Translational and linguistic validation of the Arabic version of dysfunctional voiding symptom score questionnaire.

INTRODUCTION: Dysfunctional voiding is a multifactorial condition that encompasses a wide variety of symptoms rendering its diagnosis a challenging process. In this setting, several tools have been proposed to aid the diagnosis of this disease among which is the Dysfunctional Voiding Symptom Score (DVSS). The DVSS has been translated and validated to different languages including Japanese, Thai, Chinese, Serbian, and Portuguese. The aim of the current study is to translate and cross-culturally validate the DVSS into the Arabic language. MATERIAL AND METHODS: The DVSS was translated and culturally adapted to the Arabic language following the standards of the ISPOR for the translation and cultural adaptation process for patient-reported outcomes measures. Subsequently, the translated version underwent a pre-test on 15 patients with dysfunctional voiding. Afterwards, the translated version was filled by 82 pediatric patients and/or their parents with dysfunctional voiding and then the same questionnaire was refilled by the patients and their families one week later at home. Finally, a group of healthy children and/or their parents were recruited to fill the questionnaire as a control group. Cronbach's alpha, Pearson's correlation, and Interclass correlation were used to assess for internal consistency and reliability between test-retest of the Arabic version. RESULTS: The mean total score of DVSS for the case and control groups was 16.66 ± 6.07 and 6.11 ± 3.36, respectively (P < 0.001). The Arabic-DVSS showed excellent internal consistency (Cronbach's α > 0.9) for all the questions except Q1, Q3, Q6, and Q7 that showed good internal consistency. DISCUSSION: Translational and linguistic validation of the DVSS questionnaire into Arabic language is an important step toward its introduction in the clinical practice in Arabic countries; however, this step has also to consider the cultural variations between countries and not just linguistic translation. Generally, the Arabic-DVSS showed a satisfactory test-retest internal consistency and reliability with an excellent Cronbach's α (0.982) and ICC (0.962) for the total score of the Arabic-DVSS. Yet, the main limitation of this study was that it was only advocated for the translation and validation of the Arabic-DVSS and did not assess its value in patients' follow-up. CONCLUSION: The Arabic version of the DVSS is reliable and valid to help in the evaluation of DV in children of Arabic countries.

Minimally Invasive Reduction of Intraarticular Calcaneal Fractures With Percutaneous Fixation Using Cannulated Screws Versus Kirschner Wires: A Retrospective Comparative Study.

BACKGROUND: Several minimally invasive techniques were developed for management of intraarticular calcaneal fractures. This study aimed to compare the functional and radiological outcomes of 2 minimally invasive reduction and fixation techniques using cannulated screws or Kirschner wires (K-wires) for fixation. METHODS: This study was a retrospective comparative review of patients with displaced intraarticular calcaneal fractures, who were treated with cannulated screws or K-wires techniques. Clinical and radiological data were collected and compared between both groups. Functional outcomes and patient satisfaction using the Maryland Foot Score (MFS) and the visual analogue scale (VAS) of pain, in addition to the complications, were compared between both groups. RESULTS: In total, 70 patients were included in the study: 34 in the cannulated screws group, with a mean age of 35.2 ± 4 years, and 36 in the K-wires groups, with a mean age of 33.4 ± 3 years. The operative time was shorter in the K-wires group (40.5 ± 5.6 minutes) compared to the cannulated screw group (49.5 ± 4.5 minutes), P < .001. There were no statistically significant differences between both groups regarding the radiological parameters, including Bohler's angle, angle of Gissane, calcaneal width, height, or length. The mean MFS, mean VAS, and complications were not different between the 2 groups. CONCLUSION: Treatment of displaced intraarticular calcaneal fractures with minimally invasive reduction and fixation using either cannulated screws or K-wires can achieve similar excellent functional and radiological outcomes, with high patient satisfaction. The use of K-wires has the advantage of reduced operative time than cannulated screws. LEVELS OF EVIDENCE: Level III: Retrospective comparative study.

Sacrococcygeal Morphologic and Morphometric Risk Factors for Idiopathic Coccydynia: A Magnetic Resonance Imaging Study.

