-
Urologia Internationalis 2022Sacral neuromodulation (SNM) is an effective treatment in patients with overactive bladder syndrome or nonobstructive urinary retention when conservative treatment...
INTRODUCTION
Sacral neuromodulation (SNM) is an effective treatment in patients with overactive bladder syndrome or nonobstructive urinary retention when conservative treatment fails. Several factors that could impact outcome with SNM have been studied. This systematic review investigated these predictive factors and their relevance for clinical practice.
METHODS
Systematic review according to the PRISMA guidelines was conducted. This review is registered in the PROSPERO register (CRD42015016256).
RESULTS
Seventy-eight studies (of which 11 abstracts) were included. Females, younger patients, and a tined lead procedure tend to be predictive in successful SNM outcome. Factors that did not influence SNM outcome were prior back surgery, surgery for stress urinary incontinence, affective symptoms, and duration of complaints. Reduced detrusor contractility is associated with a lower success rate. The level of evidence of most studies (graded according to the Centre for Evidence-Based Medicine) was 3b.
CONCLUSION
Even though this systematic review investigated predictive factors (gender, age, type of procedure, type of lead, and detrusor contractility), no general consensus on predictive factors could be made. Most studies are small, retrospective, and involve a heterogeneous population. Therefore, prospective research in larger specific patient groups remains necessary to find predictors of SNM outcome.
Topics: Electric Stimulation Therapy; Female; Humans; Prospective Studies; Retrospective Studies; Sacrum; Treatment Outcome; Urinary Bladder, Overactive; Urinary Retention
PubMed: 34058731
DOI: 10.1159/000513937 -
Neurourology and Urodynamics Jun 2021The aim of this systematic review is to provide an updated report on the efficacy and complications of sacral neuromodulation (SNM) and percutaneous tibial nerve... (Review)
Review
AIM
The aim of this systematic review is to provide an updated report on the efficacy and complications of sacral neuromodulation (SNM) and percutaneous tibial nerve stimulation (PTNS) in the treatment of chronic nonobstructive urinary retention (CNOUR), with a focus on the contemporary technique of SNM utilizing the percutaneous placement of tined leads.
METHODS
This systematic review was conducted with the use of PRISMA guidelines and registered with PROSPERO (CRD42020208052). A systematic literature search was conducted in Embase, PubMed, and Cochrane databases. Inclusion criteria include English language and human participants. Exclusion criteria include SNM studies involving less than 10 CNOUR patients, studies containing data obtained using open, surgical implantation of nontined leads, and studies that only reported the test phase success rate with no long-term efficacy data. The risk of bias assessment was conducted using the National Institutes of Health study quality assessment tool.
RESULTS
A total of 16 papers studies were included (11 SNM and 5 PTNS) in this review. The success rate for SNM ranges between 42.5% and 100% (median = 79.2%) for the test stimulation phase and 65.5%-100% (median = 89.1%) in the long term. Most SNM studies reported revision and explantation rates of lesser than 20%. The success rate was much lower for PTNS, in the 50%-60% range and complications were minimal.
CONCLUSION
SNM using the contemporary percutaneous tined lead implantation technique appears to be an effective treatment for CNOUR and is durable in the long term. Compared to SNM, PTNS appears less efficacious with less evidence supporting its use in CNOUR. Further prospective studies are required to define the role of PTNS in the treatment of CNOUR.
Topics: Electric Stimulation Therapy; Humans; Lumbosacral Plexus; Sacrococcygeal Region; Sacrum; Tibial Nerve; Treatment Outcome; Urinary Retention
PubMed: 33973670
DOI: 10.1002/nau.24694 -
Obstetrics and Gynecology Jun 2021To systematically review objective and subjective success and complications of apical suspensions for symptomatic uterine or vaginal vault pelvic organ prolapse (POP). (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To systematically review objective and subjective success and complications of apical suspensions for symptomatic uterine or vaginal vault pelvic organ prolapse (POP).
DATA SOURCES
MEDLINE, CENTRAL, ClinicalTrials.gov, and EMBASE (2002-2019) were searched using multiple terms for apical POP surgeries, including comparative studies in French and English.
METHODS OF STUDY SELECTION
From 2,665 records, we included randomized controlled trials and comparative studies of interventions with or without hysterectomy, including abdominal apical reconstruction through open, laparoscopic, or robotic approaches and vaginal apical reconstructions. Repairs using transvaginal mesh, off-the-market products, procedures without apical suspension, and follow-up less than 6 months were excluded.
