Subjective Satisfaction Rate Research Articles

2139 PELVIC ORGAN PROLAPSE AND PESSARY USE: IS IT A VIABLE LONG TERM TREATMENT OPTION?

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Pelvic Prolapse1 Apr 20122139 PELVIC ORGAN PROLAPSE AND PESSARY USE: IS IT A VIABLE LONG TERM TREATMENT OPTION? Sophie Ramsay, Frederick Bouchard, and Le Mai Tu Sophie RamsaySophie Ramsay Sherbrooke, Canada More articles by this author , Frederick BouchardFrederick Bouchard Sherbrooke, Canada More articles by this author , and Le Mai TuLe Mai Tu Sherbrooke, Canada More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.2310AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The main objective of this retrospective study is to evaluate whether long-term use of vaginal pessaries is an appropriate conservative treatment for women with pelvic organ prolapses (POP). METHODS From 1998 to 2010, 429 women with POP had a pessary trial. Vaginal atrophy and constipation were addressed prior to the trial. Patients were encouraged to use topical estrogen and mucolytic cream at home. A follow-up appointment was scheduled at one month where a pessary maintenance regime was chosen. Additional follow-up visits were then scheduled yearly, or before as patient needs. Data collected included specific information concerning pessary use, incidence of vaginal erosions or other associated morbidities, and subjective satisfaction rate. RESULTS Average age at presentation was 71.1 ± 9.7 years old. 50% of patients had had hysterectomy and 22% had had a prior prolapse surgery. 62% (n = 258) of women had a successful pessary trial, defined as a one-month use of the pessary with subjective improvement of symptoms and no significant complication. Median duration of pessary use was 35 months (1-136). 96% of women were satisfied or very satisfied with their pessaries. 66% (n = 170) of patients could handle pessary by self-maintenance, while 23% (n = 59) needed assistance from a regional nurse, and 11% (n = 28) necessitated maintenance by our clinic nurses. Pessary self-maintenance regime was associated with a prolonged pessary use (38 months vs 30 months for the nurse group vs 27 months for the clinic group, p = 0.021). The overall erosion rate was 16%. Multivariate analysis demonstrated that erosions are associated with older age (p = 0.011), constipation (p = 0.018), and use of topical estrogen cream (p = 0.001). The severity of vaginal atrophy increased with older age (p < 0.001) and older patients were therefore more likely to use topical estrogen cream (p < 0.001). Both the severity of vaginal atrophy and intensive estrogen treatment before pessary trial were associated with a higher rate of erosions (p < 0.001 and p = 0.04). There was no major complication. 66% (n = 170) of women who underwent a successful pessary trial are still using a pessary. CONCLUSIONS Vaginal pessaries appear to be an appropriate treatment option for women with troublesome POP. These long-term results show that patient's satisfaction is excellent and most women who underwent a successful pessary trial continue to use pessary through time. Regular maintenance and follow-up are essential, especially as the occurrence of vaginal erosions is difficult to predict. Erosions do not seem totally preventable by the use of topical estrogen. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e864 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sophie Ramsay Sherbrooke, Canada More articles by this author Frederick Bouchard Sherbrooke, Canada More articles by this author Le Mai Tu Sherbrooke, Canada More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Mid-term Outcome of Opening-wedge High Tibial Osteotomy for Varus Arthritic Knees

