Papers by Paolo Di Benedetto
Europa medicophysica, 2005
Del Popolo G, Mosiello G, Pilati C, Lamartina M, Battaglino F, Buffa P, Redaelli T, Lamberti G, M... more Del Popolo G, Mosiello G, Pilati C, Lamartina M, Battaglino F, Buffa P, Redaelli T, Lamberti G, Menarini M, Di Bendetto P, De Gennaro M 1. NeuUrology Unit University of Florence Italy, 2. Urodynamic and NeuroUrology Unit Bambino Gesù Children's Hospital Rome Italy, 3. Spinal Unit CTO Hospital , Rome. Italy, 4. Urology Unit Villa delle Ginestre Palermo Italy, 5. Spina Bifida Clinic , Hospital of Vicenza, Italy, 6. Department of Paediatric Surgery , Giannina Gaslini Institute, Genova Italy, 7. Spinal Unit Niguarda Hospital Milan, Italy, 8. Rehabilitation Center Caraglio Hospital Italy, 9. Montecatone Rehabilitation Center Imola, Italy, 10. Rehabilitation Institute Gervasutta, Udine Italy
A Clinical Approach
Rather curiously, among the vascular pathologies affecting the Central Nervous System, very littl... more Rather curiously, among the vascular pathologies affecting the Central Nervous System, very little has been said regarding the spinal cord. On the contrary, much it has been reported from brain. It has been reported that due to the variability of the vascular anatomy of the spinal cord, it is rather difficult to predict the eventual deficit that will occur, following the occlusion of a specific spinal artery. In 2001, even the exact epidemiological prevalence of the spinal cord infarction is far from to be known; probably, it represents less than 1% of all acute strokes. Beginning from data collected over thirty years of activity of our Clinic, we try to categorize etiology, pathophisiology and clinical course of vascular spinal cord disease, with a review on literature of the topic.
Journal of Orthopaedics and Traumatology : Official Journal of the Italian Society of Orthopaedics and Traumatology, 2021
Purpose The aim of this retrospective study was to investigate the clinical follow-up of patients... more Purpose The aim of this retrospective study was to investigate the clinical follow-up of patients with external snapping hip syndrome (ESHS) treated with endoscopic gluteus maximus tendon release and to compare the residual muscular strength and thigh circumference as an indirect outcome measure. Methods Patients of all ages with external snapping hip syndrome were treated with endoscopic gluteus maximus tendon release. Outcome measures evaluated included: visual analog scale (VAS), modified Harris Hip Score (mHHS), and Non-Arthritic Hip Score (NAHS). The gluteus maximus strength and the circumference of the thigh were also evaluated. Results Among 25 patients, 23 fulfilled the inclusion criteria and one patient was lost to follow-up. The series included 22 patients, 6 males and 16 females with a mean age of 27.9 ± 13.4 years (range 16–76 years). All patients had resolution of the snapping symptoms after the procedure. The mean follow-up was 18 ± 9.3 months. All outcomes improved in...
Hypothesis / aims of study Lower urinary tract symptoms (LUTS) are commonly reported in women and... more Hypothesis / aims of study Lower urinary tract symptoms (LUTS) are commonly reported in women and their increase in prevalence is significantly observed after the menopause. It is known that perimenopausal transition could be associated with genitourinary anatomical changes due to ovarian hormonal impaired production. Bladder diary (3-day frequency-volume chart) could be a simple tool able to investigate the pattern of bladder voiding in women. The aim of our study was to investigate LUTS in continent perimenopausal women in order to suggest programs of preventive pelvic floor muscle training.
European journal of physical and rehabilitation medicine, 2009
The aim of this study was to propose a new voice rehabilitation program for Parkinson's Disea... more The aim of this study was to propose a new voice rehabilitation program for Parkinson's Disease (PD) patients based on voice and choral singing treatment (VCST). The authors carried out a pilot test-retest non-controlled study with twenty PD patients that voluntarily took part to the speech rehabilitation treatment. Patients underwent 20 hours of speech therapy, two sessions of one hour every week, and 26 hours of choral singing, one session of two hours every week. The speech and choral activity were directed by a speech therapist expert in PD and choral singing. The pre- and post-treatment assessment included neurological and otolaryngological evaluation, voice and speech acoustic analysis, auditory quality of voice analysis, respiratory function evaluation, that were carried out within two weeks before and after VCST. The authors observed a significant improvement (P<0.05) of functional residual capacity (FRC%), maximum inspiratory pressure (MIP), maximum expiratory pressu...
