Improvement In Subjective Symptoms Research Articles

Holmium Laser Enucleation of the Prostate Is Associated with Complications and Sequelae Even in the Hands of an Experienced Surgeon Following Completion of the Learning Curve

BackgroundHolmium laser enucleation of the prostate (HoLEP) is considered a challenging procedure even for surgeons who have completed the learning curve. ObjectivesTo assess outcomes and complications following HoLEP performed by a highly experienced surgeon. Design, setting, and participantsThis was a single-institution prospective study (NCT03583034) performed at a tertiary referral centre that included 243 consecutive patients with lower urinary tract symptoms (LUTS) due to benign prostatic enlargement (BPE) treated with HoLEP by a single experienced surgeon (>1600 cases). Outcome measurements and statistical analysisPatients were assessed using validated questionnaires and uroflowmetry at baseline and several follow-up dates. Intraoperative and postoperative complications were recorded. Kaplan-Meier analysis was used to estimate recovery rates for urinary continence and erectile function. Logistic regression models were constructed to assess predictors of postoperative complications. Results and limitationsOf the 243 patients, 78 (32.1%) had an indwelling urethral catheter. The median prostate volume (PV) was 87 cm3 (interquartile range 60–115) and 146 patients (59.8%) had PV >80 cm3. At 3-mo follow-up, 219 patients (90.1%) had a peak flow rate >20 ml/s and 182 (74.9%) had no postvoid residual urine. The improvement in subjective symptoms was significant at 1-mo follow-up and was maintained until 12 mo after surgery. Urinary continence recovery was slow, with an estimated rate of 68% (95% confidence interval [CI] 62–74%) at 1 mo and 94% (95% CI 91–97%) at 12 mo after HoLEP. The recovery rate for erectile function was 53% (95% CI 46–61%) at 1 mo and 85% (95% CI 77–90%) at 12 mo. Postoperative complications occurred in 36 patients (14.8%) during their hospital stay, in 34 (14%) within 1 mo following discharge from hospital, and in ten (4.1%) at later follow-up dates. Clinically significant complications (Clavien-Dindo ≥2) were observed in 44 cases (18%) and were more common for patients with an indwelling catheter at baseline (odds ratio 5.05; p = 0.006). ConclusionsHoLEP is an effective procedure for treating LUTS due to BPE, although it is not devoid of complications and sequelae, even in the hands of a highly experienced surgeon. Patient summaryHolmium laser treatment of the prostate to reduce its size has positive results for urinary function when performed by an experienced surgeon, even in complex cases, although there can be complications.

Long-term outcomes of fornix reconstruction and cicatricial entropion repair in ocular mucous membrane pemphigoid and drug-related secondary pemphigoid

ObjectifExaminer les résultats à long terme de la reconstruction du fornix oculaire et de la réparation de l'entropion cicatriciel en présence d'une pemphigoïde de la muqueuse oculaire (MMP, pour mucous membrane pemphigoid) et d'une MMP secondaire. MéthodesOn a procédé à un examen rétrospectif des dossiers médicaux de patients qui présentaient une MMP et qui devaient subir une reconstruction du fornix oculaire (greffe de membrane amniotique ou greffe de muqueuse buccale) ou une réparation de l'entropion cicatriciel (intervention de Wies) entre le 1er janvier 2000 et le 1er septembre 2020. La biopsie de la muqueuse des patients était positive et/ou ces derniers présentaient des caractéristiques cliniques typiques d'une MMP ou d'une MMP secondaire. Le paramètre primaire consistait en une réussite globale de la reconstruction du fornix oculaire mesurée par le maintien de sa profondeur lors de la dernière visite de suivi. La disparition du trichiasis, l'acuité visuelle et le soulagement des symptômes subjectifs comptaient au nombre des paramètres secondaires. RésultatsAinsi, 8 patients (10 yeux) présentant un diagnostic de MMP (3 hommes et 5 femmes; âge médian : 71 ans) et 4 patients (4 yeux) présentant un diagnostic de MMP secondaire (2 femmes et 2 hommes; âge médian : 87 ans) ont été admis à l’étude. La durée moyenne du suivi était de 22,7 mois (fourchette : 0,3–87,5 mois) dans le cas des patients présentant une MMP et de 15,4 mois (fourchette : 3,0–43,9 mois) dans celui des patients présentant une MMP secondaire. Dans le groupe MMP, 30,0 % des yeux ont fait l'objet d'une reconstruction du fornix oculaire, 60,0 % des yeux ont fait l'objet d'une réparation de l'entropion et 10,0 % des yeux ont subi les 2 formes d'intervention. La récurrence d'un symblépharon et la perte de la profondeur du fornix oculaire sont apparues dans tous les yeux qui présentaient une MMP en moyenne 6,4 ± 7,0 mois après l'intervention; le trichiasis avait réapparu chez tous les patients lors de la dernière visite de suivi. Chez les patients qui présentaient une MMP secondaire, 75,0 % des yeux ont présenté une récurrence du symblépharon, et 66,7 %, une récurrence du trichiasis. On a noté un soulagement à court terme des symptômes tant dans la MMP que dans la MMP secondaire. ConclusionsLa reconstruction du fornix oculaire et la réparation de l'entropion cicatriciel au sein de notre cohorte de patients présentant une MMP ou une MMP secondaire ont donné lieu à un soulagement à court terme des symptômes, mais une récurrence s'est produite en moyenne 6 mois après l'intervention.

