Bladder pain syndrome and sexual function: a systematic review and meta-analysis.

INTRODUCTION AND HYPOTHESIS: Bladder pain syndrome (BPS)/interstitial cystitis can adversely affect physical, mental, and sexual health. The aim of the systematic review is to compare sexual function between patients with BPS and healthy controls and to examine whether or not treatment of BPS improves sexual function. METHODS: A literature search was conducted on Embase, Medline, and other databases. Studies comparing sexual function in BPS patients with healthy controls and before/after treatment were included. Where appropriate, data were pooled in a meta-analysis, using a random effects model and the standardised mean difference (SMD) was used for comparison. RESULTS: Out of 384 studies initially identified, 26 studies met the inclusion criteria for the systematic review and 11 for the meta-analysis. Six studies compared sexual function in BPS cases with healthy controls. All studies found that the Female Sexual Function Index (FSFI) was worse in BPS cases than in controls. Pooled data from 5 studies showed that the SMD was -1.02 (CI -1.64, -0.4) in total FSFI scores between the cases and controls, p=0.001. Further analysis showed better sexual function in all FSFI subdomains in healthy controls. Five studies compared sexual function in BPS patients before treatment with after treatment. Pooled data from 3 studies showed an overall improvement in total FSFI score after intravesical treatment: SMD=0.69 (CI 0.23, 1.14), p=0.003. Further analysis showed improvement in all subdomains. CONCLUSION: Our review suggests that sexual function might be worse in BPS patients than in the general population, but it seems to improve with intravesical BPS treatment.

Staphylococcus aureus bacteriuria: implications and management.

Background: Staphylococcus aureus is isolated in around 0.2%-4% of positive urinary cultures, more commonly in the contexts of long-term care, urological abnormalities and procedures, male sex, older age and comorbidities. Isolation may represent contamination, colonization, urinary tract infection or bacteraemic seeding from another site, and may be linked to S. aureus bacteraemia. However, there is little guidance on investigation and management of S. aureus bacteriuria. We performed a retrospective analysis of cases in our service, including clinical characteristics, investigations and treatment. Methods: Data were collected on all urine samples taken from adult patients over a 5-year period from which S. aureus was isolated. Detailed analysis including investigations and management was conducted in those collected over a 1-year period. Results: From 511 patients, 668 urine cultures positive for S. aureus were identified; 6.5% of cases were positive for MRSA. Of 93 patients who had blood cultures taken, there were 6 cases of S. aureus bacteraemia, 4 of which were associated with urological instrumentation. Of 94 cases analysed in detail, 57% were treated with antibiotics, and 49% had repeat urine cultures. Factors associated with recurrence were urinary catheterization, urological abnormality, diabetes and inpatient status. Conclusions: Our experience does not support the routine taking of blood cultures or treatment of asymptomatic bacteriuria in well patients with S. aureus bacteriuria in this setting. However, repeat urine culture, and investigation and treatment of higher risk patients, for example, prior to bladder instrumentation, may be warranted. We propose a simple algorithm to guide clinicians.

The safety and efficacy of day-case total joint arthroplasty.

INTRODUCTION: The popularity of day-case arthroplasty has been fuelled by focus on its cost effectiveness for the healthcare system. Safety concerns still remain. The aim of this review was to compare readmission rates after total joint arthroplasty for patients undergoing day-case surgery and for inpatients. METHODS: A comprehensive online search of databases was performed for all published articles in the English language evaluating readmission rates after total hip arthroplasty (THA) and total knee arthroplasty (TKA). Seventeen studies were deemed eligible and included in the meta-analysis. RESULTS: All studies included in the meta-analysis described readmission rates following THA/TKA. The readmission rate for day-case patients was 1.9% (n=124) whereas for inpatients, it was 2.0% (n=12,399). Compared with inpatient arthroplasty, day-case arthroplasty was associated with lower total readmission rates (odds ratio [OR]: 0.77, 95% confidence interval [CI]: 0.63-0.94, p=0.01). Furthermore, day-case surgery conferred a decrease in readmission rates for both THA (1.3% vs 7.0%) and TKA (2.7% vs 4.3%). Moreover, day-case THA and TKA were both associated with a decreased chance of readmission (OR: 0.27, 95% CI: 0.17-0.42, p<0.00001; and OR: 0.55, 95% CI: 0.42-0.72, p<0.00001 respectively). CONCLUSIONS: This review emphasises that with a thoughtful, designated protocol and with careful patient selection, day-case arthroplasty is a safe and effective option.

Trypan blue staining of filtering bleb in eyes with operate trabeculectomy.