STUDY DESIGN: Retrospective case-control study. OBJECTIVES: To evaluate the sacrococcygeal morphologic and morphometric features in idiopathic coccydynia using magnetic resonance imaging (MRI). METHODS: MRI scans from 60 patients with idiopathic coccydynia were compared with scans of 60 controls. Assessment of coccygeal morphology included coccygeal segmentation, coccygeal types, bony spicules, sacrococcygeal joint fusion, and intercoccygeal joint fusion and subluxation. Morphometric parameters included coccygeal straight and curved lengths, coccygeal curvature index, sacrococcygeal and intercoccygeal joint angles, sacral straight and curved lengths, sacral curvature index, sacral angle, sacrococcygeal straight and curved lengths, sacrococcygeal curvature index, and sacrococcygeal angle. RESULTS: The coccydynia group included 28 males and 32 females, with a mean age of 36.1 years. Type II coccyx and bony spicules were more common in coccydynia, P = 0.003 and 0.01, respectively. Sacrococcygeal joints were fused less commonly in coccydynia, P = 0.02. Intercoccygeal joint subluxation was more common in coccydynia, P = 0.007. The sacral angle was lower in coccydynia, P = 0.01. The sacrococcygeal curved length was higher in coccydynia, P < 0.001. The sacrococcygeal curvature index was lower coccydynia, P < 0.001. In females only, the coccygeal curvature index was lower in coccydynia patients, P = 0.04. In males only, the intercoccygeal angle was lower in coccydynia patients, P = 0.02. CONCLUSIONS: Type II coccyx, bony spicules, intercoccygeal joint subluxation were more common, and sacrococcygeal joint fusion was less common in coccydynia patients. Sacral angle and sacrococcygeal curvature index were lower, while sacrococcygeal curved length was higher in coccydynia patients. LEVEL OF EVIDENCE: Level 3. Case-control study.

Treatment of tibial shaft nonunion with a retained nail in morbidly obese patients.

PURPOSE: Morbid obesity is a rising worldwide health problem. Tibial shaft nonunion with retained intramedullary nail (IMN) in the morbidly obese is a challenging orthopaedic problem. Prolonged immobilization carries a significant risk of complications. This study aimed to investigate whether decortication and cancellous bone grafting with the application of a circular external fixator (CEF) over the preexisting IMN can achieve fracture union and avoid serious complications. METHODS: We retrospectively reviewed 27 consecutive morbidly obese patients treated for tibial diaphysis aseptic nonunion after failed IMN. All cases were treated with osteoperiosteal decortication, cancellous bone grafting, and fixation with CEF over the IMN. Peri-operative multidisciplinary patient evaluation included internal medicine, cardiology, chest, vascular surgery, and anesthesia consultations. The union rate, bone results, functional results, and complications were recorded. RESULTS: The mean age of the patients was 37.9 years. The mean BMI was 45.8. Sixteen cases (59.3%) were treated for hypertrophic nonunion, while 11 cases (40.7%) were treated for atrophic nonunion. Seven cases (25.9%) had open initial injury, 14 cases (51.9%) had associated comorbidities, and seven cases (25.9%) were smokers. Twenty-six cases united. The mean time to union was 5.2 months. Bone results and functional results were good to excellent in 96.3% of the cases. We recorded 25 complications in 21 patients. However, most of the complications were minor. CONCLUSION: Decortication and cancellous bone grafting with the application of CEF over the preexisting nail is a safe and reliable treatment method for aseptic tibial shaft nonunion with retained IMN in morbidly obese patients.

Mirabegron versus Solifenacin in Children with Overactive Bladder: Prospective Randomized Single-Blind Controlled Trial.

