Pubic Pain Research Articles

Assessment of the quality of life of pregnant women with pubic and lower back pain when using kinesiotaping

Physiologically determined changes in the musculoskeletal system during pregnancy lead to the development of pain syndrome in the pubic area and lower back, which in turn lead to a decrease in the quality of life. Materials and methods: Evaluation of the effectiveness of kinesiotaping in symphysiopathy and dorsopathy during pregnancy with respect to the level of quality of life using the validated SF-36 questionnaire "Quality of Life Assessment", the Oswester questionnaire of disability in lower back pain and the Roland – Morris questionnaire "Lower Back pain and disability". Results: In both groups (control and observation), there is a decrease in the level of individual components of quality of life, while the "Physical component" has statistically significant differences between the groups, excluding "Role functioning due to physical condition", which shows a higher level of quality of life in group 2. When assessing the Psychological component, statistical differences between the groups were not revealed it was. According to the results of statistical analysis conducted on the basis of the Oswestry questionnaire, the level of quality of life in group 2 was also significantly higher than in group 1. According to the Roland-Morris questionnaire, it was revealed that despite the higher level of quality of life in group 2, confirmed in our study, disorders in both groups they are still defined as expressed. The most common complaints that reduce the quality of life in pregnant women with pain in the womb and lower back were also identified. Conclusions: Since the quality of life is an integral indicator of most aspects of life, this indicator can be considered the most successful for evaluating the effectiveness of treatment.

Urologic Morbidity in Surgery of Placenta Accreta Spectrum in Universitas Andalas Hospital

Background: Hysterectomy for placenta accreta spectrum disorders is known to be associated with urologic morbidity, including intentional or unintentional cystostomy, ureteral injury, and bladder fistula. Case: A 32year old woman with urine retention post total hysterectomy on indications placenta accreta spectrum Grade 3 type 4 S2 segment- 9 days ago, referred to Universitas Andalas Hospital. The patient complained difficulty to urinate, hematuria and supra pubic pain. Physical examination sign of acute abdomen unclear. A Pelvic abdominal ultrasound was performed, the result were Acites and complex acites, left renal hydronefrosis, cystitis and sludge gallblader. From the laboratory result found anemia, leucocytosis, trombositosis, ureum, creatinine and albumin were in normal limit, hyponatremia, hypokalemia, hypocalsemia. The patient were given antibiotics, blood transfusion and natrium, kalium and calcium correction. Cystoscopy was performed to explore the bladder, the result were found adhesion and ruptured at the posterior wall of the bladder a long 3 cm then proceed with laparotomy to repair the bladder and adhesiolisis. During hospitalization, the patient’s condition was good, hemodynamics was stable with sufficient diuresis. The patient was discharged on day 4 after laparotomy of bladder repair with temporary urine catheter installed. Discussion: This patient diagnose previously is placenta accreta spectrum with percreta graded so had a high risk of urologic morbidity. The bladder ruptured occurred after 9th day of hysterectomy. This can occur because the injury during dissection of the uterine vesicular fold undergoes necrosis and then become opens on the 9th day after hysterectomy. A multidisciplinary team should be made in management of placenta accreta spectrum. A team comprising a consultant maternal fetal medicine with pelvic surgery experienced, a blood bank team, an anesthesiologist, a urologist skilled, an interventional radiologist and an experienced neonatologist is advised. Keywords: urologic complication, placenta accreta, urologic morbidity

History of pain around the lumbopelvic region during perinatal period: a prospective cohort study.