MP13-15 HOLMIUM LASER ENUCLEATION OF THE PROSTATE IS ASSOCIATED WITH COMPLICATIONS AND SEQUELAE EVEN IN THE HANDS OF AN EXPERIENCED SURGEON

You have accessJournal of UrologyCME1 Apr 2023MP13-15 HOLMIUM LASER ENUCLEATION OF THE PROSTATE IS ASSOCIATED WITH COMPLICATIONS AND SEQUELAE EVEN IN THE HANDS OF AN EXPERIENCED SURGEON Francesco Montorsi, Paolo Capogrosso, Giuseppe Fallara, Eugenio Ventimiglia, Edoardo Pozzi, Federico Belladelli, Luigi Candela, Francesco Pellegrino, Federico Dehò, Andrea Salonia, and Alberto Briganti Francesco MontorsiFrancesco Montorsi More articles by this author , Paolo CapogrossoPaolo Capogrosso More articles by this author , Giuseppe FallaraGiuseppe Fallara More articles by this author , Eugenio VentimigliaEugenio Ventimiglia More articles by this author , Edoardo PozziEdoardo Pozzi More articles by this author , Federico BelladelliFederico Belladelli More articles by this author , Luigi CandelaLuigi Candela More articles by this author , Francesco PellegrinoFrancesco Pellegrino More articles by this author , Federico DehòFederico Dehò More articles by this author , Andrea SaloniaAndrea Salonia More articles by this author , and Alberto BrigantiAlberto Briganti More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003233.15AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Holmium laser enucleation of the prostate (HoLEP) is considered a challenging procedure. However, whether long surgical experience is able to improve peri- and post-operative outcomes is still unknown. We thus investigated results and complications after HoLEP performed by a highly experienced surgeon. METHODS: This is a single-institutional prospective study (NCT03583034) performed at a tertiary referral centre including 243 consecutive patients with lower urinary tract symptoms (LUTS) due to benign prostatic enlargement (BPE) treated with HoLEP by a single highly experienced surgeon (>1600 cases performed). Patients were assessed using validated questionnaires, PSA measurements and uroflowmetry at baseline and several follow-up dates. Intra- and postoperative complications were recorded and graded according to Clavien-Dindo (CD) classification. The Kaplan-Meier analysis estimated urinary continence (UC) (defined as no pad) and erectile function (EF) recovery rates. Logistic regression models assessed predictors of post-operative complications. RESULTS: Median (IQR) prostate volume (PV) was 87cc (60-115) with 146 (59.8%) patients having a PV>80 cc and 78 (32.1%) having an indwelling catheter at baseline. At 3-month follow-up, 219 (90.1%) patients had a peak flow rate >20 ml/s, and 182 (74.9%) had a null residual urine volume. Improvement in subjective symptoms as assessed with the IPSS was significant already at 1-month, and it was maintained until 12-month after surgery. UC recovery was slow with estimated rates of 68% (62-74%) at 1-month and 94% (91-97%) at 12-month post-HoLEP. Increased PV (HR 0.95; 95% CI: 0.91-0.99), incontinence at baseline (HR 0.45; 95% CI: 0.27-0.73) and a higher baseline IPSS (HR 0.97; 95% CI: 0.94-0.99) were predictors of worse UC recovery rates (all p<0.04). The EF recovery rates were 53% (46-61%) at 1-month and 85% (77-90%) at 12-month post-HoLEP. Post-operative complications were reported in 36 (14.8%) patients during hospital stay [CD-2: 14 (5.8%); CD-3: 1 (0.4%)], in 34 (14%) within one month post-discharge [CD-2: 17 (6.9%); CD-3: 1 (0.4%)] and in 10 (4.1%) at later follow-up [CD-2: 3 (1.2%); CD-3: 6 (2.4%)]. Severe complications (CD≥2) were more common in patients with indwelling catheter at baseline (OR: 5.05; p=0.006). CONCLUSIONS: A highly experienced surgeon is commonly referred complex cases of LUTS due to BPE. Although HoLEP remains an effective procedure, it is not devoid of complications and sequelae even in the hands of a surgeon with more than 1600 procedures completed. Source of Funding: No © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e179 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Francesco Montorsi More articles by this author Paolo Capogrosso More articles by this author Giuseppe Fallara More articles by this author Eugenio Ventimiglia More articles by this author Edoardo Pozzi More articles by this author Federico Belladelli More articles by this author Luigi Candela More articles by this author Francesco Pellegrino More articles by this author Federico Dehò More articles by this author Andrea Salonia More articles by this author Alberto Briganti More articles by this author Expand All Advertisement PDF downloadLoading ...

PD14-05 FACTORS ASSOCIATED WITH DISCONTINUATION OF ONABOTULINUM TOXIN-A THERAPY FOR OVERACTIVE BLADDER IN A DIVERSE URBAN POPULATION

