Pelvic Dysfunction Research Articles

Dissection of the inferior mesenteric vein versus of the inferior mesenteric artery for the genitourinary function after laparoscopic approach of rectal cancer surgery: a randomized controlled trial

BackgroundTotal Mesorectal Excision (TME) is the standard surgical technique for the treatment of rectal cancer. However, rates of sexual dysfunction ofup to 50% have been described after TME, and rates of urinary dysfunction of up to 30%. Although other factors are involved, the main cause of postoperative genitourinary dysfunction is intraoperative injury to the pelvic autonomic nerves. The risk is particularly high in the inferior mesenteric artery (IMA). The aim of this study is to compare pre- and post-TME sexual dysfunction, depending on the surgical approach usedin the inferior mesenteric vessels: either directly on the IMA, or from the inferior mesenteric vein (IMV) to the IMA.MethodsProspective, randomized,controlled study of patients with rectal adenocarcinoma with neoadjuvant chemoradiotherapy, who will be randomly assigned to one of two groups depending on the surgical approach to the inferior mesenteric vessels. The main variable is pre- and postoperative sexual dysfunction; secondary variables are visualization and preservation of the pelvic autonomic nerves, pre- and postoperative urinary dysfunction, and pre- and postoperative quality of life. The sample will comprise 90 patients, 45 per group.DiscussionThe aim is to demonstrate that the dissection route from the IMV towards the IMA favors the preservation of the pelvic autonomic nerves and thus reducesrates of sexual dysfunction post-surgery.Trial registrationEthical and Clinical Research Committee, Parc Taulí University Hospital: ID 017/315. ClinicalTrials.gov TAU-RECTALNERV-PRESERV-2018 (TRN: NCT03520088) (Date of registration 04/03/2018).

The OptiLUTS trial: improving care for therapy-resistant symptoms of the pelvis in Belgium

ABSTRACT Introduction/Background The management of therapy-resistant lower urinary tract symptoms (LUTS) and symptoms resulting from pelvic organ dysfunctions are subject to a high variability in the Belgian health-care centres. Practical guidelines and standardized patient clinical care pathways are often lacking and unadapted to the Belgian healthcare system. Objectives The OptiLUTS trial aims to improve the multidisciplinary care of therapy-resistant symptoms of the pelvis in the Belgian healthcare setting. Project A aims for the improvement of knowledge of 2nd line treatments for LUTS among general practitioners. In project B a treatment algorithm for the overactive bladder syndrome and non-obstructive urinary retention will be developed specifically for Belgium. In Project C a patient customized sacral neuromodulation (SNM) care pathway will be set up. Methods Part A: Explorative study among general practitioners by distribution of a questionnaire. Part B: Review of existing guidelines and use of the Delphi method to obtain expert consensus. Part C: A single center comparative study to compare outcomes before and after implementation of the SNM care pathway. Patients scheduled for the first stage of Interstim therapy™ will be included (N=100). Primary endpoints are the sensitivity and specificity of a new pelvic symptom assessment tool, the conversion to implant and explantation rates. Conclusion There is a margin for improvement in the care process of patients with therapy-resistant symptoms of the pelvis in the Belgium healthcare system. In the OptiLUTs trial adapted guidelines and a clinical care pathway will be developed to standardize and increase the efficiency of care. Trial registration Approval for the trial by the Ethics Committee of the Ghent University hospital: EC/2018/0244.

