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Purpose: To define transcutaneous medial plantar nerve stimulation (T-MPNS) as a new neuromodulation method and assess the efficacy of T-MPNS on quality of life (QoL) and clinical parameters associated with incontinence in women with idiopathic overactive bladder (OAB). Materials and Methods: Twenty-one women were included in this study. All women received T-MPNS. Two self-adhesive surface electrodes were positioned with the negative electrode near the metatarsal-phalangeal joint of the great toe on the medial aspect of the foot and the positive electrode 2 cm inferior-posterior of the medial malleolus (in front of the medio-malleolar-calcaneal axis). T-MPNS was performed 2 days a week, 30 minutes a day, for a total of 12 sessions for 6 weeks. Women were evaluated for incontinence severity (24-h pad test), 3-day voiding diary, symptom severity (Overactive Bladder Questionnaire [OAB-V8]), QoL (Quality of Life-Incontinence Impact Questionnaire [IIQ-7]), positive response and cure-improvement rates, and treatment satisfaction at baseline and at the 6th week. Results: Statistically significant improvement was found in the severity of incontinence, frequency of voiding, incontinence episodes, nocturia, number of pads, symptom severity, and QoL parameters at the 6th week compared with baseline. Treatment satisfaction, treatment success, and cure or improvement rates were found to be high at the 6th week. Conclusions: T-MPNS was first described in the literature as a new neuromodulation method. We conclude that T-MPNS is effective on both clinical parameters and QoL associated with incontinence in women with idiopathic OAB. Randomized controlled multicenter studies are needed to validate the effectiveness of T-MPNS. [ABSTRACT FROM AUTHOR]

The aim of the study was to determine which vasoactive agent was more efficacious for erectile dysfunction (ED), intracavernosal papaverine or oral sildenafil, in paraplegic men within the first year after injury by using a penile color Doppler ultrasound as a quantitative imaging method and to determine the association between responses to these two vasoactive agents and factors such as neurological lesion level and lesion severity. A total of 31 male in-patients with spinal cord injury, aged over 18 years, and with neurological lesions below the T6 level within the first year after injury with ED were included. Visual and auditory sexual stimulus (VASS) on day 1 (group 1), VASS with 25 mg intracavernosal papaverine (group 2) and after a wash-out period of papaverine on day 2, and VASS with 50 mg oral sildenafil on day 5 (group 3) were administered to each patient. Measurements of the peak systolic velocity and end diastolic velocity, which were used as vascular parameters during each procedure type, were taken using penile color Doppler ultrasound. Considering the severity of the lesion and the levels of the neurological lesion, there was a statistically significant difference between the PSV values of the group 1 and the other two groups (P less than 0.05). There was no statistically significant difference between the peak systolic velocity and end diastolic velocity values of groups 2 and 3 (P greater than 0.05) in terms of both the severity and the levels of the lesion. Efficacies of intracavernosal papaverine hydrochloride or oral sildenafil citrate for ED were similar at all neurological lesion levels and lesion severity in paraplegic men within the first year after spinal cord injury.

Copyright of Journal of Physical Medicine & Rehabilitation Sciences is the property of Turkiye Klinikleri and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract Introduction Medial antebrachial cutaneous nerve (MACN) neuropathy is reported to be caused by iatrogenic reasons. Although the cases describing the posterior branch of MACN neuropathy are abundant, only one case caused by lipoma has been found to describe the anterior branch of MACN neuropathy in the literature. As for the reason for the forearm pain, we report the only case describing isolated anterior branch of MACN neuropathy which has developed due to repeated minor trauma. Case presentation We report a 37-year-old woman patient with pain in her medial forearm and elbow following the shaking of a rug. Pain and symptoms of dysestesia in the distribution of the right MACN were found. Electrophysiological examination confirmed the normality of the main nerve trunks of the right upper limb and demonstrated abnormalities of the right MACN when compared with the left side. Sensory action potential (SAP) amplitude on the right anterior branch of the MACN was detected to be lower in proportion to the left. In the light of these findings, NSAI drug and physical therapy was performed. Dysestesia and pain were relieved and no recurrence was observed after a follow-up of 14 months. Conclusion MACN neuropathy should be taken into account for the differential diagnosis of the patients with complaints of pain and dysestesia in medial forearm and anteromedial aspect of the elbow.

