A low-intensity behavioral therapy intervention for urinary incontinence was effective and should be considered as a first-line treatment for urinary incontinence in older women.
Necrotising soft tissue infections of the perineum and genitalia are associated with a high rate of mortality and morbidity. We reviewed the records of 29 consecutive patients to investigate the possible correlation between clinical outcome and number of types of bacteria cultured, focus of infection, presence of diabetes, patient age, renal function and delay until presentation. The patients had an average of 3.9 bacterial organisms cultured intra-operatively (range 1-9). Patients with a rectal focus of infection had a greater number of bacteria and required longer hospitalisation and more operative procedures than patients with dermal or urethral foci. Those over the age of 60 had significantly longer hospital stays and higher mortality. Diabetes and impaired renal function did not increase mortality or morbidity. Suprapubic cystostomy was required in 24 patients (83%), diverting colostomy in 9 (31%) and orchiectomy in 3 (10%). Six patients (21%) died despite broad spectrum antibiotics and aggressive and frequent surgical debridement.
Acute, nontraumatic scrotal emergency operations were done on 104 patients. The testes were saved in 79 per cent of 67 patients with torsion of the spermatic cord. When the patients who presented late are excluded, aggressive treatment allowed a 93 per cent testicular salvage rate. Spontaneous or manipulative detorsion preoperatively resulted in a 100 per cent testicular salvage rate. If the patient seeks medical advice early a high testicular salvage rate can be obtained by proper diagnosis and prompt, aggressive detorsion either by manipulation when examined initially or at operation. These maneuvers are combined with bilateral orchiopexy to ensure permanent cure.
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