You have accessJournal of UrologyCME1 Apr 2023PD14-05 FACTORS ASSOCIATED WITH DISCONTINUATION OF ONABOTULINUM TOXIN-A THERAPY FOR OVERACTIVE BLADDER IN A DIVERSE URBAN POPULATION Arshia Aalami Harandi, Mariel Liebeskind, and Nitya Abraham Arshia Aalami HarandiArshia Aalami Harandi More articles by this author , Mariel LiebeskindMariel Liebeskind More articles by this author , and Nitya AbrahamNitya Abraham More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003261.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Although overactive bladder (OAB) is a common condition affecting 16% of Americans, few patients continue second-line and third-line treatment. This study sought to investigate factors associated with discontinuation of intravesical Onabotulinom Toxin-A (BTX-A) injections among a diverse urban population. METHODS: This was a retrospective review of patients who underwent BTX-A injection for OAB at a university hospital between November 2015 and December 2021. Patients were considered to have discontinued BTX-A therapy if they only received one treatment and it had been more than 1 year since last date of service. Patients with neurogenic OAB were excluded. Patient demographics, past medical history, symptoms, and post-operative outcomes were compared between groups with Chi-squared, Student’s t-test, or Fisher’s exact test. RESULTS: BTX-A injections were administered to 272 patients who met study criteria of which 114 (41.9%) had discontinued BTX-A therapy. Our cohort included 235 (86%) women and had a mean age of 61.5 and mean BMI of 30.8. Patients discontinuing BTX-A therapy had a higher median income ($59K vs. $50K, p<.01) and were more likely to have reported nocturia (61.7% vs. 39.3%, p<.001). Patients who discontinued were less likely to have reported subjective improvement of symptoms at their first post-procedure visit (73.0% vs. 83.6%, p<.05). Similarly, patients who developed post-operative urinary retention were more likely to discontinue BTX-A therapy (17% retention in discontinuation group vs. 8% in those who continued p<.05). There were no associations between discontinuation and Race/Ethnicity, distance to clinic, smoking history, or post-operative urinary tract infections. CONCLUSIONS: Adverse outcome after BTX-A injection, such as post-operative urinary retention, is associated with discontinuation of therapy, whereas subjective improvement in symptoms is associated with continuation of therapy. Given the large proportion (>40%) of patients who discontinued BTX-A treatment, further research is needed to identify barriers to continuation of care. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e414 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Arshia Aalami Harandi More articles by this author Mariel Liebeskind More articles by this author Nitya Abraham More articles by this author Expand All Advertisement PDF downloadLoading ...

MP07-01 MESH-FREE MANAGEMENT OF APICAL PELVIC ORGAN PROLAPSE: A COMPARATIVE STUDY OF VAGINAL SACROSPINOUS FIXATION V ROBOTIC UTEROSACRAL LIGAMENT SUSPENSION

You have accessJournal of UrologyCME1 Apr 2023MP07-01 MESH-FREE MANAGEMENT OF APICAL PELVIC ORGAN PROLAPSE: A COMPARATIVE STUDY OF VAGINAL SACROSPINOUS FIXATION V ROBOTIC UTEROSACRAL LIGAMENT SUSPENSION Sandra Elmer, Omar Salehi, Niranjan Sathianathen, Jodie McDonald, Nathan Lawrentschuk, and Caroline Dowling Sandra ElmerSandra Elmer More articles by this author , Omar SalehiOmar Salehi More articles by this author , Niranjan SathianathenNiranjan Sathianathen More articles by this author , Jodie McDonaldJodie McDonald More articles by this author , Nathan LawrentschukNathan Lawrentschuk More articles by this author , and Caroline DowlingCaroline Dowling More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003222.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Pelvic organ prolapse (POP) significantly impacts quality of life for many women. Mesh sacral colpopexy (SCP) has a recurrence rate up to 23%, and vaginal procedures to correct apical POP up to 41%. After the FDA warnings and restrictions of transvaginal mesh, increasing concerns regarding mesh have resulted in a need for mesh-free alternatives. This study compares 2 mesh-free techniques, robotic/laparoscopic uterosacral ligament suspension (RUSL) and vaginal sacrospinous fixation (SSF) in managing apical POP. METHODS: A prospective clinical audit of 115 women with apical POP who underwent RUSL (n=61) or SSF (n=54) by a single surgeon. Demographic data included age, parity, and previous POP surgery. A pre-operative (preop) pelvic floor (PF) questionnaire was used to identify prevalence of bladder, bowel and vaginal symptoms. POP-Q was recorded at surgery and at post-operative (postop) reviews. The absolute change in POP-Q scores were recorded as objective measures of PF support. Other postop metrics used include symptomatic vaginal bulge, need for repeat POP surgery (reop) and subjective improvement in symptoms based on patient-reported outcome measures (PROMs). Postop adverse events (AE) were recorded (Clavien Dindo grading scale). Wilcoxon rank sum test, Pearson’s Chi-squared test and Fisher’s exact test were used to compare groups, and univariate analysis to predict factors for success/reop. RESULTS: Baseline demographics were similar (Table 1). Mean time from surgery was 736 (RUSL) and 565 days (SSF). Difference in postop C points was not significant (RUSL: median -8 (IQR 2), SSF: median -7cm (IQR 2), p=0.279). Procedure success rates (postop C point <0) were not different (RUSL 90.2%, SSF 92.5%, p=0.92). Reop rates for apical recurrence were SSF 1.9%, RUSL 6.6%, p=0.21; univariate odds ratio 0.26 [95% CI 0.03 to 2.43]. Univariate analysis for reop found that age, parity and surgery type were not predictors of reoperation (p=0.26, p=0.92, p=0.78). The most common postop AE was urinary tract infection (RUSL 10.2%, SSF 10.5%). CONCLUSIONS: RUSL and SSF are safe and effective mesh-free techniques for management of apical POP based on objective improvements in POP-Q score and PROMs. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e84 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sandra Elmer More articles by this author Omar Salehi More articles by this author Niranjan Sathianathen More articles by this author Jodie McDonald More articles by this author Nathan Lawrentschuk More articles by this author Caroline Dowling More articles by this author Expand All Advertisement PDF downloadLoading ...