Тренировка мышц тазового дна после родов для профилактики дисфункции тазовых органов: проспективное моноцентровое открытое рандомизированное исследование

Тренировка мышц тазового дна после родов для профилактики дисфункции тазовых органов: проспективное моноцентровое открытое рандомизированное исследование

Reintegration needs of young women following genitourinary fistula surgery in Uganda

Introduction and hypothesisGenitourinary fistulas (usually arising following prolonged obstructed labor) are particularly devastating for women in low-income counties. Surgical repair is often difficult and delayed. While much attention has been devoted to technical surgical issues, the challenges of returning to normal personal, family, and community life after surgical treatment have received less scrutiny from researchers. We surveyed young Ugandan women recovering from genitourinary fistula surgery to assess their social reintegration needs following surgery.MethodsA cross-sectional survey of 61 young women aged 14–24 years was carried out 6 months postoperatively. Interviews were carried out in local languages using a standardized, interviewer-administered, semistructured questionnaire. Data were entered using EpiData and analyzed using SPSS.ResultsOngoing reintegration needs fell into interrelated medical, economic, and psychosocial domains. Although >90% of fistulas were closed successfully, more than half of women had medical comorbidities requiring ongoing treatment. Physical limitations, such as foot drop and pelvic muscle dysfunction impacted their ability to work and resume their marital relationships. Anxieties about living arrangements, income, physical strength, future fertility, spouse/partner fidelity and support, and possible economic exploitation were common. Sexual dysfunction after surgery—including dyspareunia, loss of libido, fear of intercourse, and anxieties about the outcome of future pregnancies—negatively impacted women’s relationships and self-esteem.ConclusionsYoung women recovering from genitourinary fistula surgery require individualized assessment of their social reintegration needs. Postoperative social reintegration services must be strengthened to do this effectively.

325. Model: Pelvic muscle pressure is the missing link in pregnancy hypertension

Hypothesis Placental ischemia/hypoxia is NOT the major initiating event in the pathogenesis of preeclampsia. It is pelvic muscle pressure. Methods During my Winston Churchill Memorial Trust traveling fellowship to explore how to prevent trauma to pelvic floor muscles during birth, I conducted a review of the literature published between 1990 and 2017 investigating classification, assessment, and (physiotherapeutic) treatment of pelvic dysfunction and muscle physiology and biomechanics during pregnancy and postpartum. Expert opinions with biomedical engineers and muscle physiologists were also sought via interviews. Findings Studies revealed a conceptual model where muscles in the pelvic area become chronically tense (a high tone pelvis) because of multifactorial insults antepartum and postpartum. Pressurizing the pelvis and culminating in raised blood pressure. A triad of interrelated insults were identified which are mothers being encouraged to do Kegels with no relaxation component. The growing number of mothers with emotional stress disorders which manifest physically as tense muscles especially those in the pelvic region. And thirdly postural adaptations of pregnancy such as lumbar lordosis and anterior pelvic tilt being amplified by mothers poor lifestyle practices such as prolonged sitting, wearing heels and inadequate breathing causing shortened piriformis, quadriceps and other pelvic region muscles. Creating an unstable pelvis and compensatory spasm of antagonist muscles such as the pelvic floor to try and balance the pelvis.These tight or spasmed pelvic muscles are not just dysfunctional, but theoretically left unused their blood vessels become stiff resisting blood flow and causing volume overload at the heart, with a compensatory heart rate and blood pressure increase. Conclusion We are dealing with a pelvic pressure issue, not just a blood pressure one. A silent epidemic of tight pelvic muscles should be considered as a major initiating event in the pathogenesis of pregnancy hypertension in a significant number of mothers. Further studies are needed in this exciting area.

Autonomic nervous system of the pelvis - general overview.

Autonomic nervous system of the pelvis is still poorly understood. Every year more and more pelvic procedures are carried out on patients suffering from different pelvic disorders what leads to numerous pelvic dysfunctions. Authors tried to review, starting from historical and clinical background, the most important reports on anatomy of the pelvic autonomic plexuses. We also pay attention to complete lack of knowledge of students of medicine on the autonomic nervous structures in the area studied. We present anatomical description of the pelvic plexuses including their visceral branches and anatomy of surrounding pelvic tissues which still remains unclear. More and more attention is paid to the topography of the plexuses specially because of new pain releasing techniques - neurolysies.

Functional outcomes of nerve-sparing laparoscopic eradication of deep infiltrating endometriosis: a prospective analysis using validated questionnaires.

