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Aim: to analyze the prevalence of nocturia and its possible neuro-urological correlations in patients with a history of acquired brain injury (ABI).Methods: a single-centre population-based prospec...

Introduction: The aim of the study is to evaluate the effectiveness of a Multi-disciplinary team (MDT) and multi-disciplinary approach in the treatment of Chronic Pelvic Pain (CPP). Methods: The data of all consecutive patients referred for a CPP from 11/2016 to 2/2019 has been prospectively collected. The sample was divided in two groups: Group A, made by patients managed after the institution of our MDT, and Group B, made of patients managed before this date. The MDT is composed by three urogynecologists, a psychologist and a physiotherapist. All Group A patients underwent a weekly bladder instillation with dimethyl sulfoxide (DMSO), kinesiotherapy for trigger points and Percutaneous Tibial Nerve Stimulation for 10 consecutive weeks. Patients were asked to perform a self-treatment following the Stanford Protocol and to adhere to a specific diet. All Group B patients were managed only with DMSO instillations and a strict diet. Results: The Group A was made of 41 females and 6 males while the Group B was made of 38 females and 5 males. The Group A patients showed a statistically significant improvement in the Pelvic Pain Urgency Frequency, in the frequency times reported at the 6 months voiding diary, and a better Patient Global Impression of Improvement. Conclusions: Our data support the efficacy of the MDT in the management of CPP. The multimodal approach might represent an effective and reproducible non-invasive option to manage successfully CPP.

Despite the variety of existing treatments, due to the lack of clarity of the aetiopathological mechanisms underlying CPP, the relative treatment is often unsatisfactory and limited to reduction of the symptoms. Currently, the increasing attention paid to the concomitant causes of CPP has been reflected in a new multimodal and multidisciplinary team approach. Although clinical practice and existing guidelines attribute an essential role to the physiotherapist in the management of chronic pelvic pain, the scientific evidence supporting the effectiveness of physiotherapy is not yet clear. Among conservative treatments, manual therapy remains however the first treatment option.

In the case of suprapontine lesions, the most common bladder dysfunction is neurogenic detrusor overactivity. Antimuscarinics can be considered the mainstay of treatment, while other therapies like cannabinoids look promising. Intravesical injection of botulinum toxin can be considered the main second-line treatment in case of failure of antimuscarinics. Conservative treatments should be associated with drugs. Cognitive effects of therapy shall be bared in mind for all the therapies with systemic absorption.

In daily practice, the instrumental diagnosis is often emphasised, but in the patient with a suprapontine lesion the clinical examination is critical: assessing perineal sensory function, abdominal and cremasteric reflexes and reflexes of the sacral arch can allow, in addition to a more precise diagnosis, a more accurate and safe rehabilitation.

Introduction: Recent preliminary studies showed that tonic-trophic characteristics of the pelvic muscles are related to postoperative male urinary incontinence. The aim of the current study was to test whether perineal body tone (PBT), evaluated using the Beco perineometer (Perineocaliper), is related to urinary continence recovery after robot-assisted laparoscopic prostatectomy (RALP). Materials and Methods: The study population consisted of 48 patients who underwent RALP between January and July 2009. Surgical interventions were performed by a single surgeon and patients were evaluated by a single physiotherapist. All patients were taught pelvic floor muscle exercises (PFME). PBT was evaluated in each patient preoperatively, as well 30 days and 3 months after surgery. In addition, patients were evaluated with a 24-hr pad-test and the International Consultation on Incontinence-questionnaire (ICI-Q). Results: Mean age at surgery was 65.5 years (range 46–63). Twenty-four patients underwent a bilateral nervesparing procedure (50%). One-month after surgery, 25 (52.1%) patients were continent while 23 (47.9%) patients were still incontinent. A statistically significant difference in preoperative perineometric measures was observed between continent and incontinent patients (mean 1.36 cm vs. 0.80 cm; P < 0.001). This difference was even more pronounced when comparing postoperative perineometric measures (mean 1.24 cm vs. 0.43 cm; P < 0.001). Evaluation of patients 3 months after surgery showed an increase in perineometric measures (mean increase 0.76 cm). The increase was significantly higher in patients who became continent after 3 months relative to patients who were still incontinent despite PFME (mean perineometric measures 1.45 cm vs. 1.00 cm; P ¼ 0.021). Conclusions: Our results demonstrate that urinary continence recovery is related to PBT recovery. Further studies are needed to confirm whether perineometric measures may be used as a predictive tool for the risk-stratification of postoperative UI. Neurourol. Urodynam. 31:513–516, 2012. 2012 Wiley Periodicals, Inc.

INTRODUCTION AND OBJECTIVES: The frequency-volume chart or micturition diary records a patientias voiding pattern during normal daily activities. The aim of this study was to formulate a comprehensive pelvic diary testing it on a selected population of healthy young female athletes in order to discover possible hidden pelvic dysfunctions. METHODS: The pelvic diary was designed after a structured literature review carried out from 1966 to December 2010 using MEDLINE via PubMed. In order to test this 7-day pelvic diary in a healthy control group a pilot observational prospective cohort study was planned, involving healthy young female athletes. Moreover all participants had to fill out the following validated symptom and healthrelated quality of life (HR-QoL) questionnaires: ICI-Q SF, OAB-q Short Form, P-QOL, Wexner score. RESULTS: From January 2012 to March 2012 a 7-day pelvic diary and the validated questionnaires were mailed to 422 female athletes by post. Replies were received from 284 of them. The mean age was 24.9 years with a mean body mass index of 20.9. Most of them were either volleyball (60.4%) or basketball (26.4%) players. Mean urinary frequency was 5.4 1.7. Mean compiled days were 6.4 1.5 days. Mean daily urine volume was 1119 600.9. Overall 46 subjects reported urinary incontinence episodes and 66 urgency. Moreover 12 athletes reported voiding problems. Concerning bowel symptom, 18 had faecal incontinence (77.8% gas incontinence) and 6 complained of pain during defecation. Regarding sexual and genital problems, 6 complained of dyspareunia and 10 had a feeling of heaviness in the vaginal area. The mean Wexner score was 6.01; the mean OAB-q SF score was 6.2. Concerning P-OQL domains we recorded the following mean score values: general health 30.1 10.18; prolapse impact 15.8 12.4; role limitation 15.2 13.0; physical limitation 14.9 12.8; personal relationships 6.5 11.2; emotions 15.4 14.3; sleep/energy 14.5 12.6; severity measures 15.6 14. CONCLUSIONS: Our comprehensive pelvic diary allowed us to detect hidden pelvic dysfunctions in young healthy women like validated symptom questionnaries. Because a validated urinary diary does not currently exist, in order to corroborate our preliminary results future steps will be to compare our pelvic questionnaire against an adequate gold standard such as the above mentioned validated symptom questionnaires.

Background: Despite improvements in surgical techniques, urinary incontinence (UI) is not uncommon after radical prostatectomy (RP), and it may dramatically worsen quality of life (QoL). Objective: To determine the benefit of starting pelvic floor muscle exercise (PFME) 30 d before RP and of continuing PFME postoperatively for early recovery of continence. Design, setting, and participants: A randomised, prospective study was designed. Men with localised prostate cancer (PCa) who underwent an open radical retropubic prostatectomy (RRP) at our department of urology were included. Intervention: Patients were randomised to start PFME preoperatively and continue postoperatively (active group: A) or to start PFME postoperatively alone (control group: B). Measurements: The primary outcome measure was self-reported continence after surgery. Secondary outcome measures were assessed by degree of UI based on a 24-h pad test and QoL instruments (International Continence Society [ICS] male short form [SF]). Results and limitations: Of 143 men evaluated for the study, 118 were randomised either to start PFME preoperatively and continue postoperatively (group A; n = 59) or to start postoperative PFME(group B; n = 59). After 1 mo, 44.1%(26 of 59) of patients were continent in group A, while 20.3% (12 of 59) were continent in group B (p = 0.018). At 3 mo, 59.3%(35 of 59) and 37.3%(22 of 59) patients were continent in group A and group B, respectively (p = 0.028). The ICS male SF mean score showed better results in group A than in group B patients at both 1 mo (14.6 vs 18.3) and 3 mo (8.1 vs 12.2) after RP (p = 0.002). In age-adjusted logistic regression analyses, patients who performed preoperative PFME had a 0.41-fold lower risk of being incontinent 1 mo after RP and a 0.38-fold lower risk of being incontinent 3 mo after RP (p