Partial mobilisation of the neurovascular bundle for ventral penile curvature correction: A proof-of-concept study

2021 ◽  
pp. 205141582110593
Author(s):  
Pankaj M Joshi ◽  
Marco Bandini ◽  
Guido Barbagli ◽  
Manuel Hevia ◽  
Francesco Montorsi ◽  
...  
Keyword(s):  
Tunica Albuginea ◽  
Neurovascular Bundle ◽  
Penile Curvature ◽  
Proof Of Concept ◽  
Level Of Evidence ◽  
Curvature Correction ◽  
Concept Study ◽  
Patient Reported ◽  
Residual Curvature ◽  
Skin Erosion

Background: To lift the neurovascular bundle (NVB) is a critical step during dorsal plications for ventral penile curvature correction. Indeed, this procedure may hesitate in nerves and vascular damage. Herein, we present a revolutionary approach of partial NVB mobilisation that avoids dissection among 10 and 2 o’clock positions decreasing the risk of injuring nerves and vessels. Methods: We assessed ventral penile curvature after penile degloving, marking the level of maximal bending. Bilateral para urethral incisions were made and the Buck’s fascia carefully mobilised from the tunica albuginea. The mobilisation of NVB was carried until 10 and 2 o’clock, avoiding the area between 10 and 2 o’clock positions, where nerves and vessels are more concentrated. The 10 and 2 o’clock positions correspond also to the dorsal edges of the two cavernosa cylinders, where plications are more effective. Penile straightening after surgery was defined as residual curvature less than 10 degrees. Results: Between 2016 and 2020, we have operated 33 men and 32 boys with ventral penile curvature. The severity of penile curvature was mid (<30 degrees) in 13 (20%) patients, moderate (30–60 degrees) in 33 (51%) patients, and severe (> 60 degrees) in 19 (29%) patients. Penile straight was achieved for all patients. We recorded three haematoma, three glans skin erosion, and one curvature recurrence after 13 months of follow-up. No patient reported erectile dysfunction. Conclusion: This proof-of-concept study shows that partial NVB mobilisation is technically easier and safer compared to complete NVB mobilisation, without compromising the success of surgery. Level of evidence: Not applicable

scholarly journals Mobile App-based documentation of patient-reported outcomes — 3-months results from a proof-of-concept study on modern rheumatology patient management

2021 ◽  
Vol 23 (1) ◽  
Author(s):  
Jutta G. Richter ◽  
Christina Nannen ◽  
Gamal Chehab ◽  
Hasan Acar ◽  
Arnd Becker ◽  
...  
Keyword(s):  
Disease Activity ◽  
Disease Surveillance ◽  
Patient Management ◽  
Activity Index ◽  
Retention Rate ◽  
Likert Scale ◽  
Mobile App ◽  
Proof Of Concept ◽  
Concept Study ◽  
Patient Reported

Abstract Background Mobile medical applications (Apps) offer innovative solutions for patients’ self-monitoring and new patient management opportunities. Prior to routine clinical application feasibility and acceptance of disease surveillance using an App that includes electronic (e) patient-reported outcome measures (PROMs) warrant evaluation. Therefore, we performed a proof-of-concept study in which rheumatoid arthritis (RA) patients used an App (RheumaLive) to document their disease. Methods Accurate PROM reporting via an App in comparison to paper-based versions was investigated to exclude media bias. Sixty participants recruited from 268 consecutive RA outpatients completed paper-based and electronic PROMs (Hannover Functional Questionnaire/derived HAQ; modified RA disease activity index) using the App at baseline and follow-up visits. Between visits, patients used their App on their own smartphone according to their preferences. The equivalence of PROM data and user experiences from patients and physicians were evaluated. Results Patients’ (78.3% female) mean (SD) age was 50.1 (13.1) years, disease duration 10.5 (9.1) years, and paper-based HAQ 0.78 (0.59). Mean confidence in Apps scored 3.5 (1.1, Likert scale 1 to 6). ePROMs’ scores obtained by patients’ data entry in the App were equivalent to paper-based ones and preferred by the patients. After 3 months, the App retention rate was 71.7%. Patients' overall satisfaction with the App was 2.2 (0.9, Likert scale 1 to 6). Patients and physicians valued the App, i.e., for patient-physician interaction: 87% reported that it was easier for them to document the course of the disease using the App than “only” answering questions about their current health during routine outpatient visits. Further App use was recommended in 77.3% of the patients, and according to physicians, in seven patients, the App use contributed to an increased adherence to therapy. Conclusion Our study provides an essential basis for the broader implementation of medical Apps in routine care. We demonstrated the feasibility and acceptance of disease surveillance using a smartphone App in RA. App use was convincing as a reliable option to perform continuous, remote monitoring of disease activity and treatment efficacy. Trial registration ClinicalTrials.gov, NCT02565225. Registered on September 16, 2015 (retrospectively registered).