Many women experience pain around the low back and pelvic girdle during/after pregnancy. These pains have different risk factors and require independent management strategies. Therefore, an epidemiological database is required to understand when each type of pain occurs, and how serious it could be. Thus, the history of pain in the lumbopelvic region throughout the perinatal period was investigated. The information of 170 women recruited at the obstetrics and gynecology clinics in Japan was collected at 12, 24, 30, and 36weeks of pregnancy, in the early days after childbirth, and one month after childbirth. The presence and severity of sacroiliac joint pain, pubic pain, groin pain, and low back pain were assessed using a numerical rating scale. Descriptive statistics were used to determine changes in the prevalence of pain. In addition, the change in the severity of each type of pain was observed through descriptive statistics, by including only those who had pain. The sacroiliac joint pain showed a twofold increase from 12 to 24weeks, while the pubic pain suddenly increased after 24weeks. The severity of pubic and groin pain increased sharply during pregnancy. Regarding low back pain, the change in the severity was lesser than the other pains. The sacroiliac joint pain was the highest among the four pains during pregnancy. Each type of pain had a different incidence rate and a different time of onset and aggravation. These results help women and health professionals to manage, and prevent these harmful symptoms.

Prevalence of Symphysis Pubis Dysfunction in Pregnant Women

Pregnancy is a period when a woman’s body leads to various musculoskeletal issues including Symphysis Pubis Dysfunction (SPD). The term symphysis pubis dysfunction refers to a collection of distressing symptoms that occur in the pelvic area and cause limitation while performing activities of daily living. Objective: To find the Prevalence of symphysis pubis dysfunction in pregnant women. Methods: From June 2022 to January 2023, following a duration of 6 months, a descriptive cross-sectional study was conducted on 267 pregnant women aged 20-35 years. Those with pelvic pain during any trimester were enrolled from gynecology department of Riphah International Hospital and Al-Khidmat Razi Hospital, Rawalpindi. Participants meeting inclusion criteria were evaluated for symphysis pubic pain based on specific criteria, including (signs and symptoms, palpation, and diagnostic tests like the Positive Patrick Faber and Trendelenburg tests). Pain severity was assessed using visual analogue scale. Results: Out of 267 participants, 32% participants were diagnosed with symphysis pubis dysfunction while 68% participants did not have SPD. The most prevalent symptoms are turning over in the bed (79 %), bending down (75%), and standing on one leg (71%) which is mostly reported by the majority of women in the third trimester with moderate pain perception. Conclusions: Study concluded the notable prevalence of SPD with the most prevalent symptoms turning over in the bed, bending down, and standing on one leg. These symptoms were predominantly noted among women in the third trimester, accompanied by a moderate level of pain.

Chronic Pubalgia in a Young Adult Managed by Iliohypogastric and Ilioinguinal Nerve Blocks

Chronic pubic pain is a commonly occurring problem in young males who are engaged in high-intensity physical activities such as sportsmen and army recruits among others. We would like to discuss a similar case of pubalgia which occurred in a 20-year-old male who is an avid athlete. The patient had reported multiple times to the hospital and was admitted and evaluated thoroughly. He was kept on nonsteroidal anti-inflammatory drugs and pregabalin for about a month. Despite this aggressive pain management, the patient continued to have continuous pain in his left groin. Due to his pain and inability to perform physically, the patient went into depression. After a thorough clinical evaluation, we offered the patient an ultrasound-guided iliohypogastric and ilioinguinal nerve block which resulted in the complete disappearance of his symptoms within a week, and he was able to return back to his regular training.

MP42-14 BIOLOGIC MESH BUTTRESS WITH VERTICAL RECTUS ABDOMINIS MUSCLE FLAP TO REESTABLISH PELVIC INTEGRITY DURING CYSTECTOMY FOR ANTERIOR URINARY FISTULA

