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Pelvic anatomy

Michael V Friedman, J Derek Stensby, Jeremiah R Long, Stephen A Currie, Travis J Hillen
PURPOSE: Review the MRI appearance of different bursae located throughout the pelvis, including the pertinent osseous and musculotendinous anatomy. MATERIALS AND METHODS: Bursae are potential spaces that reduce friction between opposed moving components which can become inflamed, clinically mimicking internal derangement. RESULTS: This series illustrates the most common as well as lesser-known pelvic bursae. Common causes of bursitis including overuse, trauma, and infection are presented...
September 28, 2016: Clinical Imaging
Benedetta Gui, Francesco Maria Danza, Anna Lia Valentini, Maria Elena Laino, Alessandro Caruso, Brigida Carducci, Elena Rodolfino, Ersilia Devicienti, Lorenzo Bonomo
Cesarean section (CS) may have several acute complications that can occur in the early postoperative period. The most common acute complications are hematomas and hemorrhage, infection, ovarian vein thrombosis, uterine dehiscence and rupture. Pelvic hematomas usually occur at specific sites and include bladder flap hematoma (between the lower uterine segment and the bladder) and subfascial or rectus sheath hematoma (rectus sheath or prevescical space). Puerperal hemorrhage can be associated with uterine dehiscence or rupture...
October 19, 2016: Diagnostic and Interventional Radiology: Official Journal of the Turkish Society of Radiology
Joel Wells, Jeffrey J Nepple, Karla Crook, James R Ross, Asheesh Bedi, Perry Schoenecker, John C Clohisy
BACKGROUND: Hip dysplasia represents a spectrum of complex deformities on both sides of the joint. Although many studies have described the acetabular side of the deformity, to our knowledge, little is known about the three-dimensional (3-D) head and neck offset differences of the femora of dysplastic hips. A thorough knowledge of proximal femoral anatomy is important to prevent potential impingement and improve results after acetabular reorientation. QUESTIONS/PURPOSES: (1) Are there common proximal femoral characteristics in patients with symptomatic hip dysplasia undergoing periacetabular osteotomy (PAO)? (2) Where is the location of maximal femoral head and neck offset deformity in hip dysplasia? (3) Do certain subgroups of dysplastic hips more commonly have cam-type femoral morphology? (4) Is there a relationship between hip ROM as well as impingement testing and 3-D head and neck offset deformity? METHODS: Using our hip preservation database, 153 hips (148 patients) underwent PAO from October 2013 to July 2015...
October 17, 2016: Clinical Orthopaedics and related Research
Thorsten Jentzsch, Lazaros Vlachopoulos, Philipp Fürnstahl, Daniel A Müller, Bruno Fuchs
BACKGROUND: Sarcomas are associated with a relatively high local recurrence rate of around 30 % in the pelvis. Inadequate surgical margins are the most important reason. However, obtaining adequate margins is particularly difficult in this anatomically demanding region. Recently, three-dimensional (3-D) planning, printed models, and patient-specific instruments (PSI) with cutting blocks have been introduced to improve the precision during surgical tumor resection. This case series illustrates these modern 3-D tools in pelvic tumor surgery...
September 21, 2016: World Journal of Surgical Oncology
Brian Cohen, Dominic Kleinhenz, Jonathan Schiller, Ramin Tabaddor
Athletic Pubalgia, more commonly known as sports hernia, is defined as chronic lower abdominal and groin pain without the presence of a true hernia. It is increasingly recognized in athletes as a source of groin pain and is often associated with other pathology. A comprehensive approach to the physical exam and a strong understanding of hip and pelvic anatomy are critical in making the appropriate diagnosis. Various management options are available. We review the basic anatomy, patholophysiology, diagnostic approach and treatment of athletic pubalgia as well as discuss associated conditions such as femoroacetabular impingement...
October 4, 2016: Rhode Island Medical Journal
Rainer Kimmig, Peter Rusch, Paul Buderath, Bahriye Aktas
Superior hypogastric plexus (SHG) contains mainly sympathetic and most probably also postganglionic parasympathetic fibers. Thus, surgical damage of SHG may cause autonomic pelvic organ dysfunction (Kraima et al., 2015). As already shown for rectal cancer, preservation of the autonomic nerves is facilitated by robotic surgery and may avoid sexual dysfunctions and voiding disorders (Kim et al., 2015). In this educational video, we demonstrate left lower paraaortic lymph node dissection preserving the SHG using ICG fluorescence to label the lymphatic compartment...