V08-09 TRANSURETHRAL DORSAL BUCCAL GRAFT URETHROPLASTY FOR PROXIMAL FEMALE URETHRAL STRICTURES

You have accessJournal of UrologyCME1 Apr 2023V08-09 TRANSURETHRAL DORSAL BUCCAL GRAFT URETHROPLASTY FOR PROXIMAL FEMALE URETHRAL STRICTURES Francis Jefferson, Jonathan Warner, Maraika Robinson, and Brian Linder Francis JeffersonFrancis Jefferson More articles by this author , Jonathan WarnerJonathan Warner More articles by this author , Maraika RobinsonMaraika Robinson More articles by this author , and Brian LinderBrian Linder More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003306.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Treatment options for proximal female urethral strictures have significant limitations such as high recurrence rate (urethral dilation) and de novo stress urinary incontinence (flap/graft reconstruction). The objective of this video was to describe a novel dorsal inlay buccal graft urethroplasty technique that reduces technical difficulty and eliminates the need for urethral mobilization. METHODS: Stay sutures are placed at the urethral meatus, and a nasal speculum is placed into the urethra staying distal to the stricture. A beaver blade is then used to incise the urethra at the 12 o'clock, 10 o’clock, and 2 o’clock positions; these are superficial, non-full thickness incisions. A laparoscopic suture passing device is then used to pass a suture from the bladder to the urethral lumen at the 12:00 o'clock position. The suture is then passed through corresponding mid portion of the buccal graft ensuring that the mucosal side will be in the urethral lumen when the graft is deployed. This is repeated at the 10 o'clock and 2 o'clock positions with placement of the proximal suture at the level of the bladder neck and then through the corresponding location on the buccal graft. The graft is then parachuted into position at the level of the bladder neck. A laparoscopic knot pusher is then used to tie down the proximal sutures through the urethra. After trimming the excess buccal graft flush with the meatus, the distal aspect of the graft is sutured to the vaginal epithelium to recreate the urethral meatus. A wide-bore catheter is placed for 3 weeks postoperatively. RESULTS: In 6 consecutive patients treated with this technique with a median follow-up of 3.9 months, surgical success has been 100% as indicated by urethral patency on cystourethroscopy and subjective symptom improvement. There have been no cases of de novo stress urinary incontinence. Pre- and post-operative maximum urine flow rate (Qmax) and post-void residual volumes (PVR) are shown in the table. CONCLUSIONS: A transurethral inlay approach for dorsal buccal graft placement is a feasible option for management of female proximal urethral structure. Given decreased periurethral dissection compared to other techniques, this approach may decrease the risk of de novo stress urinary incontinence. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e751 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Francis Jefferson More articles by this author Jonathan Warner More articles by this author Maraika Robinson More articles by this author Brian Linder More articles by this author Expand All Advertisement PDF downloadLoading ...

The effect of single kinetic oscillation stimulation treatment on nonallergic rhinitis.

Kinetic oscillation stimulation (KOS) is a new treatment method for nonallergic rhinitis (NAR), usually delivered twice with a 2- to 4-week interval, and thought to stabilize autonomous dysregulation in the nasal mucosa. We aimed to assess the long-term (1 year) results following one KOS treatment amongst patients with NAR. KOS was administered through a latex balloon placed in the patient's nasal cavity. The balloon is connected to a device that fills the balloon with air pulses, thus vibrating the balloon for 10 min per side. Outcomes were evaluated through patient-reported outcome measures (Sino-Nasal Outcome Test 22 [SNOT-22], Total Nasal Symptom Score [TNSS], Nasal Obstruction Symptom Evaluation [NOSE], and 15D) and measures of patency (rhinomanometry, acoustic rhinometry, peak nasal inspiratory flow [PNIF], and clinical inferior turbinate size). Pre-treatment actions were repeated at 1, 3, 6, and 12 months. In all 49 patients, we found significant improvement in the SNOT-22, NOSE, and TNSS scores. At 12 months, SNOT-22 improved from 44 to 34, NOSE from 60 to 45, TNSS from 8 to 7, and PNIF from 80 to 100 L/min (p < .005 for all). We observed no major complications. One KOS treatment appears to provide NAR patients with a subjective symptom improvement for at least 1 year, thus possibly decreasing the need for invasive treatment methods. III.

Epiglottopexy in Infants Younger Than 6 Months Old: A Case Series.

Severe laryngomalacia, characterized by apnea, hypoxia, and feeding difficulties, is an uncommon diagnosis that often requires surgical intervention with supraglottoplasty. Children who require surgery at a young age and those with additional comorbidities pose a special challenge and may require further surgical interventions. Posterior displacement of the epiglottis has been noted in some infants with congenital stridor and is commonly treated with epiglottopexy. The goal of our study is to review the outcomes of epiglottopexy combined with supraglottoplasty in our cohort of infants younger than 6 months old with severe laryngomalacia. A retrospective chart review of infants younger than 6 months old who underwent epiglottopexy combined with supraglottoplasty for severe laryngomalacia from January 2018 to July 2021 at a tertiary care children's hospital. 13 patients (age 1.3 week-5.2 months) underwent supraglottoplasty and epiglottopexy for severe laryngomalacia and epiglottis retroflection. The patients were admitted to the intensive care unit and remained intubated for at least one night. All patients demonstrated subjective and objective improvement in upper airway respiratory signs and symptoms. Ten patients demonstrated aspiration immediately postoperatively, despite 4 of them having no concern for aspiration at preoperative evaluation. On follow-up, 1 patient required revision supraglottoplasty and epiglottopexy for persistent laryngomalacia, and 2 patients required tracheostomy tube placement due to cardiopulmonary comorbidities. Infants younger than 6 months old with medical comorbidities undergoing epiglottopexy with supraglottoplasty may demonstrate significant improvement in respiratory symptoms. Worsening dysphagia may complicate the postoperative period, particularly among children with medical comorbidities.

