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1.
Prog Urol ; 31(17): 1192-1200, 2021 Dec.
Artigo em Francês | MEDLINE | ID: mdl-34493442

RESUMO

CONTEXT: The PP Convergences criteria group together 10 of the most significant clinical criteria for sensitization in the context of chronic pelvic pain. They are the result of a consensus of experts and represent to date the only clinical evaluation guide to identify patients with pelvic perineal pain in whom a pelvic sensitization component can be evoked. OBJECTIVE: This work concerns the psychometric validation of these criteria. The aim is to answer 3 questions: 1) is the instrument reliable (i.e., sensitive, specific and accurate)?; 2) can we define a screening score for pelvic-perineal pain by sensitization from the CPP criteria?; 3) can combinations of criteria be defined to predict pelvic-perineal sensitization from the CPP criteria? METHODOLOGY AND SUBJECTS: In total, 308 patients with pelviperineal pain were recruited during their medical consultation. PROCEDURE: Fifteen expert physicians were asked to judge the presence or absence of the 10 CPP criteria and to make a diagnosis of the presence or absence of pelviperineal sensitization in their patient. RESULTS: ROC curve analysis indicated that a score of 5 was the closest to a perfect score with a sensitivity of 95% and a specificity of 87%. They also indicate that the CPP criteria have a very good sensitivity (97%) and specificity (91%) and present globally a good reproducibility on all the criteria (Kappa>0.6). Finally, the statistical analyses reveal that the most discriminating criterion for predicting sensitization is Q8 (pain persisting after sexual activity). CONCLUSION: The CPP criteria represent a very good screening tool for pelvic sensitization. The score of 5 corresponds to the score at which the patient has sufficient clinical criteria to be classified as sensitized. LEVEL OF EVIDENCE: 4.


Assuntos
Dor Crônica , Dor Pélvica , Dor Crônica/diagnóstico , Humanos , Dor Pélvica/diagnóstico , Períneo , Psicometria , Reprodutibilidade dos Testes
2.
Prog Urol ; 30(11): 571-587, 2020 Sep.
Artigo em Francês | MEDLINE | ID: mdl-32651103

RESUMO

INTRODUCTION: Pelvic and perineal pain after genital prolapse surgery is a serious and frequent post-operative complication which diagnosis and therapeutic management can be complex. MATERIALS ET METHODS: A literature review was carried out on the Pubmed database using the following words and MeSH : genital prolapse, pain, dyspareunia, genital prolapse and pain, genital prolapse and dyspareunia, genital prolapse and surgery, pain and surgery. RESULTS: Among the 133 articles found, 74 were selected. Post-operative chronic pelvic pain persisting more than 3 months after surgery according to the International Association for the Study of Pain. It can be nociceptive, neuropathic or dysfunctional. Its diagnosis is mainly clinical. Its incidence is estimated between 1% and 50% and the risk factors are young age, the presence of comorbidities, history of prolapse surgery, severe prolapse, preoperative pain, invasive surgical approach, simultaneous placement of several meshes, less operator experience, increased operative time and early post-operative pain. The vaginal approach can cause a change in compliance and vaginal length as well as injury to the pudendal, sciatic and obturator nerves and in some cases lead to myofascial pelvic pain syndrome, whereas the laparoscopic approach can lead to parietal nerve damage. Therapeutic management is multidisciplinary and complex. CONCLUSION: Pelvic pain after genital prolapse surgery is still obscure to this day.


Assuntos
Prolapso de Órgão Pélvico/cirurgia , Dor Pélvica/etiologia , Períneo , Complicações Pós-Operatórias/etiologia , Humanos , Reoperação
3.
Prog Urol ; 28(11): 548-556, 2018 Sep.
Artigo em Francês | MEDLINE | ID: mdl-29884538