You have accessJournal of UrologyCME1 Apr 2023MP42-14 BIOLOGIC MESH BUTTRESS WITH VERTICAL RECTUS ABDOMINIS MUSCLE FLAP TO REESTABLISH PELVIC INTEGRITY DURING CYSTECTOMY FOR ANTERIOR URINARY FISTULA Syed M. Alam, Jordan Stiverson, and Hadley Wyre Syed M. AlamSyed M. Alam More articles by this author , Jordan StiversonJordan Stiverson More articles by this author , and Hadley WyreHadley Wyre More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003280.14AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Post-radiation puboprostatic and pubourethral fistulae are devastating conditions, and surgical intervention remains highly morbid. Here, we describe a novel technique using a mesh buttress and vertical rectus abdominis muscle flap (VRAM) to restore pelvic integrity during cystectomy for anterior urinary fistulae. METHODS: Patients having undergone cystectomy with ileal conduit were identified in a prospectively maintained database. Those having undergone VRAM harvest with placement of a mesh buttress for anterior urinary fistula were selected for analysis. Following supratrigonal cystectomy, all patients underwent a left-sided VRAM harvest. After the bladder plate was fulgurated, a biologic mesh was tailored to the pelvic defect and sutured to the posterior trigone. It was then incorporated circumferentially around the levator muscles and anteriorly to the pubic bone and underside of rectus fascia. Prior to circumferential closure of the underlying space, a VRAM flap was secured in the pelvis. The remainder of the mesh was then secured, creating a tunnel for the flap pedicle. Surgical metrics and post-operative outcomes were evaluated using descriptive statistics. RESULTS: Between 2019-2021, eleven patients underwent this technique, of which five carried a diagnosis of post-radiation anterior urinary fistula with pubic osteomyelitis. The median age was 73 years, and all patients were male. Three patients previously underwent radical prostatectomy, all of whom underwent subsequent endoscopic intervention for vesicourethral anastomotic stenosis. One patient underwent transurethral resection of the prostate after radiation. One patient had no prior surgical history. Median operative time was 387 minutes and median blood loss was 500cc. Average length of stay was five days. No patients developed an immediate post-operative complication. All patients had positive intra-operative bone cultures. No patients reported persistent pubic, groin, or thigh pain after surgery. No fistula recurrence occurred at a median follow-up of 264 days. CONCLUSIONS: The use of a mesh buttress in conjunction with pelvic VRAM flap is a novel technique designed to restore pelvic integrity for patients undergoing cystectomy for an anterior urinary fistula. Source of Funding: N/a © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e573 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Syed M. Alam More articles by this author Jordan Stiverson More articles by this author Hadley Wyre More articles by this author Expand All Advertisement PDF downloadLoading ...

Left Pubic Tuberculosis Was Misdiagnosed as Synovitis of the Left Hip

A 51-year-old male patient was admitted to hospital with “1 week of restricted movement in left hip pain.” The patient denied trauma and had no other specific discomfort. Slightly reduced weight and physical strength, normal diet. No previous history of tuberculosis or exposure. Admission examination: no obvious abnormalities in the appearance of the spine, no tenderness and percussion pain. Left groin tenderness (+), left hip and buttock percussion pain (+), left 4-word experiment (+). Admission to complete relevant investigations: consider infectious lesions of the left pubic bone. After admission to the hospital and standardized treatment of tuberculosis, the patient's left pubic pain was significantly improved.

Magnetic resonance imaging-guided high-dose planned adaptive intensity-modulated radiation therapy for locally advanced cervical cancer

Magnetic resonance imaging-guided radiotherapy can accurately irradiate moving targets such as cervical cancer. An 82-year-old woman with locally advanced cervical cancer was referred for palliative radiotherapy. She had refused chemotherapy and brachytherapy, so she was treated with external beam radiotherapy to control her uterine bleeding and to alleviate pubic pain. Since her cervical cancer had no metastases, and she was expected to survive for a long time, curative doses of radiation (70–80 Gy/28 fractions) were administered by magnetic resonance imaging-guided planned adaptive intensity-modulated radiation therapy. Six months after intensity-modulated radiation therapy, the tumor disappeared without adverse events, and her symptoms were relieved. To the best of our knowledge, this is the first report of locally advanced cervical cancer treated with high-dose magnetic resonance imaging-guided adaptive intensity-modulated radiation therapy.