November 2016: Gynecologic Oncology Reports
Vibhor Wadhwa, Aws S Hamid, Yogesh Kumar, Kelly M Scott, Avneesh Chhabra
Pudendal neuralgia is being increasingly recognized as a cause of chronic pelvic pain, which may be related to nerve injury or entrapment. Due to its complex anatomy and branching patterns, the pudendal nerve abnormalities are challenging to illustrate. High resolution 3 T magnetic resonance neurography is a promising technique for the evaluation of peripheral neuropathies. In this article, the authors discuss the normal pudendal nerve anatomy and its variations, technical considerations of pudendal nerve imaging, and highlight the normal and abnormal appearances of the pudendal nerve and its branches with illustrative case examples...
September 23, 2016: Acta Radiologica
Patricia L Hardré, Mikio Nihira, Edgar LeClaire, Michael Moen
OBJECTIVE: The aim of this study was to describe how professional expertise is defined and understood among gynecologic surgeons and what experiential factors contribute to that understanding. METHODS: Semistructured interviews with 16 experts in Female Pelvic Medicine and Reconstructive Surgery were conducted to identify how expertise in their field is defined, recognized, and assessed. Independent thematic analysis of the interview transcripts was performed by each member of the research team and then distilled and synthesized into convergent themes...
September 21, 2016: Female Pelvic Medicine & Reconstructive Surgery
Julian A Gingold, Tommaso Falcone
Surgical management of endometriosis has been shown to improve dysmenorrhea at all disease stages and is recommended in severe disease for treatment of infertility. Deeply infiltrating endometriosis (DIE) produces thick inflammatory tissue that precludes visualization of anatomical landmarks and distorts normal anatomy. Excision of DIE poses several technical and surgical challenges that mandate a clear understanding of the anatomy of the pelvic sidewall. This review details relevant surgical anatomy and addresses the principles of safe retroperitoneal entry, ureterolysis and excision of endometriotic lesions...
April 2016: Journal of Endometriosis and Pelvic Pain Disorders
Louise T S Arenholt, Bodil Ginnerup Pedersen, Karin Glavind, Marianne Glavind-Kristensen, John O L DeLancey
INTRODUCTION AND HYPOTHESIS: The paravaginal defect has been a topic of active discussion concerning what it is, how to diagnose it, its role in anterior vaginal wall prolapse, and if and how to repair it. The aim of this article was to review the existing literature on paravaginal defect and discuss its role in the anterior vaginal wall support system, with an emphasis on anatomy and imaging. METHODS: Articles related to paravaginal defects were identified through a PubMed search ending 1 July 2015...
September 17, 2016: International Urogynecology Journal
Corina Christmann-Schmid, Annemijn Philine Annette Wierenga, Eveline Frischknecht, Christopher Maher
OBJECTIVE: The aim of this prospective observational study was to obtain a better understanding of the anatomy and to classify the observed different perineal presentations at the time of posterior colporrhaphy and to describe specific surgical techniques used. METHODS: To classify the observed perineal findings, the Pelvic Organ Prolapse Quantification System with a newly introduced additional measurement of the perineal ridge (PR) was taken intraoperatively and postoperatively in 121 consecutive women undergoing posterior colporrhaphy...
September 16, 2016: Female Pelvic Medicine & Reconstructive Surgery
Zeelha Abdool, Hans P Dietz, Gerhard B Lindeque
OBJECTIVE: To date most studies on the functional anatomy of the pelvic floor have focussed on Caucasian women. There is scant information on this topic involving other ethnic groups. This study investigates levator hiatal area and pelvic organ descent in three racially diverse ethnic groups of healthy nulliparous East Asian, Caucasian and Black South African females, using three dimensional (3D) transperineal ultrasound (TPUS). METHODS: A total of two hundred and seven nulliparous women from three different ethnic groups aged 18 to 40 years were recruited for this prospective observational study between June 2012 and April 2015...
September 8, 2016: Ultrasound in Obstetrics & Gynecology
J A Reid, C L Templeman, D A Groneberg, D Brueggmann, J M Jaque
Many patients have a rudimentary knowledge of their body's anatomy and functioning. In a clinical setting, deficits in patient understanding can lead to miscommunication affecting patient care and satisfaction. Hence, this study aims to estimate a baseline of patient knowledge regarding pelvic anatomy and to assess their educational preferences in learning about related topics. For this cross-sectional study, we developed a 24-item assessment with questions related to pelvic anatomy, health, and function. The questionnaire was validated using feedback from anonymous community focus groups, and then distributed to English-speaking female patients at the Women's Clinic of LAC + USC Medical Center (Los Angeles)...
September 6, 2016: Journal of Community Health
Angela Gm O'Neill, Suneil Jain, Alan R Hounsell, Joe M O'Sullivan
Image guided radiotherapy (IGRT) is an essential tool in the accurate delivery of modern radiotherapy techniques. Prostate radiotherapy positioned using skin marks or bony anatomy may be adequate for delivering a relatively homogenous whole pelvic radiotherapy dose but these are not reliable when using reduced margins, dose escalation or hypo-fractionated stereotactic radiotherapy. Fiducial markers (FMs) for prostate IGRT have been in use since the 1990's. They require surgical implantation and provide a surrogate for the position of the prostate gland...