Minerva ginecologica, 2004
Pelvic floor rehabilitation (PFR) is an important and recommended strategy for the treatment of m... more Pelvic floor rehabilitation (PFR) is an important and recommended strategy for the treatment of many urogynecological disorders including urinary incontinence (UI). The recognised pioneer of PFR is the American gynecologist Arnold Kegel who, over 50 years ago, proposed pelvic floor muscle exercises (PFME) to prevent and/or treat female UI. Kegel's techniques were successfully used by others too, but as the years passed these techniques sank into unjustified oblivion. In the 1980s in Europe the medical world's interest in PFME techniques gained ground, contemporaneously with functional electrical stimulation (FES) and biofeedback (BFB). As a general rule, the least invasive and least dangerous procedure for the patient should be the first choice, and behavioural and rehabilitative techniques should be considered as the first line of therapy for UI. The behavioural approaches in women with UI and without cognitive deficits are tailored to the patient's underlying problem, ...
Neurourology and Urodynamics
Our results suggest that pelvic floor muscles self training (PFMsT) could be an easy and effectiv... more Our results suggest that pelvic floor muscles self training (PFMsT) could be an easy and effective treatment, indicated in women with SUI unable to follow supervised rehabilitation sessions because of the hospital distance or too long waiting lists. Therefore in our clinical practice PFMsT may be included in the framework of continence promotion programs, in association with hospital individual or group PFMT sessions and adapted physical activity protocols.
Il trattamento conservativo perineale contempla tutti gli interventi terapeutici che non includon... more Il trattamento conservativo perineale contempla tutti gli interventi terapeutici che non includono il ricorso alla farmacoterapia o alla chirurgia. Con detto termine si fa riferimento non solo alle terapie fisiche e chinesiterapiche perineali, ma anche ai programmi di rieducazione minzionale , alle terapie complementari ed agli ausili urologici (1). Certamente la riabilitazione perineale in senso stretto comprende essenzialmente la chinesiterapia perineale (pelvic floor muscle training o PFMT), il biofeedback (BFB), la stimolazione elettrica funzionale (SEF), l'utilizzo eventuale dei coni vaginali e il ricorso ai programmi di rieducazione minzionale. Si deve a Arnold Kegel la riscoperta in chiave moderna della riabilitazione perineale quando, oltre 50 anni fa (2, 3), propugnò l'utilizzo di esercizi perineali per prevenire e/o trattare il prolasso genitale (PG) e l'incontinenza urinaria femminile (IUF). Da allora, dopo oltre un trentennio di oblio, le tecniche di riabilitazione perineale si sono affermate progressivamente in vari paesi sì da meritare un riconoscimento in ambito scientifico da parte dell'International Continence Society (ICS) nel 1992 e, soprattutto, dall'International Consultation on Incontinen-ABSTRACT A normal perineal function is observed by a normal micturition, defecation, and sexual activity in absence of anatomic alterations as pelvic prolapse. This function is due to the coordination of several structures and nervous centres. When an alteration of this function occurs, we may notice pelvic prolapse, urinary incontinence, pelvic chronic pain. If there is an underlying dysfunction of pelvic floor muscles, as a strength reduction or a lack of control on muscle contraction, then we can improve muscular function and reduce symptoms by means of pelvic floor rehabilitation techniques. We have to investigate the alterations which have lead to the particular pelvic dysfunction in order to use the correctly selected rehabilitation techniques. Pelvic floor muscle training (PFMT), that's the most effective technique, has to be performed during and after pregnancy, when urinary incontinence occurs, in subjects complaining genital prolapse or chronic pelvic pain. Functional electrical stimulation (FES) has a role in reducing pelvic pain; this technique is also used to achieve and improve pelvic muscles control, to reduce detrusor activity by activating inhibitory reflexes, to strengthen pelvic floor muscles in prolonged home rehabilitation programs. Biofeedback (BFB) technique helps PFMT in improving pelvic floor muscles control and strength.
