Zdjelična rehabilitacija urinarne inkontinencije nakon radikalne prostatektomije

Radical prostatectomy (RP) performed by open, laparoscopic, or robotic approach is considered the gold standard for localized prostate cancer (PCa). However, it carries the risk of postprostatectomy urinary incontinence (UI) and erectile dysfunction (ED) which significantly reduce patients’ satisfaction with surgery and quality of life (QoL), therefore it is important to decrease the possibility or severity of these complications to a minimum. There are several preoperative prognostic factors such as urethral length and closing pressure obtained by magnetic resonance imaging and profilometry, as well as several variations in the surgical approach such as preservation of the neurovascular bundle (NVB) and puboprostatic ligaments, sparing or reconstruction of bladder neck, Retzius-sparing approach, and meticulous surgical dissection, used to predict or prevent unwanted side effects of RP. In addition, there are postoperative methods that can help reduce complications. In this review, we will present the role of pelvic rehabilitation with an emphasis on pelvic floor muscle training (PFMT) in reducing consequences of radical surgery.Otvorena, laparoskopska ili robotska radikalna prostatektomija predstavlja zlatni standard za liječenje karcinoma prostate. Međutim, ona također nosi rizik postprostatektomijske inkontinencije i erektilne disfunkcija koje značajno smanjuju zadovoljstvo bolesnika operacijom i njegovu kvalitetu života, zbog toga je važno njihovu pojavnost smanjiti na minimum. Postoji nekoliko preoperativnih prognostičkih faktora kao što su dužina i tlak zatvaranja uretre dobiveni magnetskom rezonancom i profilometrijom te nekoliko varijacija u kirurškom pristupu kao što su očuvanje neurovaskularnog snopa i puboprostatičnih ligamenata, očuvanje i rekonstrukcija vrata mokraćnog mjehura, očuvanje Retziusovog prostora, ali i pedantna kirurška tehnika kojima se neželjene posljedice radikalne prostatektomije predviđaju, odnosno preveniraju. Postoje i postoperativne metode koje mogu pomoći u smanjenju komplikacija. U ovom radu prikazati ćemo ulogu rehabilitacije zdjelice s naglaskom na vježbe mišića dna zdjelice na smanjenje posljedica radikalne kirurgije

CERVICAL SPINE FRACTURE IN A PATIENT WITH ANKYLOSING SPONDYLITIS – A CASE REPORT

Ankilozantni spondilitis (AS) kronična je upalna reumatska bolest iz skupine seronegativnih spondiloartropatija (SpA) koja neliječena dovodi do postupne ascendentne osifi kacije vezivnih struktura kralježnice s potpunim gubitkom pokretljivosti. U AS-u se istodobno zbivaju procesi resorpcije i stvaranja nove kosti, koji utječu na funkcionalni status i kvalitetu života bolesnika. Osteoporoza i posljedični prijelomi kralježnice na malu traumu znatna su komplikacija AS-a, a najčešće se događaju u području vratne kralježnice. Za razliku od osteoporotičnih prijeloma u postmenopauzalnoj osteoporozi, prijelomi kralježnice u AS-u, iako nastaju na malu traumu, češće su klinički manifestni uz popratni neurološki defi cit. Prijelomi u AS-u zahvaćaju ne samo trup kralješka već sva tri dijela kralježničnog stupa uz posljedičnu nestabilnost te nalažu imobilizaciju ili kirurško liječenje. Mortalitet bolesnika s AS-om nakon prijeloma kralježnice znatno je viši u odnosu prema općoj populaciji stoga je ključno rano prepoznavanje i adekvatno zbrinjavanje. Za postavljanje dijagnoze najčešće je potrebno učiniti kompjutoriziranu tomografi ju (CT) jer se na standardnim radiogramima radi obilja nove kosti može previdjeti prijelom. U radu je prikazan bolesnik s AS-om koji je zadobio prijelom u području vratne kralježnice posljedično trzajnoj ozljedi.Ankylosing spondylitis (AS) is a chronic infl ammatory rheumatic disease from the group of seronegative spondyloarthropathies (SpA), which, if untreated, leads to a gradual ascending ossifi cation of the connective structure of the spine with a complete loss of mobility. In AS the processes of resorption and new bone formation occur at the same time, and both aff ect the long-term functional status and quality of life of patients. Osteoporotic spinal fractures are a signifi cant complication of AS, occurring most frequently in the cervical spine. Unlike osteoporotic fractures in postmenopausal osteoporosis, fractures of the spine in AS oft en occur aft er minor trauma, are frequently clinically manifested, and can have accompanying neurological defi cits. Fractures in AS aff ect not only the vertebral body, but all three parts of the vertebral column, with consequent instability which requires immobilization or surgical treatment. The mortality of patients with AS aft er fractures of the spine is signifi cantly higher than in the general population, thus early recognition and adequate care are crucial. With standard radiography only, due to an abundance of new bone formation, the fractures may be overlooked. Multislice computed tomography (MSCT) is usually required for diagnosis, and in unclear cases magnetic resonance imaging (MRI) is of help in the fi nal assessment of the trauma. We present a patient with AS who suff ered a fracture of the cervical spine aft er a whiplash injury

Functional Magnetic Stimulation of the Pelvis and Urinary Incontinence after Radical Prostatectomy

Functional magnetic stimulation (FMS) is a method based on the use of a magnetic field to stimulate different parts of the body with the aim of their treatment or rehabilitation. As a noninvasive, relatively cheap and fast method without significant side effects, it is used for several decades for many parts of human body to reduce related pain or increase its functionality. In urology it is mainly indicated for pelvic floor rehabilitation to reduce problems with urination mostly in female patients, alone or more often in combination with different methods for pelvic floor rehabilitation. In this review we will pre- sent current role of FMS in patients with urinary incontinence after radical prostatectomy

