Refined Nomogram Incorporating Standing Cough Test Improves Prediction of Adjustable Trans-Obturator Male System (ATOMS) Success to Treat Post-Prostatectomy Male Stress Incontinence

(1) Background: The adjustable transobturator male system (ATOMS) device serves to treat post-prostatectomy incontinence, as it enhances residual urinary sphincteric function by dorsal compression of the bulbar urethra. We investigated the clinical parameters affecting continence recovery using this device and developed a decision aid to predict success. (2) Methods: We reviewed consecutive men treated with first-time ATOMS for post-prostatectomy incontinence from 2014 to 2021 at our institution. Patient demographics, reported pads per day (PPD), 24-h pad-test and Standing Cough Test (SCT), results’ grades 1–4, according to Male Stress Incontinence Grading Scale (MSIGS), and the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) questionnaire were assessed. Treatment success was defined as no pads or a single PPD with ≤20-mL 24-h pad-test. Logistic regression was performed using a stepwise model (entry 0.15 and stay criterium 0.1) to evaluate independent variables’ determinant of dryness. Receiver-operating characteristic (ROC) curves for predictive variables were evaluated and their area under curve (AUC) was compared. A nomogram was generated and internally validated to predict probability of treatment success. (3) Results: Overall, 149 men (median age 70 years, IQR 7) were evaluated with a median follow-up of 45 months (IQR 26). Twelve patients (8%) had previous devices for incontinence, and 21 (14.1%) had pelvic radiation. Thirty-five men (23.5%) did not achieve continence after ATOMS adjustment (use of no or one security PPD with ≤20-mL 24-h pad-test). In univariate analysis, Charlson comorbidity index (p = 0.0412), previous urethroplasty (p = 0.0187), baseline PPD (p < 0.0001), 24-h pad-test (p < 0.0001), MSIGS (p < 0.0001), and ICIQ-SF questionnaire score (p < 0.0001) predicted ATOMS failure. In a multivariable model, 24-h pad-test (p = 0.0031), MSIGS (p = 0.0244), and radiotherapy (p = 0.0216) were independent variables, with AUC 0.8221. The association of MSIGS and 24-h pad-test was the superior combination (AUC 0.8236). A nomogram to predict the probability of ATOMS failure using the independent variables identified was proposed. (4) Conclusions: Several variables were identified as predictive of success for ATOMS using clinical history, physical examination (MSIGS), and factors that evaluate urine loss severity (PPD, 24-h pad-test, and ICIQ-SF questionnaire). MSIGS adds prognostic value to 24-h pad-test in assessing success of ATOMS device to treat post-prostatectomy incontinence. A nomogram was proposed to calculate the risk of ATOMS failure, which could be of interest to personalize the decision to use this device or not in the individual patient.

Nordic Walking in Rehabilitation of Women with Stress Urinary Incontinence after Sling Operations

