or the differences in PFM function in women with and without sexual dysfunctions. Quality of selected studies was assessed using the Mixed Methods Appraisal Tool by a team of two reviewers and disagreements were resolved by consensus or involvement of a third-party. Results The literature search resulted in 33 eligible studies including 14 interventional studies and 19 observational studies. Most studies (31/33) were of moderate quality or higher. Overall, 10 of the 14 interventional studies reported that PFM training had a significant effect on sexual function. Of the 11 observational studies investigating the association between PFM function and sexual function, 8 showed significant correlations (ranging from weak to strong) with sexual satisfaction, lubrication, arousal, orgasm or overall sexual function. Of the observational studies, 7 supported the involvement of the PFM as part of the sexual response (i.e. in the arousal and orgasm phases). Regarding the 3 studies evaluating the differences in the PFM function of women with and without sexual dysfunctions, the results were conflicting. Conclusions Findings of this review support the involvement of the PFM in sexual function and in sexual response in women without pain and pelvic dysfunctions. This review supports the need to further investigate modalities targeting the PFM as part of the management for sexual dysfunctions. Disclosure No

37 - Development of a multiprofessional pathway for patients with pelvic dysfunction: The birth of the pelvic unit

37 - Development of a multiprofessional pathway for patients with pelvic dysfunction: The birth of the pelvic unit

Application of physical therapy methods for patients after stroke with spasticity in the early period

acute cerebrovascular accident is the leading cause of disability. Stroke ranks 4th among diseases that lead to death or disability. The consequences of stroke include neurological disorders, motor disorders (plegia, hemiparesis, paresis, muscle spasticity), loss of sensation, pelvic dysfunction, loss of coordination and balance, high risk of falls, and impaired ability to move independently and perform daily activities. To achieve optimal independence, stroke patients need qualified rehabilitation care as part of a multidisciplinary team. Evidence-based medicine, treatment, and rehabilitation interventions have improved significantly in the acute and early periods for stroke patients. However, in the late period, today, more than half of patients remain limited in their daily activities and have movement disorders that significantly affect their quality of life and independence. Description of the objective. To substantiate the use of evidence-based medicine methods in physical therapy to restore motor function in patients after stroke in the early period. Materials and methods. From October to December 2021, 20 patients with spasticity, aged 47-85 years, who had suffered an ischemic and hemorrhagic stroke, took part in the examination and rehabilitation activities at Kyiv City Clinical Hospital № 6, Palliative Care Department, for a period of 3 weeks to 1 month. Voluntary consent for examination, treatment, and rehabilitation was obtained from all patients and their caregivers. The diagnostic methods used were computed tomography, magnetic resonance imaging, and, if necessary, laboratory tests. Tests and scales for physical therapy were used to determine functional impairment in stroke patients with muscle spasticity: Rankin Scale, Riverbed Mobility Index, Pain Score, Modified Ashworth Scale, Degree of Arm and Hand Recovery; Degree of Leg and Foot Recovery. Results. After analyzing the methods of evidence-based medicine on the topic of the problem, we have confirmation that in the early period, recovery rates are high. However, in the late period after a stroke, the onset of muscle spasticity significantly limits the motor capabilities of patients and complicates the recovery process. In the late period, the effectiveness of methods to overcome spasticity has not been fully developed, and attention is not focused on the complications that arise and accompany them throughout the recovery period. The appearance of muscle spasticity significantly limits the motor capabilities of patients, affects the psycho-emotional state of a person, and causes pain, which prevents the full use of the affected limb. Muscle spasticity inhibits and complicates the restoration of motor function in the long term. Conclusions. The study confirms the high effectiveness of the proposed methods of evidence-based medicine in reducing pain and increasing the range of motion in the shoulder, elbow, and wrist joints in the early period in patients after stroke. As for the late period, this issue remains incomplete and requires further study. In the palliative care unit of Kyiv City Clinical Hospital № 6, an individual multidisciplinary approach to patients after stroke was used, which contributed to the achievement of the goals. It can be stated that evidence-based medicine methods for the acute and early period have a positive effect on patient independence, and improve cognitive function and motor activity of the affected limbs.

