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Tarik Sammour, Ahmed W H Barazanchi, Andrew G Hill
BACKGROUND: The aim of this systematic review was to update previous PROSPECT ( ) review recommendations for the management of pain after excisional haemorrhoidectomy. METHODS: Randomized studies and reviews published in the English language from July 2006 (end date of last review) to March 2016, assessing analgesic, anaesthetic, and operative interventions pertaining to excisional haemorrhoidectomy in adults, and reporting pain scores, were retrieved from the EMBASE and MEDLINE databases...
October 20, 2016: World Journal of Surgery
So-Eun Han, Eun-Ji Kim, Hyun Hwan Sung, Jai-Kyong Pyon
BACKGROUND: Reconstruction of extensive penoscrotal defects is a surgical challenge. Resurfacing defects in highly complex three-dimensional structures and restoring their function are an essential part of the reconstruction of penoscrotal regions. OBJECTIVE: We describe a technique using internal pudendal artery perforator (IPAP) pedicled propeller flaps created from the gluteal fold. This could be a reliable surgical option that maintains a natural looking scrotal pouch with minimal donor site morbidity and optimal sexual activity...
October 12, 2016: European Urology
Burcu Örmeci, Egemen Avcı, Çigdem Kaspar, Özlem Eranıl Terim, Tibet Erdoğru, A Emre Öge
OBJECTIVES: To examine the diagnostic value of pudendal somatosensory evoked potentials (SEP) in pudendal nerve entrapment neuropaty (PNE) by stimulating the two sides separately after provocation by a standard sitting position. Routine pudendal SEPs performed in the supine position with bilateral simultaneous stimulation may fail to show the abnormality because the complaints of PNE appear or worsen in the sitting position. METHODS: Forty-nine patients with PNE and 16 controls were included...
October 7, 2016: Urology
Sira Carrasco García de León, José Manuel Flores Barragán, Natalia Villasanti Rivas
Sacrococcygeal chordoma is a malignant tumour originating from remnants of the notochord. Chordomas are slow-growing tumours whose symptoms develop insidiously. We present the case of a 72-year-old woman with a 6-month history of genital pain radiating to the perianal area and exacerbating when she was in a sitting position. MRI and PET studies revealed a large mass in the sacrococcygeal region causing bone destruction and invasion of neurovascular structures. The immunohistochemical study of the surgical specimen determined it to be chordoma...
May 2016: Case Reports in Neurology
J Koudy Williams, Gopal Badlani, Ashley Dean, Shannon Lankford, Kimberly Poppante, Tracy Criswell, Karl-Erik Andersson
BACKGROUND: Many factors may influence the efficacy of cell therapy for intrinsic urinary sphincter deficiency (ISD), including the route of administration of the cells and the condition of the sphincter. The goal of this study was to compare local versus intravenous administration of autologous skeletal muscle precursor cells (skMPCs) when administered to nonhuman primates (NHPs) with either acute or chronic ISD. METHODS: Thirty-two adult female monkeys were divided into eight groups (n = 4/group): (1) control; (2) surgically induced ISD/no treatment; (3) acute ISD (6-week duration)/local vehicle only; (4) acute ISD/local skMPC injection; (5) acute ISD/systemic skMPC; (6) chronic ISD (6-month duration)/local vehicle; (7) chronic ISD/local skMPC; (8) chronic ISD/systemic skMPC...
October 7, 2016: Stem Cell Research & Therapy
Seung Woo Cho, Hak Chang, Sung Tack Kwon
Extramammary Paget's disease (EMPD) is a rare, slow-growing intraepithelial malignancy that mainly involves the genital region, including the vulva, penis, scrotum, perianal, and periurethral areas. Although several treatment options exist, wide local excision with a safe margin is considered the treatment of choice. After resection of the lesion, it is often challenging to reconstruct the defect because defects in the perineal region require adequate volume for protection and are susceptible to infections, which is a particularly significant risk for large defects...
September 2016: Archives of Plastic Surgery
Ki Wook Sung, Won Jai Lee, In Sik Yun, Dong Won Lee
BACKGROUND: Perineal defects are commonly encountered during the treatment of conditions such as malignancy, infectious disease, and trauma. Covering large defects in the perineal area is challenging due to its complicated anatomy and the need for functional preservation. METHODS: Fourteen patients who underwent reconstructive surgery with multiple perforator flaps for defects >100 cm(2) in the perineal area were included in this retrospective cohort study. Characteristics of the perforator flap operation and postoperative outcomes were reviewed...
September 2016: Archives of Plastic Surgery
Iman Khalil, Saad E Itani, Zeina Naja, Ahmad Salah Naja, Fouad M Ziade, Jean-Marc Ayoubi, Mariam A El-Rajab, Zoher M Naja
STUDY OBJECTIVE: Compare the effectiveness of nerve stimulator-guided pudendal nerve block (PNB) vs general anesthesia (GA) for anterior and posterior (AP) colporrhaphy in terms of pain relief and analgesic consumption within 24 and 48 hours postoperatively. DESIGN: Prospective randomized trial. PATIENTS: Fifty-seven patients whose ages ranged between 20 and 53 years scheduled to undergo AP colporrhaphy due to the presence of cystorectocele...