Spinal Cord, 2008
Study design: Thirty-six patients with unsatisfactory treatment of neurogenic bowel dysfunctions ... more Study design: Thirty-six patients with unsatisfactory treatment of neurogenic bowel dysfunctions (NBD) were enrolled from Spinal Units and Rehabilitation Centers in Italy. Treatment was for 3 weeks using a newly developed integrated system with an enema continence catheter for transanal irrigation (Peristeen, Coloplast A/S Kokkedal Denmark). Objectives: To evaluate the effects of Peristeen Anal Irrigation on NBD and patient quality of life (QoL). Setting: Italy. Methods: Lesion level, ambulatory status and hand functionality were determined in all patients. NBD symptoms and QoL were evaluated before and after treatment, using a specific questionnaire. Statistical analysis was performed using McNemar Test and Sign Test. Results: Thirty-six patients were enrolled, and 32 patients completed the study. At the end of the treatment, 28.6% of patients reduced or eliminated their use of pharmaceuticals. Twenty-four patients became less dependent on their caregiver. There was a significant increase in patients' opinion of their intestinal functionality (P ¼ 0.001), QoL score (P ¼ 0.001) and their answers regarding their degree of satisfaction (P ¼ 0.001). A successful outcome was recorded for 68% of patients with fecal incontinence, and for 63% of patients with constipation. Conclusion: Peristeen Anal Irrigation is a simple therapeutic method for managing NBD and improving QoL. It should be considered as the treatment of choice for NBD, playing a role in the neurogenic bowel analogous to that of intermittent clean catheterization in bladder treatment.
Neurological Sciences, 2007
This study assessed the concurrent validity of the State-Trait Anxiety Inventory (STAI), the Hosp... more This study assessed the concurrent validity of the State-Trait Anxiety Inventory (STAI), the Hospital Anxiety and Depression Scale (HADS) and the Hamilton Anxiety Scale (Ham-A) for evaluating anxiety in a group of 46 Parkinson's disease (PD) patients. The magnitude of correlations between the scales was high (all p<0.01), indicating a good concurrent validity. The item-by item analysis indicated that the main characteristics of anxiety in PD patients were 'inability to relax', 'restlessness or inability to feel calm' and 'feeling tense'. The association between anxiety, as measured by the HADS-A, with demographic characteristics or clinical features of PD was not significant, supporting existing data suggesting that anxiety in PD is not closely correlated with the severity of motor symptoms or the degree of disability. The HADS-A may be the most appropriate scale for documenting patient-reported anxiety in depression.
Int. Journal of Clinical Pharmacology and Therapeutics, 2006
Objective: To determine whether dose titration based on therapeutic response is superior to stand... more Objective: To determine whether dose titration based on therapeutic response is superior to standard dosing of oral trospium chloride in patients with neurogenic detrusor overactivity and, moreover, to investigate the possible underlying causes of differences in efficacy at equal doses in some patients. Patients and methods: Using a double-blind approach, two groups (standard dose and adjustable dose) with a total of 80 patients were treated with trospium chloride coated tablets for a period of 3-5 weeks. Treatment duration and daily doses varied depending on change of urodynamic parameters defined as therapeutic response. In Week 1, both groups started on 45 mg/day (3 × 15 mg). In the adjustable dose group, it was permissible to increase the daily dose to 90 or 135 mg/day depending on the urodynamic treatment response. In contrast, doses remained unchanged in the standard dose group although a need for dose adjustment had been recognized under the double-blind conditions. Therapeutic response was defined as improvement of at least two of the following three urodynamic parameters: bladder compliance ³ 20 ml/cmH 2 O, maximum cystometric capacity > 250 ml and maximum detrusor pressure £ 40 cmH 2 O. Changes in individual urodynamic parameters were defined as secondary efficacy variables. Primary and secondary parameters were assessed by comparing baseline values with those at the end of treatment. Therapeutic response was analyzed by using the Fisher-Yates test, and the Mann-Whitney U-test was used for secondary parameters. Trospium plasma concentration was measured to assess patient's compliance and as a tool to elucidate possible factors influencing treatment efficacy. Safety and tolerability were evaluated based on withdrawal rates and adverse
Current Opinion in Urology, 2000