Application to help physiotherapists in the evaluation of pelvic dysfunctions after cervical cancer

Resumo Introdução O câncer de colo do útero é causado pela infecção persistente por alguns tipos de papilomavírus humano e o seu tratamento envolve quimioterapia, radioterapia e cirurgia, podendo ocasio-nar diferentes disfunções no assoalho pélvico. Desta forma, a fisioterapia tem papel importante na avaliação e tratamento das disfunções pélvicas decorrentes do tratamento oncológico. Objetivo Desenvolver uma tecnologia digital em formato de aplicativo para auxiliar fisioterapeutas na avaliação de disfunções pélvicas após câncer de colo do útero. Métodos Trata-se do desenvolvimento de uma tecnologia digital em formato de aplicativo, que foi realizado após aprovação do Comitê de Ética em Pesquisa do Núcleo de Medicina Tropical. O instrumento foi elaborado por fisioterapeutas com expertise e experiência na área. Os pesquisadores realizaram reuniões para finalizar o processo de criação do checklist, e o aplicativo foi programado em ambiente Androide Studio. Ao final, o aplicativo foi avaliado por duas fisioterapeutas especialistas na área. Resultados O aplicativo criado apresenta cinco capítulos abordando sintomas de disfunção urinária, função sexual, função anal, dor e alterações como linfedema, estenose vaginal e fibrose vaginal. Conclusão A utilização do aplicativo poderá auxiliar os profissionais fisioterapeutas na avaliação de disfunções pélvicas após câncer de colo do útero.

Aplicativo para auxiliar fisioterapeutas na avaliação de disfunções pélvicas após câncer de colo do útero

Abstract Introduction Cervical cancer is caused by a persistent infection with some types of human papillomavirus (HPV), and its treatment entails chemotherapy, radiotherapy and surgery. This may cause different kinds of dysfunction in the pelvic floor. Hence, physiotherapy plays an important role in the evaluation and treatment of urogynecological dysfunctions occasioned by the oncological treatment. Objective To develop a digital technology in application format to help physiotherapists in the assessment of pelvic dysfunctions after cervical cancer. Methods A digital technology in application format was developed after approval from the Ethics in Research Committee of the Tropical Medical Center. The instrument was developed by a physiotherapist with expertise and experience in the area. The researchers held meetings to finalize the creation of the checklist, and the application was programmed using the Android Studio Environment. In the end, the application was evaluated by two physiotherapist experts in the field. Results The application created displays five sections addressing the symptoms of urinary dysfunction, sexual function, anal function, pain and alterations such as: lymphedema, vaginal stenosis and vaginal fibrosis. Conclusion The use of the application may help physiotherapists in the assessment of pelvic dysfunctions after cervical cancer.

Evaluasi KIPPas (Kartu Instrumen Prediktor Pangastuti) Jogja sebagai Instrumen Prediktor Disfungsi Dasar Panggul Pasca Persalinan Vaginal

Background: Postpartum pelvic floor dysfunction is pelvic floor disorder, which can be in the form of pelvic organ prolapse, urinary problem, defecation problem or sexual dysfunction. The incidence of postpartum pelvic floor dysfunction occurs in 46% of postpartum women. Until now, there is no standard instrument used to estimate the incidence of postpartum pelvic floor dysfunction. In previous studies, an instrument was obtained, namely KIPPas Jogja, to estimate the incidence of pelvic floor dysfunction after delivery, but it was still not sufficient for the number of research samples needed.Objective: To evaluate the Pangastuti Jogja Predictor Instrument Card (KIPPas Jogja) as a predictor of pelvic floor dysfunction in the form of pelvic organ prolapse after vaginal delivery.Method: This study was a prospective cohort study. Subjects who gave vaginal delivery were examined according to the KIPPas Jogja instrument and then evaluated for the diagnosis of pelvic floor dysfunction in the form of pelvic organ prolapse with POPQ examination and complaints of pelvic floor dysfunction using the PFDI and FSFI instruments at 3 months postpartum.Results and Discussion: From 133 research subjects, the results of the KIPPas Jogja assessment are high risk in 42.9% of subjects and low risk in 57.1% of subjects. The incidence of pelvic floor dysfunction in the form of pelvic organ prolapse was found in 69.17% subjects. Complaints of pelvic floor dysfunction were present in 20.31% subjects and complaints of sexual dysfunction in 11.3% subjects. The sensitivity of KIPPas Jogja is 80% and specificity is 95% with a positive predictive value of 97% and a negative predictive value of 68% to detect pelvic dysfunction in the form of pelvic organ prolapse. Meanwhile, to predict complaints of pelvic floor dysfunction, measured with PFDI-20, the sensitivity was 93% and specificity was 52%, and the positive predictive value was 33% and the negative predictive value was 96%. To predict sexual dysfunction, KIPPas obtained sensitivity of 64%, specificity of 42% with a positive predictive value of 10% and a negative predictive value of 92%.Conclusion: KIPPas Jogja can be used as a predictor of postpartum pelvic floor dysfunction. Keywords: postpartum pelvic floor dysfunction, KIPPas Jogja, POPQ, PFDI-20, FSFI

