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Surgical Endoscopy Jun 2024Pudendal nerve entrapment (PNE) is an underdiagnosed condition affecting a spectrum of pelvic functions, primarily pain, as outlined by Nantes diagnostic criteria.... (Review)
Review
BACKGROUND
Pudendal nerve entrapment (PNE) is an underdiagnosed condition affecting a spectrum of pelvic functions, primarily pain, as outlined by Nantes diagnostic criteria. Although numerous surgical decompression techniques are available for its management, consensus on efficacy and safety is lacking. This study conducts a systematic review and meta-analysis to assess the efficacy and complication rates of the main surgical decompression techniques.
METHODS
A comprehensive literature search was conducted in PubMed®, Embase®, Web of Science®, and ClinicalTrails.gov® on 19th of April 2023. Initial screening involved title and abstract evaluation, with subsequent retrieval and assessment of abstracts and full-text articles. Studies assessing pain outcomes before and after surgical release of the pudendal nerve were included. Studies without full-text, focusing on diagnostic methods or with outcomes relating solely to LUTS, digestive symptoms, or sexual dysfunction, were excluded. Risk of bias assessement was conducted using the National Institute of Health (NIH) Study Quality Assessment tool. Studies were categorized based on three surgical techniques: perineal, transgluteal, and laparoscopic transperitoneal. Random-effects meta-analysis with subgroup analysis were used. Meta-regression analyses were conducted to investigate the influence of covariates on the observed outcomes.
RESULTS
Nineteen studies, comprising 810 patients, were included. The overall significant pain relief rate across all techniques was estimated at 0.67 (95% CI 0.54 to 0.78) with considerable heterogeneity (I = 80.4%). Subgroup analysis revealed success rate for different techniques: laparoscopic (0.91, 95% CI 0.64 to 0.98), perineal (0.69, 95% CI 0.52 to 0.82), and transgluteal (0.50, 95% CI 0.37 to 0.63). The laparoscopic technique exhibited a complication rate of 16.0%. Meta-regression indicated that patient age and median follow-up significantly influenced outcomes.
CONCLUSION
While comparing surgical techniques is challenging, this meta-analysis highlights important outcome differences. The laparoscopic technique appears most promising for pain improvement. However, the study also emphasizes the need for further robust, long-term research due to significant heterogeneity across studies and prevelent risk of bias. PROSPERO database: CRD42023496564.
PubMed: 38942945
DOI: 10.1007/s00464-024-10990-w -
International Urogynecology Journal Jun 2024The objective was to examine the outcomes of posterior tibial nerve stimulation (PTNS) on bladder, bowel, and sexual health-related quality of life among a cohort of...
INTRODUCTION AND HYPOTHESIS
The objective was to examine the outcomes of posterior tibial nerve stimulation (PTNS) on bladder, bowel, and sexual health-related quality of life among a cohort of patients with multiple sclerosis (MS) with refractory lower urinary tract symptoms (LUTS).
METHODS
Patients with MS and refractory LUTS were recruited for a prospective, observational study using PTNS to treat their symptoms. Patients underwent 12 weekly 30-min PTNS sessions and bladder, bowel, and sexual symptoms were evaluated at baseline, 3, 12, and 24 months with voiding diaries, visual analog scales (VAS), and validated patient-reported questionnaires, including the American Urological Association Symptom Score (AUA-SS), Neurogenic Bladder Symptom Score (NBSS), Michigan Incontinence Symptom Index (M-ISI), Health Status Questionnaire, Sexual Satisfaction Scale, and Bowel Control Scale.
RESULTS
A total of 23 patients were recruited: 18 started PTNS and 14 completed 3 months of PTNS. Of the 18 who started PTNS, the mean age was 52 years (SD 12), 61% were female, 83% were white, and most patients had relapsing remitting (39%) MS. Baseline (n=18) and 3-month voiding (n=11) outcomes showed no significant change in number of voids or incontinence episodes. The median VAS symptom improvement was 49 (IQR 26.5, 26) and 9 (53%) patients elected for monthly maintenance PTNS. On paired analysis, there was a significant improvement in median change in NBSS, AUA-SS, and M-ISI. There was no significant change in bowel or sexual dysfunction.
CONCLUSIONS
This prospective, observational study of PTNS in patients with MS with refractory LUTS shows improvement in patient-reported bladder outcomes, but not in number of voids per day or bowel or bladder function.
PubMed: 38942931
DOI: 10.1007/s00192-024-05836-x -
International Journal of Surgery Case... Jun 2024Iliac artery aneurysms are rare, with isolated iliac artery aneurysms responsible for only 2 % of all aneurysmal diseases. External iliac artery (EIA) aneurysms are...
