ABSTRACT
Background: the International Continence Society [ICS] defined overactive bladder syndrome [OAB] as urinary urgency with or without urge incontinence, often accompanied by frequency and nocturia in absence of infection. Urinary urgency is the complaint of a sudden compelling desire to void which is difficult to defer with patients often suffering from anxiety due to fear of leakage. Urge urinary incontinence is defined as involuntary leakage of urine, accompanied or immediately preceded by urgency. Overactive bladder syndrome is a symptomatic diagnosis. On the other hand, detrusor overactivity [DO] is an urodynamic finding, characterized by involuntary detrusor contractions during the filling phase, which may be spontaneous or provoked. These terms aren't interchangeable, as overactive bladder syndrome patients may not have detrusor activity on urodynamic testing
Aim of the Work: to determine the relation between clinical improvement and urodynamic based improvement in patients with overactive bladder syndrome receiving anticholinergic drugs
Patients and Methods: this study included thirty eight patients, who presented to the Outpatient Urology Clinic at Ahmed Maher Teaching Hospital with symptoms of OAB syndrome. This study design was prospective. Patients clinical histories were taken, they were examined thoroughly, and completed an IPSS questionnaire. This was followed by a urinalysis, free uroflowmetry and a pelvi-abdominal ultrasound
Results: this study included thirty eight patients who were divided into two groups. Group A included twenty one patients, fifteen females and six males with mean age of 48.2 years old [21-60], who did not have detrusor overactivity in the first urodynamic study. On the other hand, group B included seventeen patients, ten females and seven males with mean age of 43.7 years old [18-58], who had detrusor overactivity in the initial urodynamic study. Patients in both groups received Solifenacin 10 mg once daily for twelve weeks before completing another IPSS questionnaire and undergoing a follow up urodynamic study
Conclusion: in this study, we concluded that there was strong correlation between urodynamic and clinical improvement in OAB patients after Solifenacin treatment as patients who were improved urodynamicaly reported improvement of their symptoms while those with poor urodynamic response reported that their symptoms were either the same as before treatment or worse. We also concluded that Solifenacin 10 mg once daily led to significant improvement in IPSS results of OAB patients with significant increase in volume to first desire and maximum cystometric capacity
ABSTRACT
This study aimed to evaluate the functional results of management of traumatic anterior gleno-humeral instability by arthroscopic capsular shift using suture anchors. This prospective study was carried out on 20 patients who attended to the outpatient clinic of Suez Canal University hospital, during the period from 2004 to the end of 2006. Patients [19 male patients and 1 female with range of age from 20-50 years] included in the study had the criteria of chronic traumatic anterior glenohumeral instability. Every patient had complete history taking, complete physical examination of shoulders and cervical spine and range of motion of the shoulder joint, evaluation of the strength of the deltoid and rotators and screening neurological examination and investiagations of the shoulder joint by radiographs as plain x-ray and sometimes MRI. All patients had Bankart lesion managed by capsular shift using Mitek suture anchors. Average follow- up period was 16.5 months. Assessment of the improvement of motion ranges were registered, and satisfaction of each patient as well as in the criteria of the UCLA scale. The UCLA score revealed significant improvement in the status of the shoulder. Preoperatively: none of the patients rated their satisfaction as good or excellent. Postoperatively 16 [80%] rated their satisfaction as good or excellent and 4 [20%] rated it as fair or poor. For range of motion, most of the patients show improvement in range of elevation from 158.25 to 172.25 degrees. The mean external rotation measured 48.75 degrees preoperative and 45.20 postoperative with loss less than 5%. The mean abduction was 173.25 degrees preoperative and 172.25 postoperative with loss less than 5%. Most of the patients show improvement in range of all movements within three months of operations. For the degree of instability, the final mean UCLA score was found to be 34.11 points for the patients with recurrent dislocation, 35 points for the patient with recurrent subluxation after an initial dislocation, and 33 points for the patient with Apprehension [p = 0.519]. After one year of follow up no patient suffered from recurrence of dislocation or apprehension and only one patient [5%] suffered from subluxation. Arthroscopic repair with suture anchors is an effective surgical technique for the treatment of degenerated labrum using capsular shift. Open repair does not offer a significantly better result in terms of stability, and what is more, can negatively affect the recovery of full ROM of the shoulder. Because the arthroscopic procedure has some advantages regarding duration of surgery, morbidity, postoperative pain, time of hospitalization, and risk of complications, also it is more cost-effective