Postprostatektomijakska kontinencija nakon funkcionalne magnetske stimulacije zdjelice

Although radical prostatectomy is considered the gold standard for optimal treatment of localized prostate cancer, this radical surgery carries a significant risk of erectile dysfunction and urinary incontinence which can be present as transient or permanent side effects in many patients. We have made significant advances in diagnostic and surgical approach to prostate cancer, using a number of new methods that are becoming increasingly available, resulting in better treatment outcomes. However, we still do not use all the possibilities for the prevention and treatment of these side effects, probably due to their insufficient research, or unclear effectiveness. Functional magnetic stimulation is a method used to treat a large number of diseases, i.e., to alleviate their symptoms and ailments. Its role through pelvic stimulation has been proven in the treatment of incontinence in women, and in our study, we want to determine its role in more detail, primarily in the treatment of urinary incontinence in patients after prostate cancer surgery. In case of positive results, this method may be recommended for wider use in patients with adverse effects of radical prostatectomy.Iako se radikalna prostatektomija smatra zlatnim standardom za optimalno liječenje lokaliziranog raka prostate, ova radikalna operacija nosi značajan rizik od erektilne disfunkcije i urinarne inkontinencije koje su prisutne kao prolazne ili trajne nuspojave kod velikog broja bolesnika. Napravili smo značajan napredak u dijagnostičkom i kirurškom pristupu raku prostate primjenjujući niz novih metoda koje su sve dostupnije, što je rezultiralo boljim rezultatima liječenja. Međutim, još uvijek nedovoljno rabimo sve mogućnosti za prevenciju, ali i liječenje ovih nuspojava, vjerojatno zbog njihove nedovoljne istraženosti, odnosno nejasne učinkovitosti. Funkcionalna magnetska stimulacija je metoda koja se primjenjuje za liječenje velikog broja bolesti, odnosno za olakšavanje njihovih simptoma i tegoba. Njezina uloga kroz stimulaciju mišića zdjelice je dokazana u liječenju inkontinencije kod žena, a u našem istraživanju želimo detaljnije utvrditi njezinu ulogu, prvenstveno u liječenju urinarne inkontinencije u bolesnika nakon operacije raka prostate. U slučaju pozitivnih rezultata ova se metoda može preporučiti za širu primjenu u bolesnika s neželjenim posljedicama radikalne prostatektomije

ANTI-TNF THERAPY AND THE RISK OF MALIGNANCIES AND INFECTIONS IN INFLAMMATORY RHEUMATIC DISEASES - OUR EXPERIENCE

Background: Early diagnosis is the key to successful treatment of inflammatory rheumatic diseases and the use of conventional disease-modifying antirheumatic drugs (csDMARD) and biologic disease-modifying antirheumatic drugs (bDMARD) or biologics have substantially contributed to better disease control. Biological drugs have been approved for the treatment of rheumatoid arthritis (RA), juvenile arthritis (JIA), ankylosing spondylitis (AS) and psoriatic arthritis (PsA). Subjects and methods: The study involved 79 adult patients with rheumatoid arthritis (RA) and ankylosing spondylitis (AS), psoriatic arthritis (PsA) or undifferentiated spondyloarthropathy (USpA) - the last three clinical entities belong to a common group called spondyloarthropathies (SpA); receiving anti-TNF therapy at the department of Rheumatology and Rehabilitation, Clinical Hospital Center Zagreb. The duration of therapy was a minimum of 1 month, with the mean duration of 32.024.0 months. The infections recorded were infections that appeared during treatment or soon after the treatment was stopped. Results: During the course of therapy 17 patients (21.5%) experienced an infection, with the total number of 21 infections. This resulted in an overall incidence rate (IR) of 9.9/100 patient-years. Of the patients with RA 76.5% developed an infection, which was significantly higher than for patients with SpA (p<0.001). The IR/100 patient-years for all infections in RA patients was 23.7 compared to 2.8 in patients with SpA. Female gender was associated with a significantly higher infection rate (70.6%, p=0.005). There were 8 infections that were considered serious, yielding an IR of 3.8/100 patient-years. There was only one malignancy case in our study. Conclusion: Every fifth patient developed an infection during the course of anti-TNF therapy, and more than one third of all infections were serious. RA and female gender was associated with a significantly increased number of infections

Pathogenesis of Extraarticular Manifestations in Rheumatoid Arthritis—A Comprehensive Review

Rheumatoid arthritis (RA) is among the most prevalent and debilitating autoimmune inflammatory chronic diseases. Although it is primarily characterized by destructive peripheral arthritis, it is a systemic disease, and RA-related extraarticular manifestations (EAMs) can affect almost every organ, exhibit a multitude of clinical presentations, and can even be asymptomatic. Importantly, EAMs largely contribute to the quality of life and mortality of RA patients, particularly substantially increased risk of cardiovascular disease (CVD) which is the leading cause of death in RA patients. In spite of known risk factors related to EAM development, a more in-depth understanding of its pathophysiology is lacking. Improved knowledge of EAMs and their comparison to the pathogenesis of arthritis in RA could lead to a better understanding of RA inflammation overall and its initial phases. Taking into account that RA is a disorder that has many faces and that each person experiences it and responds to treatments differently, gaining a better understanding of the connections between the joint and extra-joint manifestations could help to create new treatments and improve the overall approach to the patient