Gonarthrosis in the relatively young and active population causes major daily discomfort and disability. If the arthritic process is mainly limited to the medial compartment, the axis of a varus knee can be realigned laterally with high tibial osteotomy to unload the medial compartment and allow some cartilage regeneration and pain relief. This study describes the outcomes of patients who underwent opening-wedge high tibial osteotomies using Puddu plate (Arthrex, Naples, Florida) fixation. Eighteen patients (22 knees) with genu varum and medial compartment osteoarthritis were followed-up for an average of 6.3±2.3 years after high tibial osteotomy with Puddu plate fixation and iliac crest allograft. Clinical outcome was assessed by the Oxford Knee Score and subjective satisfaction rating. Pre- and postoperative radiographs were evaluated for tibiofemoral angle, Insall-Salvati index, and Kellgren-Lawrence Grading Scale for osteoarthritis. Mean patient age at surgery was 44±13.7 years, and mean body mass index was 29.1±4.7 kg/m(2). At last follow-up, mean Oxford Knee Score improved from 22.4±13.5 to 37.2±13.7 (P=.002). Average subjective satisfaction rate at last follow-up was 8±3. The measured tibiofemoral angle was corrected to an average genu valgum of 3.3°±4.8° (P=.001). No patient showed severe postoperative osteoarthritis (ie, Kellgren-Lawrence grade 4) at last follow-up. All radiographs showed full incorporation of the bone grafts. At the end of the study, 2 patients underwent total knee replacement. Opening-wedge high tibial valgus osteotomy with Puddu plate fixation can be a reliable procedure for the treatment of medial-compartment osteoarthritis of the knee associated with varus deformity.

Open Lateral Retinacular Closure Surgery for Treatment of Anterolateral Knee Pain and Disability After Arthroscopic Lateral Retinacular Release

Background: Although lateral retinacular release (LR) surgery has historically been one of the most commonly used arthroscopic procedures for the treatment of patellar instability and anterior knee pain, it may be associated with complications and poor functional outcome measures. Purpose: To examine the clinical efficacy of open lateral retinacular closure (LRC), a novel but technically simple procedure in the treatment of disabling anterolateral knee pain, tenderness, and positive medial patellar apprehension testing in patients who have undergone prior arthroscopic LR surgery. Study Design: Case series; Level of evidence, 4. Methods: The records of 22 patients who had previously undergone an arthroscopic LR and underwent a diagnostic arthroscopy and LRC were reviewed. Physical examination findings and symptoms after prior LR surgery, duration between LR and LRC surgeries, and arthroscopic findings immediately before LRC were analyzed. Preoperative and postoperative Lysholm knee scores and activity levels were compared, and subjective satisfaction ratings assessed. Results: Average follow-up after LRC was 3.2 years. Mean preoperative Lysholm knee score was 46.5 (range, 25-90), which improved postoperatively to a mean score of 86 (range, 48-100). Fourteen percent of patients subjectively rated their preoperative function as fair and 86% as poor. Postoperatively, 82% rated themselves as good or excellent and 18% as fair, with all patients improving from the LRC procedure. All patients stated that they would have the procedure again for the same problem. Conclusion: Open LRC provides significant pain relief and improvement in functional knee outcome scores in patients with persistent pain and tenderness at the site of a previous lateral release and a positive medial patellar apprehension test. Lateral release procedures should be considered with caution. For patients with anterolateral knee pain and symptoms of medial patellar instability after lateral release, LRC may provide symptomatic relief and functional improvement.

Medium- to Long-Term Outcome of Ankle Arthrodesis

Despite improvement in outcome after ankle arthroplasty, fusion of the ankle joint is still considered the gold standard. A matter of concern is deterioration of clinical outcome as a result of loss of motion and advancing degeneration of adjacent joints. We performed a long-term study to address these topics. Between 1990 and 2005 a total of 121 ankle arthrodeses were performed at our institute. Thirty-five cases were excluded because of simultaneous subtalar arthrodesis. Ten had died and ten were lost to followup. Six had a bilateral ankle arthrodeses, leaving 60 patients (66 ankles) eligible for followup. There were 40 males and 26 females with a mean age at surgery of 47 years. In 60 ankles, fusion was obtained using a two-incision, three-screw technique. All patients were assessed using validated questionnaires and clinical rating systems: Short Form 36 (SF-36), American Orthopaedic Foot and Ankle Society (AOFAS) Ankle and Hindfoot scale, Foot and Ankle Ability Measure (FAAM) and a subjective satisfaction rating. Radiological progression of osteoarthritis of the adjacent joints was assessed. Fusion was achieved in 91% after primary surgery. In six patients rearthrodesis was needed to obtain fusion. The mean SF-36 score was 63 (SD, 22) for the physical component scale and 81 (SD, 15) for the mental component scale. The mean FAAM score was 69 (SD, 17) and the mean AOFAS Ankle Hindfoot score was 67 (SD, 12). Ninety-one percent were satisfied with their clinical result. Infection occurred once. No other serious adverse events were encountered. In all contiguous joints significant progression of arthritis was appreciated. Ankle arthrodesis using a two-incision, three-screw technique was a reliable and safe technique for the treatment of end-stage osteoarthritis of the ankle. It resulted in a good functional outcome at a mean followup of 9 years. Progressive osteoarthritis of the contiguous joints was clearly appreciated but the functional and clinical importance of these findings remains unclear.