Flexible endoscopic Zenker's diverticulotomy - A retrospective review of outcomes in 75 patients

ObjectiveFlexible endoscopic Zenker's diverticulotomy (FEZD) is a procedure performed primarily by gastroenterologists for treatment of symptomatic Zenker's diverticulum (ZD). Given the lack of prior investigations with large sample sizes, we report on one of the largest series of patients who underwent FEZD. MethodsA review of patients who underwent FEZD at our institution from 2006 to 2021 was performed. Data were abstracted for patient demographics, clinical features, procedural characteristics, adverse events, and outcomes. ResultsA total of 75 patients (37 women) with mean age of 77.9 (33–102) years and mean (range) follow-up of 1.1 (0–13.2) years were identified. 67.9 % of FEZD cases were performed under general anesthesia. The mean procedure time was 37.1 min. Same day discharge and resumption of oral intake was seen in 56.4 % and 57.1 % of cases, respectively. Adverse events included intraprocedural bleeding (15.7 %) controlled with endoscopic means, infection (4.8 %) exclusively managed with antibiotics in all but one case, subcutaneous emphysema (2.4 %), and perforation (10.7 %) conservatively managed in all but one case. 97.6 % of patients had sustained subjective improvement in symptoms following their procedure. Fifteen patients (20 %) experienced recurrence after undergoing initial FEZD—26.7 % percent of whom were sufficiently treated with repeat FEZDs. Younger age was associated with recurrence (p < 0.01). ConclusionFEZD is an effective, safe procedure for the management of symptomatic ZD. It is a viable alternative for patients in whom otorhinolaryngological procedures via rigid endoscopy are not an option.

Outcomes following use of VersaWrap nerve protector in treatment of patients with recurrent compressive neuropathies.

Epineural scarring following previous carpal or cubital tunnel release can lead to pain and permanent dysfunction. To prevent this cascade, nerve wraps are an option. The purpose of this study was to evaluate outcomes following use of VersaWrap nerve protector during surgical decompression and neurolysis in patients with recurrent compressive neuropathies in the upper extremity. Twenty patients comprised the patient cohort, with a mean postoperative follow-up time of 139 days (range: 42-356 days). There were 13 females and 7 males, with a mean age of 43.4 years. Fourteen surgeries were performed for revision cubital tunnel, 5 for revision carpal tunnel, and 1 for revision radial tunnel syndrome. Average duration of symptoms prior to revision surgery with VersaWrap was 2 years (range 9 months to 6 years). Postoperatively, the mean DASH score was 57.7 and VAS 3.1. Mean s2PD median distribution was 7.3, s2PD ulnar distribution 8.9, m2PD median distribution 6.9 and m2PD ulnar distribution 7.3. All patients had subjective improvement of symptoms and were satisfied with their result. No patients in our cohort required further revisional surgery. In conclusion, the use of VersaWrap as a nerve protector following revision surgery for recurrent compressive neuropathies in the upper extremity was safe and effective. Level of Evidence: IV; retrospective case series.

Fecal microbiota transplantation in Parkinson's disease-A randomized repeat-dose, placebo-controlled clinical pilot study.

The intestinal microbiome plays a primary role in the pathogenesis of neurodegenerative disorders and may provide an opportunity for disease modification. We performed a pilot clinical study looking at the safety of fecal microbiota transplantation (FMT), its effect on the microbiome, and improvement of symptoms in Parkinson's disease. This was a randomized, double-blind placebo-controlled pilot study, wherein orally administered lyophilized FMT product or matching placebo was given to 12 subjects with mild to moderate Parkinson's disease with constipation twice weekly for 12 weeks. Subjects were followed for safety and clinical improvement for 9 additional months (total study duration 12 months). Fecal microbiota transplantation caused non-severe transient upper gastrointestinal symptoms. One subject receiving FMT was diagnosed with unrelated metastatic cancer and was removed from the trial. Beta diversity (taxa) of the microbiome, was similar comparing placebo and FMT groups at baseline, however, for subjects randomized to FMT, it increased significantly at 6 weeks (p = 0.008) and 13 weeks (p = 0.0008). After treatment with FMT, proportions of selective families within the phylum Firmicutes increased significantly, while proportion of microbiota belonging to Proteobacteria were significantly reduced. Objective motor findings showed only temporary improvement while subjective symptom improvements were reported compared to baseline in the group receiving FMT. Constipation, gut transient times (NS), and gut motility index (p = 0.0374) were improved in the FMT group. Subjects with Parkinson's disease tolerated multi-dose-FMT, and experienced increased diversity of the intestinal microbiome that was associated with reduction in constipation and improved gut transit and intestinal motility. Fecal microbiota transplantation administration improved subjective motor and non-motor symptoms. ClinicalTrial.gov, identifier: NCT03671785.

Conjugate treatment with high concentration normobaric oxygen and hyaluronic acid for vaginal atrophy: a prospective study.