INTRODUCTION
Iliac artery aneurysms are rare, with isolated iliac artery aneurysms responsible for only 2 % of all aneurysmal diseases. External iliac artery (EIA) aneurysms are extremely rare, and the exact cause is unknown. In this case, we report a giant aneurysm without any risk factor presented with rupture and managed by open repair.
PRESENTATION OF CASE
An 85-year-old man presented to the emergency department with sudden onset right lower quadrant abdominal pain and vague right lower limb pain. After a complete physical examination, an abdominopelvic CT scan revealed an 80 mm EIA aneurysm containing thrombosis and active leakage. The patient underwent open repair of an aneurysm using a graft between the Aorta and EIA. The surgery was uneventful. Later in the ICU, the patient experienced a cardiac arrest and unfortunately could not recover from it.
DISCUSSION
In this case, a patient with a relatively large aneurysm presented with abdominal pain and lower limb discomfort. Although endovascular surgery is recommended for the repair of iliac aneurysms, open repair is common for ruptured aneurysms. Endovascular repair is less invasive but may lead to contrast-induced renal dysfunction. Open repair may induce complications such as sexual dysfunctions, graft infection, and pelvic ischemic conditions.
CONCLUSION
EIA aneurysms are exceedingly rare. They may present with a Rupture that puts the patient in critical condition, such as in this case. Due to the hemodynamic instability, open repair is considered one of the main approaches for repairing the aneurysm.
PubMed: 38941729
DOI: 10.1016/j.ijscr.2024.109964 -
Annals of Ibadan Postgraduate Medicine Apr 2024Adverse Childhood Experiences (ACE) are negative occurrences in childhood, including abuse (emotional, physical, and sexual abuse), neglect (emotional and physical) or...
INTRODUCTION
Adverse Childhood Experiences (ACE) are negative occurrences in childhood, including abuse (emotional, physical, and sexual abuse), neglect (emotional and physical) or household dysfunctions, which are linked to compromised health and well-being in adulthood. The consequences are wide and diverse including Sexual Risk Behaviour (SRB).
AIM
We embarked on this study to identify types and prevalence of ACE as well as the association between ACE and the adoption of SRB among the students of a tertiary institution in Oyo State, Nigeria.
SUBJECTS AND METHODS
A descriptive cross-sectional study was conducted amongst students of Oyo State College of Agriculture and Technology. A questionnaire was used to obtain information on sociodemographic characteristics, ACE and SRB. Descriptive and inferential statistics were used to analyse the data as applicable.
RESULTS
A total of 395 respondents participated in the study. The mean age of respondents was 21.06±3.13years. Emotional abuse and physical neglect had the highest prevalence of 65.6% and 44.3% respectively. Unprotected sex was the most prevalent SRB (19.5%). Majority (91.4%) of the respondents had experienced at least one ACE. There was a graded dose response between ACE and SRB. Participants with sexual risk behaviour were twice likely to have been exposed to household dysfunction (OR: 2.2 CI 1.3 - 3.7).
CONCLUSION
ACE and its subsequent effect on developing SRB have been demonstrated; its prevention and early identification should be an integral part of public health programs.
PubMed: 38939884
DOI: No ID Found -
JACC. Advances Jan 2024Septal myectomy improves symptoms in the majority of patients with obstructive hypertrophic cardiomyopathy (HCM), but there are limited prospective data on functional...
BACKGROUND
Septal myectomy improves symptoms in the majority of patients with obstructive hypertrophic cardiomyopathy (HCM), but there are limited prospective data on functional outcomes after operation.
OBJECTIVES
The authors investigated quality of life measures and prevalence of sexual dysfunction before and after septal myectomy for obstructive HCM.
METHODS
Between January 2018 and October 2019, 436 patients underwent transaortic septal myectomy at our clinic. All patients were screened for eligibility, and 197 (45.2%) were enrolled in this prospective survey study. Patients received a questionnaire pertaining to quality of life and sexual health before and within 4 to 6 months postoperatively, and 113 (57.4%) completed the follow-up survey.
RESULTS
The mean age of the 54 (47.8%) women and 59 (52.2%) men was 54.7 ± 14.1 years. Quality of life, including both mental and physical components, improved significantly in both men ( < 0.001) and women ( < 0.001). Women reported mild sexual dysfunction at baseline, and following septal myectomy, they experienced significant ( < 0.05) improvement in most domains pertaining to sexual health. In men, the International Index of Erectile Function median score was 23 (IQR: 7.0-29.5), which is consistent with mild dysfunction at baseline, and there was significant improvement following surgery in young (age ≤55 years) men ( < 0.001).