Reverse Shoulder Prosthesis for Acute Four-Part Fracture: Tuberosity Fixation Using a Horseshoe Graft

Results of hemiarthroplasty for complex four-part proximal humerus fractures in the elderly have been unreliable. Although patients often achieve pain relief, return of above-shoulder level function can be challenging, because tuberosity nonunion, malunion, and/or resorption is quite common. The reverse shoulder replacement has been advocated as a reliable alternative for these patients. Preliminary studies have suggested that tuberosity healing is critical for achieving external rotation strength after reverse shoulder arthroplasty. We describe a technique of tuberosity repair using a wedge horseshoe graft, which can provide improved surface area for tuberosity healing. A clinical series of seven patients treated with this technique is reported with a minimum follow-up of 12 months (range, 12-23 months). The tuberosity union rate was 86% (six of seven patients). Average active forward elevation was 117° (range, 95°-150°), and active external rotation was 19° (range 0°-30°). Visual analog scale pain scores averaged 0.6 (range, 0-1), visual analog scale function averaged 8.7 (range, 7-10), mean American Shoulder and Elbow Surgeons pain was 47.1 (range, 45-50), and mean American Shoulder and Elbow Surgeons function was 39.2 (range, 31-50). Subjective satisfaction ratings were excellent for four patients, and good for two, and satisfactory for one. No patients were unsatisfied with their outcomes. The horseshoe graft technique provides a reliable means for anatomic restoration of the tuberosities, facilitating the return of shoulder function in elderly patients with complex four-part proximal humerus fractures treated with a reverse total shoulder.

Carbon Dioxide (CO2) Laser-Assisted Microdiscectomy for Extraforaminal Lumbar Disc Herniation at the L5-S1 Level

The purpose of this study was to analyze the surgical outcomes of carbon dioxide (CO(2)) laser-assisted microdiscectomy for extraforaminal lumbar disc herniations (EFLDH) at the L5-S1 level. Microdiscectomy via the lateral transmuscular route is beneficial for treating EFLDH at the L5-S1 level. However, this technique may not effectively remove concomitant foraminal lumbar disc herniation (FLDH), resulting in persistent leg pain and a necessity for revision surgery. CO(2) laser-assisted microdiscectomy could be an effective alternative, as it enables effective decompression of EFLDH as well as of the accompanying FLDH, despite a narrow operative window. Thirty-one consecutive patients with EFLDH at the L5-S1 level who underwent CO(2) laser-assisted microdiscectomy via the lateral transmuscular route were prospectively enrolled. Clinical outcomes were assessed 1 year after surgery by using the visual analogue scale (VAS) scores, Oswestry Disability Index (ODI), and patient's subjective satisfaction rate. Of the 31 patients, 10 were male and 21 were female, with a mean age at surgery of 62.2 years. All patients showed improvement in leg pain immediately after surgery. Transient dysesthesia developed in one patient. Of the 28 patients (90.3%) followed for a 1-year period, the mean VAS for back pain and leg pain, as well as the mean ODI, decreased significantly from 5.2, 8.3, and 60.7% to 2.6, 1.8, and 18.1%, respectively. The mean subjective satisfaction rate was 75.7%. Clinical success was observed in 27 patients (96.4%), and reherniation occurred in one patient (3.6%). No patient underwent reoperation for reherniation or segmental instability. CO(2) laser-assisted microdiscectomy for EFLDH at the L5-S1 level showed satisfactory surgical results at the 1-year follow-up.