Copyright of Journal of Physical Medicine & Rehabilitation Sciences is the property of Turkiye Klinikleri and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objectives: This study aims to assess the correlations between disease specific quality of life (QoL), general health status and clinical variables in patients with ankylosing spondylitis (AS), and also to determine a cutoff value for the disease specific QoL questionnaire. Patients and methods: A total of 124 patients (80 males, 44 females; mean age 40.6±11.1 years; range, 20 to 65 years) who fulfilled the modified New York criteria for AS were included in this cross-sectional study. All patients received a comprehensive rheumatologic assessment including disease specific instruments for disease activity, functional status, spinal mobility and QoL. Furthermore, short form-36 (SF-36) was used to determine general health status. Pain levels of the patients were assessed with visual analog scale (VAS). Pearson's analysis was used to assess correlation among variables, with moderate, strong, or very strong correlations if the value was between 0.40-0.69, 0.70-0.89, and 0.90-0.99, respectively. To determine a cutoff value for the ankylosing spondylitis quality of life (ASQoL) score, the area under the receiver operating characteristic curve (AUC) was computed according to clinical parameters which have the strongest correlations with ASQoL. Results: The mean ASQoL score was 8.8±4.9. There was a significantly positive correlation between ASQoL and disease activity, functional status, spinal mobility and pain VAS whereas there was a significantly negative correlation between ASQoL and the SF-36 subscale scores except for mental health and emotional role (p<0.001). The strongest positive correlation was found between ASQoL and the Bath Ankylosing Spondylitis Disease Activity Index (r=0.721, p<0.001) whereas the strongest negative correlation was found between ASQoL and the first question of SF-36 (r=-0.844, p<0.001). A cutoff value of eight in ASQoL showed good discriminative properties for impaired QoL where sensitivity and specificity were simultaneously maximized according to disease activity (AUC=0.84 [95% confidence interval (CI): 0.770-0.908, p<0.001]) and the patients' global health status (AUC=0.85 [95% CI: 0.782-0.923, p<0.001]) in patients with AS. Conclusion: There was a strong correlation between ASQoL and disease activity as well as the patients' global health status in patients with AS. A cutoff value of eight in ASQoL could be used with good discriminative properties for impaired QoL in AS. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the efficacy of single and combined use of biofeedback (BF) and electrical stimulation (ES) added to bladder training (BT) on incontinence‐related quality of life (QoL) and clinical parameters in women with idiopathic overactive bladder (OAB). Material and Methods: Seventy women were randomized into four groups as follows: Group 1 received BT alone (n = 18), Group 2 received BT + BF (n = 17), Group 3 received BT + ES (n = 18), and Group 4 received BT + BF + ES (n = 17). BF and ES were performed 3 days a week, 20 min a day, a total of 24 sessions for 8 weeks. All women were evaluated in terms of incontinence severity (pad test), pelvic floor muscles strength (perineometer), 3‐day voiding diary (frequency of voiding, nocturia, incontinence episodes, and number of pads), QoL (incontinence impact questionnaire), treatment success (positive response rate), cure/improvement rate, treatment satisfaction (Likert scale), and discomfort level (visual analog scale). Results: At the end of the treatment, severity of incontinence, frequency of voiding, incontinence episodes, and treatment satisfaction significantly improved in Group 3 and Group 4 compared with the other two groups. In Group 3 and Group 4, high statistically significant values were found in cure/improvement and positive response rates as opposed to Group 1 and Group 2. In Group 2 and Group 3, statistically significant improvements were seen in nocturia and QoL compared with Group 1. Moreover, statistically significant improvements in nocturia and QoL were found in Group 4 compared with the other three groups. There was no difference in the discomfort level of application between the groups. Conclusion: We conclude that in the first‐line conservative treatment of women with idiopathic OAB: (i) adding BF and/or ES to BT increases treatment effectiveness, (ii) clinical efficiency is greater when the combination includes ES, (iii) BT + BF + ES (triple combination) is the most effective treatment option in reducing nocturia and improving QoL. [ABSTRACT FROM AUTHOR]

