The role of post-operative radiographs in predicting risk of flexor pollicis longus tendon rupture after volar plate fixation of distal radius fractures - a case control study.

BACKGROUND AND AIM: Volar plating of distal radius fractures is one of the common procedures performed in trauma surgery. Flexor pollicis longus (FPL) rupture has been described as complication following volar plating of distal radius fractures. The aim of our study was to investigate the possible relation between parameters measured on post-operative radiographs and the occurrence of FPL ruptures. MATERIALS AND METHODS: This was a case control study. The post-operative radiographs of 11 FPL rupture, and 22 non-FPL rupture patients were reviewed with respect to fracture reduction and plate position and the various parameters were calculated by five independent people. Logistic regression was used to examine the importance of the variables. RESULTS: We identified two significant factors to predict FPL rupture after volar plating of distal radial fractures. These were radial tilt and plate distance from the joint line. The odds ratio of ruptures was 0.74 (95% CI 0.57-0.95) for every degree of radial tilt <25° and 0.50 (95% CI 0.28-0.88) for every millimetre that the distal end of the plate was away from the volar lip of the distal radius at the wrist joint. CONCLUSION: Post-operative radiographs could help us predict FPL rupture after distal radius volar plating. The findings also highlight the need for good fracture reduction and thoughtful placement of the volar plate intraoperatively to minimise the risk of FPL tendon rupture.

Grading of benign prostatic obstruction can predict the outcome of transurethral prostatectomy.

PURPOSE: We investigate whether urodynamic grading of benign prostatic obstruction and detrusor contractility predicts the outcome of transurethral prostatectomy. MATERIALS AND METHODS: A total of 53 patients who were suitable candidates for transurethral prostatectomy completed an assessment protocol before and 3 months after surgery, which included International Prostate Symptom Score, uroflowmetry, ultrasonography (prostatic size and residual urine volume) and standard pressure flow study. The results of the pressure flow study were analyzed to grade obstruction (unequivocal, equivocal or no obstruction) and detrusor contractility (weak or normal) using our simplified pressure flow nomogram. RESULTS: Analysis of the pressure flow study data demonstrated that the efficiency of detrusor contraction was weak in 6 of 27 men with unequivocal, 11 of 23 with equivocal and 2 of 3 with no obstruction. Treatment outcome was significantly better in patients with unequivocal obstruction and normal detrusor contractility. Treatment failure occurred in 80% of patients with equivocal obstruction and impaired detrusor contractility, and 100% of the unobstructed group. Urodynamic grading of obstruction and detrusor contractility predicted treatment outcome with a sensitivity of 87%, specificity 93% and positive predictive value 95%. CONCLUSIONS: Urodynamic grading of benign prostatic obstruction and detrusor contractility can reliably predict treatment outcome and, therefore, enable the urologist to identify a subgroup of patients who would not benefit from surgery.

Chronic urinary retention--a sensory problem?

Factors which predispose some men with benign prostatic hyperplasia to chronic urinary retention whilst others develop acute retention are not understood. In order to assess whether there is an occult neuropathy associated with chronic retention, neurophysiological measurements were used to test the integrity of the lower urinary tract nerve supply. A series of 22 male patients with chronic urinary retention secondary to prostatic hyperplasia underwent sacral reflex latency measurement; 73% demonstrated a sensory suprasacral abnormality with intact spinal reflex arcs. These results suggest that although the sacral reflex pathways are intact, there is a sensory/proprioceptive abnormality in the higher neurological centres which may be an adaptive mechanism to the presence of bladder outflow obstruction.

Urinary retention in men after total hip arthroplasty.

A prospective study of sixty-four men was conducted before they underwent a total hip arthroplasty to try to identify the factors that are predictive of postoperative urinary retention. Although neither the urological history nor the physical examination provided information that was helpful in accurately identifying the patients who were at risk, those whose peak urinary flow rate was less than seventeen milliliters per second did have a statistically significant likelihood of the development of urinary retention. A system of management that we hope will reduce the incidence of this complication is proposed.

Improved seminal characteristics in infertile men after a conservative treatment regimen based on the avoidance of testicular hyperthermia.

Evidence to support the contention that avoidance of testicular hyperthermia (due to hot baths and/or tight clothing) will improve fertility is, in the main, anecdotal. Semen samples derived from 128 infertile men were analyzed before and after a 3-month conservative treatment regimen. Six seminal characteristics were studied. Clinical evaluation included normal bath temperature, types of underwear worn, and past history of hernia repair, orchiopexy, or varicocelectomy. The patients were divided into three groups (A to C) according to sperm density and then subclassified on the basis of progressive motility status. The results show that a significant, or approaching significant, improvement in seminal characteristics occurs in certain groups of oligospermic individuals with pretreatment progressive motility of less than 40%. In clinical trials, it should be recognized that any improvement in seminal quality following pharmacologic or surgical intervention may include a contribution from conservative treatment.

The urological management of spinal cord damaged patients: a clinical algorithm.

A scheme for the management of the common urological presentations encountered in spinal cord damaged patients is provided in flow chart form. The diagrams indicate how urological investigations can be used to greatest effect. A simple computer programme based on these charts is available.

A physiological approach to the investigation of chronic urinary retention.

Twenty-six male patients with chronic urinary retention were investigated by self filling cystometry, followed by fast filling cystometry. Fast filling cystometry tended to increase the end filling pressure and to indicate a smaller bladder capacity than did self filling cystometry. Inadequate filling of the bladder may lead to an unrepresentative detrusor voiding contraction and an incorrect diagnosis of detrusor failure. Fast filling cystometry masks detrusor instability, which may be a factor producing upper tract dilatation and renal impairment. It is suggested that chronic retention of urine should be investigated by self filling cystometry.

Endoscopic bladder transection.

Endoscopic bladder transection has been performed in 30 patients with symptoms as a result of unstable bladder activity. The symptomatic improvement produced justifies the use of this new operation which should replace the open procedure.

Surgical treatment of the 'slipping rib syndrome'.

This review seeks to draw attention to the existence of the 'slipping rib syndrome' as a not uncommon clinical entity. It is characterized by trunk pain in a radicular distribution, often related to certain movements or activity, but not associated with other visceral symptoms. The diagnosis is a clinical one, with surgical excision of the affected rib and costal cartilage a successful simple treatment for relieving those patients of a severe and persistent pain syndrome.

The role of urodynamics in the management of spinal cord injured patients.

The urological management of 1126 consecutive patients treated at the Mersey Regional Spinal Injuries Centre between 1947 and 1983 is reviewed. It is concluded that when urodynamics is included in the urological investigative profile, in addition to clinical, biochemical, intravenous urographic and cystourethrographic assessments, then treatment failure is less likely.

Dilatation of urethral strictures using an endoscopically placed guide.

The blind dilatation of a tight urethral stricture can be a difficult and potentially dangerous procedure. The technique described in this paper enables such strictures to be safely dilated after endoscopic placement of a suitable guide over which Cosbie-Ross bougies can be 'railroaded'. The dilatation can be done gently and progressively using initially very fine bougies, which would be dangerous to use without a guide in view of the likelihood of perforating the urethra.