Reply

We agree with the authors of the editorial comment concerning their first question that “surgical cure” is not a sufficient measure to assess the success of stress urinary incontinence (SUI) treatment. However, measurement of the outcomes of SUI treatment is still challenging. The outcome measures used to evaluate therapy success lack consensus and comparability.1 As the authors state, patients' subjective satisfaction rates have often been greater than the pad-free or cure rates. Despite that, some patients might not be satisfied with the surgical outcome despite postoperative continence.

Editorial Comment

The authors should be commended for studying the difficult population of men with stress incontinence after radical prostatectomy and radiotherapy. The authors report the outcomes for the AdVance sling and conclude that, in select patients, the procedure achieves a success rate of 50%, with results stable for a median follow-up of 18 months. They also state that treatment success is reduced compared with the reported success rates in patients who have not undergone radiotherapy. Some of the criticisms of this study are common to many reports on the outcomes after treatment of male stress incontinence. A careful reading of this report (and many others on the same topic) raises 2 important questions. First, whether the “success” rate is really 50%; and second, whether the outcomes are really worse in patients who have undergone adjuvant radiotherapy. Results of the AdVance Transobturator Male Sling After Radical Prostatectomy and Adjuvant RadiotherapyUrologyVol. 77Issue 2PreviewTo prospectively evaluate the efficacy of the functional AdVance transobturator sling for the treatment of male stress urinary incontinence (SUI) in patients after radical prostatectomy and additional adjuvant radiotherapy. Full-Text PDF ReplyUrologyVol. 77Issue 2PreviewWe agree with the authors of the editorial comment concerning their first question that “surgical cure” is not a sufficient measure to assess the success of stress urinary incontinence (SUI) treatment. However, measurement of the outcomes of SUI treatment is still challenging. The outcome measures used to evaluate therapy success lack consensus and comparability.1 As the authors state, patients' subjective satisfaction rates have often been greater than the pad-free or cure rates. Despite that, some patients might not be satisfied with the surgical outcome despite postoperative continence. Full-Text PDF

Single Scrotal Incision Orchiopexy for Children with Palpable Low-Lying Undescended Testis: Early Outcome of a Prospective Randomized Controlled Study

PurposeWe prospectively evaluated the surgical outcomes of single scrotal incision orchiopexy in children with a palpable undescended testis compared with the traditional two incision orchiopexy.Materials and MethodsA total of 398 orchiopexies (292 children) were included and randomly assigned to the single scrotal incision orchiopexy group (Group I, 147 children, 201 testes) or the traditional inguinal incision orchiopexy group (Group II, 145 children, 197 testes). The final number of patients enrolled (excluding those lost to follow-up) was 107 children (146 testes) in group I and 105 children (141 testes) in group II. Success was defined as no complications, postoperative intrascrotal location of the testis, and no conversion to the traditional inguinal approach. Surgical outcomes and complications were compared between the two groups. Testicular location, complications, and subjective satisfaction rate were assessed at the follow-up evaluation at least 12 months postoperatively.ResultsThe overall success rate in group I was 92.5% in 135 of 146 testes; the remaining 9 testes required conversion to traditional two incision orchiopexy. In group II, orchiopexy was successful in 136 of 141 testes (96.5%). The operation time and hospital stay were significantly shorter in group I (40.5±25.9 minutes, 2.1±0.8 days) than in group II (62.3±35.6 minutes, 2.5±0.7 days), respectively (p<0.001, p=0.03). Postoperative complications were found in two cases (hematoma, wound dehiscence) in group I and in one case (wound dehiscence) in group II; all cases with complications recovered with conservative care. The subjective rate of satisfaction with the cosmetic result was 96.6% in group I and 96.5% in group II (p=0.97).ConclusionsWe conclude that single scrotal incision orchiopexy is a simple technique that is associated with a shorter operation time and hospital stay than the traditional method and that is more feasible cosmetically.