BACKGROUND: Myofascial pain syndrome (MPS) which is an important cause of musculoskeletal pain has shown a dramatic increase in recent years. OBJECTIVES: We aimed to evaluate the efficacy of intramuscular electrical stimulation therapy (IMS) and low-level-laser-therapy (LLLT) in patients with MPS. METHODS: Patients were randomly divided into three groups. First group were treated with LLLT and stretching exercise. Second group were treated with IMS and stretching exercise. Third group were treated with only stretching exercise. The patients were evaluated through the pain intensity, pain threshold, cervical joint movement range and the neck disability index parameters. RESULTS: An improvement was found in all parameters for all groups, except for the pain threshold within the control group at the end of the treatment and one month after the treatment. It was found that pain score was significantly lower in Group 1 and 2 at one month after the treatment compared to Group 3. Similarly, it was found that pain threshold score was significantly higher in Group 2 at one month after the treatment compared to Group 3. CONCLUSIONS: In this study we observed that both LLLT and IMS treatments added on to stretching are effective in improving pain parameters in patients with MPS. [ABSTRACT FROM AUTHOR]

ntroduction: The aim of this study was to determine whether there is an association between fall risk measured posturographically and clinical balance tests among people who are over 65 years of age, and to identify the discriminative ability of the posturographic fall risk index. Materials and Methods: Two hundred and twenty participants who were over 65 years of age were included in the study. The balance and fall risk of participants were assessed with the Berg balance scale (BBS) and a posturography device; functional mobility with the Timed Up and Go (TUG) test; lower extremity neuromuscular function with the Chair Stand test (CST) and qual-ity of life with the Short Form-36 (SF-36). Participants were grouped into two, as fallers and non-fallers, on the basis of the past year's fall history. Results: A total of 78 participant (35.5%) had a history of falling, while 142 (64.5%) of the subjects did not. Age, TUG and posturographic fall risk index of fallers were significantly higher than for nonfallers, whilst some subgroups of the SF-36, BBS and mean CST scores were lower (p<0.05). There were negative correlations between posturographic fall risk and the BBS (r=-0.84) and CST (r=-0.40) yet a positive correlation with the TUG (r=0.67) (p<0.05). Using the agreement between the posturographic fall risk index and history of falls, the area under the ROC curve was 0.818. In this study, when the cut-off value 51< was used, sensitivity was found to be 76.9% and specificity was 73.9%, with a higher value for the Youden index: 0.508. Conclusion: It was shown that fallers had poorer balance, functional mobility, lower extrem-ity neuromuscular function and quality of life than nonfallers. The study also demonstrated that posturographically obtained fall risk was significantly correlated with clinical balance tests and had good discriminative ability to identify fallers. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to investigate whether patients with ankylosing spondylitis (AS) have a higher fall risk than healthy subjects and to determine whether fall risk is associated with the clinical features of AS. Patients and methods: Forty AS patients (28 males, 12 females; mean age 37.20+9.92 years; range 20 to 60 years) who met the modified New York criteria and 40 age and gender-matched healthy controls were included. All participants were assessed by a static posturography device which provided numerical values in the percentage for fall risk. Patient interviews were used to assess the history of falls for the previous 12 months. The following tools were used for all AS patients: The Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) for disease activity, the Bath Ankylosing Spondylitis Functional Index (BASFI) for function, the Bath Ankylosing Spondylitis Metrology Index (BASMI) for spinal mobility, and the Ankylosing Spondylitis Quality of Life (ASQoL) questionnaire for quality of life. Results: There were no differences in the sociodemographic characteristics among the AS patients and the healthy controls (p>0.05). The mean fall risk was significantly higher for the AS patients compared to the controls (p<0.05). The ratio of AS patients who had a positive history of falls was significantly higher than controls (p<0.05). Fall risk was positively and significantly associated with the BASDAI (r=0.713, p<0.001), BASFI (r=0.751, p<0.001), BASMI (r=0.527, p<0.001), and ASQoL (r=0.627, p<0.001). The fall risk was not associated with the age, sex, body mass index and disease duration (p>0.05). Conclusion: Fall risk increased in patients with AS which was associated with poor spinal mobility, functional status, quality of life and higher disease activity. Increased risk of falling should be taken into consideration in the rehabilitation of the patients with AS. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study is to compare the efficacy of mature mud pack and hot pack therapies on patients with knee osteoarthritis. Design: This study was designed as a prospective, randomized-controlled, and single-blinded clinical trial. Twenty-seven patients with clinical and radiologic evidence of knee osteoarthritis were randomly assigned into two groups and were treated with mature mud packs (n 15) or hot packs (n=12). Patients were evaluated for pain [based on the visual analog scale (VAS)], function (WOMAC, 6 min walking distance), quality of life [Short Form-36 (SF-36)], and serum levels of tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), and insulin-like growth factor-1 (IGF-1) at baseline, post-treatment, and 3 and 6~months after treatment. Results: The mud pack group shows a significant improvement in VAS, pain, stifness, and physical function domains of WOMAC. The difference between groups of pain and physical activity domains is significant at post-treatment in favor of mud pack. For a 6 min walking distance, mud pack shows significant improvement, and the difference is significant between groups in favor of mud pack at post-treatment and 3 and 6 months after treatment. Mud pack shows significant improvement in the pain subscale of SF-36 at the third month continuing until the sixth month after the treatment. Significant improvements are found for the social function, vitality/energy, physical role disability, and general health subscales of SF-36 in favor of the mud pack compared with the hot pack group at post-treatment. A significant increase is detected for IGF-1 in the mud pack group 3 months after treatment compared with the baseline, and the difference is significant between groups 3 months after the treatment. Conclusion: Mud pack is a favorable option compared with hotpack for pain relief and for the improvement of functional conditions in treating patients with knee osteoarthritis. [ABSTRACT FROM AUTHOR]

Copyright of Turkish Journal of Physical Medicine & Rehabilitation / Turkiye Fiziksel Tip ve Rehabilitasyon Dergisi is the property of Turkish Society of Physical Medicine & Rehabilitation and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Complex regional pain syndrome (CRPS) is a syndrome characterized by a combination of pain, trophic changes, and vasomotor disturbances. Although the case reports in the literature describing the CRPS secondary to lumbar disc herniation (LDH) are abundant, in these case reports CRPS is diagnosed in only one extremity. Based on the most recent information available, this is the first case of CRPS associated with LDH that developed in bilateral lower extremities and could be successfully treated conservatively. A 49-year-old male patient was admitted to the clinic with complaints of pain and swelling of both feet and ankles, particularly on the left side. The patient had a history of an episode of low back pain radiating down the left leg that had developed two months previously after bending and lifting. Lumbar magnetic resonance imaging showed posterocentrally- and bilateral paramedially-located L5-S1 disc protrusion. One month after the onset of low back pain, painful stiffness and swelling developed in the joints of both ankles and feet, accompanied by edema, hyperhydrosis and allodynia in the dorsum of the left foot. He did not have any history of trauma. The medical history and laboratory investigations were normal. A diagnosis of CRPS in bilateral lower extremities was confirmed by direct foot-ankle radiographs and three-phase bone scintigraphy. A comprehensive conservative treatment program consisting of drug treatment (nonsteroidal anti-inflamatory drugs, gabapentin and calcitonin), physical therapy, and rehabilitation methods consisting of active-passive range of motion exercises to both ankles with gentle stretching, desensitization activities, gait training, application of a hot pack, ultrasound and transcutaneous electrical nerve stimulation to the lumbar region were applied. The patient's symptoms were relieved by these conservative treatments in six weeks. No recurrence occurred after a follow-up of 12 months. CRPS should be considered as a cause of persistently painful and swollen bilateral lower extremities in a patient with LDH. Early, accurate diagnosis should permit initiation of appropriate treatment and increase the success of the treatment. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to compare the efficacy of ultrasound (US) and ketoprofen phonophoresis (PH) in the treatment of carpal tunnel syndrome (CTS). Design: This study was a prospective, randomised, controlled, double-blinded clinical trial with follow-up at 8 weeks. Fiftyone patients (76 median nerves) with clinical and electrophysiologic evidence of mild or moderate CTS were included in the study. They were randomly assigned to one of three groups; group 1 received sham US and splinting, group 2 received US and splinting, and group 3 received ketoprofen phonophoresis and splinting. Patients were evaluated by use of electrophysiological variables such as median motor distal latency (mMDL), median sensory distal latency (mSDL), functional status scale (FSS), symptom severity scale (SSS) and visual analog scale (VAS). Electrophysiological variables and scales were evaluated at the beginning, end of therapy (2{nd} week) and 8{th} week. Results: All the randomised patients were included in the intention-to-treat (ITT) analysis. The per protocol (PP) analysis included only those patients who complied with the study protocol. After completing 2 weeks of treatment, seven out of 51 randomized patients did not finish the study protocol due to non-compliance to splinting, illness and lost to follow-up. Those patients were excluded from PP analysis. Participants were similar in all clinical, electrophysiological and demographic respects (p>0.05). An improvement was found in all parameters (VAS, FSS, SSS, mMDL and mSDL) for all groups at the end of the treatment and 8th week. It was found that pain score was significantly lower in group 3 compared to other treatment groups at 8{th} week according to ITT and PP analysis (p= 0.002, p=0.004 and p=0.001, p=0.001). Conclusion: Ketoprofen PH as adjuvant therapy on splinting is effective with respect to reduction of pain. Adding US therapy to the splinting is not superior to the splinting alone in patients with CTS. [ABSTRACT FROM AUTHOR]

Copyright of Turkish Journal of Physical Medicine & Rehabilitation / Turkiye Fiziksel Tip ve Rehabilitasyon Dergisi is the property of Turkish Society of Physical Medicine & Rehabilitation and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: Medial antebrachial cutaneous nerve (MACN) neuropathy is reported to be caused by iatrogenic reasons. Although the cases describing the posterior branch of MACN neuropathy are abundant, only one case caused by lipoma has been found to describe the anterior branch of MACN neuropathy in the literature. As for the reason for the forearm pain, we report the only case describing isolated anterior branch of MACN neuropathy which has developed due to repeated minor trauma. Case presentation: We report a 37-year-old woman patient with pain in her medial forearm and elbow following the shaking of a rug. Pain and symptoms of dysestesia in the distribution of the right MACN were found. Electrophysiological examination confirmed the normality of the main nerve trunks of the right upper limb and demonstrated abnormalities of the right MACN when compared with the left side. Sensory action potential (SAP) amplitude on the right anterior branch of the MACN was detected to be lower in proportion to the left. In the light of these findings, NSAI drug and physical therapy was performed. Dysestesia and pain were relieved and no recurrence was observed after a follow-up of 14 months. Conclusion: MACN neuropathy should be taken into account for the differential diagnosis of the patients with complaints of pain and dysestesia in medial forearm and anteromedial aspect of the elbow. [ABSTRACT FROM AUTHOR]

Copyright of Turkish Journal of Physical Medicine & Rehabilitation / Turkiye Fiziksel Tip ve Rehabilitasyon Dergisi is the property of Turkish Society of Physical Medicine & Rehabilitation and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: It was aimed to investigate the relationship of lesion level and severity with bladder behavior based on urodynamic findings in patients with spinal cord injury (SCI). Materials and Methods: Forty nine patients who were on inpatient rehabilitation programme in our clinic with the diagnosis of SCI after the spinal shock period were included in the study. Neurological level (cervical, thoracal, lumbosacral) and severity of the lesion (complete, incomplete) were set according to the American Spinal Injury Association (ASIA) classification. It was assessed if the level and severity of the SCI related to neurogenic bladder type, maximum cystometric capacity (MCC) and compliance which were designated with urodynamic study and methods of bladder management. Results: There was no difference in terms of age, sex, disease duration, neurogenic bladder type, MCC, compliance, method of bladder management on admission according to the level and severity of the lesion among patients with SCI (p>0.05). Level and severity of SCI were significantly associated with the method of bladder drainage at discharge (r: 0.33, p<0.01 and r: 0.40, p<0.005, respectively). 