CONCLUSIONS
Quality of life is significantly improved following septal myectomy in patients with obstructive HCM. Both women and men reported mild sexual dysfunction at baseline, and women and younger men (age ≤55 years) experienced significant improvements in sexual health.
PubMed: 38939809
DOI: 10.1016/j.jacadv.2023.100763 -
Journal of Aggression, Maltreatment &... 2024Adverse Childhood Experiences (ACEs) confer considerable risk for negative outcomes across the lifespan, but there is limited research examining whether the measurement...
Adverse Childhood Experiences (ACEs) confer considerable risk for negative outcomes across the lifespan, but there is limited research examining whether the measurement of ACEs can be interpreted the same way across diverse groups of individuals. In particular, the measurement of ACEs among early child education teachers has received little attention. Given that millions of children receive care from early child education teachers, and evidence that ACEs can severely disrupt teacher's abilities to support young children, it is critical to accurately assess for and respond to teacher ACEs. The present study examined the factor structure and measurement invariance of the 11-item Behavioral Risk Factor Surveillance Survey (BRFSS) version of the ACEs measure across a diverse group of teachers. Data were collected from 605 teachers in a southeastern state between 2018 and 2021. Teachers ranged in age from 18 to 81 years (35% young; 56% middle; and 9% older adults) and were diverse across race (46% White; 53% Black). Teachers completed the BRFSS version of the ACEs measure and a demographics questionnaire. Factor analyses replicated the theorized three-factor solution, with household dysfunction, emotional/psychological abuse, and sexual abuse emerging as distinct factors. Multigroup confirmatory factor analyses demonstrated measurement invariance across teacher age and race. Comparisons of scores indicated ACEs levels varied across teacher age and race. Overall, findings suggest the BRFSS version of the ACEs measure can be used to assess adverse childhood experiences across diverse groups of early child education teachers.
PubMed: 38939647
DOI: 10.1080/10926771.2024.2323651 -
Cureus May 2024Erectile dysfunction (ED) is defined as the inability to achieve and maintain an erection powerful enough to permit pleasurable sexual activity. There are four...
BACKGROUND
Erectile dysfunction (ED) is defined as the inability to achieve and maintain an erection powerful enough to permit pleasurable sexual activity. There are four categories for ED grades. The illness may be influenced by vascular, neurological, psychological, and hormonal factors. Anxiety about performance and relationship issues are common psychological triggers.
AIM
This study aimed to determine the prevalence, risk factors, and awareness of ED and its management in the population of Saudi Arabia.
METHOD
This community-based, cross-sectional study was conducted among adult Saudi males in all five regions of Saudi Arabia (Central, Eastern, Western, Southern, and Northern). A self-administered questionnaire was distributed among participants using an online survey. The questionnaire includes sociodemographic data (i.e., age, region, marital status, education), medical history, and erectile function (International Index of Erectile Function (IIEF-5)) as a diagnostic tool for ED.
RESULTS
In total, 924 men took part. About 512 (55.4%) were aged between 18 and 25 years old, and nearly two-thirds (595, 64.4%) were single. The Internet was the most common source of ED information 495 (53.6%). Based on respondents' knowledge, the most common risk factor of ED was depression (561, 60.8%), while the most common treatment option was lifestyle modification (654, 70.8%). The prevalence of ED among adult Saudi men was 198 (21.4%). Independent risk factors for ED include having been married, being an employee, and previous operation of the perineum.
CONCLUSION
ED was common among the Saudi male population. ED was more prevalent among older men with associated chronic diseases and had elevated body mass index (BMI). Having been married, being an employee, and having a previous perineum operation were identified as the significant independent risk factors for ED. Longitudinal studies are needed to determine the cause and effect of the recognized risk factors for ED among men.
PubMed: 38939275
DOI: 10.7759/cureus.61233 -
Journal of Child & Adolescent Trauma Jun 2024Previous research has linked childhood exposure to family dysfunction and violence with long-term health outcomes, including mental health and later exposure to...