TABULATION, INTEGRATION, AND RESULTS
Relative risk (RR) was used to estimate the effect of surgical procedure on each outcome. For each outcome and comparison, a meta-analysis was conducted to pool the RRs when possible. Meta-regression and bias tests were performed when appropriate. The GRADE (Grades for Recommendation, Assessment, Development and Evaluation) system for quality rating and PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) reporting were used. Sixty-two articles were included in the review (N=22,792) and 50 studies in the meta-analyses. There was heterogeneity in study quality, techniques used, and outcomes reported. Median follow-up was 1-5 years. Vaginal suspensions showed higher risk of overall and apical anatomic recurrence compared with sacrocolpopexy (RR 1.82, 95% CI 1.22-2.74 and RR 2.70, 95% CI 1.33-5.50) (moderate), whereas minimally invasive sacrocolpopexy showed less overall and posterior anatomic recurrence compared with open sacrocolpopexy (RR 0.59, 95% CI 0.47-0.75 and RR 0.59, 95% CI 0.44-0.80, respectively) (low). Different vaginal approaches, and hysterectomy and suspension compared with hysteropexy had similar anatomic success. Subjective POP recurrence, reintervention for POP recurrence and complications were similar between most procedures.
CONCLUSION
Despite variations in anatomic outcomes, subjective outcomes and complications were similar for apical POP procedures at 1-5 years. Standardization of outcome reporting and comparative studies with longer follow-up are urgently needed.
SYSTEMATIC REVIEW REGISTRATION
PROSPERO, CRD42019133869.
Topics: Female; Humans; Hysterectomy; Laparoscopy; Observational Studies as Topic; Pelvic Organ Prolapse; Postoperative Complications; Randomized Controlled Trials as Topic; Plastic Surgery Procedures; Recurrence; Reoperation; Robotic Surgical Procedures; Sacrum; Surgical Mesh; Vagina
PubMed: 33957652
DOI: 10.1097/AOG.0000000000004393 -
Journal of Wound, Ostomy, and...The purpose of this systematic review was to identify and evaluate the use of prophylactic foam dressings for prevention of hospital-acquired pressure injuries (HAPIs).
PURPOSE
The purpose of this systematic review was to identify and evaluate the use of prophylactic foam dressings for prevention of hospital-acquired pressure injuries (HAPIs).
METHODS
A systematic review was conducted in accordance with the Preferred Reporting Items of Systematic Reviews and Meta-analysis Statement (PRISMA).
SEARCH STRATEGY
Four researchers independently conducted searches in Health Source, Cochrane of Systematic Reviews, CINAHL, and PubMed. Search terms included: "pressure* OR skin breakdown AND sacrum*"; "ICU patient* OR critical care patient*"; and "foam dressing OR prophylactic* or prevent*."
FINDINGS
The search identified 380 articles; 14 met eligibility criteria. The methodological quality of the included studies was variable. Findings from all studies included in our review support a decrease in HAPI incidence with use of sacral foam dressings.
IMPLICATIONS
Findings from this review suggest that prophylactic foam dressings decrease sacral HAPI occurrences in critical care patients. While additional research is needed, current best evidence supports use of prophylactic foam sacral dressings for patients at risk for HAPI.
Topics: Bandages; Hospitals; Humans; Incidence; Pressure; Pressure Ulcer; Sacrococcygeal Region; Wound Healing
PubMed: 33951710
DOI: 10.1097/WON.0000000000000762 -
World Neurosurgery Jul 2021Intraosseous pneumatocyst refers to gas-filled cystic lesions inside bone. Whereas ilium and sacrum are the commonest locations for pneumatocysts, vertebral...
BACKGROUND
Intraosseous pneumatocyst refers to gas-filled cystic lesions inside bone. Whereas ilium and sacrum are the commonest locations for pneumatocysts, vertebral pneumatocysts are rare. Various theories have been proposed to explain the etiopathogenesis of vertebral pneumatocysts and the most widely accepted theory is the extension of air from intervertebral disc or joint spaces into the pneumatocyst cavity. The aim of this systematic review was to study all the cases of vertebral pneumatocyst reported in the literature to understand this rare disease and its clinical importance.