OBJECTIVE: To report the use of trypan blue staining of the filtering bleb to assess its functional status in eyes undergoing phacoemulsification after trabeculectomy. SUBJECTS AND METHODS: This retrospective study was conducted at a tertiary eye care centre in North India and studied 33 eyes of 33 patients ( with previously operated trabeculectomy), who underwent phacoemulsification. Trypan blue dye (0.06%) was used to stain the anterior capsule. After completion of phacoemulsification, the staining of the trabeculectomy bleb was noted as diffuse, patchy, minimal or no staining. RESULTS: Of the 33 eyes, 13 had diffuse staining (39.4%, mean IOP = 9.3 ± 2.2 mm Hg), 7 (21.2%, mean IOP= 15.5 ± 1.8 mm Hg) had patchy staining, 4 had minimal staining (12.1%, mean IOP= 17.5 ± 0.5mm Hg) and nine (27.3%, mean IOP= 19.3 ± 1.6 mm Hg) had no staining. These staining patterns were labeled as groups 1 - 4 respectively. Statistical analysis showed that the difference between the IOPs in Group 1 - 2 and between Group 2 - 3 was not significant statistically (p=0.682 and 0.665 respectively). However the differences between the IOPs between Groups 1 - 3, 1 - 4, 2 - 4, and 3 - 4 were found to be highly significant statistically (p less than 0.0005). CONCLUSIONS: Trypan blue dye can be used to test the amount of sub conjunctival filtration in eyes undergoing phacoemulsification cataract surgery.

Repositioning of Ahmed glaucoma valve tube in the anterior chamber with prolene sutures to manage tube-endothelial touch.

BACKGROUND: Corneal endothelial damage is a known complication of aqueous shunt surgery. OBJECTIVE: To describe a new technique for repositioning the Ahmed glaucoma valve tube in a case of tube-endothelial touch. CASE: A patient with advanced glaucoma, having undergone Ahmed glaucoma valve (AVG) implantation, developed localized corneal endothelial damage due to contact between the tube and superior corneal endothelium. Two 10-0 prolene anchor sutures were passed over the tube in the anterior chamber, repositioning it away from the endothelium, thus preventing further damage to the corneal endothelium. Resolution of corneal oedema was noted without affecting the tube drainage and intraocular pressure. CONCLUSION: Intracameral repositioning of the shunt tube using prolene sutures is a useful technique for correcting the tube malposition.

Occupational physical activity and long-term risk of musculoskeletal symptoms: a national survey of post office pensioners.

The objective of this work was to address the relationship between physical activity in the workplace and subsequent musculoskeletal pain syndromes. We performed a survey of 5,042 men and women aged 70-75 years, selected from the retirement population of a large national employer (the post office). Subjects were sent a short postal questionnaire enquiring about all occupations held for at least 1 year, the physical activities performed in those jobs, and about recent rheumatic symptoms. The 1-month period prevalence of rheumatic symptoms ranged from 19.9% for hip pain or stiffness in men to 50% for knee pain or stiffness in women. Symptoms were more common in women than men at all sites and there were significant (P < 0.001) associations between symptoms at different sites. Obesity was significantly (P < 0.001) associated with the risk of pain or stiffness at the knee and hip. Prolonged occupational exposure (20+ years) to heavy lifting was associated with hip pain (RR = 1.5; 95% CI = 1.2-1.8); and prolonged exposure to working with arms elevated was associated with an increased risk of shoulder pain (RR = 1.4; 95% CI = 1.2-1.6). Tall stature (P = 0.003) and heavy lifting (P < 0.001) were both associated with increased risks of low back pain among men. This survey confirms the high prevalence of musculoskeletal symptoms observed in previous population-based studies. Associations between occupational activities and musculoskeletal symptoms were specific for activity type and skeletal site involved. Our results imply that the adverse effects of these occupational activities can be found many years after cessation of exposure.

Comparison of perceived occupational health needs among managers, employee representatives and occupational physicians.

The aim of this study was to assess how occupational health providers view the importance of different occupational health functions compared with their customers (managers and union representatives). A postal survey was undertaken requesting that managers of medium and large companies, union representatives and occupational physicians rank in order of importance 13 listed functions of an occupational health service which have appeared in the published literature. The results were analysed and tabulated to allow comparison of the responses among the four groups. The two functions ranked as most important by all four groups were advice on the work environment and advice on medical retirement. Dental services as an occupational health service function were ranked as least important by all four groups, with provision of physiotherapy services by occupational health departments also perceived as relatively unimportant by managers of medium and large companies. A wide discrepancy of views was revealed between physicians, managers and unions over the importance of immunization for travel and work and the rehabilitation and resettlement of sick and injured workers. The physicians ranked these functions as more important than the managers or union representatives. Managers of medium-sized companies also ranked counselling in the workplace much higher than the other respondents. The study shows the dilemma that occupational health services may face in deciding what functions should be provided compared to what their customers wish to be provided.