Poruchy pánevního dna u žen z pohledu koloproktologa

Summary: Disorders of the pelvic floor and anorectal dysfunction are a major cause of discomfort for many women. As a result of shyness and embarrassment, women come for medical examination after a longer period of difficulties, mostly for progressive disorder of defecation and continence. Despite the low morbidity, anorectal dysfunctions have a very significant impact on patient’s quality of life and therefore dia­gnosis and subsequent treatment should be aimed at every possible cause. Gastroenterological examination can play an important part In primary detection, but also in the multidisciplinary dia­gnostic process of pelvic floor pathology. Likewise, coloproctology is an integral part of the dia­gnostic-therapeutic algorithm of pelvic dysfunctions. The aim of the article is to provide information on the pathophysiology, dia­gnosis and treatment of anorectal disorders from the perspective of coloproctology. Anorectal dysfunctions are a multidisciplinary problem, therefore, to achieve good treatment results, the cooperation of different specializations is essential. Key words: anorectal dysfunction – defecation – prolapse – rectocele – incontinence – rectopexy

Pelvic floor muscle training for conservative treatment of urinary incontinence and erectile dysfunction after radical prostatectomy: a review of literature

Gytis Makarevičius 1 Faculty of Medicine, Vilnius University, Vilnius, Lithuania Abstract Both, urinary incontinence (UI) and erectile dysfunction (ED) reduce person’s quality of life. Current research shows, that pelvic floor muscle training (PFMT) might lessen pelvic dysfunction symptoms. Aim: To present the current epidemiology of pelvic floor muscle dysfunction in radical prostatectomy (RP) patients and […]

Female Sexual Dysfunctions and Urogynecological Complaints: A Narrative Review.

Female sexual dysfunctions represent a real widespread problem, usually faced from a psychological point of view; however, millions of women worldwide are impacted by pelvic floor dysfunction, personal shame and social taboos, however, continue to inhibit free conversation on the subject. Women’s quality of life is considerably improved by screening, diagnosing, and controlling urogenital and sexual issues. This review aims to provide a critical perspective of urogenital conditions and common disturbances in female sexual function associated with these issues. It also includes a discussion of postpartum pelvic dysfunction.

Guillain — Barré syndrome following asymptomatic COVID-19 in an adolescent: a clinical case

Guillain — Barré syndrome (GBS) is a rare disease that occurs with an approximate incidence of 1.7 cases per 100,000 children in the pediatric population. The gender difference in the prevalence of the disease is characterized by a 20% greater vulnerability of boys than girls. The exact cause of Guillain — Barre syndrome is unknown; however, it can occur after respiratory infection by Haemophilus influenzae, recent or ongoing Campylobacter jejuni infection or poliovirus. Since the beginning of the COVID-19 pandemic, there have been some reported Guillain — Barré diagnoses among adults following SARS-CoV-2 infection. The article describes a clinical case of an adolescent girl who was admitted to the Regional Municipal Non-Profit Facility “Chernivtsi Regional Children’s Clinical Hospital” with signs of flaccid paraplegia of the lower extremities, pelvic dysfunction and paraparesis of the upper extremities after she had suffered a sudden severe pain syndrome. She had previously been diagnosed with asymptomatic SARS-CoV-2. Initial complex investigations were as follows: high white blood cells count, elevated levels of procalcitonin (PCT), C-reactive protein and D-dimer, low SARS-CoV-2 IgM level and positive IgG titer, high levels of protein in spinal fluid. Electroneuromyography findings and nerve conduction test of lower extremities showed decreased M amplitude and H reflex response. The patient received oxygen therapy, hemodynamic support, cardiac support (infusions and inotrope therapy), gradual antibacterial therapy and was administrated with intravenous normal human immunoglobulin. She was also treated with a short course of parenteral glucocorticoids, vasoactive neurometabolites, nootropics, anticholinesterases, non-steroidal anti-inflammatory drugs along with physical therapy and massages. The patient began demonstrating slow but positive improvement in her limb motor functions and sensitivity within one month.

Cerebral microangiopathy according to magnetic resonance imaging of the brain in patients undergoing longterm programmed hemodialysis

