Urethral sphincter botulinum-A toxin injection could be considered a reliable treatment modality in children with nonneurogenic neurogenic bladder after the failure of conservative therapy.

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Alpha-blockers have been established as medical expulsive therapy for urolithiasis. We aimed to assess the effect of tamsulosin and doxazosin as adjunctive therapy following SWL for renal calculi. We prospectively included 150 patients who underwent up to four SWL sessions for renal stones from June 2008 to 2009. Patients were randomized into three groups of 50 patients each, group A (phloroglucinol 240 mg daily), group B (tamsulosin 0.4 mg once daily plus phloroglucinol), and group C (doxazosin 4 mg plus phloroglucinol). The treatment continued up to maximum 12 weeks. Patients were evaluated for stone expulsion, colic attacks, amount of analgesics and side-effects of alpha-blockers. There were no significant differences between the groups regarding stone expulsion rates (84; 92 and 90%, respectively). The mean expulsion time of tamsulosin was significantly shorter than both control group (p = 0.002) and doxazosin (p = 0.026). Both number of colic episodes and analgesic dosage were significantly lower with tamsulosin as compared to control and doxazosin. Steinstrasse was encountered in 10 (6.7%) patients with no significant difference between the groups. 16 patients on tamsulosin and 21 on doxazosin experienced adverse effects related to postural hypotension. Moreover, 2 (4%) patients in the tamsulosin group reported ejaculatory complaints. In conclusion, adjunction of tamsulosin or doxazosin after SWL for renal calculi decreases the time for stone expulsion, amount of the analgesics and number colic episodes. There was no benefit regarding the overall stone expulsion rate. The side-effects of these agents are common and should be weighted against the benefits of their usage.

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Background and purpose: Neck pain is one of the most common musculoskeletal disorders in the general population which have large economic burden on the health care system. So, the purpose of the study was to investigate the effect of muscle energy technique in form of post isometric relaxation (PIR) with the traditional physical therapy treatment versus traditional physical therapy treatment alone on pain and range of motion (ROM) in patients with chronic mechanical neck pain (MNP). Materials and methods: Thirty patients randomly assigned into two equal groups. Group A received a traditional physical therapy program while group B received the same program in addition to PIR technique instead of passive stretching. Neck pain and disability was measured using neck pain and disability scale while ROM of the cervical spine was measured by OB goniometer. Results: There were significant decreases (P<0.05) in pain and there were significant increases (P<0.05) in ROM post treatment for both groups. However, there was significance differences (P<0.05) between both groups post treatment in the measurable variables. Conclusion: Adding PIR technique to the conventional physical therapy treatment program of chronic MNP was more effective in reducing pain and functional disability and increasing cervical ROM than the traditional treatment program alone.

ObjectiveTo study the natural history of stone passage in children with ureterolithiasis and to define factors predictive of spontaneous passage.Patients and methodsIn all, 72 children with ureteric stones were evaluated; patients with ureteric calculi of >10 mm were excluded, as were those with absolute indications for surgical stone removal. Stone size, location, side, presence of hydronephrosis, perinephric stranding and degree of the tissue-rim sign were estimated by unenhanced helical computed tomography (UHCT). All patients were sent home with no administration of an α-blocker. The stone status was evaluated by a plain abdominal film or CT at ≈6 weeks after the initial diagnostic evaluation. The time from the initial complaint to the passage of the stone was recorded for each patient.ResultsIn all, 54 (75%) children with ureteric stones of ⩽6 mm eventually passed their stones spontaneously. However, stones of <4 mm and those in the distal ureter had a significantly higher spontaneous passage rate and shorter time to stone passage (P < 0.05). The UHCT findings of a higher degree of the tissue-rim sign, hydronephrosis and perinephric fat stranding were associated with a lower likelihood of stone passage.ConclusionsThe rate of spontaneous passage of ureteric stones in children varies with stone location, and perinephric stranding on UHCT seems to be useful for predicting the possibility of spontaneous passage. In cases with unfavourable signs an early intervention might have better outcomes than conservative therapy.

Background and purpose: Spasticity in the hands and a wrist is a major problem in the management of stroke patients. Different energy levels of shock wave therapy (SWT) have been used for treatment of spasticity. So, the purpose of the study was to compare the effect of two different energy levels of radial SWT on spastic muscles of the hand and wrist in patients affected by stroke. Materials and Methods:Patients randomly assigned into two groups. Group A received the low energy radial SWT while group B received the medium energy radial SWT. Spasticity of wrist and fingers was evaluated using Modified Ashworth Scale (MAS), range of motion (ROM) of the wrist was evaluated using digital goniometer and pain was measured by Visual Analogue Scale (VAS).Results: there was a significant decrease in MAS scores of the wrist flexors and fingers flexors muscles post treatment for both groups (P<0.05). The ROM was significantly increased post treatment from (48.46±2.09) to (70.02±3.23) for group A and from (49.15±1.95) to (79.13±3.42) for group B. Also VAS scores was a significantly decreased in both groups post treatment. Conclusion:Radial SWT is an effective therapeutic tool in reducing flexor spasticity of the wrist and hand in patients with stroke. Moreover, the medium energy level was superior to the low energy level in regarding to the measured treatment outcomes.

Introduction. As one of the highly prevalent musculoskeletal disorders, low back pain incurs high medical care costs. Proprioceptive neuromuscular facilitation has been used in treating chronic low back pain. This study aimed to investigate the effects of multiple proprioceptive neuromuscular facilitation techniques on endurance of the trunk musculature, spinal mobility, and impairment of function in cases of chronic low back pain. Methods. Patients in this study were randomly assigned into 3 groups. Group A received rhythmic stabilization training, group B received a combination of isotonic exercises, while group C received a combination of both rhythmic stabilization training and combination of isotonic exercises. Trunk endurance was evaluated with trunk flexion and trunk extension endurance tests, spinal mobility was assessed with a modified Schober test, and functional impairment was measured with oswestry disability index. Results. ANoVA showed significant differences (p < 0.05) among the groups after treatment in the measured outcomes. Tukey's honest significant difference post-hoc test revealed a highly statistically significant improvement in the measured outcomes of group C in comparison with the other groups in the post-intervention conditions. Conclusions. The application of the rhythmic stabilization training technique of proprioceptive neuromuscular facilitation followed by a combination of isotonic exercises was more effective than implementing either technique alone in the treatment of patients with chronic low back pain.