September 2, 2016: British Journal of Radiology
I Hujazi, T Jones, S Johal, P Bearcroft, G Muniz-Terra, V Khanduja
The aim of this study is to measure the ischiofemoral distance (IFD) in the normal hip with healthy surrounding soft tissues and describe its variations caused by gender, age and proximal femoral anatomy so that this could serve as a reference for future studies on this subject. This is a retrospective study in which we reviewed the CT scans of 149 patients (298 hips) who had a CT of their pelvis for non-orthopaedic (abdomino-pelvic) pathology. The images were reviewed by two independent observers and the IFD (the smallest distance between the lateral cortex of the ischial tuberosity and the posteromedial cortex of the lesser trochanter), offset (the perpendicular distance from the centre of the femoral head to a line running down the middle of the shaft of the femur) and the neck-shaft angle (the angle between the lines in the middle of the neck to the line forming the axis of the femoral shaft) were measured...
August 2016: Journal of Hip Preservation Surgery
Michael E Rezaee, Zubin Shetty, David Pridmore, Chirag N Dave, Sugandh D Shetty
BACKGROUND: Nephroureterectomy is the standard of care for transitional cell carcinoma (TCC) involving the upper urinary tract. However, few published case reports exist describing the surgical treatment of ectopic kidneys with TCC. Surgical removal of a pelvic kidney can be complicated by aberrant vasculature supply, a tortuous ureter and abutting anatomical structures. Thus, it is necessary to determine the most appropriate surgical technique for treatment of pelvic kidneys with suspected malignancy...
2016: J Endourol Case Rep
Sophie Plagakis, Darren Foreman, Peter Sutherland, Andrew Fuller
We highlight two cases of transperitoneal robot-assisted radical prostatectomy (RARP) in patients with pelvic kidneys because of congenital development and renal transplant. These uncommon cases present a challenge to the surgeon contemplating surgery because of access and anomalous vascular and ureteral anatomy. We describe the technical considerations that are paramount in effectively completing transperitoneal RARP, and believe it should be considered as a treatment option in men with pelvic kidneys.
2016: J Endourol Case Rep
Antonio Simone Laganà, Salvatore Giovanni Vitale, Maria Antonietta Trovato, Vittorio Italo Palmara, Agnese Maria Chiara Rapisarda, Roberta Granese, Emanuele Sturlese, Rosanna De Dominici, Stefano Alecci, Francesco Padula, Benito Chiofalo, Roberta Grasso, Pietro Cignini, Paolo D'Amico, Onofrio Triolo
Endometriosis is defined as the presence of endometrial mucosa (glands and stroma) abnormally implanted in locations other than the uterine cavity. Deep infiltrating endometriosis (DIE) is considered the most aggressive presentation of the disease, penetrating more than 5 mm in affected tissues, and it is reported in approximately 20% of all women with endometriosis. DIE can cause a complete distortion of the pelvic anatomy and it mainly involves uterosacral ligaments, bladder, rectovaginal septum, rectum, and rectosigmoid colon...
2016: BioMed Research International
V Balaya, C Ngo, L Rossi, C Cornou, C Bensaid, R Douard, A S Bats, F Lecuru
Radical hysterectomy (RH) is an effective treatment for early-stage cervical cancer IA2 to IIA1 but RH is often associated with several significant complications such as urinary, anorectal and sexual dysfunction due to pelvic nerve injuries. Pelvic autonomic nerves including the superior hypogastric plexus (SHP), hypogastric nerves (HN), pelvic splanchnic nerves (PSN), sacral splanchnic nerves (SSN), inferior hypogastric plexus (IHP) and efferent branches of the IHP. We aimed to precise the neuroanatomy of the female pelvis in order to provide key-points of surgical anatomy to improve NSRH for cervical cancer...
September 2016: Gynécologie, Obstétrique & Fertilité
Juan-Pablo Caballero-Romeu, Juan-Antonio Galán-Llopis, Daniel Pérez-Fentes, Alberto Budia-Alba, Marcos Cepeda-Delgado, Jose-Luis Palmero-Marti, Jose-Ramón Cansino-Alcaide, Pablo Caballero-Pérez, Gaspar Ibarluzea-Gonzalez
PURPOSE: The aim of this study is to assess the effectiveness, safety, and reproducibility of the micro-ureteroscopy (m-URS) in the treatment of distal ureteral stones in women. MATERIALS AND METHODS: A multicenter, prospective observational study was designed and conducted between March and December 2015. We included women having at least one stone in the distal ureter and being a candidate for surgical treatment using the 4.85F sheath of MicroPerc(®). Patients with clinical criteria and/or laboratory analysis indicating sepsis or coagulation alteration were excluded...
September 28, 2016: Journal of Endourology
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