Vulvovaginal atrophy is a condition closely related to low circulating estrogen levels, with post-menopause being the main cause. However, patients of childbearing age may also present with these symptoms due to treatments that reduce estrogen production. Local estrogen therapy is the causal treatment of local symptoms, but it is not always accepted and is often abandoned by patients. In recent years, alternative therapies have been proposed: fractional CO2 laser or the conjugate treatment with normobaric oxygen and hyaluronic acid, the latter being the subject of this study. The study aimed to evaluate the effectiveness of conjugate topical treatment with normobaric oxygen and hyaluronic acid. 50 patients were evaluated and treated with 5 applications of 15 minutes each, every 15 days, with Caressflow®. All patients presented at least one of the symptoms related to vulvovaginal atrophy: dryness, burning, and dyspareunia. In all cases, vulvoscopy, colposcopy, and cervicovaginal cytology were performed. The patients were interviewed with an analogic scale (VAS) concerning the severity of symptoms before and after the treatment. Colposcopy and PAP-smear were assessed by mean of Vaginal Health Index Score (VHI) at baseline and at the end of the treatment. All patients completed the treatment scheme and presented with a significant improvement in subjective symptoms. The colposcopy and PAP-smear performed 10 days after the end of the last treatment showed a significant improvement in the appearance and elasticity of the vaginal epithelium and the cytological picture, which showed, in the sample taken after treatment, hyaluronic acid vesicles within the cell cytoplasm. This study corroborates the data presented in the latest published papers on the effectiveness of treatment with normobaric O2 and hyaluronic acid on vaginal atrophy. Efficacy has been confirmed both in terms of subjective symptoms reported by the patients and objective improvement at colposcopy and PAP-smear cytology.

Влияние пола пациентов на изменения глазной поверхности после синустрабекулэктомии

Background: the effect of gender on the rate and course of ocular surface diseases (in particular, conjunctival and corneal xerosis) is fairly well known. Meanwhile, gender-dependent changes in the ocular surface after trabeculectomy have not yet been studied. Aim: to analyze the effect of gender on changes in the ocular surface after trabeculectomy. Patients and Methods: this study enrolled 443 patients (168 men and 275 women) who underwent surgical interventions for uncontrolled primary open-angle glaucoma (POAG) in 2016–2020 and were followed up for 6–24 months. Trabeculectomy was performed as the first IOP- lowering procedure in 418 patients (150 men and 268 women) and reoperation in 25 patients (18 men and 7 women). Changes in subjective symptoms (OSDI) and clinical and functional signs of dry eye syndrome (tear film break-up time/TBUT and total tear production by Schirmer's I test) characterizing the ocular surface in various surgical outcomes (complete and partial success, failure) in men and women were analyzed. Results: women have more severe subjective symptoms but not functional signs of dry eye preoperatively. They are characterized by strict adherence to treatment (manifested in lower initial IOP compared with men) but more frequent eye drop instillations and greater cumulative preservative load on the ocular surface. Gender is not an independent risk factor for surgical failure. Successful trabeculectomy results in a significant reduction in the severity of conjunctival and corneal xerosis symptoms (OSDI) for at least 2 years in both genders. Despite clear postoperative improvement, women are significantly inferior to men in this parameter at all study control points. TBUT in both men and women increases significantly during the first 6 months postoperatively, and over the next 1.5 years TBUT stabilizes at the achieved level. An increase in Schirmer's I test results in men becomes significant only at the end of the second year of follow-up. In women, a significant increase in total tear production is reported as early as 6 months after trabeculectomy and changes slightly over the next 1.5 years. Restarting IOP-lowering medications in partial success and failure of trabeculectomy eliminates the improvement of ocular surface condition achieved during the drug-free period as early as after 6 months. Conclusions: regardless of gender, successful trabeculectomy results in a significant and long-term (at least 2 years) improvement of subjective symptoms (OSDI) and functional signs (in particular, TBUT) of conjunctival and corneal xerosis. Women are characterized by a clearer improvement in the parameters studied than men. Significant gender differences are found only when comparing subjective symptoms in the first year after surgery. Restarting IOP-lowering medications postoperatively brings the parameters back to baseline levels. KEYWORDS: gender, glaucoma, trabeculectomy, ocular surface, dry eye disease, OSDI, tear film break-up time, TBUT, Norn's test, Schirmer's I test. FOR CITATION: Antonova A.V., Nikolaenko V.P., Brzheskiy V.V., Vuks A.Ja. Effect of gender on the ocular surface after trabeculectomy. Russian Journal of Clinical Ophthalmology. 2023;23(3):136–145 (in Russ.). DOI: 10.32364/2311-7729-2023-23-3-5.

Oral appliance therapy for obstructive sleep apnea: a retrospective study in a psychiatric sleep clinic

We evaluated the continuity and effectiveness of oral appliances (OAs) for treating obstructive sleep apnea (OSA) in a psychiatric sleep clinic, specifically focusing on mild cases and those with psychiatric comorbidity. We retrospectively examined the medical records of 106 OSA patients treated with OA. Survival analysis was performed to assess the discontinuation of OA use. Clinical Global Impression-Improvement (CGI-I) scale were obtained from medical records. The apnea-hypopnea index (AHI), measured by polysomnography (PSG), and Epworth Sleepiness Scale (ESS) were compared between diagnosis and after post-OA treatment if a second PSG for efficacy assessment was conducted. Among all 106 patients, Kaplan-Meier analysis estimated a discontinuation rate of 16.8% at 1 year. This tended to be higher for OSA patients with psychiatric comorbidity (22.7%) than those without (11.6%), though it was not statistically significant (P=0.08). The overall rate of improvement in CGI-I scale was 37.7% and was significantly lower in OSA patients with psychiatric comorbidity (25.0%) than those without (48.3%). Among the 74 patients who underwent a second PSG, AHI and ESS were significantly lower after OA treatment for the entire group and subgroups of OSA severity at diagnosis and psychiatric comorbidity, except for ESS in the moderate OSA severity subgroup. OA continuation was relatively good, and sleepiness was relieved by OA use, even in mild OSA patients and those with psychiatric comorbidity. However, the continuation and subjective improvement of symptoms were slightly lower in OSA patients with psychiatric comorbidity.