RESUMO

OBJECTIVE: Pelvic-perineal pain often accompanied by pain of the perineum and pelvi-trochanteric muscles, we sought to observe the frequency of postural disturbances in relation to the pelvi-perineal muscles in patients who consult for pelvic perineal pain compared to a control population free of these pain. MATERIAL AND METHODS: The prospective monocentric study was conducted during consultations of pelvic perineal pain in the urology department of Nantes and was based on 5 clinical tests successively looking for the presence of thoraco-lumbar hinge syndrome, myofascial syndrome in the pelvic diaphragm, pelvic instability, pelvic-pedic quadrilateral dysfunction and paravertebral muscle hypertonia. RESULTS: A total of 51 subjects were included in the study and divided into two populations: 26 patients, 25 controls. Thoraco-lumbar hinge syndrome was found in 28 % of patients vs 4 % of controls (P=0.024); myofascial syndromes were present in 68 % of patients vs 25 % of controls (P=0.005); pelvic instability concerned 76 % of patients vs 33 % of controls (P=0.002); the dysfunctions of the pelvic-pedic quadrilateral concerned 96 % of the patients vs 58 % of the controls (P=0.001); paravertebral muscle hypertonia was found bilaterally in 32 % of patients vs 4 % of controls (P=0.077) and unilaterally in 36 % of patients vs 0 % of controls (P=0.001). CONCLUSION: Patients with chronic pelvic perineal pain had significantly more posture problems than non-pain patients. It seemed relevant to us that the postural assessment was integrated into their usual clinical examination. LEVEL OF EVIDENCE: 4.


Assuntos
Dor Crônica/fisiopatologia , Dor Pélvica/fisiopatologia , Períneo/fisiopatologia , Equilíbrio Postural , Coluna Vertebral/fisiopatologia , Adulto , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
4.
BJOG ; 124(2): 251-260, 2017 01.
Artigo em Inglês | MEDLINE | ID: mdl-27465823

RESUMO

OBJECTIVE: To compare the effect of corticosteroids combined with local anaesthetic versus local anaesthetic alone during infiltrations of the pudendal nerve for pudendal nerve entrapment. DESIGN: Randomised, double-blind, controlled trial. SETTING: Multicentre study. POPULATION: 201 patients were included in the study, with a subgroup of 122 women. METHODS: CT-guided pudendal nerve infiltrations were performed in the sacrospinous ligament and Alcock's canal. There were three study arms: patients in Arm A (n = 68) had local anaesthetic alone, those in Arm B (n = 66) had local anaesthetic plus corticosteroid and those in Arm C (n = 67) local anaesthetic plus corticosteroid with a large volume of normal saline. MAIN OUTCOME MEASURES: The primary end-point was the pain intensity score at 3 months. Patients were regarded as responders (at least a 30-point improvement on a 100-point visual analogue scale of mean maximum pain over a 2-week period) or nonresponders. RESULTS: Three months' postinfiltration, 11.8% of patients in the local anaesthetic only arm (Arm A) were responders versus 14.3% in the local anaesthetic plus corticosteroid arms (Arms B and C). This difference was not statistically significant (P = 0.62). No statistically significant difference was observed in the female subgroup between Arm A and Arms B and C (P = 0.09). No significant difference was detected for the various pain assessment procedures, functional criteria or quality-of-life criteria. CONCLUSIONS: Corticosteroids provide no additional therapeutic benefits compared with local anaesthetic and should therefore no longer be used. TWEETABLE ABSTRACT: Steroid infiltrations do not improve the results of local anaesthetic infiltrations in pudendal neuralgia.


Assuntos
Corticosteroides/administração & dosagem , Anestésicos Locais/administração & dosagem , Lidocaína/administração & dosagem , Bloqueio Nervoso/métodos , Neuralgia do Pudendo/terapia , Método Duplo-Cego , Quimioterapia Combinada , Feminino , Humanos , Pessoa de Meia-Idade , Medição da Dor , Estudos Prospectivos , Nervo Pudendo , Radiografia Intervencionista/métodos , Resultado do Tratamento
5.
Prog Urol ; 26(17): 1213-1221, 2016 Dec.
Artigo em Francês | MEDLINE | ID: mdl-27614384