To analyze the frequency and risk factors for urinary incontinence (UI) in Italy. Eligible for th... more To analyze the frequency and risk factors for urinary incontinence (UI) in Italy. Eligible for this cross-sectional study were men aged &amp;amp;amp;amp;amp;amp;gt;/=50 years and women aged &amp;amp;amp;amp;amp;amp;gt;/=40, randomly identified among registered subjects of a network of general practitioners during the period March-October 1997. All subjects were invited by telephonic interview to determine the presence of UI, reported by the subjects as loss of urine in the last year. The subjects with UI were further questioned at home for evaluation of the type, degree and frequency of UI episodes. Of the 5,488 subjects interviewed (2,767 women and 2,721 men), 92 (3%) men and 316 (11%) women reported at least one episode of UI during the year before the interview. The frequence of UI increased with age both in men and women, being 2 and 11% in men and women, respectively, aged 50-60 years and 7 and 16% in those aged &amp;amp;amp;amp;amp;amp;gt;/=70. Of the subjects with UI identified, 229 women and 64 men and a group of 289 subjects without UI were questionned at home using a detailed questionnaire. Six and 55% of men and women, respectively, reported stress incontinence, 20 and 12% urge incontinence and 20 and 24% mixed incontinence. The risk of UI increased with body mass index in women. A history of recurrent urinary infection was associated with UI in men and less markedly in women. No association emerged between education, smoking and alcohol or coffee consumption and risk of UI. Parity was directly associated with the risk of UI in women. The study offers a quantitative estimate of the prevalence of UI and its main risk factors in this Italian population.
BMC Women's Health, 2011
Background The role of episiotomy as a protective factor against pelvic floor disorders postpartu... more Background The role of episiotomy as a protective factor against pelvic floor disorders postpartum has been debated for many years, but its routine use has been hitherto discouraged in the literature. Comparisons between restrictive and routine use of episiotomy in existent literature, however, fail to include any consideration relating to quality of life. The aim of this study, therefore, is to state the role of episiotomy in preserving the perineum from damage, in order to prevent the influence of pelvic floor disorders on women's psycho-physical wellness after the sixth month postpartum. Methods A follow-up telephone interview was performed among 377 primiparous and secondiparous Caucasian women who had a child by spontaneous or operative vaginal delivery in 2006 using a self-created questionnaire and King's Health Questionnaire (KHQ). Results The mean age at delivery was 35.26 (±4.68) years and episiotomy was performed in 59.2% of women. Multivariate linear regression sh...
Behavioural Neurology, 2006
We assessed the concurrent validity of the Hospital Anxiety and Depression Scale (HADS) and the G... more We assessed the concurrent validity of the Hospital Anxiety and Depression Scale (HADS) and the Geriatric Depression Scale (GDS) against the Hamilton Rating Scale for Depression (Ham-D) in patients with Parkinson’ disease (PD). Forty-six non-demented PD patients were assessed by a neurologist on the Ham-D. Patients also completed four mood rating scales: the HADS, the GDS, the VAS and the Face Scale. For the HADS and the GDS, Receiver Operating Characteristics (ROC) curves were obtained and the positive and negative predictive values (PPV, NPV) were calculated for different cut-off scores. Maximum discrimination between depressed and non-depressed PD patients was reached at a cut-off score of 10/11 for both the HADS and the GDS. At the same cut-off score of 10/11 for both the HADS and the GDS, the high sensitivity and NPV make these scales appropriate screening instruments for depression in PD. A high specificity and PPV, which is necessary for a diagnostic test, was reached at a cu...
Practical Issues in Geriatrics, 2017
Spinal Cord, 2004
artificial urinary sphincter cuff in a female patient affected by neurogenic urinary incontinence... more artificial urinary sphincter cuff in a female patient affected by neurogenic urinary incontinence. Objective: To describe this rare surgical solution. Setting: Department of Urology in Italy. Methods: A 43-year-old woman affected by flaccid paraplegia, acontractile bladder and incompetent bladder neck, underwent an implantation of an artificial urinary sphincter AMS 800. After 7 years, a mechanical failure of the device occurred and pubovaginal sling (PVS) utilizing the cuff of the sphincter was employed due to the poor quality of rectus fascia and the development of previous allergy for some heterologous materials. Results: At 17 months follow-up, the patient is contnent and able to empty the bladder by clean intermittent self-catheterization (CIC). Conclusion: The risk of developing an allergy reaction due to the employment of heterologous materials and the impossibility to use the rectus fascia obliged us to adopt the pre-existent cuff of the artificial urinary sphincter AMS 800.
