Wpływ urazu kręgosłupa powikłanego zaburzeniami neurologicznymi na funkcje seksualne – dysfunkcje seksualne u mężczyzn

Sexual impairment and decreased fertility constitute a part of a complex dysfunction typical for men with spinal injury with neurological consequences (SINC). Despite the progress in medical sciences and quality of care provided for disabled persons, the problem is often neglected by medical professionals and caregivers.Aim of the study: Presentation of patophysiological background and specificity of sexual dysfunction typical for men following SINC. Review of contemporary treatment modalities designed for erectile dysfunction and infertility in men after SINC.Method: Literature review, authors’ clinical experience.Results and conclusions: Specific neurological deficit with overlapping adaptation problems and depression account for erectile dysfunction in men after SINC. There is a wide range of efficient therapies addressed to patients suffering from erectile disturbances resulting from SINC. Selection of a proper therapy depends on location (level) of the lesion of a neural structure, type of deficit, functional status, presence of symptoms of autonomic dysreflexia, concomitant diseases and patient’s individual preferences. Patient’s awareness of the disability and positive attitude towards acceptance of alternative forms of sexual expressions are crucial for the therapeutic success. Ejaculation dysfunction and infertility are common among men after SINC. Application of contemporary methods of assisted reproduction may be efficient in about half of male population with SINC

Współczesne metody oceny układu wydalniczego u osób po urazie kręgosłupa powikłanym zaburzeniami neurologicznymi – diagnostyka dolnych dróg moczowych

Introduction: Spinal injury with neurological deficit usually results in a neurogenic bladder disorder. The problem may range from total lack of micturition during the spinal shock phase to various forms of detrusor-sphincter dyssynergia. Typical consequences include increased intra-vesical pressure, inability to effectively empty the bladder, increased risk of vesico-ureteral reflux, infection, bladder or kidney stones, neoplastic complications within the urinary tract and renal failure. Proper diagnostics of urinary tract function and morphology enables choosing adequate bladder emptying strategy, early diagnosis and effective treatment of urinary complications in patients after spinal injury with neurological deficit.Study purpose: Presentation of contemporary methods of functional, imaging and endoscopic diagnostic tests of the lower urinary tract in patients with spinal injury with neurological deficit. We discuss clinical value and accuracy of particular diagnostic methods in prevention and monitoring of the therapy of urinary complications.Study form: Literature review.Conclusions: Although urodynamic studies serve as the principal tool among the modern methods of the lower urinary tract function assessment, simple functional tests such as measurement of residual urine volume measurement or cystometrogram may be helpful in clinical practice, particularly during the early post-traumatic phase. Ultrasonographic examination is the first choice imaging study. Clinical validity of screening cystoscopy in spinal injury with neurological deficit patients remains doubtful, but this procedure is of unquestionable value in cases with haematuria

Impact of spinal injury with neurological consequences on sexual function: Sexual dysfunctions in women

Patophysiological background of sexual dysfunctions in women after spine injury with neurological consequePatophysiological background of sexual dysfunctions in women after spine injury with neurological consequences (SINC) is a difficult object of scientific investigations and is not as accurately described as sexual impairment in men after SINC. In particular, systematic reports on pregnancy and its complications in women after SINC are lacking. Aim of the study: Presentation of backgrounds and specificity of sexual disorders, dysfunctions of partner relationships and contraception in women after SINC.Method: Literature review, authors’ clinical experience.Results and conclusions: Persons with sexual dysfunction following SINC should be subjected to psychological evaluation and specified sexual education. These specific interventions should be introduced at the appropriate time and take into account functional progress made during rehabilitation and the level of patients’ acceptance of disability. Partner’s involvement is crucial for effective psychotherapy of persons after SINC. A possibility to take the advantage of experience of other persons with a similar disorder is of particular value during the therapy. There is a positve correlation between the ability to experience sexual satisfaction and quality of social adaptation after SINC. The form, acceptance and efficiency of sexual education in persons after SINC are affected by cultural conditions.nces (SINC) is a difficult object of scientific investigations and is not as accurately described as sexual impairment in men after SINC. In particular, systematic reports on pregnancy and its complications in women after SINC are lacking. Aim of the study: Presentation of backgrounds and specificity of sexual disorders, dysfunctions of partner relationships and contraception in women after SINC.Method: Literature review, authors’ clinical experience.Results and conclusions: Persons with sexual dysfunction following SINC should be subjected to psychological evaluation and specified sexual education. These specific interventions should be introduced at the appropriate time and take into account functional progress made during rehabilitation and the level of patients’ acceptance of disability. Partner’s involvement is crucial for effective psychotherapy of persons after SINC. A possibility to take the advantage of experience of other persons with a similar disorder is of particular value during the therapy. There is a positve correlation between the ability to experience sexual satisfaction and quality of social adaptation after SINC. The form, acceptance and efficiency of sexual education in persons after SINC are affected by cultural conditions