A modified surgical technique of fibrin glue-assisted double bipedicle conjunctival flaps for patients with ocular surface diseases.

This study aimed to describe and investigate the surgical outcome and complications of fibrin glue-assisted double bipedicle conjunctival flaps (CFs) (FADCOF), an alternative surgical technique that restores a stable ocular surface in patients with painful blinding ocular surface disease combined with a shortage of bulbar conjunctiva. Six eyes of six patients with painful blinding ocular surface disease were enrolled in this study. All patients had inadequate superior or inferior conjunctiva tissue to cover the whole corneal surface owing to previous surgeries or ocular surface diseases. These patients received FADCOF between 2009 and 2019. The main outcome included surgical success rate, visual analog scale (VAS) pain score, ocular inflammation score, and postoperative complications. Surgical success was defined as resolution of initial ocular complaints and restoration of a stable ocular surface with no flap melting, retraction, or dehiscence resulting in re-exposure of the corneal surface. All of the six eyes (100%) achieved surgical success. All patients reported significant improvement in subjective symptoms and complete resolution of ocular pain after the surgery (VAS pain score: 6.5 ± 0.5 preoperatively to 0.0 ± 0.0 at 1 month). Ocular inflammation score decreased significantly from a presurgical value of 1.83 ± 0.69 to 0.33 ± 0.47 1 month after the surgery. No postoperative complication was found during the long-term follow-up (range: 12-82 months). FADCOF is a reliable alternative for patients with painful blinding ocular surface diseases unsuitable for single total CF surgery. This surgical technique yields fast ocular surface stabilization, satisfactory recovery, and low complication rates.

JS-CME-2: REDUCTION IN CARDIOVASCULAR MORBIDITY AND MORTALITY BY CARDIAC REHABILITATION: WHAT'S THE EVIDENCE?

The Japanese Society of Cardiac Rehabilitation defines cardiac rehabilitation (CR) as follows. Cardiac rehabilitation refers to a long-term, multifaceted, comprehensive program designed to optimize a cardiac patients physical, psychological, social, and vocational status, in addition to stabilizing, slowing, or even reversing the progression of the underlying atherosclerotic or heart failure processes, thereby reducing recurrence, rehospitalization and mortality and enabling patients to live comfortably and actively. CR programs include medical assessment, prescribed exercise training, coronary risk factor modification, patient education, counseling and optimal medical therapy for individual patients, which are provided by a multi-disciplinary team in a coordinated manner. Comprehensive CR consists of continuous multidisciplinary team medical care centered on exercise therapy and disease management. Comprehensive CR improves exercise tolerance and physical function in most heart diseases. Improvements in subjective symptoms and QOL are also observed in many heart diseases. Concerning long-term prognostic improvement effect, it is observed in coronary artery disease and heart failure. Reduced readmissions are also observed in heart failure patients. Mechanisms for improving the long-term prognosis of patients with coronary artery disease and heart failure include: 1) improvement of coronary risk factors, 2) improvement of vascular endothelial function and systemic anti-arteriosclerosis/anti-inflammatory effects via suppression of oxidative stress, 3) improvement of autonomic nerve function, 4) increase in skeletal muscle mass and associated various myokine actions. Based on the above-mentioned evidence, all clinical guidelines of the Japanese Circulation Society, AHA, and ESC strongly recommend participation in CR as class I (evidence and/or general agreement that a given procedure or treatment is effective and useful) for patients after acute myocardial infarction. In post-CABG patients, American and European guidelines recommend CR as Class I. As for chronic heart failure, exercise therapy is strongly recommended as class I in all heart failure clinical guidelines in Japan, Europe, and the United States. However, a clinical problem is the low rate of CR participation in patients with heart disease. This tendency is particularly conspicuous in Japan. Furthermore, an increase in the number of elderly heart failure patients with frailty is also a major issue. There is a need to create a system that supports patients through a community network throughout the acute, recovery, and maintenance phases.

The Effects of Omega-3 Fatty Acids Supplementation in Bronchial Asthma

Bronchial asthma is a chronic inflammatory disease. Allergies are intensely related to bronchial asthma and to other respiratory diseases such as chronic sinusitis, middle ear infections, and nasal polyps. Treatment can vary from inhalers to oral medications to drugs delivered in a nebulizer or breathing machine. Besides, dietary involvement was a significant tool to reduce the severity of many chronic inflammatory diseases including asthma. Randomly assigned, double blind, and placebo controlled 290 adults with mild to moderately persistent bronchial asthma concluded in this study, were subjected to alternating phases of supplementation with omega-3 fatty acids, vitamin C and Zn either singly or in combination. Subjective symptom improvement, pulmonary function, and biochemical tests were carried out at the beginning of the study and at the end of each therapeutic phase. The study findings showed that nearly half of the cases were in age between 18 years to 40 years followed by 29.6 of the cases that fall in age range between 40 years and 60 years. It was clear that all the four supplements (ogema-3 fatty acids, vitamin C and Zn, and combination) contributed more than placebo in reducing the severity of bronchial asthma. However, omega 3 fatty acids and combined supplement significantly contributed in symptomatic improvement (p < 0.05). There was a significant improvement of pulmonary function and sputum inflammatory markers with diet supplementation (p < 0.05). So, the subjects with mild and moderately persistent bronchial asthma may get benefit from their dietary supplementation with omega 3 fatty acids, Zinc and vitamin C. It is evident from this study that omega 3 fatty acids and combined supplementation significantly improved the severity of bronchial asthma.