PURPOSE: The purpose of this study is to investigate the efficacy and safety of mirabegron versus solifenacin in the treatment of newly diagnosed overactive bladder (OAB) in children. METHODS: We conducted a prospective randomized controlled study on pediatric patients with newly diagnosed OAB. Patients were randomized into 3 groups: mirabegron (50 mg once daily) in group I, solifenacin (5 mg) in group II, and placebo in group III. Before starting our treatment and at the end of the 3 months course, we obtained a 3-day voiding diary. This diary included incontinence episode per day, mean voided volume per micturition, mean number of micturition per day, and post-void residual urine. Moreover, the parents/patients were asked to rate symptom relief, and the adverse events were recorded throughout the study period. RESULTS: A total of 190 patients aged from 5 to 14 years completed this study. At the end of this trial, both groups I and II showed significant improvement versus placebo regarding our efficacy parameters with no significant difference between group I and II. The overall success rate based on assessment of symptom relief was significantly higher in the treated groups (87.5% in I and 90.2% in II) versus placebo (55.8%). Dry mouth was reported in 2.8, 10, and 0% and constipation in 2.8, 11.4, and 1.4% in group I, II, and III, respectively, without statistically significant difference between group I and placebo. However, there was a significant difference between group II and placebo regarding these side effects. CONCLUSION: Both mirabegron and solifenacin have comparable efficacy regarding the control of OAB symptoms in the newly diagnosed children, but mirabegrone seems to have less side effects.

Augmented Repair of Acute Total Achilles Tendon Rupture With Peroneus Brevis Tendon Transfer Using Oblique Transosseous Calcaneal Tunnel: A Prospective Case Series.

Acute Achilles tendon rupture is one of the most common tendon injuries. This prospective study aimed to evaluate the functional outcomes of augmented repair of acute Achilles tendon rupture with peroneus brevis tendon transfer and fixation to an oblique calcaneal transosseous tunnel. Functional evaluation was performed using the American Orthopaedic Foot & Ankle Society (AOFAS) score and Achilles Tendon Total Rupture Score (ATRS). Postoperative complications were recorded. This study included 33 males and 9 females, with a mean age of 26.1 ± 4.2 years. The Achilles tendon ruptures were right in 24 patients and left in 18 patients. The cause of rupture was sports injuries in all patients. The mean distance from the calcaneal insertion to the tear site was 4.4 ± 1.3 cm. The mean time from injury to surgery was 2.4 ± 1.6 days. The mean follow-up time was 40.3 ± 4.9 months. The mean AOFAS and ATRS scores were 99.3 ± 1.2 and 95.9 ± 1.9, respectively, at 12 months of follow-up. The mean time to return to work was 12.1 ± 1.2 weeks. The mean time to return to light sports activities was 16.1 ± 1.8 weeks postoperatively. None of the patients developed re-rupture. Augmented repair of acute Achilles tendon ruptures with peroneus brevis tendon transfer is a robust repair with excellent functional outcomes and early weight-bearing and return to sports activities.

Silodosin versus Tamsulosin as Medical Expulsive Therapy for Children with Lower-Third Ureteric Stones: Prospective Randomized Placebo-Controlled Study.

AIM: To compare the efficacy and safety of silodosin versus tamsulosin as medical expulsive therapy for stones of lower-third ureter in children. PATIENTS AND METHODS: This prospective single-blind placebo-controlled randomized study included 167 pediatric patients who presented with distal ureteric stone (DUS) less than 1 cm. Patients were randomized into 3 groups; group I received silodosin 4 mg once daily, and group II received tamsulosin 0.4 mg while those in group III had placebo. The side effects of the used drugs, both rate and time of stone expulsion, and number of pain episodes were compared among the study groups for a maximum of 4 weeks. RESULTS: Follow-up data of our patients after treatment revealed that the stone expulsion rate was significantly higher and the time to stone expulsion was significantly shorter in group I (89.3%, 12.4 ± 2.3 days) and group II (74.5%, 16.2 ± 4.2 days) compared to group III (51.8%, 21.2 ± 5.6). However, a statistically significant difference between silodosin and tamsulosin groups in favor of the former one was reported regarding the 2 studied items. Meanwhile, pain episodes requiring analgesia were statistically fewer in group I and II in contrast to placebo group. Adverse events were comparable among all groups. CONCLUSION: Silodosin provides significantly better stone expulsion rate and shorter expulsion time than tamsulosin for treatment of DUS. Both medications showed good safety profiles in children. However, further studies are required on a larger scale to confirm our results. Assessment of drug safety on younger age-group is still needed.