METHODS
A comprehensive search of the PubMed, Embase, and Scopus databases was performed to retrieve case reports and case series describing the cases of pneumatocyst.
RESULTS
A total of 61 cases of incidentally reported vertebral pneumatocyst were included in the systematic review. The mean age of the patients was 57.82 ± 10.2 years (range, 31-89 years). The mean size of the pneumatocysts was 8.67 ± 4.18 mm (range, 2-20 mm).
CONCLUSIONS
The prevalence of pneumatocyst increased with increasing age, with most of the reported patients belonging to the 50-70 years age-group. Most of these patients have large pneumatocysts with degenerative changes in spine. Another less common subset of young patients with small pneumatocysts without associated degenerative changes has also been described. Pneumatocysts were most common in the cervical spine, with C5 being the most commonly affected vertebra. Most of the pneumatocysts remain stable in size on follow-up, although 3 cases of enlarging pneumatocyst have also been reported. An enlarging pneumatocyst should be closely followed up, although its benign nature has been reported in the literature.
Topics: Adult; Aged; Aged, 80 and over; Cervical Vertebrae; Cysts; Diagnosis, Differential; Female; Humans; Incidental Findings; Male; Middle Aged
PubMed: 33933696
DOI: 10.1016/j.wneu.2021.04.092 -
Neurosurgical Focus May 2021Long-term local control in patients with primary chordoma and sarcoma of the spine and sacrum is increasingly reliant upon en bloc resection with negative margins. At...
OBJECTIVE
Long-term local control in patients with primary chordoma and sarcoma of the spine and sacrum is increasingly reliant upon en bloc resection with negative margins. At many institutions, adjuvant radiation is recommended; definitive radiation is also recommended for the treatment of unresectable tumors. Because of the high off-target radiation toxicities associated with conventional radiotherapy, there has been growing interest in the use of proton and heavy-ion therapies. The aim of this study was to systematically review the literature regarding these therapies.
METHODS
The PubMed, OVID, Embase, and Web of Science databases were queried for articles describing the use of proton, combined proton/photon, or heavy-ion therapies for adjuvant or definitive radiotherapy in patients with primary sarcoma or chordoma of the mobile spine and sacrum. A qualitative synthesis of the results was performed, focusing on overall survival (OS), progression-free survival (PFS), disease-free survival (DFS), and disease-specific survival (DSS); local control; and postradiation toxicities.
RESULTS
Of 595 unique articles, 64 underwent full-text screening and 38 were included in the final synthesis. All studies were level III or IV evidence with a high risk of bias; there was also significant overlap in the reported populations, with six centers accounting for roughly three-fourths of all reports. Five-year therapy outcomes were as follows: proton-only therapies, OS 67%-82%, PFS 31%-57%, and DFS 52%-62%; metastases occurred in 17%-18% and acute toxicities in 3%-100% of cases; combined proton/photon therapy, local control 62%-85%, OS 78%-87%, PFS 90%, and DFS 61%-72%; metastases occurred in 12%-14% and acute toxicities in 84%-100% of cases; and carbon ion therapy, local control 53%-100%, OS 52%-86%, PFS (only reported for 3 years) 48%-76%, and DFS 50%-53%; metastases occurred in 2%-39% and acute toxicities in 26%-48%. There were no studies directly comparing outcomes between photon and charged-particle therapies or comparing outcomes between radiation and surgical groups.
CONCLUSIONS
The current evidence for charged-particle therapies in the management of sarcomas of the spine and sacrum is limited. Preliminary evidence suggests that with these therapies local control and OS at 5 years are comparable among various charged-particle options and may be similar between those treated with definitive charged-particle therapy and historical surgical cohorts. Further research directly comparing charged-particle and photon-based therapies is necessary.
Topics: Chordoma; Humans; Retrospective Studies; Sacrum; Sarcoma; Spinal Neoplasms; Treatment Outcome
PubMed: 33932924
DOI: 10.3171/2021.2.FOCUS201059 -
Sports Medicine (Auckland, N.Z.) Jul 2021Inertial measurement units (IMUs) are used for running gait analysis in a variety of sports. These sensors have been attached at various locations to capture stride... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Inertial measurement units (IMUs) are used for running gait analysis in a variety of sports. These sensors have been attached at various locations to capture stride data. However, it is unclear if different placement sites affect the derived outcome measures.