RESUMO

INTRODUCTION: Vulvodynia is a common and debilitating disease, for which treatments are often of limits efficacy. As the Impar node receives nociceptive afferents from pelvis and perineum, it is a potential therapeutic target to treat pain in this region. The objective of the study was to evaluate the relevance of ropivacaine Impar node infiltration in patients suffering from rebel vulvodyny. METHODS: This was a retrospective, single-center study. The Impar node infiltrations were performed by a single operator in eight patients suffering from rebel vulvodynia. Ropivacaine and iopamidol were administered in prone position with a lateral approach under scanner. The anaesthetic diagnostic block of the Impar node was positive in all eight patients included in the study. Thereafter these patients benefited of 2 additional therapeutic infiltrations. Subsequently, an infiltration of the node with 100UI of botulinum toxin was performed in two patients with a bilateral approach under scanner. The analgesic efficacy was evaluated by a Visual Analogic Scale (VAS) before, immediately after, and at day 15 following the infiltration. A subjective evaluation of pain comprising the percentage of overall improvement and duration of analgesic efficacy was performed after the third infiltration. RESULTS: Comparison of the VAS before and immediately after the Impar block showed in the first anesthetic block a significant decrease in pain median VAS from 51/100 to 16/100 (P=0.01). Similarly, for the second block, VAS decreased from 52.5/100 to 15/100 (P=0.02). The maximal pain reported on Day 15, was significantly lower after the third infiltration than that after the first (P=0.03). Five patients reported an overall improvement in their quality of life of over 50%, which lasted an average of six weeks. A long lasting effectiveness was obtained in the two patients who benefited of the botulinum toxin. CONCLUSION: The infiltration of Impar node is an interesting technique for patients suffering of rebel vulvodynia. LEVEL OF EVIDENCE: 4.


Assuntos
Amidas/administração & dosagem , Anestésicos Locais/administração & dosagem , Vulvodinia/tratamento farmacológico , Adulto , Anestesia Local , Feminino , Humanos , Pessoa de Meia-Idade , Estudos Retrospectivos , Ropivacaina , Adulto Jovem
7.
Surg Radiol Anat ; 34(1): 73-9, 2012 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-21643789

RESUMO

PURPOSE: Rectal examination is difficult to carry out by students because of their lack of knowledge and fear. It is therefore necessary to search for methods in order to facilitate its practice. This work mainly focuses on the palpation of the posterior lateral area of the rectum. METHODS: This work bases itself on the study of the average length of indexes and on the anatomical study of the dissection and prints of two pelvises. In the lithotomy position, we can identify three successive levels of exploration of the posterior and lateral area of the rectum. These three levels are defined by the extremity of the index, and the distal and proximal interphalangeal articulations placed successively on the tip of the coccyx. A 180° rotation of the hand enables at each level to identify the parietal structures that the pad of the index comes across, but excludes the palpation of genital organs and rectum. RESULTS: The first level corresponds to the higher part of the anal canal, the ischioanal fossa and the ischium. The second level corresponds to the levator ani muscle, the ischioanal fossa and the pudendal canal. The third level corresponds to the sacrospinous ligament, the ischiatic spine and the internal obturator muscle. CONCLUSIONS: In spite of the significant differences between the lengths of the indexes, the use of these landmarks will facilitate the identification of parietal anatomical structures. The internal organs' palpation will depend on the patient's position, his efforts in pushing, the length of the index, and the way the examiner presses on the perineum.


Assuntos
Canal Anal/anatomia & histologia , Exame Retal Digital/métodos , Imageamento por Ressonância Magnética/métodos , Tomografia Computadorizada por Raios X/métodos , Adulto , Cadáver , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Sensibilidade e Especificidade , Fatores Sexuais , Adulto Jovem
8.
Prog Urol ; 22(17): 1051-7, 2012 Dec.
Artigo em Francês | MEDLINE | ID: mdl-23182119

RESUMO

INTRODUCTION: Some patients have atypical perineal neuropathic pain that differs from a pudendal neuralgia. The purpose of this study was to define a new clinical entity of such pain and to evaluate the therapeutic benefit of corticosteroid infiltration. MATERIAL AND METHODS: Retrospective study of 72 patients presenting with atypical perineal pain. A nerve block was performed using added steroid anesthetic in cluneal inferior nerve, at the endo-ischial area. Pain assessment was recorded 8 days and 10 minutes before the injection and 5 minutes and 3 weeks after the procedure. RESULTS: The population included 40 (55%) women, mean age 55. Forty-nine (68%) patients presented with a positive block test. These patients were characterized by ischio-perineal neuropathic pain, respecting the penis or clitoris, worse sitting (98%), especially on hard seats, do not wake up at night, and not accompanied by superficial hypoesthesia. A decrease in VAS scores (>30%) at 23 weeks follow-up following the addition of corticosteroids during infiltration was observed in only 29 (40%) patients. CONCLUSION: The current series described the population characteristics of cluneal inferior neuralgia by ischial conflict.