Outcome of Minimally Invasive Osteosynthesis for Displaced Intra-articular Calcaneal Fractures Using Cannulated Screws: A Prospective Case Series.

This prospective study sought to assess the functional and radiological outcomes of minimally invasive osteosynthesis using cannulated screws and to examine the effect of different parameters on the functional outcome. The Maryland foot score and the visual analog scale of pain were used to assess the functional outcomes and postoperative patient's satisfaction rate. Preoperative and postoperative Böhler's angle, angle of Gissane, calcaneal width, and height, were compared. The study included 46 fractures in 40 patients; 38 (95%) males and 2 (5%) females with a mean age of 34.8 ± 3 years. The mean time lapse to surgery was 3.2 ± 2.1 days. The mean duration of surgery was 39.8 ± 9.3 minutes. The mean follow-up period was 29.2 months. At final follow-up, the mean Maryland foot score was 85 ± 6.3. Satisfactory results were achieved in 91.3% of fractures, while unsatisfactory in 8.7%. The mean visual analog scale score of pain decreased from 7.3 ± 05 preoperatively to 1.2 ± 0.7 at the final follow-up, p <.001. Postoperatively, there was significant improvement of Böhler's angle, angle of Gissane, calcaneal width, and height, p < .001. Factors associated with better functional outcomes included reduced time lapse to surgery, p = .032, and more accurate restoration of the calcaneal parameters. Management of intra-articular calcaneal fractures by minimally invasive osteosynthesis using cannulated screws can achieve satisfactory functional and radiological outcomes. Better outcomes are associated with reduced time lapse to surgery, and accurate reduction and restoration of calcaneal angles, height, and width.

Clinical and Radiological Outcomes of Minimally Invasive Reduction and Percutaneous K-wire Fixation for Intra-articular Calcaneal Fractures.

There has been much controversy over the optimal operative treatment of intra-articular calcaneal fractures. Open reduction and internal fixation is associated with a high incidence of postoperative soft tissue complications. This study sought to evaluate the outcomes of indirect reduction and percutaneous K-wire fixation for displaced intra-articular calcaneal fractures. This was a prospective study of 40 consecutive patients with 44 Sanders type II or III intra-articular calcaneal fractures who had undergone closed or mini-open reduction and percutaneous K-wire fixation from 2013 to 2016. The Maryland Foot Score and visual analog scale score for pain were used to assess functional outcomes and postoperative patient satisfaction. Twenty-two patients were men and 18 patients were women, with a mean age of 34.5 years. According to the Sanders classification, 26 fractures were type II and 18 were type III. Mean follow-up was 31.9 months. The clinical outcome was satisfactory for 36 fractures (81.8%) and unsatisfactory for 8 fractures (18.2%). Mean time of radiological union was 8.7 weeks. Mean full weight-bearing time was 13 weeks. Mean visual analog scale score was 1.4 when radiographic fracture healing was detected. Repeated follow-up radiographs showed no loss of reduction or collapse of the posterior facet. Closed or mini-open reduction and percutaneous K-wire fixation of Sanders type II or III calcaneal fractures has excellent functional outcomes with minimal soft tissue complications. [Orthopedics. 2020; 43(2): 97-101.].

Preoperative multislice computed tomography evaluation of shoulder deformities in brachial plexus birth palsy patients undergoing tendon transfer.