Traditional Siddha Medicinal Herbs Used in the Treatment Urinary Tract Infection (Muthira Kiricharam)- A Narrative Review

Urinary tract infection is one the commonest bacterial infection in clinical practice. The infection mostly occurs in the lower part of urinary tract i.e., urinary bladder and urethra in which women are commonly affected due to the anatomical variation in urethra. UTI are primarily caused by gram-negative bacteria, but gram-positive bacteria may also be involved. The most common pathogen is Escherichia coli with the frequency rate of 33%, followed by Klebsiella pneumoniae (11%), Staphylococcus aureus (22.2%), Pseudomonas sp. (7.4%). UTI is commonly represented with the symptoms related to cystitis and pyelonephritis such as dysuria (painful urination), increased frequency of urine, supra pubic discomfort and pain in flanks, etc. As per Siddha text, UTI can be correlated with the terms Muthira kiricharam which has other synonyms such as Neer surukku, Neer kadupu etc. Various herbs have been mentioned in Siddha literatures for the treatment of UTI. The main aim of this review is to summarize the scientific evidences supporting the medicinal herbs mentioned in Siddha text for the treatment of UTI.

Management of prostatosymphyseal fistula following photoselective vaporization of the prostate: Case series and systematic review of the literature.

Background:This study is aimed to describe our institutional experience and review the literature to date on prostatosymphyseal fistula (PSF), or puboprostatic fistula, following bladder outlet procedures such as transurethral resection of the prostate (TURP) or laser photoselective vaporization of the prostate (PVP).Materials and methods:We retrospectively queried our institutional experience for management of PSF following PVP performed for symptomatic benign prostatic hyperplasia. We also performed a systematic literature review for PSF following PVP or TURP. Finally, we describe our surgical approach to the management of this challenging condition.Results:We identified 7 cases of PSF following PVP from our institution, as well as an additional 7 cases following PVP and 9 cases following TURP from literature review. The diagnosis of PSF was made between 0.5 and 24 months following PVP, and the most specific symptoms were pubic pain and difficulty ambulating. Most patients requiring several evaluations before the diagnosis was made using appropriate imaging studies. Seventy percent of patients required surgical intervention including fistula repair or prostatectomy. Our surgical approach has evolved, and we now routinely perform robotic fistula repair with Y-V plasty and interposition flap with excellent results.Conclusions:Puboprostatic fistula is a rare and poorly described complication of PVP or TURP. To the best of our knowledge, this case series of PSF following PVP represents the largest series to date and doubles the number of reported cases in the literature. Robotic fistula repair with interposition of either peritoneal or perivesical fat flaps appears to be a viable management strategy.

Septic arthritis and osteomyelitis of the pubic symphysis – a retrospective study of 26 patients

Introduction: Septic arthritis and osteomyelitis of the pubic symphysis (SAS) are rare conditions with nonspecific symptoms leading to diagnostic delay and treatment. Aim: We draw awareness to this condition elucidating the diagnostic procedures, surgical intervention and antibiotic management. Methods: This entail a retrospective follow-up study of 26 consecutive patients, median age of 71 years (range: 48–89) surgically treated for septic arthritis of the pubic symphysis between 2009 and 2020. Patient files, diagnostic imaging and bacterial cultures were evaluated. Results: Before diagnosed with SAS, 21 of the patients had previous pelvic surgery (16 due to malign conditions, 5 due to benign conditions), while 5 of the patients were not previously operated. Median follow-up period after SAS surgery was 18.5 months (range: 8 to 144.5 months). Dominating symptoms were severe suprapubic/pubic pain ( 26), gait difficulties ( 10) and intermittent fever ( 9). Diagnostic delay was between 1 and 12 months. The diagnostic imaging included magnetic resonance imaging (MRI) ( 24), computer tomography (CT) ( 17) and/or PET-CT ( 10), predominantly displaying bone destruction/erosion of the symphysis ( 13), abscess ( 12) and/or fistula ( 5) in the adjacent muscles. All patients underwent surgical debridement with resection of the symphysis and received a minimum of 6 weeks antibiotic treatment. Fourteen patients presented with monocultures and 4 patients with polycultures. Five patients underwent at least one revision surgery. Twenty-three patients experienced postoperative pain relief at 6 weeks follow-up, and 19 patients were ambulant without walking aids. Conclusion: SAS are rare conditions and should be suspected in patients with infection, pubic pain and impaired gait, especially after pelvic surgery. Bone infection, abscess and fistula near the symphysis can be visualized with proper imaging, most frequently with MRI. For most patients in this cohort surgical debridement combined with a minimum of 6 weeks antibiotic treatment resulted in pain relief, improved walking ability and a low recurrence rate.