Assuntos
Neuralgia/diagnóstico , Neuralgia/etiologia , Períneo/inervação , Feminino , Humanos , Ísquio , Masculino , Pessoa de Meia-Idade , Bloqueio Nervoso , Neuralgia do Pudendo/diagnóstico , Neuralgia do Pudendo/etiologia , Estudos Retrospectivos
10.
Prog Urol ; 20(12): 1111-5, 2010 Nov.
Artigo em Francês | MEDLINE | ID: mdl-21056392

RESUMO

OBJECTIVE: How to propose psychotherapy in a patient with chronic pelvic and perineal pain? PATIENTS AND METHODS: Description of the psychological and behavioural profile of patients with chronic pelvic and perineal pain, the indications for proposing psychotherapy and the reasons for choosing a particular type of psychotherapy. RESULTS: Very few studies have analysed the impact of psychotherapy in the treatment of chronic pelvic and perineal pain and more extensive studies should be conducted. CONCLUSIONS: Advice concerning the modalities of referring a patient to a psychotherapist, based on a multidisciplinary approach.


Assuntos
Dor Pélvica/terapia , Períneo , Psicoterapia/métodos , Doença Crônica , Humanos
11.
Prog Urol ; 20(12): 1027-34, 2010 Nov.
Artigo em Francês | MEDLINE | ID: mdl-21056381

RESUMO

OBJECTIVE: Analysis of complex pelvic and perineal pain. MATERIAL AND METHODS: Review of the literature concerning the various types of functional pelvic pain. RESULTS: Various forms of pelvic pain are frequently associated: painful bladder syndrome (interstitial cystitis), irritable bowel syndrome, endometriosis pain, vulvodynia, chronic pelvic pain syndrome (chronic prostatitis). Pelvic pain is often associated with fibromyalgia or complex regional pain syndrome (reflex sympathetic dystrophy). The pathophysiological mechanisms involved in these syndromes are all very similar, suggesting a triggering element, neurogenic inflammation, reflex muscular and autonomic responses, central hypersensitization, emotional reactions and biopsychosocial consequences. DISCUSSION: The concept of visceral pain is evolving and, in practice, complex pelvic pain can comprise neuropathic components, complex regional pain syndrome components, hypersensitization components, and emotional components closely resembling posttraumatic stress syndrome. CONCLUSIONS: When pain cannot be explained by an organ disease, the pain must be considered to be expressed via this organ. Chronic pelvic and perineal pain can become self-perpetuating and identification of its various mechanisms can allow the proposal of individually tailored treatments.


Assuntos
Dor Pélvica/diagnóstico , Períneo , Doença Crônica , Fibromialgia/complicações , Humanos , Dor Pélvica/etiologia , Transtornos de Estresse Pós-Traumáticos/complicações , Vísceras
12.
Prog Urol ; 20(12): 1084-8, 2010 Nov.
Artigo em Francês | MEDLINE | ID: mdl-21056388

RESUMO

OBJECTIVE: To define the place of pudendal nerve surgery in pudendal nerve entrapment syndromes. MATERIALS AND METHODS: Description of the various surgical techniques and published results. RESULTS: The original surgical technique, which remains the reference technique, consists of performing surgical release of the pudendal nerve from the infrapiriformis foramen to Alcock's canal via a transgluteal approach. This surgical procedure is safe and gives encouraging results validated by a prospective, randomized protocol: 66 to 80% of patients are improved. Other transvaginal or transperineal approaches have also been proposed. CONCLUSION: Pudendal nerve surgery is a reasonable treatment option when all other treatments have failed. However, the various techniques proposed and their respective criticisms must be carefully evaluated.


Assuntos
Dor Pélvica/cirurgia , Períneo , Doença Crônica , Humanos , Procedimentos Neurocirúrgicos , Pelve/inervação
13.
Prog Urol ; 20(12): 1072-83, 2010 Nov.
Artigo em Francês | MEDLINE | ID: mdl-21056387