Radical eradication of deep infiltrating endometriosis (DIE) is associated with a high risk of iatrogenic autonomic denervation and pelvic dysfunction. Our aim was to prospectively analyze peri-operative details and post-operative functional outcomes (in terms of pain relief and bladder, rectal, and sexual function) among women operated for DIE of the posterior compartment with nerve-sparing technique, using the visual analogue scale and validated questionnaires. All women undergoing laparoscopic nerve-sparing eradicative surgery for DIE nodules of the posterior compartment ≥ 4cm ± bowel resection were included. Pain scores [using Visual Analogue Scale (VAS) scores] were collected before surgery and 6 and 12months after surgery. Functional outcomes in terms of bladder, rectal, and sexual function, were evaluated using validated questionnaires (i.e., ICIQ-UISF, NBD score, and FSFI) administered pre-operatively and 6months after surgery. A total of 34 patients were included. Twenty-eight (82.4%) of them had already undergone a previous abdominal surgery for endometriosis. Bowel resection was performed in 16 (47.1%) patients. Median VAS score levels of pelvic pain were significantly decreased after surgery both at 6 (median 3, range 0-7 and 2, 0-7, respectively) and at 12months (3, 0-8 and 2, 0-7), compared to pre-operative levels (9, 1-10 and 3, 0-7, respectively) (p < 0.0001). No differences were found in terms of urinary function between pre- and post-operative ICIQ-SF questionnaires. In no cases, bladder self-catheterization was needed at the 6-and 12-month follow-up. Median NBD score was 3.5 (0-21) pre-operatively and 2 (0-18) after 6months (p = 0.72). The pre-operative total FSFI score was 19.1 (1.2-28.9) vs. 22.7 (12.2-31) post-operatively (p = 0.004). The nerve-sparing approach is effective in eradicating DIE of the posterior compartment, with satisfactory pain control, significant improvement of sexual function, and preservation of bladder and rectal function.

Initiating a women's health physician–run rehabilitation clinic in the United States

Pelvic dysfunction can lead to persistent impairment and disability when left untreated. While some diagnoses overlap with those seen in a general Physical Medicine and Rehabilitation (PM&R) outpatient setting and Obstetrics/Gynecology (Ob/Gyn), management varies with changes in biomechanics and function in contexts of fecundity, gravidity, post-partum status, post-menopause, history of surgical intervention, or history of sexual trauma. PM&R initiated a collaboration with Ob/Gyn to create a physician-run Women's Health Rehabilitation specialty clinic embedded within an established Ob/Gyn clinic at an academic university hospital in the United States. The clinic focuses on pelvic floor disorders and musculoskeletal issues associated with pregnant or post-partum women. Over 50 referrals were made from Ob/Gyn in the initial months of clinic launch. Diagnoses included low back pain and sacroiliac joint dysfunction related to pregnancy, pelvic floor instability, dyspareunia, post-partum thoracic back pain, and coccydynia. Management included education of biomechanics, referral to Pelvic Floor-specialized Physical Therapy (PFPT), medications, referral to Psychology, and injections. Despite significant enthusiasm from Ob/Gyn and the patients, initial referrals were delayed due misunderstanding regarding difference between PM&R and PT, failure to recall initiation of clinic, and flawed protocol with ancillary staff on scheduling process. Despite infrastructure of a large academic institution in a metropolitan area, there was a paucity of availability of PFPT multiple sites within the academic affiliation or the metropolitan area. Comprehensive Women's Health Rehabilitation lead by physiatrists can address biomechanical issues, treat pain, perform interventional procedures, and coordinate care with PFPT and other professionals to address contributing factors, like mood disturbances and life situations. Our clinic aim is to expand collaborations with increased marketing, face-to-face interaction, and visibility at multidisciplinary events. We expect to increase referral sources and numbers as well as educate more of the medical community about our specialty.