Mechanical Influence of Pubic Nonunion on the Stress Distribution After Curved Periacetabular Osteotomy: Patient-Specific Three-Dimensional Finite Element Analysis

BackgroundPubic nonunion after curved periacetabular osteotomy (CPO) reportedly occurs in 1%-17% of patients and causes pubic pain in 21%. Furthermore, pubic nonunion is associated with a risk of ischial ramus stress fracture, but the mechanical influence of pubic nonunion has not been fully clarified. MethodsPatient-specific finite element (FE) analysis was performed using Mechanical Finder software. Three FE models (pre-CPO, union, and nonunion models) were constructed from preoperative and postoperative computed tomographic data. The contact area (mm2) and contact pressure (MPa) in the hip joint as well as the equivalent stress (MPa) at the ischial ramus were evaluated among the 3 FE models. ResultsPatient-specific FE models were generated using 18 consecutive hips treated with CPO. The mean contact pressure in the hip joint was not significantly different between the union and nonunion models (0.50 ± 0.10 vs 0.50 ± 0.09 MPa, P = .88). However, the mean equivalent stress at the ischial ramus in the nonunion models was 1.7 times higher than that in the union models (1.13 ± 0.77 vs 0.64 ± 0.45 MPa, P < .01). ConclusionFE analysis revealed that pubic nonunion did not affect the mechanical distribution in the hip joint itself but increased the mean equivalent stress at the ischial ramus. This finding suggests the importance of achieving pubic union after CPO to avoid the risk of ischial ramus stress fracture.

An Overview: Antibiotic Sensitive Pattern in Urinary Tract Infection

Urinary tract infections (UTIs) are the inflammatory disorders of the urinary tract caused by the abnormal growth of pathogens. Urinary tract infections can be community acquired or nosocomial. Symptoms of UTIs such as fever, burning sensations while urinating, LAP, itching, formation of blisters and ulcers in the genital area, genital and supra pubic pain, and pyuria generally depend on the age of the person infected the location of the urinary tract infected. E.coli is the major etiologic agent in causing UTI, which accounts for up to 75%-90% of cases whereas Staphylococcus saprophyticus causes an estimated 5 - 1 5% of UTIs frequently in younger women. P. mirabilis, Klebsiella species, P. aeruginosa and Enterobacter species are less frequent offenders. Less commonly, Enterococci, G. vaginalis and U. urealyticum are also known agents in UTIs. Due to the rapidly evolving adaptive strategies of bacteria, the etiology of UTI and antibiotic resistance profile of bacterial uropathogens have changed considerably over the past years, both in community and nosocomial infections. Treatment of UTIs cases is often started empirically and therapy is based on information determined from the antimicrobial resistance pattern of the urinary pathogens.

