No abstract

Transcutaneous tibial nerve stimulation (TTNS) has proven itself a valuable treatment option for various lower urinary tract conditions like the overactive bladder syndrome or neurogenic detrusor overactivity. The aim of this study was to investigate acute changes in urodynamic parameters due to bilateral TTNS.Methods: 51 patients (18 -87 years; 61 % female) with various lower urinary tract symptoms were enrolled in this study. They were single-blinded and randomly assigned to receive simultaneous-bilateral TTNS either during their first urodynamic examination, followed by a second round under the influence of a placebo stimulation technique, or vice versa.Results: For subjects without signs of anatomical pathologies filling volume at the first desire to void (FDV) increased significantly by 54 ml (IQR 26 to 81; p < 0.01) under the influence of TTNS compared to placebo. Their maximum cystometric capacity increased by 41 ml (IQR 10 to 65; p = 0.02). The median micturition volume of patients with pathological amounts of post-void residual (>100 ml) increased by 76 ml compared to patients without urinary retention (IQR 6 to 166; p = 0.03). Conclusions:Compared to placebo, simultaneous-bilateral TTNS showed significant improvements of bladder functioning like delayed FDV, increased maximum cystometric capacity and reduced urinary retention. Patients with signs of anatomical pathologies do not seem to benefit from TTNS. Further studies need to be conducted to compare the effectiveness of bilateral to unilateral TTNS.

Background: We assessed a wide array of body composition parameters to identify those most relevant as prognostic tools for patients undergoing radical cystectomy (RC) due to bladder cancer (BC). Methods: In this retrospective, single-center study, preoperative computed tomography (CT) scans of 657 patients were measured at the level of the 3rd lumbar vertebra (L3) to determine common body composition indices including sarcopenia, myosteatosis, psoas muscle index (PMI), subcutaneous and visceral fat index (SFI and VFI), visceral-to-subcutaneous fat ratio (VSR), and visceral obesity. Predictors of overall survival (OS) and cancer-specific survival (CSS) were identified in univariate and multivariate survival analysis. Results: Sarcopenia and a low PMI were independently associated with shorter OS (Sarcopenia: HR 1.30; 95% CI 1.02–1.66; p = 0.04 and a low PMI: HR 1.32; 95% CI 1.02–1.70; p = 0.03) and CSS (Sarcopenia: HR 1.64; 95% CI 1.19–2.25; p < 0.01 and a low PMI: HR 1.41; 95% CI 1.02–1.96; p = 0.04). Myosteatosis, measured as decreasing average Hounsfield units of skeletal muscle, was an independent risk factor for OS (HR 0.98; 95% CI 0.97–1.00; p = 0.01) and CSS (HR 0.98; 95% CI 0.96–1.00; p < 0.05). The assessed adipose tissue indices were not significant predictors for OS and CSS. Conclusions: Sarcopenia, a low PMI, and myosteatosis are independent predictors for OS and CSS in patients undergoing radical cystectomy for bladder cancer.

Ankle or hindfoot arthrodesis represents a promising option for patients with severe osteoarthritis and can safeguard patients from increasing immobility.