It is known that urinary incontinence remains one of the most common diseases in women, representing a serious medical and social problem. Practice shows that sling operations without subsequent rehabilitation measures, especially in the long term, do not solve the problem. In urogynecology, the use of physical exercises and physiotherapeutic methods is aimed at restoring impaired urinary functions. A relatively new approach to the rehabilitation of women after sling operations is the inclusion of Nordic walking (NW) into the rehabilitation program. Certain experience in this field has been accumulated in Sverdlovsk Regional Clinical Hospital № 1 (Yekaterinburg). Aim. To improve the efficiency of treatment of female stress urinary incontinence using the technique of NW in rehabilitation programs after sling operations. Material and methods. In Sverdlovsk Regional Clinical Hospital № 1 in Yekaterinburg, NW is included in rehabilitation programs for women with stress urinary incontinence after sling operations. Experience in planning and conducting a four-week course of NW under the physiotherapist guidance has been accumulated. Patients after sling operations (n= 85) were randomized into two groups. Rehabilitation program of patients of the first group (n = 37) included a 4-week course of NW on the background of basic therapy (antibacterial therapy, antispasmodics, anticoagulants), while in the second group (n = 48) only basic therapy was realized. The dynamics of clinical manifestations of stress urinary incontinence was studied, uroflowmetry parameters, PAD-test data, cough test were evaluated; the answers of the patients to the questions of the international questionnaires PFDI-20, PFIQ-7 were analyzed. Results and discussion. The variability of the currently used methods of rehabilitation of patients with stress urinary incontinence requires objectification of the results. The study showed that Nordic walking (NW) is a pathogenetically justified and clinically effective method for rehabilitation of women with stress urinary incontinence after sling operations. The analysis of the rehabilitation activities data based on the dynamics of leading clinical symptoms, PAD test, cough test, uroflowmetry parameters revealed significant differences (p<0.05) between two groups at all follow-up periods: a month, three and nine months. Postoperative objective evaluation of the treatment results correlate with patients’ subjective data: women who completed a course of NW rated their quality of life significantly higher than patients of the control group under the rehabilitation program without inclusion of therapeutic physical factors. The structure of NW classes is based on the understanding that the body response to the physical factors impact is provided by various organs and systems. The inclusion of NW in rehabilitation programs requires adherence to the basic principles of achieving training status. Conclusion. The expediency of NW including in the complex treatment of patients with stress urinary incontinence is due to the regression of main clinical symptoms, reliably significant dynamics of instrumental parameters and test results in comparison with the group that received only basic therapy. The implementation of the therapeutic effect is based on the principle of unity of syndromicpathogenetic and clinical-functional approaches. Clinical-functional approaches is the basis for the implementation of the therapeutic effect.

Long-term effects of hysterectomy due to uterine fibroids in women of reproductive age

The article presents an analytical assessment of long-term postoperative consequences in women of reproductive age after hysterectomy for uterine fibroids. The aim of the study to determine the structure of long-term results of hysterectomy for uterine fibroids in women of reproductive age using different approaches to the possibility of optimizing the diagnostic algorithm in the preoperative period in the future. Materials and methods – 160 women aged 40 to 50 years with symptomatic uterine fibroids, who underwent hysterectomy performed by vaginal, laparoscopically assisted vaginal, abdominal, were examined. Research methods are the following: physical examination of patients, assessment of pelvic floor (cough test, Valsalva maneuver, “Stop Test” with Kegel cones), diagnosis of urogenital dysfunction using a standardized POP-Q system; instrumental examination:, complete urodynamic testing, cystometry, (for assessment of the severity of urinary incontinence the classification of the International Continence Society (ICS) was used); assessment of the patient’s quality of life on the 10th day after surgery, 3, 6, 12 months and three years after surgery using the international standard questionnaire MOS SF-36; study of the local infectious status of the female body (bacteriological and bacterioscopic examination of discharge from vagina and urethra, determination of vaginal pH Results and their discussion. The structure of distant postoperative manifestations was determined (after 36 months of postoperative monitoring): clinical manifestations of intestinal function discomfort in the same degree in patients of three subgroups, 2.4 and 2.9 times less often in group I patients indicated chronic pelvic pain, in 1.7 times less often - for genitourinary disorders, vaginal prolapse in a third of cases, especially in women with abdominal HE and classic vaginal HE (30.0±5.0 % and 37.8±5.0 %, respectively, against 17.8±4.0 % – in the group with laparotomically assisted HE). Conclusions. Given the data on genitourinary disorders and vaginal prolapse in almost a third of observations after hysterectomy for uterine fibroids, it is advisable to consider additional examination of latent signs of genitourinary syndrome at the preoperative stage to optimize the choice of access, the volume of surgical treatment.