BACKGROUND: Brachial plexus birth palsy (BPBP) refers to a birth related paralysis of the upper extremity. The current study was designed to evaluate the efficacy of computed tomography (CT) in the assessment of humeral head posterior subluxation and glenoid retroversion preoperatively and to evaluate whether or not bony deformity correlates with functional improvement (based on Modified Mallet Score) following tendon transfer in brachial plexus birth palsy patients. PATIENTS AND METHODS: This prospective study included 30 patients, 15 below 4 years and 15 above 4 years old, with a mean age 3.65 ±â€¯1.39 (range 2-8) years old. Thirteen patients were males (43.3%) and 17 were females (56.6%). The left side was affected in 13 patients (43.3%), while the right in 17 (56.7%). The Modified Mallet Score was used for clinical assessment of the shoulder function. A multislice CT scan with 3D reconstruction was used as a preoperative radiological assessment of the shoulder. An electromyography (EMG) of the muscles around the shoulder was performed. All patients were operated upon by anterior release of the internal rotators to improve the external rotation range of motion and by transfer of teres major and latissimus dorsi to improve the abduction motion through one anterior deltopectoral incision and a small posterosuperior incision. Postoperatively, the range of shoulder abduction and external rotation had been assessed after shoulder spica removal and till the end of follow up. RESULTS: Fourteen patients (46.7%) had a normal glenoid version angle (normal range from -12° to 2°) and normal range of articulation with the glenoid (42.3%-71.4%) and 16 patients (53.3%) had an abnormal glenoid version angle and abnormal range of articulation with the glenoid. According to the Modified Mallet Score, there was a statistically significant difference in the mean value of global abduction (P = 0.04), external rotation (P = 0.03), hand to mouth (P = 0.02), hand to neck (P = 0.03) and hand to spine (P = 0.02) between the pre- and post-operative assessment of all patients. There was a statistically significant difference in the mean value of postoperative Modified Mallet Score between the patients under the age of 4 years and those above the age of 4 years. There was no statistically significant difference between the patients with normal CT angles and those with abnormal CT angles. There was no statistically significant difference in the mean value of glenoid version angle and percentage of humeral head articulation between the patients below the age of 4 years and those above 4 years (P = 0.845). CONCLUSION: The study concluded that the glenoid version angle and humeral head articulation percentage do not negatively affect results of the tendon transfer around the shoulder in patients of upper brachial plexus birth palsy. LEVEL OF EVIDENCE: IV.

Surgical technique for biological fixation of closed segmental tibial fractures by the Less Invasive Stabilization System (LISS).

INTRODUCTION: This prospective case series study aimed to assess the value of the Less Invasive Stabilization System (LISS) to treat closed Segmental Tibial Fractures (STFs) using a proposed surgical technique. MATERIALS AND METHODS: Between August 2010 and January 2014, 21 consecutive recently (within 1 week) closed STFs that matched the inclusion criteria were enrolled. Patients were treated with the 13-hole LISS plate. All patients were followed up every 2 weeks for the first 2 months, then every month for the rest of the first 6 months and then every 6 months thereafter. Patients were assessed radiologically during the follow-up appointments and clinically at the final visit by the Lower Extremity Functional Scale (LEFS) to evaluate the result. RESULTS: The mean time to union of the proximal fracture was 15.72 ± 2.78 (range: 12-20) weeks and for the distal fracture was 20 ± 2.22 (range: 16-24) weeks, excluding delayed union in three patients. All patients except the three showed radiological observable callus in a mean duration of 4.95 (range: 3-7) weeks. The mean final follow-up LEFS was 72.4 (range: 60-80). CONCLUSION: The mean time to union of the proximal fracture was shorter than the distal fracture. The use of LISS to treat closed STFs using the proposed surgical technique has proved to give favorable results. Further studies using the described technique are needed to justify the achieved results. LEVEL OF EVIDENCE: IV (Prospective case series).

Validity of a sponge trainer as a simple training model for percutaneous renal access.