Initial experience in the treatment of Peyronie’s disease using testicular vaginal tunica graft

2021 ◽  
pp. 205141582110166
Author(s):  
Rico Luis ◽  
Villasante Nicolás ◽  
Blas Leandro ◽  
Bonnano Nicolás ◽  
Ameri Carlos
Keyword(s):  
Sexual Function ◽  
Tunica Albuginea ◽  
Peyronie’S Disease ◽  
Sexual Life ◽  
Rank Test ◽  
Penile Curvature ◽  
Initial Experience ◽  
Level Of Evidence ◽  
Paired Samples ◽  
Peyronie's Disease

Background: Peyronie’s disease (PD) is a progressive disorder of the connective tissue of the tunica albuginea of the penis that produces an abnormal curvature, painful erections and different degrees of erectile dysfunction (ED). The aim of this study is to evaluate our initial experience in the surgical treatment of PD using an autologous graft of testicular vaginal tunica. Materials and methods: A retrospective study of 23 patients was carried out between 2015 and 2019. The successful surgical stretching rate was defined as a functional 20 degrees of curvature or less. Postoperative sexual function and complications rate were evaluated as secondary objectives. We used the abbreviated IIEF-5 questionnaire and evaluated the sexual function before and after the surgical procedure. Wilcoxon signed-rank test for paired samples (U test) was used, considering a value of p<0.05 to be statistically significant. Results: Only one patient presented a recurrence of the penile curvature, resulting in a 95.6% success rate of functional stretching. We observed a 1.6 and 0.9 difference between pre- and postoperative total score and satisfaction ( p = 0.002 and p = 0.003 respectively) Conclusion: In this series, the use of testicular vaginal tunic was found to be safe and effective with a significant change in the quality of sexual life, especially reflected in the overall satisfaction after the procedure and a low rate of complications. Level of evidence: Not applicable for this multicentre audit.

scholarly journals Dorsal plication during penile orthoplasty with and without neurovascular bundle mobilizationA comparative clinical trial conducted At Ghazy Al-Hariri teaching hospital for surgical specialties (2013 –2015)

2016 ◽  
Vol 12 (2) ◽  
pp. 11-17
Author(s):  
Yousuf Mohammed Alhallaq ◽  
Yahia Muhaisin Ali ◽  
Harth Mohamed Kamber Al-Saadawi
Keyword(s):  
Tunica Albuginea ◽  
Invasive Procedure ◽  
Neurovascular Bundle ◽  
Penile Curvature ◽  
Free Zone ◽  
Group A ◽  
Penile Plication ◽  
Group B ◽  
A Prospective Study ◽  
Curvature Type

Background: Dorsal plication on each side of the penis at the 2 and 10-o’clock positions had been a mainstay for correction of ventral penile curvature. However, because only the 12-o’clock position proved to be a nerve-free zone, dorsal plication at the 12-o’clock position can be advocated. Objectives: To evaluate tunica albuginea plication with and without neurovascular bundle mobilization in patients with ventral penile curvature. Type of the study: A prospective study. Methods: A 34 patients with a mean age of (4.8 ± 0.54) years, Who still have ventral penile curvature all ≤ 30º after degloving of penis with or without other orthoplasty technique, randomized into two groups, in group (A) 17 patients subjected to midline dorsal penile plication at 12-o'clock, whereas in group (B) 17 patients subjected to plication of tunica albuginea at 2 and 10-o’clock positions after neurovascular bundle mobilization. Results: 94.1% of group (A) and 88.2% of group (B) Patients have satisfactory appearance of the penis. No complications were reported in both groups Conclusions: The incision and plication of tunica albuginea with neurovascular bundle mobilization is long and more invasive procedure than Midline dorsal penile plication with no significant differences in outcome.

scholarly journals Baduanjin Qigong Intervention by Telerehabilitation (TeleParkinson): A Proof-of-Concept Study in Parkinson’s Disease

2021 ◽  
Vol 18 (13) ◽  
pp. 6990
Author(s):  
Livia P. Carvalho ◽  
Simon Décary ◽  
Isabelle Beaulieu-Boire ◽  
Rosalie Dostie ◽  
Isabelle Lalonde ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Patient Satisfaction ◽  
Adverse Events ◽  
Proof Of Concept ◽  
Concept Study ◽  
Supervised Exercise ◽  
Patient Reported

Many people living with Parkinson’s Disease (PD) face issues with healthcare services, including delays in diagnosis and treatment, as well as limited access to specialized care, including rehabilitation programs. Non-motor and motor signs and symptoms typically observed in people with PD, such as tremor, rigidity, postural instability, bradykinesia, and freezing are particularly disabling and have been associated with falls, fractures, hospitalizations, and a worse quality of life. Baduanjin Qigong (BDJ) programs have been proven potentially effective in improving physical outcomes and reducing the incidence of falls in PD. The aim of this case report, proof-of-concept, study was to explore the adherence, feasibility, acceptability, and potential efficacy of a BDJ program offered via telerehabilitation in people with PD living in the community. Two participants performed semi-supervised exercise sessions at home, twice a week (over eight weeks) using the TeraPlus platform. Adherence, adverse events, and feasibility (technical implementability), acceptability (patient satisfaction), patient-reported, self-reported, and performance outcomes were measured. Results were based on single-subject descriptive data, minimal detectable change, and anchor-based minimally important difference. Our findings suggest that the intervention seems feasible with no major technical issues or adverse events, and high adherence; acceptable (patient satisfaction); and potentially effective to improve markers of walking performance (gait speed, balance), and quality of life (activities of daily living, mobility).

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