RESUMO

INTRODUCTION: Chronic pelvic and perineal pain can be related to a nerve lesion caused by direct or indirect trauma or by an entrapment syndrome, which must then be demonstrated by a test block. The purpose of this article is to review the techniques and modalities of somatic nerve block in the management of chronic pelvic and perineal pain. MATERIAL AND METHODS: A review of the literature was performed by searching PubMed for articles on somatic nerve infiltrations in the management of chronic pelvic and perineal pain. RESULTS: Nerves involved in pelvic and perineal pain are: thoracolumbar nerves (obturator, ilioinguinal, iliohypogastric and genitofemoral) and sacral nerves (pudendal and inferior cluneal branches of the posterior cutaneous nerve of the thigh). Infiltration has a dual objective: to confirm the diagnostic hypothesis by anaesthetic block and to try to relieve pain. Evaluation of the severity and site of the pain before and immediately after the test block is essential for interpretation of the block. The various infiltration techniques for each nerve are described together with their respective advantages, disadvantages and risk of complications. CONCLUSION: Somatic nerve blocks are an integral part of the management of chronic pelvic and perineal pain and are predominantly performed under CT guidance in order to be as selective as possible. Once the diagnosis and the level of the nerve lesion have been defined, more specific therapeutic procedures can then be proposed.


Assuntos
Bloqueio Nervoso/métodos , Dor Pélvica/terapia , Períneo , Doença Crônica , Humanos , Nervo Obturador , Pelve/inervação
14.
Prog Urol ; 20(12): 1095-102, 2010 Nov.
Artigo em Francês | MEDLINE | ID: mdl-21056390

RESUMO

INTRODUCTION: Chronic pelvic and perineal pain is a common compliant due to a wide range of causes. The treatment strategy obviously depends on the identified aetiologies, which constitute the main target of treatment. However, pain often becomes self-perpetuating with time, generating and feeding on the social and functional consequences, resulting in a specific disease: chronic pain or pathological pain. OBJECTIVES: To define the place of drug treatment in the management of chronic pelvic and perineal pain. METHODS: Review of the literature devoted to drug treatments. RESULTS: Drugs have an inevitable place in the treatment strategy, but their role is poorly known and they are rarely completely effective. Drugs can only be part of the treatment of these syndromes and can only be prescribed in the context of a predefined strategy. Other treatment modalities are also available and often essential: physiotherapy, global management, TENS (transcutaneous electrical nerve stimulation), surgery, neuromodulation (peripheral, spinal cord, cortex stimulation, intrathecal infusion). As in chronic neuropathic pain, the analgesic drugs proposed in chronic pelvic and perineal pain mainly consist of tramadol, antidepressants and antiepileptics. CONCLUSION: The limited number of specific randomized clinical trials, the sometimes insufficient efficacy of drug treatments, associated with significant adverse effects, the very disabling nature of this disease, and the frequent need for off-label prescription indicate the need for effective multidisciplinary management.


Assuntos
Dor Pélvica/tratamento farmacológico , Períneo , Doença Crônica , Humanos
15.
Prog Urol ; 20(12): 1145-57, 2010 Nov.
Artigo em Francês | MEDLINE | ID: mdl-21056397

RESUMO

INTRODUCTION: Chronic postoperative pain has been defined as pain arising after a surgical operation, present for at least 2 months, with no organic (active cancer or chronic infection) or preexisting cause. The purpose of this article is to review the risk factors and prevention of chronic postoperative pelvic and perineal pain. MATERIAL AND METHODS: A review of the literature was performed by searching PubMed for articles on risk factors and prevention of chronic postoperative pelvic and perineal pain. RESULTS: Chronic postoperative pain is frequent, disabling and represent a high cost to the community. This pain is generated by variable and complex interactions between the surgical procedure (the operated zone, perioperative management, the disease requiring the operative procedure) and the patient (age, gender, genetics, concomitant diseases, personal history). The multifactorial nature of chronic postoperative pain suggests the need for multidisciplinary management with prevention and reduction of the main risk factors. Similarly, appropriate management of acute postoperative pain has a major impact on the risk of chronic pain. CONCLUSION: A good knowledge of the risk factors and appropriate prevention can decrease the incidence and consequences of chronic postoperative pain.