Uroneurology

The function of the pelvic organs, including the lower urinary tract (LUT), is controlled by a complex network of nerves. This leaves patients with neurologic disease vulnerable to LUT and pelvic organ dysfunction. Physicians often come across urogenital complaints in their patients with neurologic disease, the symptoms of which can result in significant distress and loss of dignity and quality of life. Due to the health and economic burden that accompanies neurogenic pelvic organ dysfunction, it is important for clinicians to understand the common forms of dysfunction, essential investigations, and modes of management. This chapter covers bladder dysfunction from a physician’s perspective. Topics include neurologic control of the LUT, large bowel, and sexual functions; male and female sexual response; neurogenic bladder dysfunction and its management; diagnostic evaluation; management of neurogenic sexual dysfunction; management of erectile dysfunction; ejaculatory dysfunction; sexual dysfunction in women; and fecal incontinence. Figures illustrate efferent innervation of the LUT, neurologic detrusor overactivity, a urethral pressure profile in a patient with Fowler syndrome, an example bladder diary, an example bladder scan, and normal and obstructed flow patterns. Tables list common causes of injury at the suprapontine, suprasacral, and infrasacral levels and storage and voiding systems. This chapter contains 6 highly rendered figures, 2 tables, 53 references, 1 teaching slide set, and 5 MCQs.

The influence of foot hyperpronation on pelvic biomechanics during stance phase of the gait: A biomechanical simulation study.

Despite the theoretical link between foot hyperpronation and biomechanical dysfunction of the pelvis, the literature lacks evidence that confirms this assumption in truly hyperpronated feet subjects during gait. Changes in the kinematic pattern of the pelvic segment were assessed in 15 persons with hyperpronated feet and compared to a control group of 15 persons with normally aligned feet during the stance phase of gait based on biomechanical musculoskeletal simulation. Kinematic and kinetic data were collected while participants walked at a comfortable self-selected speed. A generic OpenSim musculoskeletal model with 23 degrees of freedom and 92 muscles was scaled for each participant. OpenSim inverse kinematic analysis was applied to calculate segment angles in the sagittal, frontal and horizontal planes. Principal component analysis was employed as a data reduction technique, as well as a computational tool to obtain principal component scores. Independent-sample t-test was used to detect group differences. The difference between groups in scores for the first principal component in the sagittal plane was statistically significant (p = 0.01; effect size = 1.06), but differences between principal component scores in the frontal and horizontal planes were not significant. The hyperpronation group had greater anterior pelvic tilt during 20%-80% of the stance phase. In conclusion, in persons with hyperpronation we studied the role of the pelvic segment was mainly to maintain postural balance in the sagittal plane by increasing anterior pelvic inclination. Since anterior pelvic tilt may be associated with low back symptoms, the evaluation of foot posture should be considered in assessing the patients with low back and pelvic dysfunction.

Development and psychometric evaluation of ICIQ-PadPROM: A quality of life questionnaire to assess the treatment effect of absorbent continence products.

To describe the development and evaluation of the ICIQ-PadPROM, the first self-reported quality of life questionnaire to assess the treatment effect of absorbent continence products, a new addition to the set of ICIQ modules providing international standardized assessment of lower pelvic dysfunction. Developed in four phases, question items semi-structured interviews were conducted with pad using men (n = 19), women (n = 6), with secondary analysis undertaken on transcripts (n = 15 women) from a previous study. Validity of a draft 67 item questionnaire was tested through cognitive debriefing interviews (n = 34) and postal survey (n = 239). Reliability was evaluated by 65 users with a 3 week interval between completions. Expert opinion and factor analysis were used to reduce the final questionnaire to 17 scored and 3 unscored items. The questionnaire comprises four scored domains: Pad design and Physical Effects (seven items), Psychological Effects (four items), Social Effects and Pad Leakage (three items) and Burden of Pad Use (three items), plus three unscored items. Levels of missing data ranged from 0 to 7.6%, with fair-to-moderate agreement. The Cronbach's alpha coefficient for all question items was 0.91 and factor analysis was undertaken to reduce redundancy. Existing incontinence-related outcome tools measure change in symptoms and quality of life impact. The ICIQ PadPROM questionnaire is the first to measure the impact of absorbent continence products on quality of life in the absence of any change in symptoms and will help policy-makers, clinicians, industry, and researchers to evaluate different products designs and materials for different patient populations.