Repetitive Musculoskeletal Injuries: A Survey of Female Adult Reconstruction Surgeons

BackgroundOccupational injuries are a prevalent and costly problem for orthopedic surgeons, especially arthroplasty surgeons performing physically demanding and repetitive tasks. The purpose of this study was to characterize occupational musculoskeletal injuries in female adult reconstruction surgeons. MethodsA prospective survey about workplace musculoskeletal injuries was distributed to female attending adult reconstruction surgeons in May 2020. Participants were identified using subspecialty membership data, social media, and personal contacts. Results were analyzed using descriptive statistics. ResultsOf the total 63 female arthroplasty surgeons who responded, 65.1% were 30-45 year old, and 42.9% were within 5 years of practice, 68.3% sustained an occupational musculoskeletal injury, most commonly forearm/wrist/hand (79.1%), shoulder (48.8%), and low back (44.2%); 10.0% of reported occupational injuries not related to pregnancy resulted in the surgeon requiring time off work, while 48.2% required temporary modifications of job performance, and 10.9% required surgical treatment. Of the injured surgeons who reported having been pregnant, 65.4% reported a workplace exacerbation of a pregnancy-related musculoskeletal condition, including low back pain (52.9%), pubic symphysis pain (35.3%), and carpal tunnel syndrome (29.4%). ConclusionA total of 68.3% of female arthroplasty surgeons reported occupational musculoskeletal injuries, predominately forearm/wrist/hand, with a portion of those requiring modifications of job performance. Musculoskeletal injuries may be mitigated by performing repetitive tasks ergonomically, correcting posture, using appropriately sized instrumentation, and using automated or lighter instruments, to potentially avoid modifications to job performance, time off work, or even surgical procedures. Further studies should investigate factors that contribute to injuries in arthroplasty surgeons and how they can be prevented.

Association Among Pelvic Girdle Pain, Diastasis Recti Abdominis, Pubic Symphysis Width, and Pain Catastrophizing: A Matched Case-Control Study.

ObjectivePregnancy-related pelvic girdle pain (PGP) may persist or occur postpartum and negatively affects women’s lives. There is uncertainty regarding the association between the structures of the bony pelvis, diastasis recti abdominis (DRA), pain processing, and PGP and to what extent these factors should be considered during physical therapy. This study aimed to evaluate the differences between women with and without PGP shortly after delivery regarding the separation of a pubic symphysis, DRA, and pain catastrophizing.MethodsWomen diagnosed with PGP 24 to 72 hours after vaginal delivery were matched to pain-free controls according to age and parity. Ultrasound evaluations of diastasis recti (interrecti distance [IRD]) during rest and curl-up task and pubic symphysis (interpubic width) were performed. The Pain Catastrophizing Scale was used to assess the level of catastrophizing. A special Cox regression model was used to fit a conditional logistic regression for a 1:2 matched case–control study.ResultsThirty-five women with clinically diagnosed PGP and 70 matched controls were included in the study. The PGP group had a significantly higher pre-pregnancy body mass index than the control group. After adjusting for body mass index in multiple conditional logistic regression, the interpubic distance (odds ratio = 1.64; 95% CI = 1.22 to 2.20) and IRD during curl-up (odds ratio = 2.01; 95% CI = 1.08 to 3.74) were significantly associated with PGP. Pain catastrophizing and IRD at rest were not associated with PGP in univariable or multivariable analysis.ConclusionsPain catastrophizing is similar for women with and without PGP early postpartum. However, the degree of the pubic symphysis and rectus abdominis separation during the curl-up task are positively associated with PGP shortly after delivery.ImpactThis study indicates that a reconsideration of the way we look at DRA is warranted. The development of a more comprehensive assessment including objective measurements and a biopsychosocial understanding is needed to inform directions for further postpartum physical therapy.

Arthroscopically assisted minimally invasive symphysioplasty for the treatment of pubic related groin pain