OBJECTIVE: To evaluate the efficacy of our simply designed trainer for junior urologists to acquire the initial skills for percutaneous renal access (PRA). SUBJECTS AND METHODS: Three sponge sheets (60 × 50 × 10 cm) were arranged horizontally over each other. A rectangular groove was made in the middle sheet to accommodate an inflated balloon of a Foley catheter, radio-opaque metal balls, metal rings, or a plastic tube that were sequentially placed for the four training tasks. In each session, 18 trainees were asked to pass a fluoroscopically guided puncture needle from a surface point to the placed object in middle sheet. Clinical impact of training was evaluated by an experience survey on a 5-piont Likert scale (for model usefulness, tactile and fluoroscopic-guidance feedback) and success rate in further mentored practice. RESULTS: There was a gradual increase in tasks' and sessions' scores over the training sessions. According to the experience survey after first clinical practice, the mean (SD) score for overall model usefulness by trainees was 3.8 (0.9) with high fluoroscopic guidance reality [3.6 (1.1)] but poor tactile realism [2.3 (0.9)]. On mentored PRA, the success rate for trainees was 78.3%. CONCLUSION: Our early evaluation showed our novel, cost-effective and reproducible sponge trainer could be an effective training model for PRA with a beneficial impact on subsequent clinical practice.

A protocol for staged arthroplasty to salvage infected nonunion of hip fractures.

BACKGROUND: Nonunion of hip fractures is not uncommon. Total hip arthroplasty is used to salvage cases of non union or secondary arthritis in these fractures. However, this option may not be available or may be difficult to achieve when infection has superseded the site of nonunion. The objective of this prospective study was to assess if a staged protocol of treatment yields good results in these difficult cases. MATERIALS AND METHODS: Twenty-seven consecutive patients who had deep hip infection with failed treatment of hip fractures (intracapsular in 16 cases and extracapsular in 11) were treated between June 2007 and September 2011. Twenty-six completed the planned two-stage hip arthroplasty and one case was lost after the first stage. The average age of the patients was 48.9 years (range 26-74 years) with an average follow up period of 44 months (30-72 months). Analysis was done using the paired t test where P < 0.05 was considered significant. RESULTS: Infection was controlled in all cases that completed the treatment protocol with no recurrence in all cases at the latest follow up. The Harris hip score of the patients improved significantly from 29 preoperatively to 85 at the latest follow up (P < 0.0001). Two patients had hip dislocation with displacement of the trochanteric fragment while three other patients had fibrous union of the trochanter. CONCLUSIONS: Staged Arthroplasty procedure to salvage infected non-union of hip fractures is successful in eradicating infection and regaining hip function. Level of evidence IV.

Single-stage revision for periprosthetic hip infection using antibiotic loaded impaction graft.

BACKGROUND: Staged revision for periprosthetic infection of the hip is an accepted and widely used technique by many surgeons. However, single-stage exchange of the hip prosthesis remains an attractive option to others because of the advantages of reduced morbidity, shorter treatment time and hospital stay in addition to the reduced cost of treatment. HYPOTHESIS: Single-stage revision for periprosthetic hip infection can achieve excellent results if a specific protocol for patients' selection and management is followed. METHODS: 52 patients with evidence of periprosthetic infection had preoperative aspiration of the affected hip. The infecting organisms were identified in 33/52 and single-stage revision was performed. The remaining 19 patients had a 2-stage exchange arthroplasty. Patients in the single-stage revision protocol had antibiotic loaded morsellized bone graft, a cemented cup and a long cementless stem. RESULTS: At an average follow up of 6 (range 4-8) years postoperatively, only 1 case of persistent infection was found in the single-stage group - a 97% rate of eradicating infection was achieved. DISCUSSION: Single-stage exchange achieves excellent success rate in patients with periprosthetic infection when a specific protocol for patient selection and management is followed.

A Protocol for Percutaneous Transarticular Fixation of Sanders Type II and III Calcaneal Fractures With or Without an Added Mini-Open Approach.