90.5% of patients with complete SCI and 64.3% of patients with incomplete SCI were using clean intermittent catheterization (CIC), 32.1% of the patients with incomplete SCI urinated spontaneously, whereas none of the patients with complete SCI could urinate. It was found that 83.3% of cervical, 81.8% of thoracic and 60% of lumbosacral injured patients were using CIC. The greatest rate of spontaneous urination (40%) was observed in people with lumbosacral injuries compared to cervical and thoracic levels (8.3 and 9.1%, respectively).The significance of this difference could not be tested statistically due to the small sample size. Level (r: 0.33) and severity (r: 0.40) of SCI, MCC (r: 0.33) and compliance (r: 0.34) were all significantly correlated with the method of bladder management at discharge. Conclusion: MCC, compliance, and level and severity of injury were found to be related with the method of bladder management at discharge in patients with SCI. On the other hand, when the lesion level and severity are insufficient in determining the bladder behavior, the necessity of urodynamical evaluation arises. [ABSTRACT FROM AUTHOR]

Aim To identify physical, cognitive, and metabolic factors affecting gait speed in patients with type-2 diabetes mellitus (T2DM) without neuropathy. Methods This cross-sectional study enrolled 71 diabetic patients without neuropathy (mean age 55.87 ± 7.74 years, 85.9% women). Neuropathy status was assessed with Douleur Neuropathique 4. We used a cut-off point for gait speed of 1 m/s to classify the participants into two groups: slow walkers (SW) and average and brisk walkers (ABW). The groups were compared in terms of age, sex, body mass index (BMI), hemoglobin A1c (HbA1c), fasting glucose, systolic blood pressure, maximal aerobic capacity (VO2 max), percentage of muscle mass, percentage of lower extremity muscle mass, Mini-Mental State Examination (MMSE) score, and years of education. Results Compared with the ABW group, the SW group had significantly lower VO2max (14.49 ± 2.95 vs 16.25 ± 2.94 mL/kg/min) and MMSE score (25.01 ± 3.21 vs 27.35 ± 1.97), fewer years of education, and these patients were more frequently women (P < 0.05). In the multivariate regression models, the combination of VO2 max, sex, and MMSE score explained only 23.5% of gait speed (P < 0.001). MMSE score and VO2 max independently determined gait speed after adjustment for age, BMI, HbA1c, fasting glucose, systolic blood pressure, percent of muscle mass, percent of lower extremity muscle mass, and years of education. Conclusion In diabetic patients without neuropathy, physical impairment and disability could be prevented by an improvement in aerobic capacity and cognitive function. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study is to evaluate the effect of intravaginal electrical stimulation (IVES) therapies with different treatment frequencies (two or five days in a week) added to bladder training (BT) on incontinence-related quality of life (QoL) and clinical parameters in women with refractory idiopathic overactive bladder (OAB)., Material and Methods: Fifty-two women with refractory idiopathic OAB were randomized into two groups as follows: Group 1 (n:26) received BT and IVES, two times in a week, for 10 weeks and Group 2 (n:26) received BT and IVES five times in a week, for 4 weeks. IVES was performed 20 minutes in a day, a total of 20 sessions for both groups. Women were evaluated for incontinence severity (24h pad test), pelvic floor muscles strength (perineometer), 3-day voiding diary (frequency of voiding, nocturia, incontinence episodes, and the number of pads), symptom severity (OAB-V8), quality of life (IIQ-7), treatment success (positive response rate), cure/improvement rate and treatment satisfaction (Likert scale)., Results: There was no statistically significant differences in all parameters between the two groups at the end of the treatment. It was found that the treatment satisfaction scores, cure/improvement and positive response rates were not significantly different between two groups (p>0.05)., Conclusion: We concluded that the application of IVES twice a week or 5 times a week added to BT were both effective on incontinence-related QoL and clinical parameters in women with refractory idiopathic OAB. These two IVES frequencies had similar clinical efficacy and patient satisfaction with a slight difference between them; 5 times per week IVES has a shorter treatment duration., Competing Interests: None declared., (Copyright® by the International Brazilian Journal of Urology.)

