Post-robot-assisted radical prostatectomy (RARP) urinary incontinence (PPI) represents the functional complication with the greatest negative impact on the patient's global quality of life (QoL). Although the role of Pelvic Floor Muscle Training (PFMT) is widely established in perioperative clinical management, it is mostly delivered on demand after surgery. This study primarily assesses the clinical efficacy of pelvic prehabilitation when systematically implemented compared with usual care. This is a prospective, non-randomized, quasi-experimental (before-and-after) study comparing all consecutive patients undergoing RARP prior to the implementation of the PFMT program with an equally sized cohort of consecutive patients exposed to PFMT before RARP. PFMT consisted of a standardized 60-minute group session delivered by dedicated pelvic physiotherapists, including pelvic floor anatomy education, supervised proprioceptive and contraction exercises, and prescription of a structured home-based training program. The primary endpoint was post-operative continence, defined as no need for pads after surgery. Functional outcomes were also assessed using the UCLA-PCI and SF-36 questionnaires at 1, 3, and 6 months after surgery, and the recourse to post-operative PFMT. Additionally, a composite variable named "True Clinical Need" was defined as no incontinence at 6 months plus a moderate/severe subjective bother (score 3 or 4 on question Q5 of the UCLA-PCI). Finally, a cost-avoidance analysis on preoperative PFMT was performed. Overall, 214 consecutive subjects were recruited: 107 per our standard pathway (no-PFMT group) and 107 who received PFMT before RARP (PFMT group). Patient-reported satisfaction and adherence to the home-based program were high (both > 8/10 on a Likert scale). Demographic, oncological, and surgical features were comparable between the two groups. The PFMT group demonstrated significantly better 6-month continence rates (82.0% vs. 66.7%, p = 0.025) and urinary function scores (57.9 vs. 51.7, p = 0.045) compared with the NO-PFMT group. The recourse to individual postoperative cycles was similar between groups (no-PFMT 3.7% vs. PFMT 5.6%), as well the true clinical need (no-PFMT 16.1% vs. PFMT 11.2%). A cost-avoidance analysis showed that prehabilitation would yield an estimated net saving of €165 per patient. A single PFMT session could significantly improve continence recovery at 6 months after RARP within economic sustainability.

Background: Gymnasts are reported as a population at high risk of low back pain. The prevention and treatment of low back pain often rely on improving the effectiveness of deep stabilizer muscles through exercises that aim to reach spinal alignment and axial lengthening. However, the scientific evidence regarding the effect of the specific instructions used during exercises on the spinopelvic complex is still lacking. To address this gap of knowledge, the aim of this pilot study was to examine the effect of specific postural and breathing instructions (spine straightening, forced expiration and perineal contraction) on the sagittal alignment of the spine before and after fifteen weeks of a specific muscle strengthening program. Methods: Low-dose biplanar radiographic images were taken in neutral position and in the five specific postures before and after the program and associated skeletal 3D reconstructions were performed allowing calculation of sacral slope, pelvic tilt, lumbar lordosis and thoracic kyphosis. Results: Sixteen gymnasts completed the entire protocol and were included in the analysis. At the end of the program, most of the postures tested led to a decrease in sacral slope, an increase in pelvic tilt, a reduction in lumbar lordosis, and a decrease in thoracic kyphosis, but with varying efficiency; the condition combining spine straightening, perineal contraction and forced expiration appeared to be the most effective in influencing all parameters simultaneously. Conclusions: The results strongly encourage combining an instruction of spine straightening with instructions of both expiration and perineal contraction, which is information of interest for coaches, physiotherapists and medical professionals.

The foot is a complex structure comprised of over 26 bones, 30 joints, numerous tendons, ligaments, and muscles responsible for our ability to stand upright, supporting the weight of the entire body and provides the base for the mechanism for bipedal gait. The foot corresponds to the portion of the lower extremity distal to the ankle and divides into hind, mid and forefoot. The articular surfaces of each bone have a covering of hyaline cartilage, and each joint is invested by a capsule and supported by ligamentous structures. The numerous muscles of the foot are attached to the bones by tendons, which allows the contraction of the muscles to exert force on the osseous structures. This complex anatomy allows the foot to adapt to uneven terrain during heel strike and become a stiff lever for better propulsion during step off. The importance of these structures to activities of daily living not surprisingly results in injury or pain to the feet as a common cause for presentation to the emergency department or primary care clinics. While the ligamentous and soft tissues are essential to foot function, this paper will primarily discuss the osseous structures.