OBJECTIVE
The aim of this systematic review and meta-analysis was to investigate the impact of placement on the validity and reliability of IMU-derived measures of running gait.
METHODS
Online databases SPORTDiscus with Full Text, CINAHL Complete, MEDLINE (EBSCOhost), EMBASE (Ovid) and Scopus were searched from the earliest record to 6 August 2020. Articles were included if they (1) used an IMU during running (2) reported spatiotemporal variables, peak ground reaction force (GRF) or vertical stiffness and (3) assessed validity or reliability. Meta-analyses were performed for a pooled validity estimate when (1) studies reported means and standard deviation for variables derived from the IMU and criterion (2) used the same IMU placement and (3) determined validity at a comparable running velocity (≤ 1 m·s difference).
RESULTS
Thirty-nine articles were included, where placement varied between the foot, tibia, hip, sacrum, lumbar spine (LS), torso and thoracic spine (TS). Initial contact, toe-off, contact time (CT), flight time (FT), step time, stride time, swing time, step frequency (SF), step length (SL), stride length, peak vertical and resultant GRF and vertical stiffness were analysed. Four variables (CT, FT, SF and SL) were meta-analysed, where CT was compared between the foot, tibia and LS placements and SF was compared between foot and LS. Foot placement data were meta-analysed for FT and SL. All data are the mean difference (MD [95%CI]). No significant difference was observed for any site compared to the criterion for CT (foot: - 11.47 ms [- 45.68, 22.74], p = 0.43; tibia: 22.34 ms [- 18.59, 63.27], p = 0.18; LS: - 48.74 ms [- 120.33, 22.85], p = 0.12), FT (foot: 11.93 ms [- 8.88, 32.74], p = 0.13), SF (foot: 0.45 step·min [- 1.75, 2.66], p = 0.47; LS: - 3.45 step·min [- 16.28, 9.39], p = 0.37) and SL (foot: 0.21 cm [- 1.76, 2.18], p = 0.69). Reliable derivations of CT (coefficient of variation [CV] < 9.9%), FT (CV < 11.6%) and SF (CV < 4.4%) were shown using foot- and LS-worn IMUs, while the CV was < 7.8% for foot-determined stride time, SL and stride length. Vertical GRF was reliable from the LS (CV = 4.2%) and TS (CV = 3.3%) using a spring-mass model, while vertical stiffness was moderately (r = 0.66) and nearly perfectly (r = 0.98) correlated with criterion measures from the TS.
CONCLUSION
Placement of IMUs on the foot, tibia and LS is suitable to derive valid and reliable stride data, suggesting measurement site may not be a critical factor. However, evidence regarding the ability to accurately detect stride events from the TS is unclear and this warrants further investigation.
Topics: Biomechanical Phenomena; Foot; Gait; Humans; Reproducibility of Results; Running; Torso
PubMed: 33761128
DOI: 10.1007/s40279-021-01443-8 -
European Cells & Materials Mar 2021For spinal load and muscle force estimation as well as for numerical model and experimental setup validation, data on human intradiscal pressure are essential.... (Meta-Analysis)
Meta-Analysis
For spinal load and muscle force estimation as well as for numerical model and experimental setup validation, data on human intradiscal pressure are essential. Therefore, the aim of the present meta-analysis was to summarise all in vitro measurements of human intradiscal pressure performed under defined boundary conditions, i.e. without external loading (intrinsic pressure), under axial loading (compression, traction, shear) and under single-planar bending loading (flexion, extension, lateral bending, axial rotation). Data were evaluated based on segmental level and normalised to force and moment. Regression analysis was performed to investigate coefficients of determination and statistical significance of relationships between intradiscal pressure and segmental level for the single loading conditions. 35 studies fulfilled the inclusion criteria, from which a total of 451 data points were collected for the meta-analysis. High coefficients of determination were found in axial compression (r2 = 0.875) and flexion (r2 = 0.781), while being low for intrinsic pressure (r2 = 0.266) and lateral bending (r2 = 0.385), all showing significant regression fitting (p < 0.01). Intradiscal pressure decreases from the upper cervical spine to the sacrum in all loading conditions, considering the same amount of loading for all segmental levels, while the intrinsic pressure exhibits a minimum of the regression curve in the mid-thoracic spine. Apart from its potential for numerical and experimental model validation, this dataset may help to understand the load distribution along the human spine.