Therapy of pubic related groin pain via minimally invasive symphysioplasty. Therapy of refractory pubic related groin pain based on osteitis pubis. Groin pain from causes other than pubic related groin pain. After aminimally invasive approach, an incision in the anterior capsule is made while protecting the dorsal capsule parts and the arcuate pubic ligament. The symphysis end plates are remodeled arthroscopically assisted using asurgical burr. The newly created pubic symphysis joint is filled with autogenous fibrin to support the formation of anew discus interpubicus. Partial weight-bearing for 4weeks with 20 kg using crutches is recommended. During the first 4weeks the range of motion should be restricted. Since2010, 10athletes (7men, 3women; average age 34.1 ± 7.8 (23-47) years) have undergone arthroscopically assisted minimally invasive symphysioplasty and treatment of femoroacetabular impingement syndrome. The average follow-up time was 5.1 (2-9) years. All patients returned to their sport level. The mean preoperative Nonarthritic Hip Score (NAHS) of 64.4 ± 15.1 (32.1-86.5) points improved to amean postoperative NAHS of 91.4 ± 9.8 (62.4-98.75) points (p < 0.0001). The average patient satisfaction (scale0 to10; 10highest satisfaction) was 9.8 ± 0.4 (9-10).

360 Genital Fat Transfer.

This study was designed to evaluate utility of transferring autologous adipose-derived mesenchymal stem cells with high regenerative capacity and adipose tissue derived-stromal vascular fraction, so-called 360 Vaginal Beautification technique, in labia majora augmentation and vaginal tightening operation. A total of 97 female patients who underwent labia majora augmentation and vaginal tightening operation with 360 Vaginal Beautification technique were included. Post-discharge early (3rd and 7th postoperative day) and late (1st and 3rd postoperative month) surgical complications were assessed , while the Female Genital Self-Image Scale (FGSIS) was applied before surgery and also during postoperative 6-12 months. All complications noted on postoperative 3rd day (ecchymosis of labia majus, ecchymosis of clitoral hood, tenderness in the pubic area and pain at the vaginal entrance points) regressed on postoperative 7th day with no infection, edema, lipoma or granuloma formation in any patient. Total mean FGSIS score was 17.7±1.6 in the pre-operative period, and increased significantly to 20.9±1.4 and 22.2±1.8 in the postoperative 6th month (p<0.001) and 12th month (p=0.013), respectively. The use of autologous fat, called 360 vaginal beautification, in the labia majora augmentation and vaginal tightening appears to be a safe technique due to use of autologous tissue transfer and to be associated with high satisfaction rate and an advantage of being more minimally invasive than surgical labia majora augmentation and vaginal tightening. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine Ratings, please refer to Table of Contents or online Instructions to Authors www.springer.com/00266 .

Effect of pregnancy exercises and education on pregnancy related musculoskeletal discomforts

Aim. Women experience significant physiological and anatomical adaptations during pregnancy to meet the maternal and foetal demands. Biomechanical and hormonal factors, ligament laxity, posture and weight gain may put lot of stress on musculoskeletal system which may in turn induce various musculoskeletal symptoms in pregnancy. Most of the women believe that physical activity during pregnancy is harmful to maternal and foetal health, which results reduction in their routine physical activity. Physical inactivity during gestational period leads to various maternal discomforts and complications. The purpose of this study is to evaluate the effect of structured antenatal exercise programme and education on pregnancy related musculoskeletal discomforts. Material and Methods. Total of 186 mothers were recruited for the study. 94 Participants were selected as the study group samples and 92 were chosen as the control group .The study group received structured antenatal classes and education in addition to routine antenatal care whereas the control group received routine antenatal care and exercises. Antenatal classes were conducted as individualised therapy for the interventional group along with routine antenatal care from 20th week of gestation. The primary outcome measure was pregnancy induced musculoskeletal dysfunction scale (PMDS scale). PMDS scale was assessed at 20, 24 and 32 weeks. Results and Discussion. There was a significant difference in the values of low back pain, symphysis pubic pain, knee pain, pelvic girdle pain and edema at 32 weeks (p value p&lt; 0.05). Exercise during pregnancy increased the β endorphin levels and decrease the perception of pain and pregnancy induced musculoskeletal symptoms. Conclusion. The antenatal exercise programme and education were found to be effective in reducing pregnancy induced musculoskeletal dysfunction. Hence we suggest the pregnancy exercise and education programme in routine antenatal care to improve maternal quality of life.