Long-Term Results after Suprapubic ARC Procedure for the Treatment of Stress Urinary Incontinence in Women: A Retrospective Data Analysis

<b><i>Introduction:</i></b> The aim of this study was to evaluate long-term safety and efficacy of the suprapubic arc (SPARC) procedure for the surgical treatment of stress urinary incontinence (SUI). <b><i>Materials and Methods:</i></b> 139 female patients treated by SPARC were included in this retrospective analysis, whereby 126 patients were available for follow-up after 1 year, 70 after 6 years, and 41 after 9 years. The cough test, pad test, uroflowmetry, and post-void residual volume measurements were performed. Severity of bother (visual analogous scale [VAS] 0–10), continence, and the satisfaction rate were assessed. Objective cure was defined as a negative cough test and pad weight ≤1 g, subjective cure as no urine loss during daily activities and no usage of pads. The VAS, pad weight, number of pads per day, and maximal flow rate were compared preoperatively and postoperatively. <b><i>Results:</i></b> Objective cure rates at 1, 6, and 9 years were 78.6, 71.4, and 70.7% and subjective cure rates were 72.2, 55.7, and 65.8%, respectively. The VAS, pad weight, number of pads, and maximal flow rate decreased significantly. Study limitations include a relatively small sample size and the retrospective fashion of the analysis. <b><i>Conclusions:</i></b> In the long-term context, SPARC showed to represent an efficient and safe procedure for treatment of female SUI.

Cough-Inducing Method Using a Tartaric Acid Nebulizer for Patients with Silent Aspiration

The tartaric acid nebulizer is a well-known cough test to evaluate cough function. This study aimed to evaluate the effectiveness of a cough-inducing method using tartaric acid (CiTA). Patients with dysphagia examined by videofluoroscopic examination of swallowing (VF) at a single institution from May 2017 to August 2017 were included in this retrospective observational study. Although undergoing VF, patients who had aspirated without reflexively coughing or who had coughed insufficiently, were instructed to cough voluntarily. Patients who could not cough voluntarily or had expectorated insufficiently underwent the CiTA method. The rate of cough induction and the effectiveness of expectoration using the CiTA method were evaluated. One hundred fifty-four patients (mean age 69.2 ± 16.8 years) were evaluated. Eighty-seven patients aspirated during VF. Of those patients, 15 were able to expectorate via the cough reflex, 18 were able to expectorate with a voluntary cough, and 12 required suctioning for removal of aspirated material. The remaining 42 patients underwent the CiTA method. Thirty-eight patients (90.4%) could reflexively cough, and 30 (71.4%) could expectorate the aspirated material. This novel method, CiTA, was effective for cough induction in patients with dysphagia, especially for those with silent aspiration.

RELATIONSHIP BETWEEN GLASGOW COMA SCALE AND AIRWAYS PROTECTIVE REFLEXES IN CEREBRO VASCULAR ATTACK PATIENTS

Introduction: The laryngeal cough reex (LCR) protects the supraglottic larynx from signicant aspiration of food or uids during inspiration or pharyngeal spillage during swallowing 1. The reex cough test (RCT), using nebulized tartaric acid solution, provides an effective stimulus to the receptors in the supraglottic mucosa, and, like a reex hammer or percussor, triggers a cascade of neurological activity in both craniospinal nerves and the central nervous system. The vagus nerve mediates the afferent component of the LCR. Aims And Objective:To nd the relation between glasgowcoma scale and airway protective reexes in Indian population. Materials And Methods: This study was a prospective observational study. Clinical history and examination is mandatory for selection of the eligible patients. All the procedure was done, only once a traumatically, in patients. Suction apparatus was made available all the time beside the patients in case they vomit. Procedure was done under supervision of senior physician. Result And Analysis: We found that in ≤5 GCS Group, 15(100.0%) patients had Intubation. In 6-8 GCS Group, 7(10.6%) patients had Intubation. In ≥9 GCS Group, 8(20.5%) patients had Intubation. Association of Intubation vs GCS Group was statistically signicant (p<0.0001). In ≤5 GCS Group, 15(100.0%) patients had Immediate Intubation. Summary And Conclusion: In our study, 11(9.2%) patients were Attenuated/ Diminished (Absent Cough and Gag reex) air way protective reexes checked later, 19(15.8%) patients were Not Applicable (As Pt Mechanical Ventilator) air way protective reexes checked later and 90(75.0%) patients were Patent (Present Cough and Gag reex) air way protective reexes checked later. Mechanical Ventilator was more in low GCS (≤5) which was statistically signicant.