Neurourology and Urodynamics, 2003
Aims: To ascertain whether abdominal pressure transmission (a.p.t.) to the urethra would be a¡ect... more Aims: To ascertain whether abdominal pressure transmission (a.p.t.) to the urethra would be a¡ected by urgency of voiding in women with mixed urinary incontinence. Methods: We urodynamically assessed 80 consecutive women. Group 1 (n ¼ 40), with stress incontinence, had stable bladders and no urgency. Group 2 (n ¼ 40), with mixed (stress þ urge) incontinence and overactive bladders, were split into Groups 2A (n ¼ 20) and 2B (n ¼ 20) according to the delay time of urgent void at cystometry (CMG) equating at least 2 min (taken as an index of moderate urgency) or, respectively, less than 2 min (taken as an index of severe urgency). Nonparametric statistics checked for signi¢cant di¡erences in a.p.t. and in pelvic £oor (peri-urethral) muscle strength level. We de¢ned a.p.t. at stress (cough) urethral pressure pro¢lometry (UPP) by the pressure transmission ratio (PTR). Pelvic £oor muscle strength was de¢ned at ''holding'' UPP by the maximum urethral pressure developed during attempts ''to hold urine'' (hMUP). Results: PTR was reduced in all women, but PTR (and hMUP) proved relatively higher in Group 2, though nonsigni¢cantly di¡erent values of PTR (and hMUP) were seen in Groups 2B and 1. Conclusions: Transmission of abdominal pressure to the urethra was reduced in all of the incontinent women. The mixed incontinence group, however, had a relatively less reduced (active component of) a.p.t., most likely dependent on a greater pelvic £oor (peri-urethral) muscle strength level secondary to frequent contractions in response to urgency. Yet, of the same mixed incontinence patients, those with the most severe urgency degrees had relatively low pelvic £oor (peri-urethral) muscle strength levels (eventually resulting from muscle fatigue? or primarily due to peri-urethral tissue atrophy?), which prevented (the active component of) a.p.t. from increasing.
European Journal of Obstetrics & Gynecology and Reproductive Biology, 2003
Objective: To investigate by questionnaire the prevalence and characteristics of urinary incontin... more Objective: To investigate by questionnaire the prevalence and characteristics of urinary incontinence (UI) in a female population aged between 18 and 49. Study design: Of 44,095 females aged 18-49.9 living in our urban area a sample of 10,000 subjects was sent a questionnaire and 3557 replied. The age-based analysis was performed on 2900 of these. Results: The overall prevalence of UI was 20%. 11% had suffered from nocturnal enuresis before 18 years old, 47% of parous women noted a relationship between the beginning of UI and delivery. Among the incontinent women 83% lost urine with physical exertion, and 44% had urge incontinence, 18% used diapers, 20% had consulted a physician and half of these had been referred for medical, surgical or rehabilitative therapy, 50% reported past or present urinary infections, 8% complained also of faecal incontinence, 22% considered loss of urine embarrassing and humiliating but only 6% revealed frustration and 2% were obliged to stay at home for long periods of time. Of the incontinents 62% defined themselves anxious or nervous and 22% of these ascribed an increase of urinary leakage to anxiety or to nervousness, 9% reported use of antidepressant drugs, 85% had sexual intercourse and only 2% considered UI as an impediment to a satisfying sexual activity. Conclusions: UI is a common problem in young women. Urge incontinence seems to be prevalent in <30 aged women while stress incontinence occurs more frequently after this age.
Brain and Cognition, 2002
Proper names (PN) have properties that are different from those of common names (CN) and as such ... more Proper names (PN) have properties that are different from those of common names (CN) and as such underlie different syntactic rules. According to one of these rule, in many languages, PN, unlike CN, do not take the determiner. It has been suggested that this happens because PN move themselves from noun position to determiner position. The present study addressed the question of whether noun to determiner movement should be just considered a formal description or rather reflects actual processing. A single aphasia case study and a group study on Alzheimer's patients provide experimental support to the view that movement from nominal to determiner position reflects some psychological computation.
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Papers by Paolo Di Benedetto