Diastasis of the rectus abdominis muscles in postpartum: Concordance of patient and clinician evaluations, prevalence, associated pelvic floor symptoms and quality of life

ObjectivesThe main objective was to assess the reliability of the patient's measurement of diastasis. The secondary aims were the estimation postpartum diastasis prevalence, of diastasis-associated pelvic floor symptoms and quality of life immediately after childbirth and at 3−6 months postpartum. Study designUsing a prospective observational design, women who gave birth in a French university hospital were eligible. After a learning phase, both clinician and patient conducted a clinical evaluation of diastasis. Then, patients were asked to complete the HerQLes, the FPFQ and a general questionnaire. Three to 6 months later, patients completed the same questionnaires online and performed a clinical evaluation of diastasis at home, as learned previously. ResultsOf 253 patients included in the study, 139 (54.9 %) completed the questionnaires at 3–6 months of follow-up. There was good correlation between clinician and patient evaluations of diastasis (kappa coefficient 0.76 [95 % CI, 0.5−0.7]). Immediately after childbirth, 210 (83 %) of the women presented diastasis including 116/210 (55 %) cases of severe diastasis and 51 (42 %) of those had persistent diastasis at 3−6 months of follow-up. Cesarean section (p = 0.05) and multiparity (p = 0.04) were factors of persistent diastasis. Severe diastasis had a significant impact on quality of life (HerQLes score) at birth (p = 0.001) and at 3−6 months (p = 0.01), but no effect on pelvic floor symptoms according the FPFQ. The occurrence and severity of diastasis did not significantly impact lumbar or pubic symphysis pain. Furthermore, the aesthetic discomfort felt by patients was significantly increased by the presence of diastasis on a numerical scale at 3−6 months (p = 0.03). ConclusionGood agreement between clinician and patient evaluations of postpartum diastasis indicated that the evaluation method is reliable. Persistent diastasis was associated with impaired quality of life.

V12-12 ROBOTIC METASTATECTOMY WITH EXTRACTION INCISION AND NATURAL ORIFICE INTRAOPERATIVE RADIATION THERAPY

You have accessJournal of UrologyBladder Cancer & Urinary Diversion (V12)1 Apr 2020V12-12 ROBOTIC METASTATECTOMY WITH EXTRACTION INCISION AND NATURAL ORIFICE INTRAOPERATIVE RADIATION THERAPY Ahmad Shabsigh* Ahmad Shabsigh*Ahmad Shabsigh* More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000957.012AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Open excision of intra-abdominal recurrent malignancies with intraoperative radiation therapy (IORT) is usually a complex and morbid procedure. The objective of this video is to report the outcome of our early experience in robotic excision of abdominal localized malignant recurrences with IORT. METHODS: Retrospective analysis of 4 consecutive patients who underwent robotic resection of localized intra-abdominal malignant recurrences and IORT at a single institution between 2015 and 2018. Wide robotic excision was performed in standard fashion. Three patients underwent IOPRT using a cone inserted through a small extraction incision and the female patient had transvaginal IORT. Intraoperative and postoperative outcomes were assessed. Peri/postoperative complications were reported according Clavien-Dindo classification system. RESULTS: 3 male patients with history of recurrent rectal cancer in the pelvis and one female patient with recurrent urethral adenocarcinoma were included. Complete resection was achieved for all patients. Average estimated blood loss was minimal. No patients needed IV narcotics. One patient developed postoperative ileus and significant prolonged pubic bone pain after discharge that eventually resolved. Average hospitalization was 1.3 days compared to 7.4 days for open surgery. 75% of patients had local disease control for at least 1 year after surgery. CONCLUSIONS: Robotic excision of localized recurrent malignant neoplasms with IORT is feasible, safe and may offer better outcomes. Experienced robotic urologic oncologists are essential to develop these multidisciplinary programs Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e1114-e1114 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ahmad Shabsigh* More articles by this author Expand All Advertisement PDF downloadLoading ...