Dysphagia Screening Protocol For Acute Stroke Patient: A Literature Review

ABSTRACT Background: Nearly two-thirds of acute stroke patients have dysphagia. Dysphagia defined as difficulty in swallowing of liquids or food, vary in severity with symptoms ranging from mild throat discomfort to inability to eat. It&rsquo;s well known that dysphagia is associated with aspiration pneumonia, dehydration, malnutrition, prolonged length of stay, and increased mortality. Early screening reduces pneumonia rates in stroke and it is usually performed by nurses. Dysphagia screening is recommended but no protocol or tool is pointed.Aim: the aim of this study is to conduct a literature review of dysphagia screening for stroke patient Methods: Literature search three databases (Scopus, Proquest, and Science Direct), with the keywords "Dysphagia" AND "Stroke" AND "Nursing", published in English between 2019 and 2021. Result: Twenty five publications relating to dysphagia screening met the inclusion criteria. There are five methods of dysphagia screening performed by nurses or other health workers: 1) a simple Questionnaire Test (4QT) method, which is by asking the following four questions: does the patient cough or choke while eating or drinking; whether the patient takes longer than usual to eat; does the patient change the thickness of the food to be able to swallow, and whether the voice turns hoarse after eating or drinking; 2) Water Swallow Test (WST) method; 3) Bed Side Screening Tool for Dysphagia (BSTD) method; 4) Volume Viscosity Swallow Test (V-VST) method, namely modification of feeding with first pudding, nectar and finally water; 5) Simplified Cough Test Method. The five screening methods for dysphagia above have been tested for sensitivity and specificity, as well as positive and negative predictive valuesConclusion: screening is a first step in the identification of swallowing impairment or dysphagia of stroke patient. Dysphagia is an independent predictor of poor patient outcome and prolonged recovery time. Nurse has an important role to conduct a screening and must ensure that the selected tools has high reliability and concurrent validity. Key Words: Stroke, Dysphagia, Screening, Nursing

Aetiologies of chronic cough diagnosed using a pathophysiologic diagnostic procedure and their treatment outcomes

BackgroundWe previously elucidated the fundamental pathophysiological features of various aetiologies of chronic cough, such as cough variant asthma, atopic cough, and sinobronchial syndrome. We also established a pathophysiological diagnostic procedure for aetiology identification. In this study, we aimed to disclose the aetiologies of chronic cough using the pathophysiological diagnostic procedure and to determine the outcomes of treatment administered on the basis of aetiology.Patients and MethodsWe retrospectively reviewed the medical records of patients with chronic cough who visited our cough specialty clinic from September 2013 to August 2018 and analyzed the pathophysiological diagnostic procedure-based aetiologies and corresponding treatments. The pathophysiological diagnostic procedure included the capsaicin cough test, methacholine cough test, bronchial reversibility test, bronchial responsiveness test, chest and sinus CT, and sputum examinations.ResultsInitially, 303 patients were selected, and 300 patients underwent the diagnostic procedure. Aetiologies of chronic cough were diagnosed in 297 patients (99.0%). In the other three patients (1.0%), all results of the diagnostic procedure were within normal limits; their aetiologies were evaluated using the therapeutic diagnostic procedure. Tweleve patients discontinued follow-up before completing treatment. Of the 291 remaining patients, cough resolved completely in 283 patients. The median time required for the complete resolution of cough was 5.0 weeks (95% CI 4.3∼5.7 weeks).ConclusionsThe pathophysiological diagnostic procedure can lead to rapid and objective diagnosis of causes of chronic cough, which leads to superior treatment results compared to therapeutic diagnostic procedure.Trial registration numberUMIN ID: UMIN000018679Key MessagesOur pathophysiological diagnostic procedure can lead to rapid and objective diagnosis of the aetiology of chronic cough, leading to superior treatment results compared to those of therapeutic diagnostic procedures.