The Influence of Pelvic Asymmetry on Trunk Symmetry Among Children

Wstęp. Asymetria miednicy i wady postawy, które jej towarzyszą mają tendencję do częstszego występowania wraz z wiekiem. Okres szkolny, który wiąże się dłuższym czasem przebywania w pozycji siedzącej oraz codzienne czynności wykonywane dominującą kończyną mogą się do tego przyczyniać. Materiał i metody. W badaniu wzięło udział 22 dzieci (12 dziewczynek, 10 chłopców) w wieku 7 lat. Po dwóch latach ponowiono badanie tej samej grupy. Asymetrię miednicy stwierdzano poprzez ocenę ustawienia kolców biodrowych. Wskaźnikiem asymetrii tułowia był kąt rotacji tułowia (KRT) mierzony skoliometrem Bunnela w obrębie wyrostów kolczystych na: górnym kręgu piersiowym, szczycie kifozy piersiowej, przejściu piersiowo-lędźwiowym, kręgosłupie lędźwiowym, a także (jeżeli obecna u pacjentów) największej deformacji (garb żebrowy, wał lędźwiowy). Wyniki. U 14 dzieci w wieku 7 lat wykryto asymetrię miednicy. Wśród badanych, w tej samej grupie pacjentów w wieku 9 lat, asymetrię odnotowano u 16 osób. Na przestrzeni tych dwóch lat wzrosła częstość występowania asymetrii tułowia u dzieci ze skośnie/zrotowanym ustawieniem miednicy. Największy progres asymetrii tułowia przy skośnym ustawieniu miednicy został odnotowany w odcinku lędźwiowym. U dzieci z miednicą symetrycznie ustawioną, największy wzrost KRT odnotowano w odcinku piersiowym. Wnioski. 1. Na powstanie asymetrii obręczy miednicznej, ma wpływ wzrastająca ilość asymetrycznie wykonywanych ruchów i przyjmowanych asymetrycznych pozycji, których sumarycznie wraz z wiekiem jest coraz więcej. 2. Największy wzrost asymetrii kręgosłupa u badanych z miednicą skośną/zrotowaną odnotowano w odcinku lędźwiowym, co świadczy o powiązaniu ze skrzywieniem obręczy miednicznej. 3. Asymetria jest procesem dynamicznym. Gdy jest bagatelizowana, postęp wady postawy może być znaczący i mogą pojawić się kompensacyjne zmiany w sąsiednich układach.Background. Pelvic asymmetry and accompanying postural defects tend to become more common with age. The school period, which is associated with spending more time in a sitting position and daily activities performed with the dominant limb, may contribute to this. Material and methods. We examined 22 children (12 girls, 10 boys) aged 7 years. The same group was re-examined two years later. Pelvic asymmetry was identified by assessing the position of the iliac spines. The indicator of trunk asymmetry was the trunk rotation angle (TRA) measured with a Bunnel scoliometer within the spinous processes on the upper thoracic vertebra, apex of thoracic kyphosis, thoracolumbar junction, lumbar spine, and (if present in patients) the greatest deformity (rib hump, hump in the lumbar region). Results. Pelvic asymmetry was detected in 14 children at the age of 7 years compared to 16 in the same group of patients aged 9 years. During these two years, the prevalence of trunk asymmetry in children with an oblique/rotated pelvis had increased. The progression of trunk asymmetry with an oblique position of the pelvis was most marked in the lumbar region. In children with symmetrical pelvis, the most marked increase in TRA was recorded in the thoracic segment. Conclusions. 1. The development of pelvic girdle asymmetry is influenced by the increasing number of asymmetrically performed movements and asymmetric body positions assumed, which increase in number with age. 2. The most marked increase in asymmetry of the spine in subjects with an oblique/rotated pelvis was seen in the lumbar spine, which proves an association of the former with tilting of the pelvic girdle. 3. Asymmetry is a dynamic process. When ignored, this postural defect progresses significantly and there may be compensatory changes in neighbouring systems

Współczesne metody oceny układu wydalniczego u osób po urazie kręgosłupa powikłanym zaburzeniami neurologicznymi – diagnostyka górnych dróg moczowych

Introduction: Morbidity and mortality related to urinary tract diseases in patients after spinal injury with neurological disturbances (SIND) are modifiable if prompt and rational diagnostics and therapy are implemented in comprehensive care. SIND increases the risk of urinary tract damage resulting from neurogenic bladder dysfunction, sequels of patient’s immobilisation, nephrotoxic effect of pharmacotherapy, necessity of bladder catheterisation. Severe damage to the urinary system resulting from reflux, urolithiasis, hydronephrosis, recurrent pyelonephritis can occur both during the early and the late phase following SIND. The risk of urinary tract cancer is markedly increased in SIND patients. The natural history of urinary tract diseases in SIND patients might be changed. The course of the disease can be scant in symptoms and signs until late stages. Study design: Overview of scholarly literature.Aim of the study: Presentation and analysis of clinical usefulness of modern tests applied in diagnostics of the urinary tract function in SIND patients. We discussed appropriateness and clinical usefulness of imaging and functional procedures of the upper urinary tract evaluation with special emphasis on basic laboratory tests, modern methods of glomerular filtration rate (GFR) assessment in SIND patients, as well as on the traditional and modern imaging studies.Conclusions: Modern comprehensive care of a patient with SIND, both at the early and late stage following spinal injury, should comprise systematic monitoring of renal function. Efficacious diagnosis is based on meticulous clinical examination. Auxiliary tests are performed according to their availability and the anticipated clinical relevance. First line diagnostic tests should comprise non-invasive techniques. Systematic and credible GFR assessment is indicated in SIND patients. Tests of choice include: 51CrEDTA or 99mTcDTPA clearance, assessment of cystatin-C level, as well as routine imaging studies of the kidneys such as renal radioisotope scanning and ultrasound examination. Urography and computed tomography may serve as auxiliary imaging techniques