High-amplitude penile vibratory stimulation (PVS) is recommended as the first line method for conservative sperm retrieval in anejaculatory Caucasian men with spinal cord injury (SCI). Evidence of its effectiveness in Asian population is lacking. We described the effectiveness of high amplitude PVS for conservative sperm retrieval in the anejaculatory local men with SCI. Records of all SCI patients referred for conservative sperm retrieval trial from August 2014 to August 2015 were screened. Those who failed in artificial stimulation methods for sperm retrieval including masturbation, prostatic massage and low amplitude PVS were subjected to high amplitude PVS using Viberect X3. Data pertaining to detailed neurological findings, time to ejaculate, seminal fluid volume and its gross appearance, somatic responses at ejaculation and any adverse events were retrieved. Successful outcome is defined as occurrence of antegrade ejaculation. Thirteen out of 16 patients fulfilled all study criteria. 46% of the patients had neurological level above T6 followed by 34% with neurological level between T7-T12. Preserved reflexogenic and spontaneous erection were reported by 84.6% and successful coitus was reported by 45.4% of the patients. The overall ejaculatory success using high amplitude, high-frequency vibratory stimulation in our study was 46.15%. Among the patients with lesion at T6 and above, the ejaculatory success rate was 66.7% while for the study subjects with lesions below T6 was 33.3%. In conclusion, PVS outcome for sperm retrieval in asian population is comparable to that of Caucasian population. Its use is highly applicable in local population.
INTRODUCTION: This is a cross-sectional study of 1 year duration (August 2013 to August 2014). The objective of the study was to investigate the diagnostic accuracy of single channel cystometry (SCC) for confirmation of neurogenic bladder following spinal cord injury.
MATERIALS AND METHODS: The study was conducted in both out-patient and in-patient services of Department of Rehabilitation Medicine, Hospital Sungai Buloh, Malaysia. Subjects in the study include sixteen patients with a clinical diagnosis of neurogenic bladder following spinal cord injury aged between 15 and 62 years. Patients with a clinical diagnosis of neurogenic bladder were subjected to cystometric evaluation using SCC in our hospital. Confirmation of the diagnosis was made by urodynamic study (UDS) in another hospital. SCC procedure involved manual intra-vesical pressure assessment using a 12F Nelaton catheter. Cystometric parameter measurement taken in this study was detrusor pressure (cm H2O) done at regular intervals from baseline, throughout bladder filling phase and voiding/leaking phase. The relationship between detrusor pressure to bladder volume from initial bladder filling until voiding or leaking phase was recorded, analyzed and graph plotted. Maximum detrusor pressure (cm H2O) during bladder filling, voiding or leaking and the maximum cystometric capacity (mls) was recorded.
RESULTS: SCC was found to have 100% sensitivity, 50% specificity, 93.33% positive predictive value and 100% negative predictive value for neurogenic bladder diagnosis. Only 55.55% patients with SCC suspicion of detrusor sphincter dyssynergia (DSD) had comparable UDS findings.
DISCUSSION: The use of SCC may be considered for objective confirmation of neurogenic bladder diagnosis following spinal cord lesion in centers with limited access to UDS. However, we are not able to establish its clinical application for confirmation of DSD.
Study site: Department of Rehabilitation Medicine, Hospital Sungai Buloh, Malaysia
Paradoxical manifestation is worsening of pre-existing tuberculous lesion or appearance of new lesions in patients whose condition initially improved with antituberculous treatment. Our hypothesis was that paradoxical manifestation in non-HIV tuberculous meningitis (TBM) patients was underestimated and this could contribute to patients' prognosis. This was the first systemic study of paradoxical manifestation in HIV-negative TBM patients. Between 2009 and 2014, TBM patients were studied prospectively in 2 hospitals. Clinical features, cerebrospinal fluid, and radiological findings were monitored. Paradoxical manifestation was divided into definite (4 weeks or more) and probable (between 14 and 27 d) after commencement of antituberculous treatment. Forty-one non-HIV TBM patients were recruited. Definite paradoxical manifestation occurred in 23/41 (56%) of the patients. Time to onset of paradoxical manifestation was between 28 days and 9 months, and majority was between 28 and 50 days. Neuroimaging manifestation in the brain (22/41 patients, 54%) and clinical manifestation (22/41 patients, 54%) were most commonly seen, followed by cerebrospinal fluid manifestation (7/41 patients, 17%). Neuroimaging changes most commonly seen were worsening of leptomeningeal enhancement, new infarcts, new tuberculomas, and enlargement of tuberculoma. Initial Computed Tomography Angiography/magnetic resonance angiography brain showed vasculitis in 14 patients, with 2 (12.5%) showing paradoxical vasculitis during follow-up. Recurrence of the paradoxical manifestation was seen in 7/23 (30%) of the patients. More than half (14/23, 61%) of the patients improved, 6 (26%) patients died, and 3 (13%) patients had persistent neurological deficit. Paradoxical manifestation was very common in non-HIV TBM patients. Neuroimaging paradoxical manifestation of 2-4 weeks may not be paradoxical manifestation but could be delayed treatment response.