Introduction. Cerebral microangiopathy (CMA), being the leading cause of vascular cognitive impairment and strokes, has a number of causes, among which chronic kidney disease (CKD) and programmed hemodialysis (HD) are the least studied.Purpose of the study: to determine the frequency of CMA neuroimaging markers and risk factors for its development in patients receiving renal replacement therapy for a long time using the programmed HD.Material and methods: the study involved 70 patients who had been on programmed HD for 10 months or more. Clinical neurological examination, laboratory tests and brain MRI were performed. The analysis of CMA neuroimaging markers was carried out in accordance with the STRIVE recommendations. Cerebral Small Vessel Disease Score (CSVDS) was used to quantify the overall severity of MR imaging markers of CMA.Results. Among 70 examined (29 men and 41 women) aged 53.0 ± 14.2 years, average HD experience – 70.0 ± 39.5 months, the main clinical manifestations of CMA were cognitive impairment (82.9%, n = 58), emotional disorders (61.4%, n = 43), sleep disorders (38.6%, n = 27), pseudobulbar syndrome (17.1%, n = 12), walking disorders (8.6%, n = 6), acute lacunar syndromes (7.1%, n = 5) and pelvic dysfunction (4.3%, n = 3). CMA neuroimaging markers of varying severity were found in 100% of cases. Expansion of perivascular spaces (100%, n = 70) and white matter hyperintensities (81.4%, n = 57) prevailed in the structure of CMA imaging markers. Cortical atrophy (67%, n = 47), cerebral microbleeds (47%, n = 33), asymptomatic lacunae (35.7%, n = 25) and minor subcortical infarctions (2.9%, n = 3) were less common. Mild CMA (1–2 points on the CSVDS scale) was determined in 38 patients (54.3%), severe CMA (3–4 points on the CSVDS scale) – in 32 patients (45.7%). The presence of uncontrolled arterial hypertension (OR 1.85, p &lt; 0.05), intradialysis hypertension (OR 2.8, p &lt; 0.05), dialysis vegetative polyneuropathies (OR 2.75, p &lt; 0.05), type 2 diabetes mellitus (OR 5.7, p &lt; 0.05) and the experience of programmed HD (more than 50 months) (OR 3.1, p &lt; 0.05) were prognostic signifi cance for the development of severe CMA in dialysis patients.Conclusion. All patients with end-stage CKD who have been on programmed HD for a long time are shown to undergo the brain MRI in order to timely diagnose CMA imaging markers and possible correction of therapy.

Total pelvic organ prolapses and its surgery with meses: Adventure or cure?

Total pelvic organ prolapse is a condition that is frequently seen in elderly women and presents with defecation and urinary system dysfunctions and impairs quality of life. Study objective: While preparing this study with its results, our aim was to evaluate the positive effect of minimally invasive repair with mesh on impaired organ functions, anatomy and quality of life in patients with obvious pelvic organ prolapse. Design: Among the people who applied to the gynecology and proctology outpatient clinic within a certain time period, the files of the patients with complaints stated below were scanned. The determined parameters were collected and evaluated prospectively. Statistical study was done with SPSS 15.0. Patients: The patients were those who applied to the gynecology and proctology outpatient clinic. Patients with complaints of vaginal/pelvic fullness, constipation, fecal incontinence, and prominent vaginal tissue prolapse between the legs were selected to participate in the study. Measurement and main results: Laparoscopic promontofixation was performed on 8 patients with overt pelvic organ prolapse (POP-Q III and IV), among those who applied to the outpatient clinic with complaints of pelvic fullness, pain, difficult urinating, constipation or overt organ prolapse between 2015-19. Pelvic dysfunction, difficult urination and defecation function of these patients were evaluated. Pelvic organ distress, urinary distress, and colorectal distress inventory questionnaires were administered to the patients before and during follow-up and the measurements were compared. Complications related to surgery and recurrence was also monitored during follow-up. In those patients followed for an average of 29.5 months. Surgical recurrence was observed in one patient and various surgical complications were observed in 4/8 patients. At the end of the comparative evaluation of the questionnaires, it was determined that the patients' pelvic function and difficult urination improved with surgery. However, an improvement could not be demonstrated in defecation function. Conclusion: Laparoscopic promontofixation should be kept in mind as a surgical method that can provide functional improvement in selected patients with overt pelvic organ prolapse.

Idiopathic longitudinally extensive myelitis: a brief historical excursion (review) and own clinical observation

Background: Idiopathic longitudinally extensive transverse myelitis is defined as a focal spinal cord lesion that involves three or more segments of the spinal cord as shown by neuroimaging, and results in a profound disability. The clinical picture of a patient with idiopathic longitudinally advanced transverse myelitis is often dramatic and may consist of paraparesis or tetraparesis, sensory disturbances, and pelvic dysfunction. Idiopathic longitudinally advanced transverse myelitis is a common manifestation of the neuromyelitis optica spectrum disorders, but can also occur in various other autoimmune and inflammatory diseases of the CNS, such as multiple sclerosis, sarcoidosis, or Sjogrens syndrome, or in infectious diseases involving the CNS. It is less likely to occur in isolation, as the only manifestation of a demyelinating disease of the nervous system of an unknown etiology (idiopathic myelitis).&#x0D; Clinical case description: The clinical observation presented in the article demonstrates the difficulties of establishing a nosological diagnosis in the case of a monophasic course of TM in the absence of other autoimmune and infectious diseases of the central nervous system. The patient with idiopathic longitudinally distributed TM had no visual disturbances and no antibodies to aquaporin 4 and to myelin oligodendrocyte glycoprotein (MOG-IgG) with twice repeated tests.&#x0D; Conclusion: In this regard, it is important to dynamically monitor the clinical manifestations and MRI signs in patients with an isolated lesion of a demyelinating nature in the form of longitudinally extensive transverse myelitis.