Efficacy of cyclosporine eyedrop 0.1% in the treatment of dry eye in primary sjogren's syndrome: A prospective Indian study

Objectives: The objective of this study was to evaluate the efficacy and safety of 0.1% cyclosporine A (CsA) eyedrop in patients having primary Sjogren's syndrome (SS) in India. Methods: A prospective consecutive case series of total 20 patients with moderate-to-severe dry eyes were treated with 0.1% CsA eyedrop twice daily along with lubricating eyedrop for 3 months. Efficacy measures included ocular staining score (OSS), van Bijsterveld score (VBS), and Schirmer's score of each eye based on the 2016 ACR-EULAR classification. Subjective improvement was also recorded at the final visit. Any adverse effects were noted. Results: Treatment with 0.1% CsA eyedrop showed a statistically significant improvement at 3 months for both OSS and VBS in each eye of study patients. A similar improvement in Schirmer's score was noted in each eye of the subjects. Subjective improvement of ocular sicca symptoms was also demonstrated. There was excellent compliance to therapy. The 0.1% CsA formulation did not show any topical or systemic side effects in any patient. Conclusion: The 0.1% ophthalmic preparation of CsA is safe and effective in the management of moderate-to-severe dry eyes in patients with primary SS in this pilot study in Indian patients.

Medium- to long-term outcomes of vaginally assisted laparoscopic sacrocolpopexy in the treatment of stage III–IV pelvic organ prolapse

BackgroundVaginally assisted laparoscopic sacrocolpopexy (VALS) refers to the placement of synthetic meshes through the vagina in addition to traditional laparoscopic sacrocolpopexy. In this study, we aimed to investigate the medium- to long-term efficacy and safety of VALS for treating stage III–IV pelvic organ prolapse (POP).MethodsThe study was designed as a case series at a single center. Patients with stage III–IV POP in our hospital from January 2010 to December 2018 were included. Perioperative parameters, objective and subjective outcomes, and complications were assessed.ResultsA total of 106 patients completed the follow-up and were included in our study. Within a median follow-up duration of 35.4 months, the objective cure ratio of VALS reached 92.45% (98/106), and the subjective success rate was 99.06% (105/106). Patients reported significant improvements in subjective symptoms. In eight patients suffering anatomic prolapse recurrence, two posterior POP cases were treated by posterior pelvic reconstruction surgery, while six anterior POP cases did not need surgical therapies. The reoperation rate was 1.89% (2/106). No intraoperative complications occurred. Three patients (2.83%) had postoperative fever, and one (0.94%) had wound infection during hospitalization. Six patients (5.66%) had mesh exposure on the vaginal wall, and de novo urinary incontinence occurred in two patients (1.89%) during the follow-up period.ConclusionVALS is an effective and safe surgical method for treating severe POP. Therefore, VALS should be considered in the treatment of severe POP due to its favorable subjective and objective outcomes, relatively low rate of infection and acceptable rate of mesh exposure.

Phlebotomy in Secondary Polycythemia: Does It Improve Clinical Symptoms? a Systematic Review

Introduction: Secondary polycythemia (SP) is the increased number of red blood cells in the body that occurs due to elevated erythropoietin levels usually secondary to chronic hypoxia. Treating the underlying cause is the mainstay of treatment of SP. Phlebotomy is rarely used in patients with SP, especially those with symptoms related to hyperviscosity. We present a systematic review assessing the effectiveness of phlebotomy in SP. Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, a comprehensive literature search was conducted on PubMed, Cochrane, and Clinical trials.gov using MeSH terms and keywords for "Polycythemia, Secondary " AND " Phlebotomy " in July 2022. We did not place any time constraints. Our search produced a total of 232 records, and duplicates were removed. After screening and removing irrelevant and review articles, we included a total of 17 original articles and case reports reporting phlebotomy as a treatment for SP in adult patients. The data were collected for baseline characteristics of the participants and efficacy and safety of the intervention. Results: A total of 86 patients from 17 articles were evaluated. (Table 1) The mean age of participants was 51 years and 89% (n=65/73) were males. Most common cause of SP was chronic obstructive pulmonary disease (COPD) 94.4%, followed by congenital cyanotic heart disease (3.4%), high altitude erythrocytosis (1.1%), and obesity hypoventilation syndrome (1.1%). Most common reported symptoms were dyspnea, confusion, headaches, exercise intolerance, and suppression of hypothalamic-pituitary-testicular axis. Two case reports also reported chorea secondary to SP while there was one case report each for hemi-retinal artery occlusion, angina attacks and portal hypertensive gastropathy. Majority of the studies had a goal hematocrit of <55%. There was subjective improvement in clinical symptoms in 85% (n=73) of the patients while 2.3% (n=2) felt worse after phlebotomy. None of the patients (9/9) with suppression of hypothalamic-pituitary-testicular axis had improvement in hormonal profile after phlebotomy. One patient developed hemiparesis, stiffness, loss of dexterity, chorea after phlebotomy with the symptoms resolving when hematocrit went back to baseline >62.5%. One patient died a week after phlebotomy due to respiratory issues. Conclusion: Phlebotomy results in clinical improvement in symptoms in patients with secondary polycythemia. Majority of the patients report either complete resolution of symptoms or at least subjective improvement. Goal hematocrit is usually <55%. Phlebotomy, although rarely used, may be considered a safe and effective treatment option for symptom management in SP, although its utility in objective improvement needs further prospective studies. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal