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Pelvic Relaxation

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181. Urological Trauma

., et al. Diagnosis and management of ureteric injury: an evidence-based analysis. BJU Int, 2004. 94: 277. 121. Chou, M.T., et al. Prophylactic ureteral catheterization in gynecologic surgery: a 12-year randomized trial in a community hospital. Int Urogynecol J Pelvic Floor Dysfunct, 2009. 20: 689. 122. Delacroix, S.E., Jr., et al. Urinary tract injures: recognition and management. Clin Colon Rectal Surg, 2010. 23: 104. 123. Visco, A.G., et al. Cost-effectiveness of universal cystoscopy to identify (...) Kidney Autotransplantation: A Minimally Invasive Way to Salvage Kidneys. Eur Urol Focus, 2018. 4: 198. 152. Zhao, L.C., et al. Robotic Ureteral Reconstruction Using Buccal Mucosa Grafts: A Multi-institutional Experience. Eur Urol, 2017. 153. Pereira, B.M., et al. Bladder injuries after external trauma: 20 years experience report in a population-based cross-sectional view. World J Urol, 2013. 31: 913. 154. Figler, B.D., et al. Multi-disciplinary update on pelvic fracture associated bladder

2018 European Association of Urology

182. Neuro-urology

with urinary incontinence. Int Urogynecol J Pelvic Floor Dysfunct, 2008. 19: 955. 61. Henze, T. Managing specific symptoms in people with multiple sclerosis. Int MS J, 2005. 12: 60. 62. Liu, C.W., et al. The relationship between bladder management and health-related quality of life in patients with spinal cord injury in the UK. Spinal Cord, 2010. 48: 319. 63. Khalaf, K.M., et al. The impact of lower urinary tract symptoms on health-related quality of life among patients with multiple sclerosis. Neurourol (...) viewpoint. J Pediatr Urol, 2017. 97. Yang, C.C., et al. Bladder management in women with neurologic disabilities. Phys Med Rehabil Clin N Am, 2001. 12: 91. 98. Podnar, S., et al. Protocol for clinical neurophysiologic examination of the pelvic floor. Neurourol Urodyn, 2001. 20: 669. 99. Harrison, S., et al. Urinary incontinence in neurological disease: assessment and management. NICE Clinical Guideline 2012. [CG148]. 100. Liu, N., et al. Autonomic dysreflexia severity during urodynamics and cystoscopy

2018 European Association of Urology

183. Male Sexual Dysfunction

. Erectile dysfunction in the cardiovascular patient. Eur Heart J, 2013. 34: 2034. 50. Seftel, A.D., et al. Coexisting lower urinary tract symptoms and erectile dysfunction: a systematic review of epidemiological data. Int J Clin Pract, 2013. 67: 32. 51. Rosen, R., et al. Lower urinary tract symptoms and male sexual dysfunction: the multinational survey of the aging male (MSAM-7). Eur Urol, 2003. 44: 637. 52. Zhang, Y., et al. Erectile Dysfunction in Chronic Prostatitis/Chronic Pelvic Pain Syndrome (...) 2 and 4 years after radical prostatectomy. J Urol, 2009. 181: 731. 79. Incrocci, L., et al. Pelvic radiotherapy and sexual function in men and women. J Sex Med, 2013. 10 Suppl 1: 53. 80. Morgia, G., et al. Association between long-term erectile dysfunction and biochemical recurrence after permanent seed I(125) implant brachytherapy for prostate cancer. A longitudinal study of a single-institution. Aging Male, 2016. 19: 15. 81. Stember, D.S., et al. The concept of erectile function preservation

2018 European Association of Urology

185. Urinary Incontinence

, S.S., et al. Responsiveness of the Pelvic Floor Distress Inventory and Pelvic Floor Impact Questionnaire in women undergoing treatment for pelvic floor disorders. Int Urogynecol J, 2013. 24: 213. 16. Kim, J., et al. 1576 Is there a relationship between incontinence impact questionnaire 7 score after surgery for stress urinary incontinence and patient-perceived satisfaction and improvement? J Urol. 189: e647.J Urol. 189: e647. (13)03402-2/abstract 17. Tran, M.G., et al. Patient reported outcome (...) )/International Continence Society (ICS) joint terminology and classification of the complications related directly to the insertion of prostheses (meshes, implants, tapes) and grafts in female pelvic floor surgery. Neurourol Urodyn, 2011. 30: 2. 21. Brown, J.S., et al. Measurement characteristics of a voiding diary for use by men and women with overactive bladder. Urology, 2003. 61: 802. 22. Nygaard, I., et al. Reproducibility of the seven-day voiding diary in women with stress urinary incontinence. Int

2018 European Association of Urology

186. Muscle-invasive and Metastatic Bladder Cancer

, and late gadolinium-enhanced imaging. Radiology, 1994. 193: 239. 103. Kim, J.K., et al. Bladder cancer: analysis of multi-detector row helical CT enhancement pattern and accuracy in tumor detection and perivesical staging. Radiology, 2004. 231: 725. 104. Yang, W.T., et al. Comparison of dynamic helical CT and dynamic MR imaging in the evaluation of pelvic lymph nodes in cervical carcinoma. AJR Am J Roentgenol, 2000. 175: 759. 105. Kim, S.H., et al. Uterine cervical carcinoma: evaluation of pelvic lymph (...) carcinoma. Acta Radiol, 1988. 29: 251. 121. Lauenstein, T.C., et al. Whole-body MR imaging: evaluation of patients for metastases. Radiology, 2004. 233: 139. 122. Schmidt, G.P., et al. Whole-body MR imaging of bone marrow. Eur J Radiol, 2005. 55: 33. 123. Yang, Z., et al. Is whole-body fluorine-18 fluorodeoxyglucose PET/CT plus additional pelvic images (oral hydration-voiding-refilling) useful for detecting recurrent bladder cancer? Ann Nucl Med, 2012. 26: 571. 124. Maurer, T., et al. Diagnostic

2018 European Association of Urology

187. Low Back Pain, Adult Acute and Subacute

of corticosteroids • Trauma with neurological signs Note: There is not sufficient data on a history of osteoporosis as a specific risk factor. Infection An uncommon but serious cause for back pain is infection. A spinal infection such as vertebral osteomyelitis or spinal epidural abscess can present as back pain with a fever. Consideration of other non-spine origins Low back pain can be due to visceral disease. Examples include (Goldman, 2011): • Disease of pelvic organs (prostatitis, endometriosis, chronic (...) pelvic inflammatory disease) • Renal disease (nephrolithiasis, pyelonephritis, perinephric abscess) • Aortic aneurysm • Gastrointestinal disease • Pancreatitis • Cholecystitis • Penetrating ulcer • Cardiac or pericardial disease • Pulmonary or pleural disease Evaluate Function Using tools can help with proper management of low back pain. The following are some of the available tools for low back pain evaluation. Other validated tools may be used, as well. Adult Acute and Subacute Low Back Pain

2018 Institute for Clinical Systems Improvement

188. Low back pain and radicular pain: evaluation and management

(NSAIDs) 102 3.3.2 Paracetamol 107 3.3.3 Opioids 110 3.3.4 Antidepressants 114 3.3.5 Anticonvulsants 117 3.3.6 Skeletal muscle relaxants 120 3.3.7 Antibiotics 122 3.3.8 Oral Methylprednisolone 124 3.4 INVASIVE TREATMENTS 124 3.4.1 Spinal injections 124 3.4.2 Radiofrequency denervation for facet joint pain 128 3.4.3 Epidural injections 134 3.4.4 Surgery and prognostic factors 140 3.4.5 Disc replacement 143 3.4.6 Spinal fusion 146 3.4.7 Spinal decompression 151 4 IMPLEMENTATION AND UPDATING

2017 Belgian Health Care Knowledge Centre

190. WHO Guidelines on Integrated Care for Older People (ICOPE)

of Recommendations Assessment, Development and Evaluation ICOPE integrated care for older people mhGAP Mental Health Gap Action Programme PFMT pelvic floor muscle training PICO population, intervention, comparison, outcome RCT randomized controlled trial WHO World Health Organizationvii Executive summary Over the past 50 years, socioeconomic development in most regions has been accompanied by large reductions in fertility and equally dramatic increases in life expectancy. This phenomenon has led to rapid changes (...) with a good understanding of mental health care for older adults. (Quality of the evidence: very low; Strength of the recommendation: conditional) Module II: Geriatric syndromes Urinary incontinence Recommendation 7: Prompted voiding for the management of urinary incontinence can be offered for older people with cognitive impairment. (Quality of the evidence: very low; Strength of the recommendation: conditional) Recommendation 8: Pelvic floor muscle training (PFMT), alone or combined with bladder control

2017 World Health Organisation Guidelines

191. CRACKCast E092 – Small Intestine

, including adenomas, leiomyomas, and lipomas; metastatic disease, ovarian cancer.) Hernias Be worried about the closed loop internal hernia – in someone post bariatric surgery! Question 3) List causes of functional small bowel obstruction. Metabolic disease (especially hypokalemia) Medications (eg. narcotics) Infection (retroperitoneal, pelvic, intrathoracic) Abdominal trauma Laparotomy Question 4) List 5 lab tests useful in the diagnosis of SBO. What findings are expected on AXR? On CT? This is a trick (...) stabilisation: consider invasive arterial monitoring Vasopressors/Inotropes: too much Alpha (squeeze) is bad. Go for dobutamine/milrinone/dopamine. Epi/Norepi/Vaso have been shown to worsen mesenteric blood flow Antibiotics in cases of suspected infarct/perforation (Ceftriaxone or Cipro + metronidazole) Consider IR directed clot retrieval / stent / fibrinolytic therapy Evidence for the phosphodiesterase inhibitor papaverine – Increases C-AMP and causes profound smooth muscle relaxation Wisecracks: Question

2017 CandiEM

192. CRACKCast E099 – Urological Disorders

in 10% of people with ABP Chronic pelvic pain syndrome Complex pain syndrome with urinary symptoms and sexual dysfunction and no organic etiology Asymptomatic inflammatory prostatitis [1] Describe the diagnosis and management of prostatitis Acute bacterial prostatitis: clinical diagnosis UTI symptoms, fevers, chills, dysuria, frequency, urgency, perineal or low back pain Tender and swollen prostate on rectal exam Urine culture, blood cultures if febrile, and STI testing At risk for urinary retention (...) leads to irreversible damage after 1-2 weeks and risk for pyelonephritis, perinephric abscess, and gram -ve sepsis. [1] Name the areas of narrowing in the ureter Stone passage and need for surgical intervention depends on: [1] Calculus size Stone size Pass rate (%) by 4 wks < 5mm 90% 5-8 mm 15% > 8 mm 5% [2] Location There are five areas of narrowing along the ureter – fig 89.4 Calyx of the kidney Ureteropelvic junction (UPJ) Uretero-pelvic brim (ureter arches over iliac vessels posteriorly

2017 CandiEM

193. AIM Clinical Appropriateness Guidelines for Interventional Pain Management

, including but not limited to the following: ? Prescription strength anti-inflammatory medications and analgesics ? Adjunctive medications such as nerve membrane stabilizers or muscle relaxants ? Physician-supervised therapeutic exercise program or physical therapy ? Manual therapy or spinal manipulation ? Alternative therapies such as acupuncture ? Appropriate management of underlying or associated cognitive, behavioral, or addiction disorders Documentation of compliance with a plan of therapy (...) . Studies have validated the efficacy of this intervention in chronic pain of facet origin. Definitions Conservative management should include a combination of strategies to reduce inflammation, alleviate pain, and improve function, including but not limited to the following: ? Prescription strength anti-inflammatory medications and analgesics ? Adjunctive medications such as nerve membrane stabilizers or muscle relaxants ? Physician-supervised therapeutic exercise program or physical therapy ? Manual

2017 AIM Specialty Health

194. AIM Clinical Appropriateness Guidelines for Spine Surgery

of strategies to reduce inflammation, alleviate pain, and improve function, including but not limited to the following: ? Prescription strength anti-inflammatory medications and analgesics ? Adjunctive medications such as nerve membrane stabilizers or muscle relaxants ? Physician-supervised therapeutic exercise program or physical therapy ? Manual therapy or spinal manipulation ? Alternative therapies such as acupuncture ? Appropriate management of underlying or associated cognitive, behavioral (...) vertebral segments (List separately in addition to code for primary procedure) 22845 Anterior instrumentation; 2 to 3 vertebral segments (List separately in addition to code for primary procedure) 22846 Anterior instrumentation; 4 to 7 vertebral segments (List separately in addition to code for primary procedure) 22847 Anterior instrumentation; 8 or more vertebral segments (List separately in addition to code for primary procedure) 22848 Pelvic fixation (attachment of caudal end of instrumentation

2017 AIM Specialty Health

195. Approaches to Limit Intervention During Labor and Birth

be offered a variety of nonpharmacologic techniques. None of the nonpharmacologic techniques have been found to adversely affect the woman, the fetus, or the progress of labor, but few have been studied extensively enough to determine clear or relative effectiveness. During the first stage of labor, water immersion has been found to lower pain scores without evidence of harm (8, ). Intradermal sterile water injections, relaxation techniques, acupuncture, and massage may result in reduction in pain (...) . A randomized trial of the effects of coached vs uncoached maternal pushing during the second stage of labor on postpartum pelvic floor structure and function. Am J Obstet Gynecol 2005;192:1692–6. Brancato RM, Church S, Stone PW. A meta-analysis of passive descent versus immediate pushing in nulliparous women with epidural analgesia in the second stage of labor. J Obstet Gynecol Neonatal Nurs 2008;37:4–12. Rouse DJ, Weiner SJ, Bloom SL, Varner MW, Spong CY, Ramin SM, et al. Second-stage labor duration

2017 American College of Obstetricians and Gynecologists

197. Diagnosis and Treatment of Low Back Pain

-inflammatory drugs, with consideration of patient-specific risks. Strong for Reviewed, Amended 22. For patients with chronic low back pain, we suggest offering treatment with duloxetine, with consideration of patient-specific risks. Weak for Reviewed, New-added 23. For patients with acute low back pain or acute exacerbations of chronic low back pain, we suggest offering a non-benzodiazepine muscle relaxant for short-term use. Weak for Reviewed, New-added 24. For patients with chronic low back pain, we (...) suggest against offering a non- benzodiazepine muscle relaxant. Weak against Reviewed, New-added 25. For patients with low back pain, we recommend against benzodiazepines. Strong against Reviewed, New-replaced 26. For patients with acute or chronic low back pain with or without radiculopathy, we recommend against the use of systemic corticosteroids (oral or intramuscular injection). Strong against Reviewed, Amended 27. For patients with low back pain, we recommend against initiating long-term opioid

2017 VA/DoD Clinical Practice Guidelines

198. The 2017 hormone therapy position statement of The North American Menopause Society

, 2017 2017 The North American Menopause SocietyCopyright @ 2017 The North American Menopause Society. Unauthorized reproduction of this article is prohibited. Urinarytractsymptoms(includingpelvicfloordisorders) Vaginal ET may improve incontinence by increasing the number of vessels around the periurethral and bladder neck region 73 and has been shown to reduce the frequencyandamplitudeofdetrusorcontractionstopromote detrusormusclerelaxation. 74,75 Estrogentherapy,alongwith pelvic floor training (...) , pessaries, or surgery, may improve synthesis of collagen and improve vaginal epithelium, but evidence for effectiveness for pelvic organ prolapse is lacking. 76 Two large trials found that users of systemic HT (CEE 0.625mgþMPA2.5mg)hadanincreasedincidenceofstress incontinence. 77,78 Increased incontinence was found in women using oral estrogen alone (RR, 1.32; 95% CI, 1.17- 1.48) and in those using combined estrogen and progestogen (RR,1.11;95%CI,1.04-1.18). 79 Vaginalestrogenuseshowed

2017 The North American Menopause Society

199. Musculoskeletal Strains and Sprains - Guidelines for Prescribing NSAIDs

. Increased intensity or change in character of pain. Pelvic or abdominal pain (other than dysmenorrhea) - Refer to . Accompanying nausea, vomiting, fever, or other signs of systemic infection or disorder. Visible joint changes, abnormal movement, weakness or inability to bear weight in any limb, or suspected fracture. Age less than 2 years. Comorbidities such as GI disorders, cardiovascular disease, renal dysfunction, liver dysfunction if NSAID therapy is being considered. Pain due to trauma (...) sodium Indicated for self-care treatment of mild to moderate pain. Ibuprofen and naproxen do not have significant anti-inflammatory effects at OTC dosages. Should not be used for longer than 10 days in adults or 5 days in children without physician supervision. Advise patient not to exceed recommended doses on package instructions. OTC Muscle Relaxants - methocarbamol / ASA, acetaminophen or ibuprofen Indicated for short-term treatment of spasm associated with acute musculoskeletal conditions. Poor

2017 medSask

200. Preventing Falls and Reducing Injury from Falls, Fourth Edition

18. Table 18: Exercise and Physical Training Interventions TYPE OF TRAINING OR EXERCISE INTERVENTION DEFINITION POTENTIAL BENEFITS Core strength training and Pilates exercise training Core strength training includes exercises targeted at strengthening the core. “The core can be described as a muscular box with the abdominals in the front, paraspinals and glutes in the back, the diaphragm as the roof, and the pelvic floor and hip girdle musculature as the bottom” (Granacher, Gollhofer, Hortobagyi (...) , 2015; Leung et al., 2011). Reduces falls and fear of falling; best suited if a person is not frail (Leung et al., 2011; Schleicher, Wedam, & Wu, 2012). Effective for people at lower risk for falls (Gillespie et al., 2012). Yoga “Yoga-based activity takes many forms, ranging from the practice of standing postures that aim to improve strength, flexibility and balance through to relaxation and meditation-based form” (Youkhana, Dean, Wolff, Sherrington, & Tiedemann, 2016, p. 22). Results in small

2017 Registered Nurses' Association of Ontario

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