On the basis of preliminary data, botulinum toxin appears to be a valuable therapeutic option and fills the gap between anticholinergics and surgery in the treatment of NNDO that is refractory to anticholinergic agents. Botulinum toxin has a promising future in urology but requires further scientific evaluation.

No abstract

Patients with spinal cord injuries are prone to knee hydrarthrosis (also known as "water on the knee"), which can cause pain, functional impairment and the restriction of social activities. Total knee arthroplasty is a potentially appropriate treatment. Here, we report on a patient presenting partial T12 AIS grade C paraplegia who was able to walk with two forearm crutches, an ankle-foot orthosis on the right leg and a knee-ankle-foot orthosis on the left leg. Thirteen years after the spinal cord injury, the patient presented with septic arthritis of the right knee, complicated by recurrent hydrarthrosis during standing and walking. Arthroscopy revealed advanced osteoarthritis. Total knee arthroplasty was performed, with very good functional and social outcomes two and half years after surgery.

BackgroundGonarthrosis is a very common condition and a real public health problem [1]. One of the pillars of its management is pain management. In addition to drug treatment, rehabilitation is part of the therapeutic arsenal.ObjectivesThe main objective of our work was to compare the contribution of balneotherapy versus dry rehabilitation in the control of pain triggers.MethodsWe carried out a prospective, comparative study carried out over a period of 15 months, (September 2016- December 2017), in 120 patients recruited from the outpatient department of the Physical Medicine and Functional Rehabilitation Department of HMPIT in whom the diagnosis of knee osteoarthritis (KOA) was made according to the criteria of the ACR [2].The patients were randomly divided into 2 groups of 60 patients each. The first group, called G1, received a standard rehabilitation program. The second group, called G2, received water gymnastics. Two evaluations were made, the first (T1) before the beginning of the rehabilitation and the second (T2) at the end of the eight weeks of treatment.ResultsThe mean age of our patients was 57.2 ± 12.5 years in G1 vs 54.3 ± 7.1 years in G2 (p = 0.012). The sex ratio was 0.2 in G1 versus 0.37 in G2 (p = 0.011). The duration of KOA was 63.4 ± 4.5 months in G1 vs 56.2±7.5 months in G2 (p=0.172).Pain was triggered by standing in 92% of cases in G1 versus 98% in G2 with a mean delay of 17.2 min for G1 and 20.1 min for G2. There was no statistically significant difference between the two groups (p=0.452). After rehabilitation, 22% of the patients in G1 and 43% in G2 noted an improvement in pain with a statistically significant difference between the 2 groups (p=0.001).Prolonged sitting in 62% of cases in G1 versus 38% in G2 with a mean delay of 6.2 min for G1 and 52.3 min for G2 awakened pain. There was a statistically significant difference between the two groups (p=0.02). After rehabilitation, 23% of the patients in G1 and 30% in G2 noted an improvement in pain with a statistically significant difference between the 2 groups (p=0.001).Pain was awakened by squatting in 93% of cases in G1 versus 97% of G2. There was no statistically significant difference between the 2 groups (p=0.554). After rehabilitation, 13% of the patients in G1 and 30% in G2 had noted a complete disappearance of pain with a statistically significant difference between the 2 groups (p=0.001).All patients in G1 and 92% of patients in G2 reported pain when climbing/descending stairs. There was no statistically significant difference between the 2 groups. An improvement in symptomatology was noted in both groups with disappearance of pain in 18% of G1 and 27% of G2.An adjustment on the parameters by which the 2 groups differed was made without impact on the results obtained.ConclusionRehabilitation has an important role in the control of pain triggers by ensuring, in addition to analgesic means, good muscle balance, joint gain and good proprioception. Balneotherapy has proven to be more effective.References[1]Johnson VL, Hunter DJ. The epidemiology of osteoarthritis. Best Pract Res Clin Rheumatol. 2014;28(1):5-15.[2]Altman R, Asch E, Bloch D, Bole G, Borenstein D, Brandt K, et al. Development of criteria for the classification and reporting of osteoarthritis. Classification of osteoarthritis of the knee. Diagnostic and Therapeutic Criteria Committee of the American Rheumatism Association. Arthritis Rheum. 1986;29(8):1039-49.Disclosure of InterestsNone declared

No abstract