Die perkutane Implantation eines interspinösen Spacers an der Lendenwirbelsäule

SURGICAL GOAL: Surgical treatment of dynamic lumbar spinal stenosis and discogenic/arthrogenic low back pain with a new percutaneous interspinous spacer as a therapeutic alternative to more invasive standard procedures. Central, lateral and foraminal dynamic lumbar spinal stenosis. Discogenic and arthrogenic (facet osteoarthritis) low back pain. Symptomatic, segmental hyperlordosis. Disc degeneration with dynamic (reducible) retrolisthesis. Interspinous pain ('Kissing-Spines'). Osteoporosis. Conus-/Cauda-syndrome. Structural spinal stenosis. Spondylolisthesis (degenerative and/or isthmic). Deformities. Previous posterior operation in index segment. Percutaneous, minimally invasive implantation of an interspinous spacer (InSpace ™, Synthes, Oberdorf, Switzerland). Early unrestricted mobilization. Good early results (after 2 year follow-up) in 42 patients with 76% subjective patient satisfaction rate. No approach related complications. Avoidance of the more invasive alternative procedure (decompression, fusion, total disc replacement) in 76.2% of the patients.

Traitement actuel arthroscopique du conflit fémoro-acétabulaire

Summary Introduction Arthroscopic treatement of femoroacetabular impingement (FAI) is recommended since it is a minimally invasive procedure allowing full access to the hip joint. Hypothesis Arthroscopic treatment can alleviate FAI without use of a perineal support. Goals of the study To describe an early experience of hip arthroscopy in the treatment of FAI using 2 types of hip distraction without perineal support; to assess morbidity of FAI release under arthroscopic control and its early clinical and radiological outcome. Materials and methods In the first 32 cases, the procedure used an invasive distractor and started with the central compartment. In the last six cases, it started with the peripheral compartment using a dedicated traction table with a contralateral buttock support. Inclusion criteria were: positive impingement test and radiological evidence of FAI. Thirty-eight consecutive patients with mean age 36 years (range 24–64) underwent arthroscopic treatment for FAI. Clinical outcome used WOMAC and Postel Merle d’Aubigne (PMA) scores. Radiological development of osteoarthritis (OA) was graded according to Tonnis score. Results At mean final follow-up of 1.3 years (range 0.5–3) there were no complications of either type of traction technique used. Mean WOMAC score increased from 55 to 75 points and PMA from 14.6 to 16.7 points. The subjective overall satisfaction rate was 79%. Radiological OA changes appeared in two hips, were unchanged in 33, and deteriorated in three. Discussion Invasive distraction has been effective but appeared complex and costly. The procedure is now performed without it and begins at the peripheral compartment by the capsulotomy, which allows secondary distraction using a contralateral buttock. Preoperative OA seems to be a negative prognostic factor for clinical outcome. Conclusions Arthroscopic treatment of FAI is a safe technique, which can be achieved without perineal complications. Limited anterior-superior capsulectomy and cephalic bone resection represent the first operative step, allowing acetabular trimming, labral reattachment and FAI relief. It is effective in term of early clinical results. Level of evidence Level IV: retrospective study.