Intra-articular fracture of the calcaneus is one of the most displeasing fractures if not properly managed. Open reduction and internal fixation have been associated with a high incidence of postoperative soft tissue complications. Closed reduction and percutaneous fixation have resulted in a greater incidence of postoperative subtalar osteoarthritis with improper reduction of the articular surface. In the present study, a mini-open approach was used in cases of failure of articular surface restoration with closed reduction. A total of 64 feet in 57 consecutive patients with an intra-articular calcaneal fracture underwent the proposed minimally invasive surgical protocol. Of the 57 patients, 7 (12.3%) had bilateral fractures. According to Sanders classification, 33 (51.6%) fractures were type II and 31 (48.4%) were type III. Seven (12.3%) patients had wedge fractures of the dorsolumbar spine without neurologic manifestations. The postoperative evaluation included radiographs and completion of the Maryland Foot Score and visual analog scale for pain. The mean follow-up period was 16 (range 12 to 36) months. The mean operative time was 42 (range 35 to 60) minutes. The mean period until union of the fracture was 12 (range 10 to 16) weeks. The clinical results according to the Maryland Foot Score revealed 52 (81%) with satisfactory (27 excellent and 25 good) and 12 (19%) with unsatisfactory (10 fair and 2 poor) results. The mean visual analog scale score was 1.5 ± 0.3 when radiographic fracture healing was observed. Six patients (9.4%) developed superficial pin tract infections that responded to local care and parenteral antibiotic therapy and resolved completely after removal of the Kirschner wires. In conclusion, the presented surgical protocol combining closed reduction with or without an added mini-open approach and percutaneous fixation improves the functional outcome and minimizes the incidence of complications.

Modified technique for reconstructing reverse Hill-Sachs lesion in locked chronic posterior shoulder dislocation.

BACKGROUND: Among the uncommon and frequently missed orthopedics injuries is the posterior shoulder dislocation, accounting for about 2-4 % of all shoulder dislocations. Commonly, it is associated with the well-known reverse Hill-Sachs lesion. Several surgical treatment modalities such as transfer of subscapularis tendon or lesser tuberosity, humeral rotational osteotomy, osteochondral grafts were used to repair this defect. Hemiarthroplasty or total shoulder arthroplasty was used as salvage procedure in non-constructable defect or neglected old dislocation. PATIENTS AND METHODS: This study included 11 patients with locked chronic posterior shoulder dislocation and reverse Hill-Sachs defects falling in the target range (25-50 % of the head size). The mean age of the patients was 39 (range 31-49) years. Mean time from injury to surgery was 9 (range 3-18) weeks. Open reduction in the dislocated head with the transfer of subscapularis tendon and the attached lesser tuberosity was done to reconstruct the reverse Hill-Sachs defect. The transferred tuberosity was fixed with size 5 Ethibond sutures. RESULTS: The mean follow-up period was 29 (range 24-39) months. The median of the scores was much improved, reaching 30 (range 20-34) (satisfactory) compared with preoperative median of 24 (range 20-25) (unsatisfactory). This was statistically highly significant (P = 0.002). Postoperatively, 9 patients had no pain or restricted daily living activities. No patient had symptoms of shoulder instability. According to the modified UCLA shoulder rating scale, there were 4 patients rated excellent, 5 patients rated good, one patient rated fair and one patient rated poor. CONCLUSION: Reconstructing the reverse Hill-Sachs defect provides adequate stability, pain relief and function in patients with locked chronic posterior shoulder dislocation and a defect involving 25-50 % of the humeral head. The used technique is simple and cost effective with no need for subsequent hardware removal. LEVEL OF EVIDENCE: II.

Subacromial injection of autologous platelet-rich plasma versus corticosteroid for the treatment of symptomatic partial rotator cuff tears.

OBJECTIVE: Rotator cuff tears are one of the most common causes of chronic shoulder pain and disability. They significantly affect the quality of life. Reduced pain and improved function are the goals of conventional therapy, which includes relative rest, pain therapy, physical therapy, corticosteroid injections and surgical intervention. Tendons have a relative avascular nature; hence, their regenerative potential is limited. There is some clinical evidence that the application of autologous platelets may help to revascularize the area of injury in rotator cuff pathologies. PATIENTS AND METHODS: This prospective randomized controlled study was done to evaluate the results of subacromial injection of platelet-rich plasma (PRP) versus corticosteroid injection therapy in 40 patients with symptomatic partial rotator cuff tears. All patients were assessed before injection, 6 weeks, 3 and 6 months after injection, using the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES), the Constant-Murley Score (CMS), the Simple Shoulder Test (SST) and a Visual Analog Scale (VAS) for pain. An MRI was performed before and 6 months after the injection for all the included patients and was graded on 0-5 scale. RESULTS: Both injection groups showed statistically significantly better clinical outcomes over time compared with those before injection. There was a statistically significant difference between RPP group and corticosteroid group 12 weeks after injection, regarding VAS, ASES, CMS and SST in favor of the RPP group. MRI showed an overall slight nonsignificant improvement in grades of tendinopathy/tear in both groups, however, without statistically significant differences between the two groups. CONCLUSION: PRP injections showed earlier better results as compared to corticosteroid injections, although statistically significant better results after 6 months could not be found. Therefore, subacromial RPP injection could be considered as a good alternative to corticosteroid injection, especially in patients with a contraindication to corticosteroid administration. LEVEL OF EVIDENCE: II.