Purpose: To evaluate the efficacy of intravaginal electrical stimulation (IVES) added to bladder training (BT) on incontinence-related quality of life (QoL) and clinical parameters in women with idiopathic overactive bladder (OAB)., Materials and Methods: Sixty-two women with idiopathic OAB were randomized into two groups using the random numbers generator as follows: Group 1 received BT alone (n:31), and Group 2 received BT+IVES (n:31). IVES was performed for twenty minutes three days a week over a course of eight weeks for a total of 24 sessions. Patients were evaluated in terms of incontinence severity (24-hour pad test), pelvic floor muscles strength (perineometer), 3-day voiding diary (frequency of voiding, nocturia, incontinence episodes and number of pads), symptom severity (OAB-V8), incontinence-related QoL (IIQ-7), treatment success (positive response rate), cure/improvement rate and treatment satisfaction (Likert scale)., Results: A statistically significant improvement was found in all parameters for all groups at the end of the treatment compared to the baseline values except pelvic floor muscles strength in Group 1 (p < 0.05). At the end of treatment, incontinence severity, frequency of voiding, nocturia, incontinence episodes, number of pads, symptom severity, and QoL were significantly improved in Group 2 compared to Group 1 (p < 0.05). Treatment satisfaction, cure/improvement, and positive response rates were significantly higher in group 2 compared to Group 1 (p < 0.05)., Conclusion: We conclude that BT+IVES were more effective than BT alone on both incontinence-related QoL and clinical parameters in women with idiopathic OAB., Competing Interests: None declared., (Copyright® by the International Brazilian Journal of Urology.)

The purpose of this article is to investigate the efficacy of intravesical oxybutynin hydrochloride (OH) to treat patients with overactive detrusors who are unresponsive to oral anticholinergic therapy alone. Twenty-five patients who were treated with oral OH for overactive detrusor (but who did not respond to treatment and were using indwelling urethral catheters) were given intravesical OH without changing oral treatment. Pre- and posttreatment bladder capacities were compared in urodynamic studies. The study showed that positive clinical results can be achieved with combined oral and intravesical OH treatments in patients with overactive detrusors who had indwelling urethral catheters because of severely reduced bladder capacity. However, a significant number of patients discontinued this treatment because of infection and difficulty in performing the procedure. Clinicians and rehabilitation nurses should provide education and support to eliminate these problems. In addition, the development of single-use standard sterile OH preparations for intravesical applications may increase the efficacy of the method.

Avascular necrosis (AVN) is a devastating adverse effect of steroid therapy rarely reported in idiopathic thrombocytopenic purpura (ITP). We describe a 64-year-old woman with progressive left knee and hip pain for 30 days resulting with the inability to ambulate. After she had been diagnosed ITP pulse steroid treatment was started in the department of Hematology. Two weeks later she described left knee and left hip pain. On physical examination, motion in her left knee and hip was severely painful without inflammation but range of motion was not limited. Magnetic resonance imaging showed multiple bony infarcts in the proximal femur, distal femur and proximal tibia, consistent with AVN. This case report is the first to define concurrent hip and knee AVN at a very early stage due to steroid use in a patient with ITP.