Urinary diversion and bladder reconstruction/replacement using intestinal segments for intractable incontinence or following cystectomy

Background Surgery performed to improve or replace the function of the diseased urinary bladder has been carried out for over a century. Main reasons for improving or replacing the function of the urinary bladder are bladder cancer, neurogenic bladder dysfunction, detrusor overactivity and chronic inflammatory diseases of the bladder (such as interstitial cystitis, tuberculosis and schistosomiasis). There is still much uncertainty about the best surgical approach. Options available at the present time include: (1) conduit diversion (the creation of various intestinal conduits to the skin) or continent diversion (which includes either a rectal reservoir or continent cutaneous diversion), (2) bladder reconstruction and (3) replacement of the bladder with various intestinal segments. Objectives To determine the best way of improving or replacing the function of the lower urinary tract using intestinal segments when the bladder has to be removed or when it has been rendered useless or dangerous by disease. Search methods We searched the Cochrane Incontinence Group Specialised Trials Register (searched 28 October 2011), which contains trials identified from the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and CINAHL, and handsearching of journals and conference proceedings, and the reference lists of relevant articles. Selection criteria All randomised or quasi-randomised controlled trials of surgery involving transposition of an intestinal segment into the urinary tract. Data collection and analysis Trials were evaluated for appropriateness for inclusion and for risk of bias by the review authors. Three review authors were involved in the data extraction. Data were combined in a meta-analysis when appropriate. Main results Five trials met the inclusion criteria with a total of 355 participants. These trials addressed only five of the 14 comparisons pre-specified in the protocol. One trial reported no statistically significant differences in the incidence of upper urinary tract infection, uretero-intestinal stenosis and renal deterioration in the comparison of continent diversion with conduit diversion. The confidence intervals were all wide, however, and did not rule out important clinical differences. In a second trial, there was no reported difference in the incidence of upper urinary tract infection and uretero-intestinal stenosis when conduit diversions were fashioned from either ileum or colon. A meta-analysis of two trials showed no statistically significant difference in daytime or nocturnal incontinence amongst participants who were randomised to ileocolonic/ileocaecal segment bladder replacement compared to an ileal bladder replacement. However, one small trial suggested that bladder replacement using an ileal segment compared to using an ileocolonic segment may be better in terms of lower rates of nocturnal incontinence. There were no differences in the incidence of dilatation of upper tract, daytime urinary incontinence or wound infection using different intestinal segments for bladder replacement. However the data were reported for 'renal units', but not in a form that allowed appropriate patient-based paired analyses. No statistically significant difference was found in the incidence of renal scarring between anti-refluxing versus freely refluxing uretero-intestinal anastomotic techniques in conduit diversions and bladder replacement groups. Again, the outcome data were not reported as paired analysis or in form to carry out paired analysis. Authors' conclusions The evidence from the included trials was very limited. Only five studies met the inclusion criteria; these were small, of moderate or poor methodological quality, and reported few of the pre-selected outcome measures. This review did not find any evidence that bladder replacement (orthotopic or continent diversion) was better than conduit diversion following cystectomy for cancer. There was no evidence to suggest that bladder reconstruction was better than conduit diversion for benign disease. The clinical significance of data from one small trial suggesting that bladder replacement using an ileal segment compared to using an ileocolonic segment is better in terms of lower rates of nocturnal incontinence is uncertain. The small amount of usable evidence for this review suggests that collaborative multi centre studies should be organised, using random allocation where possible. This review is published as a Cochrane Review in the Cochrane Database of Systematic Reviews 2012, Issue 2. Cochrane Reviews are regularly updated as new evidence emerges and in response to comments and criticisms, and the Cochrane Database of Systematic Reviews should be consulted for the most recent version of the Review.</p

Estimation of minimally important differences in EQ-5D utility and VAS scores in cancer

We wish to correct a mistake in the abstract and conclusion of our published paper [1]. In the abstract and conclusion, the MID for EQ-VAS score should be reported as 7 rather than 0.07. EQ-VAS scores range from 0 to 100, while EQ-5D index-based scores are anchored by 0 (dead) and 1 (perfect health). The specific wording in the conclusion of the abstract should read “Important differences in EQ-5D utility and VAS scores were similar for all cancers and lung cancer, with the lower end of the range of estimates closer to the MID, i. e. 0.08 for UK-index scores, 0.06 for US-index scores, and 7 for VAS scores. Author details

Online velocity constraint adaptation for safe and efficient human-robot workspace sharing

Despite the many advances in collaborative robotics, collaborative robot control laws remain similar to the ones used in more standard industrial robots, significantly reducing the capabilities of the robot when in proximity to a human. Improving the efficiency of collaborative robots requires revising the control approaches and modulating online and in real-time the low-level control of the robot to strictly ensure the safety of the human while guaranteeing efficient task realization. In this work, an openly simple and fast optimization based joint velocity controller is proposed which modulates the joint velocity constraints based on the robot's braking capabilities and the separation distance. The proposed controller is validated on the 7 degrees-of-freedom Franka Emika Panda collaborative robot

Programmable hydrocephalus shunt which cannot be unwillingly re-adjusted even in 3T MRI magnet

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Childhood Fears and the Impact of Divorce and Remarriage

Different family structures and levels of parental and financial stress were investigated in relation to children's overtly expressed fears, and secondarily, covertly measured fears and concerns. The family structures consisted of divorced and remarried families divided into those divorced less than two years and those divorced greater than two years. Intact families were used as the control group. One-hundred-twenty-one children from six to eleven years of age and their biological mothers from a semirural, southwestern town comprised the sample. The children were administered five instruments assessing overt fears, covert fears/concerns, and positiveness in family relationships. Mothers were given eight self-report measures which included a questionnaire, a report of their child's overt fears, and an indication of the positiveness in family relationships. Results indicated that the children of divorced, single mothers tended to report greater overt fears than remarried and intact families. Indications of covert fears of death and separation were also suggested. This was especially true for those single mothers divorced less than two years. Children of intact families did not generally differ from remarried groups although there were implications that remarriage too soon after divorce may impact covert fears as well as positive feelings toward the stepfather. Children of mothers reporting high levels of stress reported greater levels of overt fears than children of low stress mothers. Financial stress for mothers appeared to have greater implications for children's overt and covert fears than did parental stress. In contrast to the children of mothers reporting high levels of stress, mothers who reported low levels of stress tended to have children who reported fewer overt fears but greater covert fears and concerns. Recommendations for future research including adding parental measures to assess the coping styles as well as the effectiveness of such coping with divorce and remarriage, using different measures of overt and covert fears, and extending the study to include data from the biological fathers as well as families in which the father has custodial rights

Book Reviews

Reviews of the following books: At the Place of the Lobsters and Crabs: Indian People and Deer Isle, Maine, 1605-2005 by William A. Haviland; A History of the Italians in the State of Maine by Vincent A. Lapomarda; Beckets & Hinges: Sea Tales of Old North Yarmouth, Maine by Captain Charles C. and Abbie B. Oakes. Edited and illustrated by Arnold H. Sturtevant; Joshua Bross Rich (1820-1897): The Life and Works of a Western Maine Pioneer and Wildlife Writer by William B. Kroh