November 2016: Journal of Clinical Anesthesia
Timothy J Ness, Alan Randich, Dwight E Nelson, Xin Su
BACKGROUND AND OBJECTIVES: Neuromodulation has been reported to reliably improve symptoms of bladder overactivity and sometimes pain. The effect of electrical stimulation of several nerve pathways demonstrated to alter cystometric responses to bladder distension was examined on nociceptive responses in models of bladder hypersensitivity. METHODS: Bladder hypersensitivity was produced by several published methods including neonatal inflammation, acute inflammation, and chronic stress...
September 28, 2016: Regional Anesthesia and Pain Medicine
Marisa M Clifton, Raffi Gurunluoglu, Javier Pizarro-Berdichevsky, Todd Baker, Sandip P Vasavada
INTRODUCTION: Vaginal stenosis is an unfortunate complication that can occur after pelvic radiation therapy for gynecologic or colorectal malignancies. Treatment is challenging and can require significant reconstructive surgery. The objective of this video is to present a case of vaginal stenosis after radiation and describe vaginal reconstruction with a fasciocutaneous Singapore flap. METHODS: We describe the case of a 42-year-old woman with a history of stage 3 colorectal cancer who underwent partial colectomy, chemotherapy, and pelvic radiation...
September 28, 2016: International Urogynecology Journal
N Lemos, R M Marques, A B Oliveira, L Veloso, M C Girão
No abstract text is available yet for this article.
November 2015: Journal of Minimally Invasive Gynecology
Y-C Li, H-H Kuo, M-H Cheng, C-L Li
No abstract text is available yet for this article.
November 2015: Journal of Minimally Invasive Gynecology
Jamie M Bartley, Kim A Killinger, Judith A Boura, Priyanka Gupta, Natalie Gaines, Jason P Gilleran, Kenneth M Peters
AIMS: To evaluate neuromodulation outcomes in patients with prior back surgery. METHODS: Adults in our prospective observational sacral/pudendal neuromodulation study were retrospectively evaluated. History and operative details were reviewed, and outcomes were measured at 3, 6, 12, and 24 months with overactive bladder questionnaire (OAB q) symptom severity (SS)/health related quality of life (HRQOL), interstitial cystitis symptom/problem indices (ICSI - PI), voiding diaries, and global response assessments (GRA)...
September 27, 2016: Neurourology and Urodynamics
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
Daniel Martingano, Francis X Martingano, Rosemary Ruggiero-DeCarlo
Pregnancy-related rupture of an arterial aneurysm is an unusual occurrence associated with increased risk of morbidity and mortality. Various pregnancy-related physiologic changes appear to make pregnancy a high-risk situation for rupture of either preexisting arterial aneurysms or those that develop throughout the course of pregnancy. Splenic artery aneurysms are the most common (60%), followed by hepatic (20%), superior mesenteric (5.9%), celiac (4%), ovarian, uterine, and renal (<2%) artery. Even rarer are aneurysms involving the internal iliac artery and its branches, to which there is only one published case report...
September 2016: Obstetric Medicine
Alan J Wein
No abstract text is available yet for this article.
October 2016: Journal of Urology
James E Leone, Steve Middleton
OBJECTIVE:  To discuss the case of a 49-year-old man who presented to the sports medicine staff with pelvic pain of 10 years' duration consistent with pudendal neuralgia. BACKGROUND:  Testicular pain in men is often provoked by direct trauma or may indicate an oncologic process. DIFFERENTIAL DIAGNOSIS:  Epididymitis, athletic pubalgia, testicular tumor, sacroiliac joint dysfunction, lumbar radiculopathy. TREATMENT:  The patient responded positively to treatment and rehabilitation to restore normal mechanics to the lumbo-pelvic-hip complex...
September 14, 2016: Journal of Athletic Training
Haitham H Khalil, Marco N Malahias, Sharad Karandikar, Charles Hendrickse
The management of recurrent rectovaginal fistula after obstetric injury and cryptoglandular sepsis is considered a major surgical challenge. The fistula poses a significant negative psychosocial and sexual morbidity. In addition, the poor quality of local tissues due to previous attempts at surgical repair adds to this challenge. There are few data regarding the management of persistent or recurrent fistula in the literature; however, several studies reported high failure rates after 2 or more procedures. We present 4 cases managed successfully in a multidisciplinary approach involving fistulectomy and immediate reconstruction with an internal pudendal artery perforator island flap...
August 2016: Plastic and Reconstructive Surgery. Global Open
Jing-Yi Li, Ren Liao
BACKGROUND: Catheter-related bladder discomfort (CRBD) is a common distressing symptom complex during the postoperative period, especially after urologic procedures with a relatively greater size urinary catheter. In this study, we will enroll male patients undergoing elective prostate surgery with urinary catheterization under general anesthesia, and we will compare the efficacy of pudendal nerve block (PNB) and intravenous tramadol in CRBD prevention. METHODS/DESIGN: This trial is a prospective, randomized controlled trial that will test the superiority of bilateral PNB with 0...
2016: Trials
Vibhor Wadhwa, Kelly M Scott, Shai Rozen, Adam J Starr, Avneesh Chhabra
Chronic pelvic pain is a disabling condition that affects a large number of men and women. It may occur after a known inciting event, or it could be idiopathic. A common cause of pelvic pain syndrome is neuropathy of the pelvic nerves, including the femoral and genitofemoral nerves, ilioinguinal and iliohypogastric nerves, pudendal nerve, obturator nerve, lateral and posterior femoral cutaneous nerves, inferior cluneal nerves, inferior rectal nerve, sciatic nerve, superior gluteal nerve, and the spinal nerve roots...
September 2016: Radiographics: a Review Publication of the Radiological Society of North America, Inc
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