Evaluation of Percutaneous Tibial Nerve Stimulation for Treatment of Refractory Painful Bladder Syndrome.

OBJECTIVE: To evaluate the efficacy of intermittent percutaneous tibial nerve stimulation (PTNS) as a treatment modality for patients with refractory interstitial cystitis/bladder pain syndrome (IC/BPS). PATIENTS AND METHODS: Twenty female patients with IC/BPS (mean symptom duration of 4.5 ± 2.4 years) each had a 30-minute session of PTNS per week for 12 successive weeks and the symptoms were assessed before, during, and after the treatment sessions by voiding diary, visual analog scale (VAS) for pain, interstitial cystitis symptom and problem indices (ICSI and ICPI), and global response assessment (GRA) scale. The scores of the previous questionnaires were evaluated at weeks 0, 6, and 12. RESULTS: At week 0, the VAS, day time frequency, nocturia, and average voiding volume were 5.6 ± 1.1, 14.5 ± 4.0, 3.0 ± 0.9, and 131.8 ± 35.3 mL, respectively, meanwhile at week 12 these scores were 5.2 ± 1.5, 12.15 ± 3.7, 2.6 ± 0.7, and 141.0 ± 36.2, respectively. There was no statistically significant difference between the scores of the ICPI between weeks 0, 6, and 12 (P = .937). As regards the GRA score after the 12th session, 17 patients (85%) reported having no effect, 1 patient (5%) reported as having worse symptoms, and 2 patients (10%) reported having a mild good response. CONCLUSION: Intermittent PTNS is not a satisfactory treatment for refractory IC/BPS. However, it is recommended to perform more studies with other treatment protocol (maybe closer sessions) to confirm these results.

Perioperative use of cyproterone acetate with transurethral resection of large prostate: preliminary results.

PURPOSE: To assess the impact of short-term treatment with cyproterone acetate (CPA) on intraoperative and early postoperative complications of transurethral resection of relatively large prostate. PATIENTS AND METHODS: We recruited patients with prostate size of 60-90 g and randomized them into two equal groups. The first one had 50 mg of CPA orally twice a day (bds) for 2 weeks before the operation and maintained it for an extra week postoperatively. The other group received placebo. All patients underwent monopolar transurethral prostatectomy (M-TURP) and the prostatic chips were stained for CD34 specific for nascent blood vessels. RESULTS: Ninety-five patients were included. Mean patient age was 60.88±2.5 years and mean prostate size was 72.76±7.21 g. CPA was well tolerated with no serious adverse effects. The mean resection time and the mean weight of the resected tissue were comparable between the two groups. Intraoperative blood loss, fluid absorption, and blood loss per gram of resected tissue (259.47±78.27 mL, 787.38±300.56 mL, and 14.87±4.02 mL/g and 327.25±98.97 mL, 937.4±350.2 mL, and 17.08±5.55 mL/g, respectively) were significantly lower in the treatment group (p<0.05). In addition, excessive postoperative bleeding was encountered in one case in the treatment group and in seven in the control (p<0.05). Finally, the histopathological study revealed that the mean microvessel density in each of the suburethral portion and the hyperplastic nodules of the prostate was significantly lower in the CPA group (p<0.001). CONCLUSION: The perioperative use of CPA with M-TURP of a relatively large prostate may help in decreasing the perioperative bleeding and fluid absorption that usually take place during this procedure.