A low hip extensor strength has been associated with various musculoskeletal injuries and an impaired motor performance. Hip strength is often assessed by using an isokinetic dynamometer. However, the validity and reliability of such testing have not been examined comprehensively. In this study, 14 participants performed maximal concentric contractions on a dynamometer in supine position at 60° s[-1], 120° s[-1], 180° s[-1], and 350° s[-1] on two different days to assess inter-day reliability. Hip angle and angular velocity were determined using 3-D motion analysis (3-D MOCAP) and were compared to the angle and angular velocity of the dynamometer. Additionally, we corrected dynamometer kinematics using linear regressions incorporating pelvic tilt angle and angular velocity. Our results showed that the dynamometer angle was lower than the hip angle based on 3-D MOCAP (p < 0.001). This was mostly explained by pelvic tilt (R[2] = 0.81). From 60° to 180° s[-1] the torque was lower when the range of motion was defined based on 3-D MOCAP (d = 1.0-1.2, p < 0.001) compared to the dynamometer, which difference was reduced significantly after correcting the hip angle for the pelvic tilt by applying regression models (d = 0.12-0.35, p > 0.05). From 45° to 20° hip angles the reliability of torque was good-to-excellent except at 350° s[-1]. In future studies, considering pelvic tilt may improve the accuracy and reliability of examining hip extension torque.

Ureteral stricture is a common complication in urological practice. However, many existing animal models cause excessive tissue damage or exhibit inconsistent healing; consequently, the pathogenesis of clinical ureteral stricture of mechanical origin is not accurately reproduced. This study aimed to establish a rat model of ureteral scar stricture induced by mechanical injury and to characterize its morphological and molecular features. Adult male Sprague-Dawley rats underwent left ureteral occlusion using a micro-hemostatic clamp for 12 h. Renal morphology and function were evaluated by color Doppler ultrasound at 4, 6, and 8 weeks after surgery. Pathological and molecular changes in the injured ureter and ipsilateral kidney were assessed by histopathology, immunohistochemistry, reverse transcription quantitative PCR (RT-qPCR), and Western blot (WB). Progressive hydronephrosis of the left renal pelvis was observed over time. Marked fibroblast proliferation and collagen deposition were noted in the injured ureteral segment. Expression levels of alpha-smooth muscle actin (α-SMA), collagen type I (Col Ⅰ) and collagen type III (Col Ⅲ), fibronectin (FN), and SMAD3/p-SMAD3 were significantly increased. These findings suggest that mechanical ureteral injury induces a typical fibrotic response and leads to scar stricture formation. This model appears to reliably mimic the development and progression of ureteral stricture and may provide a useful platform for further studies on the mechanisms of ureteral scar formation, as well as for the development of preventive and therapeutic strategies.

The pelvic floor muscles (PFM) play a crucial role in urinary continence and sexual function. Regular training of PFM has been extensively studied and is widely recommended to maintain a high quality of life, particularly among women. However, there is a notable lack of information regarding the effectiveness of PFM exercises in men. This study aimed to evaluate changes in neuromuscular activity of the PFM in men before and after a 6-week PFM training program. The exercises were performed independently by the participants and integrated into their regular strength-training routines as a short 5-10 min isolated PFM sessions. The study included 16 men aged 23 ± 4 years (M ± SD), who were healthy and did not report symptoms of pelvic floor dysfunction confirmed by the Incontinence Impact Questionnaire (IIQ-7), and the International Index of Erectile Function (IIEF-5). Neuromuscular activity of the PFM was assessed using surface electromyography (EMG) with anal probe (Lifecare Anal Probe PR-06), employing the TeleMyoTM2400 (DTS) system from NORAXON. The EMG assessment protocol included 11 voluntary PFM contractions followed by relaxations, based on the Glazer's protocol. Immediately after the first EMG assessment, participants performed PFM contractions and relaxations using the biofeedback method. The same protocol was repeated after 6 weeks of training program. After the 6-weeks, a significant improvement was observed in all performed contractions. The mean amplitude of five 3-s quick contractions increased from 7.94 μV to 12.72 μV (p = 0.006; ES: r = 0.68). For five 10-s contractions, the mean value improved from 7.8 μV to 13.32 μV (p = 0.001; ES: r = 0.82). The 60-s hold contraction showed an increase from 6.39 μV to 10 μV (p = 0.001; ES: r = 0.82). Positive effects on neuromuscular activity of the PFM in men were observed after a 6-week training program. Regular performance of PFM exercises may be beneficial for maintaining the health and physiological functions associated with this muscle group. Therefore, such training should be widely recommended in men.

Functional neuroimaging, particularly functional MRI (fMRI), has become essential for studying human brain activity, as it provides an indirect measure of this activity. As its technical capabilities evolve, fMRI continues to offer new insights into the central nervous system. This review summarizes neuroimaging research since 2019 on bladder, pelvic floor, and sexual function in both healthy individuals and those with dysfunction.