Update to femoroacetabular impingement arthroscopic management

Arthroscopic treatment of femoroacetabular impingement (FAI) is recommended since it is a minimally invasive procedure allowing full access to the hip joint. Arthroscopic treatment can alleviate FAI without use of a perineal support. To describe an early experience of hip arthroscopy in the treatment of FAI using two types of hip distraction without perineal support; to assess morbidity of FAI release under arthroscopic control and its early clinical and radiological outcome. In the first 32 cases, the procedure used an invasive distractor and started with the central compartment. In the last six cases, it started with the peripheral compartment using a dedicated traction table with a contralateral buttock support. Inclusion criteria were: positive impingement test and radiological evidence of FAI. Thirty-eight consecutive patients with mean age 36 years (range 24-64) underwent arthroscopic treatment for FAI. Clinical outcome used WOMAC and Postel Merle d'Aubigné (PMA) scores. Radiological development of osteoarthritis (OA) was graded according to Tönnis score. At mean final follow-up of 1.3 years (range 0.5-3), there were no complications of either type of traction technique used. Mean WOMAC score increased from 55 to 75 points and PMA from 14.6 to 16.7 points. The subjective overall satisfaction rate was 79%. Radiological OA changes appeared in two hips, were unchanged in 33, and deteriorated in three. Invasive distraction device has been effective but appeared complex and costly. The procedure is now performed without it and begins at the peripheral compartment by the capsulotomy, which allows secondary distraction using a contralateral buttock. Preoperative OA seems to be a negative prognostic factor for clinical outcome. Arthroscopic treatment of FAI is a safe technique which can be achieved without perineal complications. Limited anterior-superior capsulectomy and cephalic bone resection represent the first operative step, allowing acetabular trimming, labral reattachment and FAI relief. It is effective in terms of early clinical results. Level IV: retrospective study.

Intelligent speed adaptation—Effects and acceptance by young inexperienced drivers

This study assessed the relative effects of two intelligent speed adaptation (ISA) systems (informative and actively supporting) on simulated driving performance and acceptability in a sample of inexperienced and experienced drivers. Participants drove a series of simulated drives under three conditions: no ISA (control), ISA informative and ISA actively supporting. The informative system significantly reduced speed and was particularly effective in reducing top-end speeds. Comparable reductions were not found for the actively supporting system. Differences in the effectiveness and acceptability of ISA systems were noted across experienced and inexperienced drivers. The ISA systems appeared more effective at reducing speeds for experienced drivers on some road types. Experienced drivers’ subjective satisfaction ratings of the systems also remained constant over the trial, whereas the inexperienced drivers’ ratings changed after experience. There was little evidence that drivers engaged in negative behavioral adaptation and no evidence that subjective workload levels increased with ISA use. Future directions for examining the safety benefits of ISA, particularly for inexperienced drivers, are discussed.

Anterior Cruciate Ligament Reconstruction With LARS Artificial Ligament: A Multicenter Study With 3- to 5-Year Follow-up

The aim of this multicenter study was to evaluate the clinical outcome of anterior cruciate ligament (ACL) reconstruction by use of the Ligament Advanced Reinforcement System (LARS) artificial ligament (Surgical Implants and Devices, Arc-sur-Tille, France) with 3- to 5-year follow-up. From August 2004 to July 2006, 159 patients with ACL rupture underwent arthroscopic ACL reconstruction with LARS artificial ligament at 4 orthopaedic sports medicine centers in China. They were retrospectively followed up for 50 +/- 6 months (range, 36 to 62 months). Outcome assessment included physical examination, KT-1000 arthrometer testing (MEDmetric, San Diego, CA), magnetic resonance imaging, radiography, Lysholm score, Tegner score, International Knee Documentation Committee score, and subjective satisfaction rate. Quadriceps and hamstring isokinetic strength was evaluated in 68 patients. The side-to-side difference in anterior translation (injured side - uninjured side) measured by KT-1000 arthrometer was 1.5 +/- 1.6 mm (range, -1 to 7 mm) postoperatively, and knee stability was significantly improved compared with preoperative data (P < .0001). Quadriceps and hamstring isokinetic peak torque of the injured limb expressed as a percentage of the contralateral limb was 93.6 +/- 10.7 and 95.8 +/- 12.0, respectively. The Lysholm score improved from 65.1 +/- 12.3 points (range, 30 to 95 points) preoperatively to 94.5 +/- 7.0 points (range, 65 to 100 points) postoperatively (P < .0001). The Tegner score improved from 3.1 +/- 1.6 (range, 0 to 6) preoperatively to 6.1 +/- 1.5 (range, 1 to 9) postoperatively (P < .0001). According to the International Knee Documentation Committee score, 94% of patients were graded A or B at last follow-up. Ninety-three percent of patients were very satisfied or satisfied with their outcome. LARS artificial ligament rupture occurred in 3 patients; knee synovitis developed in 1 of these patients. ACL reconstruction with LARS artificial ligament used in patients with the ACL stump preserved in the acute and chronic phases has a very good outcome at mean of 50 months' follow-up. The overall complication rate for ACL reconstruction with LARS artificial ligament is 5.7%, and knee synovitis developed in only 1 case. Level IV, therapeutic case series.