Previous research has linked childhood exposure to family dysfunction and violence with long-term health outcomes, including mental health and later exposure to violence. However, fewer studies have modeled depressive symptoms (stemming from childhood adversity) as a key linking variable with later intimate partner violence (IPV) - particularly among diverse youth. The present study investigated (a) the direct effect of adverse childhood events (ACEs) on intimate partner violence, (b) the indirect effect of ACEs on intimate partner violence through depressive symptoms, and (c) the moderation of these associations by race. : Data were drawn from 702 participants (80% female) 18 years of age from panel data collected in 2019 from the 18 & Life Project. Participants self-reported adverse childhood experiences, intimate partner violence, and depressive symptoms using multiple items for each measure. Additional demographic variables assessed included gender, race, and sexual orientation. Structural equation modeling using Mplus Version 8 software was used to test hypothesized associations. : While results indicate a direct association between ACEs and IPV. Evidence for an indirect link through depressive symptoms was only found for White youth. The findings of this study provide evidence for the persistent long-term influence of ACEs on mental health and relationship experiences in later life. : Our results suggest a need for early family and community-level interventions to protect children from exposure to early adverse experiences in order to protect their mental health and ensure successful relationship experiences.
PubMed: 38938967
DOI: 10.1007/s40653-023-00597-z -
Journal of Child & Adolescent Trauma Jun 2024Different types of adverse childhood experiences (ACEs) may be differentially linked to mental and behavioral health. Additionally, spirituality is associated with...
PURPOSE
Different types of adverse childhood experiences (ACEs) may be differentially linked to mental and behavioral health. Additionally, spirituality is associated with well-being, but little research has examined whether it is protective in the context of ACEs. The present study examines the influence of maltreatment and household dysfunction ACEs on distress, substance use, and sexual risk taking, and tests whether spirituality moderates the associations between childhood maltreatment, household dysfunction and distress, substance use, and sexual risk taking.
METHOD
314 college students completed the ACE-Q and measures of general mental (distress) and behavioral (substance use, sexual risk taking) health. To examine the distinct effects of maltreatment and household dysfunction on mental and behavior health, linear regression models that included both ACE types as predictors were constructed for each of the health variables. Moderation between spirituality and each type of ACEs was then examined for each outcome.
RESULTS
Childhood maltreatment predicted greater distress and sexual risk-taking even after accounting for household dysfunction, and household dysfunction predicted greater substance use even after accounting for childhood maltreatment. Childhood maltreatment interacted significantly with spirituality to predict distress, but in the opposite direction than was hypothesized. That is, the relationship between cumulative childhood maltreatment ACEs and distress was stronger among those with higher levels of spirituality.
CONCLUSIONS
Results suggest that childhood maltreatment and household dysfunction ACEs are linked to distinct mental and behavioral health consequences among young adults. Additionally, while spirituality is associated generally with better mental and behavioral health, our findings suggest that it does not buffer the impacts of childhood maltreatment or household dysfunction.
PubMed: 38938932
DOI: 10.1007/s40653-023-00571-9 -
Frontiers in Endocrinology 2024The existing research on the association between apolipoproteins (Apos) and erectile dysfunction (ED) primarily relies on observational studies and does not distinguish...
The existing research on the association between apolipoproteins (Apos) and erectile dysfunction (ED) primarily relies on observational studies and does not distinguish between organic and psychogenic causes when diagnosing ED. It is difficult to believe that Apos play a role in psychogenic ED. To address these issues, our study explored the causal relationship between lipoproteins and ED using Mendelian randomization (MR) analysis and differentiate between organic and psychogenic ED through the use of nocturnal penile tumescence and rigidity (NPTR) monitoring. Multivariate MR analysis revealed significant causal associations between high-density lipoprotein (HDL), Apo A1, and Apo B/A1 with ED (OR and 95% CI were 0.33 (0.14-0.78), 3.58 (1.52-8.43), and 0.30 (0.13-0.66)). we conducted statistical and analytical analyses on the data of 212 patients using multivariate analyses and receiver operating characteristic (ROC) curves. Patients with organic ED had significantly lower levels of HDL, Apo A1 and Apo A1/B, whereas patients with organic ED had considerably higher levels of Apo B and low-density lipoprotein (LDL). The diagnostic value of Apos in predicting the risk of organic ED was evaluated using ROC curves. The results indicated that Apo A1 and Apo A1/B demonstrated good predictive value. HDL, Apo A1, and Apo A1/B have been identified as risk factors for ED in our study. Furthermore, our research highlights the significance of Apo A1 and Apo A1/Apo B in the development of organic ED and suggests their potential use as indicators to assess the risks associated with organic ED.
Topics: Humans; Male; Mendelian Randomization Analysis; Erectile Dysfunction; Case-Control Studies; Middle Aged; Apolipoproteins; Adult; Apolipoprotein A-I; Lipoproteins, HDL
PubMed: 38938512
DOI: 10.3389/fendo.2024.1359015