Topics: Humans; Intervertebral Disc; Pressure; Rotation; Spine; Weight-Bearing
PubMed: 33745125
DOI: 10.22203/eCM.v041a25 -
World Journal of Surgical Oncology Feb 2021Isolated primary sacral diffuse large B cell non-Hodgkin's lymphoma is a very rare entity, and only 11 cases have been reported previously.
INTRODUCTION
Isolated primary sacral diffuse large B cell non-Hodgkin's lymphoma is a very rare entity, and only 11 cases have been reported previously.
CASE PRESENTATION
A 36-year-old man was referred with low backache and radiculopathy pain with a clinico-radiological and cytological diagnosis of sacral metastasis. Histopathological examination and immunohistochemistry of image-guided tissue core biopsy from the sacral mass confirmed it as high-grade diffuse large B cell lymphoma (DLBCL). With normal blood counts and bone marrow, and no lesions elsewhere on imaging, he was staged IAE and received 6 cycles of R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone) regimen chemotherapy followed by radiotherapy. The patient has completed a 3-year follow-up and is doing well with yearly imaging showing no evidence of active disease or recurrence.
CONCLUSIONS
The case shows the importance of an image-guided core biopsy and immunohistochemistry over a fine needle aspiration cytology in select cases as it can alter the treatment and outcome in patients. Because of rarity, the treatment and prognosis in primary sacral NHL is not still very clear as it is treated as per the guidelines of treatment of bone lymphoma.
Topics: Adult; Antineoplastic Combined Chemotherapy Protocols; Cyclophosphamide; Doxorubicin; Humans; Lymphoma, Large B-Cell, Diffuse; Lymphoma, Non-Hodgkin; Male; Neoplasm Recurrence, Local; Prognosis; Vincristine
PubMed: 33627139
DOI: 10.1186/s12957-021-02153-1 -
Clinical Neurology and Neurosurgery Mar 2021Pigmented villonodular synovitis (PVNS) is a lesion of uncertain etiology that involves the synovial membranes of joints or tendon sheaths, representing a diffuse and...
BACKGROUND AND OBJECTIVE
Pigmented villonodular synovitis (PVNS) is a lesion of uncertain etiology that involves the synovial membranes of joints or tendon sheaths, representing a diffuse and non-encapsulated form of the more common giant cell tumors of the synovium (GCTTS). PVNS was reclassified to denote a diffuse form of synovial giant cell tumor (TSGCT), while 'giant cell tumor of the tendon sheath (GCTTS)' was used for localized lesions. These pathologies rarely affect the axial skeleton. We provide an unprecedented and extensive systematic review of both lesions highlighting presentation, diagnostic considerations, treatment, prognosis, and outcomes, and we report a short case-series.
METHOD
We describe two-cases and conduct a systematic review in accordance with PRISMA guidelines.
RESULT
PVNS was identified in most of the cases reviewed (91.6 %), manifesting predominantly in the cervical spine (40 %). Patients commonly presented with neck pain (59 %), back pain (53 %), and lower back pain (81.2 %) for cervical, thoracic, and lumbar lesions, respectively. GTR occurred at rates of 94 %, 80 %, and 87.5 %. Recurrence was most common in the lumbar region (30.7 %). GCTTS cases (8%) manifested in the cervical and thoracic spine at the same frequency. We reported first case of GCTTS in the lumbosacral region. Both poses high rate of facet and epidural involvements.
CONCLUSION
Spinal PVNS and GCTTS are rare. These lesions manifest most commonly as PVNS within the cervical spine. Both types have a high rate of facet and epidural involvement, while PVNS has the highest rate of recurrence within the lumbar spine. The clinical and radiological features of these lesions make them difficult to differentiate from others with similar histogenesis, necessitating tissue diagnosis. Proper management via GTR resolves the lesion, with low rates of recurrence.
Topics: Adult; Back Pain; Female; Gait Disorders, Neurologic; Giant Cell Tumor of Tendon Sheath; Humans; Hypesthesia; Low Back Pain; Lumbar Vertebrae; Magnetic Resonance Imaging; Muscle Weakness; Neck Pain; Neurosurgical Procedures; Sacrum; Spinal Fusion; Spinal Neoplasms; Synovitis, Pigmented Villonodular; Thoracic Vertebrae; Young Adult
PubMed: 33596487
DOI: 10.1016/j.clineuro.2021.106489