Open Versus Endoscopic Excision of a Symptomatic Os Trigonum: A Comparative Study of 41 Cases

To compare the clinical results of a consecutive series of 43 cases of excision of a symptomatic os trigonum performed with an open versus hindfoot endoscopic technique. From 1994 to 2007, 43 patients underwent a symptomatic os trigonum excision. A subjective satisfaction questionnaire and a visual analog scale score for pain were obtained, and the American Orthopaedic Foot & Ankle Society ankle and hindfoot score and the time to return to previous sports level were determined in 41 of 43 patients at follow up. Of the ankles, 16 had an open os trigonum excision and 25 had hindfoot endoscopic surgery. Group A (16 ankles, open surgery) and group B (25 ankles, endoscopic excision) were comparable concerning age, sex, profession, and concomitant injury of the ankle. At follow-up evaluation (12 to 86 months after surgery), group B had a significantly shorter mean time to return to previous sports level. There was no difference in postoperative visual analog scale score, American Orthopaedic Foot & Ankle Society score, subjective satisfaction rating, or rating of sensory nerve loss between the 2 groups. Both open surgery and hindfoot endoscopic excision of a symptomatic os trigonum were effective and safe. Patients with an endoscopic excision had a shorter time to return to previous sports level. Level IV, therapeutic case series.

Fixation of Akin osteotomy for hallux abductus with absorbable suture

The Akin osteotomy is a widely used procedure where various fixation methods are available, predominantly with the use of metallic component (wire, screw, staple etc.). The aim of this study is to demonstrate the results of our modified Akin procedures, where the fixation of the phalangeal osteotomy is achieved by absorbable suture, without metallic component. Between July 2004 and October 2008, authors performed their first 22 consecutive Akin procedures with the above technique. Mean age of patients was 49 [standard deviation (SD) 17, range 19-69] years. Mean follow-up time was 26 (SD 13, range 8-57) months. Mean correction of the distal articular set angle (DASA) was 9.4 (SD 7.1, range 5-28) degrees. Mean shortening of the proximal phalanx was 1.8 (SD 1.0, range 0.3-4.1) mm. Among the 22 osteotomies, there was no evidence of non-union, delayed union, excessive bone callus, or loss of correction. 100% of the patients would undergo the procedure again, 91% (20/22) were completely satisfied; and 9% (2/22) were satisfied, including the one complication case. The method presented in this study for fixation of the akin osteotomy showed results identical to the ones using conventional (metal) fixation techniques concerning radiological (correction of DASA, shortening of the proximal phalanx), and clinical (complication rate, subjective satisfaction rate) findings, without the risk of complication due to hardware irritation.

A novel modification of tunical plication by plaque thinning: long-term results in treating penile curvature of Peyronie’s disease

To investigate the efficacy of a novel modified tunical plication procedure in correcting penile curvature of patients with Peyronie's disease. Penile tunical plication was performed, combined with plaque thinning with carbide burs, and 18 patients were available for a long-term follow-up. Preoperative deformity and erectile capacity were accessed, and postoperative cosmetic and functional results were evaluated by physical examination, subjective satisfaction rate, and International Index of Erectile Function-5 questionnaire (IIEF-5). During the initial assessment after 6 months since surgery, complete straightening was achieved in 83.3% patients, and the residual curvatures in the three patients were within 20°. Satisfaction rate was 94.4% while one patient was partly dissatisfied with penile shortening, although the penile shortening occurred in 66.7% patients. No de novo erectile dysfunction was observed, and sexual function was significantly improved with the IIEF-5 scores increasing from 17.3 ± 4.1 to 20.9 ± 3.3 (P = 0.008). After a mean of 50.5-month follow-up (range from 29 to 72 months), although 22.2% patients reported curvature recurrence, neither the recurrence nor the penile shortening affected coitus, and 100% patients were satisfied with the results of the operation. The plication procedure modified by plaque thinning with carbide burs is safe and effective in treating penile deformity due to Peyronie's disease, which characterized in improving the life quality of patients.