Pathogenetic determinants of endometrial dysfunction in patients with myoma

Introduction. Among the patients with infertility associated with small forms of uterine fibroids (subserous and intra mural), there are a high incidence of inflammatory changes in the cervix, chronic salpingo-opharitis, hydrosalpinx, adhesive process in pelvic organs, chronic endocervicitis and endometrial dysfunction were identified more frequently.&#x0D; The aim of the study was to investigate the clinical and morphological features of endometrial dysfunction in patients with infertility associated with uterine myoma. Material and methods. The study included 165 patients: 70 patients with primary infertility, 65 women with secondary infertility and 30 patients in the control group. All patients were examined and treated in The Research Institute of Obstetrics, Gynecology and Reproductology named after D.O. Ott. Laparoscopic and hysteroscopic examination followed by endometrial biopsy was performed on the 19-24th day of the menstrual cycle. Immunohistochemical method was used to study the expression of ER, PR receptors, proinflammatory markers (CD8+, CD20+, CD4+, CD138+), endothelial marker (CD34+) and p16ink4a oncoprotein expression. Estimation of ER and PR expression was carried out by semi-quantitative method of H-Score, other markers, by computer image analysis system “Morphology 5.0” (VideoTest, Russia). Statistical processing of the results was performed using statistical packages (Stata 13).&#x0D; Results. In group of patients with infertility associated with small forms of subserous and intramural uterine myomas, pathognomonic signs of endometrial dysfunction were: high frequency of chronic endometritis, pathological activation of neoangiogenesis, positive expression of inhibitor of cyclin-dependent kinase p16ink4a, reduction of ER and PR expression in the stromal endometrial component, change in receptor affinity of sex steroid hormones.

GOUT WITH TOPHUS MIMICKING A TUMOR OF THE THORACIC SPINE

The paper describes a rare case of thoracic spine involvement in a 28-year-old patient with gout that was manifested by acute neurologic symptoms (lower extremity paresis with pelvic organ dysfunction) and that required emergency surgery. Similar cases that are previously described, including the possible variants of the clinical manifestations, tophus localization, surgical treatment, risk factors for axial tophus formation, are separately discussed.

Long-term functional outcomes of perineal gangrene: worse than expected?-an observational retrospective study.

For survivors of perineal gangrene (PG), quality of life and functional prognosis of pelvic functions are probably overestimated. The aim of this study was to report long-term anal and urinary sphincter dysfunctions, sexual sequelae, and patients' quality of life after treatment of perineal gangrene. This retrospective observational study was conducted in one university hospital over 16years. Seventy-three patients experienced PG; 22 were subject to long-term follow-up. Three questionnaires were sent to patients to assess pelvic dysfunction and quality of life: the GIQLI, the Cleveland Incontinence Score, and the USP score for urinary dysfunction. Sexual sequelae were considered if orchiectomy or penile resection for male patients and vulvar resection for female patients were performed. Of the 72 patients included, seven died before discharge (9.7%) and at least 14 died during follow-up (19.4%), despite a mean age of 62years (± 13). Among the surviving patients, seven experienced an alteration of their quality of life (44%) (GIQLI < 96). Six patients still had a colostomy, and among the remaining patients, 11 experienced minimal to mild incontinence (68.7%), while one experienced constipation (6.2%). One patient suffered from urinary incontinence (4.5%), and six suffered from dysuria (27.3%). Three male patients (14%) underwent an orchiectomy, and one female patient (100%) underwent a vulvar resection. PG leads to a high rate of anal and urinary dysfunctions. Urinary dysfunctions are taken into account and treated; however, anal incontinence is not investigated even though it could lead to decreased quality of life.

Aging and the Pelvic Floor

To define the unique effects of age on the pelvic floor muscle and to outline current treatments of pelvic floor dysfunction in the older population. Aging has muscular, hormonal, and neurological effects on the pelvic floor that may lead to pelvic floor dysfunction. Muscular changes lead to decreased force output and weakness on clinical examination. Hormonal effects exacerbate pelvic tissue changes, most notably in the postmenopausal woman. Neurological changes are less well-defined, but gradual denervation of the pelvic floor, especially noted in parous women, has been implicated as a possible cause of pelvic floor weakness and dysfunction. Medical treatments include pessaries, medications, implanted electrical stimulation, and surgery. Pelvic floor physical therapy, including strength training and coordination training, as well as pain-relieving modalities at the level of the pelvic floor muscle, is an effective conservative management option for older adults with pelvic floor dysfunction. The literature available regarding treatment of pelvic floor dysfunction is more robust for older females compared to males. There are numerous unique considerations in the treatment of the older adult with pelvic floor dysfunction, due to muscular, hormonal, and neurological changes with age. Conservative management, including physical therapy, should be considered prior to surgical intervention. Further research is especially needed regarding the effects of age and the treatment of age-related pelvic dysfunction in the older male.

Oncologic effectiveness of nerve-sparing radical hysterectomy in cervical cancer.

ObjectiveNerve-sparing radical hysterectomy (NSRH) was introduced with the aim to reduce pelvic dysfunctions related to conventional radical hysterectomy (RH). Here, we sought to assess the effectiveness and safety of NSRH in a relatively large number of the patients of cervical cancer (CC) patients undergoing either primary surgery or neoadjuvant chemotherapy (NACT) followed by surgery.MethodsOutcomes of consecutive patients undergoing NSRH and of a historical cohort of patients undergoing conventional RH were retrospectively reviewed.ResultsThis study included 325 (49.8%) and 327 (50.2%) undergoing NSRH and RH, respectively. Via a multivariable model, nodal status was the only factor predicting for DFS (hazard ratio [HR]=2.09; 95% confidence interval [CI]=1.17–3.73; p=0.01). A trend towards high risk of recurrence was observed for patients affected by locally advanced cervical cancer (LACC) undergoing NACT followed by surgery (HR=2.57; 95% CI=0.95–6.96; p=0.06). Type of surgical procedures (NSRH vs. RH) did not influence risk of recurrence (p=0.47). Similarly, we observed that the execution of NSRH rather than RH had not a detrimental effect on OS (HR=1.19; 95% CI=0.16–9.01; p=0.87). Via multivariable model, no factor directly correlated with OS. No difference in early complication rates was observed between the study groups. Conversely, a significant higher number of late complications was reported in RH versus NSRH groups (p=0.02).ConclusionOur data suggested that NSRH upholds effectiveness of conventional RH, without increasing recurrence and complication rates but improving pelvic dysfunction rates.

Chronic sacral nerve electrostimulation in treatment of neurogenic pelvic organ dysfunction in children

the review aim is to describe the technique and results of chronic sacral neurostimulation in treatment of pelvic organ disorders in children, which have been reported in the international literature. An obligatory condition for application of chronic sacral neurostimulation (CSNS) is a positive clinical response to test electrostimulation of the S3 nerve root. The test period duration is 1-3 weeks. In the case of a positive effect, a permanent system is implanted for neurostimulation of the S3 nerve root. On treatment with CSNS, children with severe urinary incontinence had a significant decrease in the rate of incontinence episodes, and patients with urinary retention had no or reduced need for periodic catheterization. Therefore, the accumulated experience of using CSNS in children with spinal cord diseases indicates the need in further study of the technique capabilities for correction of pelvic organ dysfunctions.

Pelvic floor biofeedback therapy in pelvic floor diseases

Pelvic floor biofeedback therapy is safe and effective in chronic constipation, urinary incontinence, fecal incontinence and pelvic floor pain whereas the heterogeneous indication affects the efficacy evaluation and technical communication. The best indications are as follows: (1) Pelvic floor myogenic dysfunction without severe pelvic organ prolapse and severe neurogenic defect; (2) Patients have good mental cognition and treatment adherence who fulfill the training with the therapist. The training protocol is conducted at hospital or at home, and is as follows: (1) To help patients to target the pelvic floor muscles; (2) To improve the type I( muscle tonic contraction variability; (3) To improve the pelvic floor type I( and type II( muscles activity coordination; (4) To enhance the pelvic floor muscle strength and rectum defecation awareness. The biofeedback efficacy is evaluated with different symptoms, questionnaire score, patient satisfaction recognition and long-term outcomes. Pelvic floor biofeedback therapy will be highlighted and extended to the primary care in near future following the pragmatic randomized controlled clinical trials, collection and analysis of big data.

Is Bariatric Surgery a Prophylaxis for Pelvic Floor Disorders?

IntroductionObesity is one of the well-documented risk factors of pelvic floor disorders (PFDs). The PFDs include urinary and fecal incontinence (UI, FI) and pelvic organ prolapse (POP). Surgery-induced weight loss improves different kinds of incontinence as well as POP symptoms. However, there is a lack of evidence how bariatric surgery influences pelvic floor anatomy and function in women without previous PFDs and whether it may be concerned as PFD prophylaxis tool.Materials and MethodsThe present analysis is a prospective, non-randomized case-control study from January 2014 to September 2017. Participants underwent pelvic floor ultrasound examination with bladder neck position estimation at rest, during levator ani tension, and at Valsalva maneuver before surgery and 12–18 months after. Pelvic organ prolapse quantification (POPQ) > 2 stage and PFD complaints were the exclusion criteria.ResultsFifty-nine patients underwent bariatric surgery (57 sleeve gastrectomy and 2 gastric bypass). Mean BMI decreased from 43.8 ± 5.9 to 29 ± 4.6 kg/m2 after surgery (p < 0.001). Statistically significant higher position of the bladder neck at rest, during tension, and at Valsalva maneuver (p < 0.05) was shown after surgery. We did not demonstrate differences in bladder neck mobility and bladder neck elevation at tension after weight loss.ConclusionsBariatric surgery is associated with a betterment of bladder neck position at rest, tension, and Valsalva maneuver in women without PFDs. We postulate that bariatric surgery may be a tool for PFD prevention. It does not improve levator ani function and does not limit bladder neck mobility, which implicates that it has no influence on preexisting pelvic dysfunction.

Prognosis of surgical treatment of the tethered cord syndrome in children.

The aim of this study was to identify the factors relevant to the prognosis of the outcome of the surgical treatment of the tethered cord syndrome (TCS). The results of surgical treatment performed on 58 children with TCS were analyzed, with follow-up periods ranging from 6months to 5years. The data of preoperative clinical and instrumental examinations, as well as those of intraoperative electrophysiological diagnostics and morphometry, were compared with the dynamics of the TCS clinical presentation. The recovery rate was significantly higher in children with filum terminale abnormality (p=0.014), as well as grade I tethering (p=0.0037), and when the spinal cord tracts at the level of intervention were intact (p=0.018). Complete untethering (p=0.04) and a low threshold value of amperage in direct stimulation (<1mA) (p=0.016) were identified as factors for a favorable outcome. Worsening of neurological symptoms was more frequent in children operated over the age of 10 (p=0.03), when the TCS was manifested exclusively through the pelvic dysfunction (p=0.00004), if the F-wave block is less than 30% (p=0.0045) and the stimulation threshold during root mapping ranged from 1 to 5mA (p=0.01). The operation is recommended when structural changes are minimal. In case of severe structural changes, if the spinal cord tracts are intact, the indications for operation are determined by the risk of irreversible structural changes due to the natural course of the disease, although the risks are substantially higher.