The use of existing denture-satisfaction ratings for a diagnostic test to indicate prognosis with newly delivered complete dentures

The study investigated the relation between subjective satisfaction ratings of existing dentures and outcomes of newly delivered dentures, and the ability of the diagnostic test, using existing ratings, to indicate prognosis with newly delivered dentures. Consecutive 165 edentulous patients were recruited from November 2001 to August 2006 at a university-affiliated hospital. Dentures were fabricated with an acrylic base with full-balanced occlusion using hard resin artificial teeth by multiple prosthodontists. At the baseline and 3-month after delivery, patients rate their overall, maxillary, and mandibular satisfaction for existing and replaced dentures on a 100-mm visual analogue scale (VAS). The association between baseline ratings and newly delivered dentures was analyzed by regression analysis. The test's performance was measured by constructing a two-by-two table; patients with the following cutoff values on the VAS (overall: <or=31; maxillary: <or=47; mandibular: <or=36) were considered unsatisfied with existing or new dentures. Relative validity of the diagnostic tests was assessed by means of sensitivity, specificity, and likelihood ratios. Mandibular dentures showed a significant association between baseline and new dentures (coefficient=0.27, p=0.01). Results of test measures for overall, maxillary, and mandibular existing dentures were 71%, 38%, and 87% (sensitivity); 62%, 66%, and 49% (specificity); and 1.1, 1.9, and 1.7 (positive likelihood), and 0.5, 1.0, and 0.2 (negative likelihood). Test performance indicates that the negative (satisfied) result for mandibular existing dentures may be useful to rule out the unsatisfied patients with new mandibular dentures.

A Descriptive Examination of the Impact of Sternal Scar Formation in Women

Formation of abnormal scars is a significant source of morbidity following sternotomy. We undertook a descriptive exploratory mixed methods study of women (n=13) who participated in the Women's Recovery from Sternotomy Trial to examine the: (1) qualitative impact of the cosmetic result of sternotomy, and (2) quantitative association between subjective satisfaction and objective ratings of the sternal scar. Conventional content analysis was used to analyze the data generated from semi-structured interviews. Though the participants appreciated that having the scar was a cost of reaping the benefits of having cardiac surgery, they were not well prepared to learn to live with the scar. The scar was a poignant personal reminder that they had a health problem and underwent a distressing surgery, and it often rendered them feeling less attractive. The scar also had a public presence that they perceived rendered judgment from others. There was little association between the participants' subjective satisfaction (rated on a likert-type scale) and the objective scar rating using the Beausang Clinical Scar Assessment (r=0.348, p=0.294). The subjective perception of the sternal scar is of importance to women. Thus, appropriate preparation, post-operative counseling and support regarding the sternal scar are warranted.

Life satisfaction of adolescents and adults with cystic fibrosis: Impact of partnership and gender

Background This is the first study to assess the impact of gender and partnership on life satisfaction in adolescents and adults with CF, using a model combining subjective importance and satisfaction ratings. Methods Life satisfaction of 243 CF patients (16–58 years, M = 29.6, SD = 7.4, 46.9% male) was assessed with the Questions on Life Satisfaction (FLZ M). The effects of gender and partnership on life satisfaction were calculated. Results Significantly less males than females reported living with a partner ( χ 2 = 16.5, p < 001). Gender only had a significant effect on health-related life satisfaction, with females reporting worse life satisfaction. Partnership had small to large effects on general, health-related and CF-specific life satisfaction ( η 2 = .049–.144). Participants with partners always reported higher life satisfaction than those without partner. However, no significant interaction effect of partnership and gender could be shown. Conclusions Having a partner is associated with higher life satisfaction, regardless of the patient's gender and might have beneficial effects on medical outcomes.