Assuntos
Dor Pós-Operatória/prevenção & controle , Dor Pélvica/prevenção & controle , Períneo , Doença Crônica , Humanos , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/epidemiologia , Dor Pós-Operatória/fisiopatologia , Dor Pélvica/diagnóstico , Dor Pélvica/epidemiologia , Dor Pélvica/fisiopatologia , Guias de Prática Clínica como Assunto , Fatores de Risco
16.
Neurochirurgie ; 55(4-5): 463-9, 2009 Oct.
Artigo em Francês | MEDLINE | ID: mdl-19748642

RESUMO

The pudendal is the king of the perineum. Most often originating in the S3 root, it is responsible for the teguments of the perineum (glans penis, clitoris, scrotum, and the labia majora, the skin of the central fibrous perineal body, anus), but also the erector muscles and the striated sphincters. The social nerve, it controls erection and the voluntary sphincters. It is also the nerve of the beginnings of sexual sensation and masturbation. Its injury is expressed in perineal pain, which, when positional, suggests a tunnel syndrome. The compression points have become well known: ligament pinching between the sacrotuberous and sacrospinous ligaments, the falciform process and the pudendal canal (Alcock canal). The data from questioning the patient, the results of the neurological exam, and the at least momentary response to infiltration define the Nantes criteria, which confirm the diagnosis. Treatment is medical, physical therapy, infiltration, and, as a last resort, surgery. The results have improved because of new technical norms, with 75% of operated patients benefiting from surgery. This disorder has become well known and should be remembered, thus sparing the patient from years of suffering and needless consultations for patients who do not present with organ disease, too often implicated instead of a true canal neuropathy, whose clinical manifestation and treatment have now been validated.


Assuntos
Períneo/inervação , Nervos Periféricos/anatomia & histologia , Doenças do Sistema Nervoso Periférico/patologia , Eletrodiagnóstico , Humanos , Plexo Lombossacral/anatomia & histologia , Síndromes de Compressão Nervosa/patologia , Síndromes de Compressão Nervosa/fisiopatologia , Exame Neurológico , Procedimentos Neurocirúrgicos , Períneo/patologia , Nervos Periféricos/fisiopatologia , Nervos Periféricos/cirurgia , Doenças do Sistema Nervoso Periférico/fisiopatologia , Doenças do Sistema Nervoso Periférico/cirurgia , Raízes Nervosas Espinhais/patologia , Raízes Nervosas Espinhais/fisiopatologia
17.
Neurochirurgie ; 55(4-5): 470-4, 2009 Oct.
Artigo em Francês | MEDLINE | ID: mdl-19744676

RESUMO

In addition to the well-established syndrome of pudendal compression, and given the rich nerve trunk innervation of the perineum, pain originating in other nerve trunks can occur and must be remembered. Nerves originating high in the thoracolumbar area (ilioinguinal nerve, iliohypogastric nerve, genitor femoral nerve) can be the seat of traumatic lesions occurring during surgical approaches through the abdominal wall or can undergo compressions when crossing the fascia of the large abdominal muscles. Misleading perineal irradiations do not resemble pudendal neuralgia and should suggest pain in these trunks whose cutaneous territories are not solely perineal and whose clinical expression as pain is does not occur in the seated position. Similarly, painful minor intervertebral dysfunction of the thoracolumbar junction is not simply in the mind and should be considered, searched for, and treated. Related more to pudendal neuralgia, pain in the inferior cluneal nerve, triggered by the seated position, should be considered when the pain reaches the lateral anal region, the scrotum, or the labia majora but not involving the glans penis or the clitoris. Specific treatments (physical therapy, infiltrations, surgery) have proven effective.


Assuntos
Dor/etiologia , Períneo , Doenças do Sistema Nervoso Periférico/complicações , Feminino , Doenças dos Genitais Femininos/etiologia , Doenças dos Genitais Femininos/patologia , Doenças dos Genitais Femininos/cirurgia , Doenças dos Genitais Masculinos/etiologia , Doenças dos Genitais Masculinos/patologia , Doenças dos Genitais Masculinos/cirurgia , Genitália/inervação , Humanos , Masculino , Dor/diagnóstico , Dor/patologia , Dor/cirurgia , Doenças do Sistema Nervoso Periférico/diagnóstico , Doenças do Sistema Nervoso Periférico/patologia , Doenças do Sistema Nervoso Periférico/cirurgia
18.
Neurochirurgie ; 55(4-5): 459-62, 2009 Oct.
Artigo em Francês | MEDLINE | ID: mdl-19744678

RESUMO

Confusion between radicular and nerve trunk syndrome is not rare. With sciatic pain, any nerve trunk pain or an atypical nerve course should suggest nerve trunk pain of the sciatic nerve in the buttocks. The usual reflex with sciatic pain is vertebral-radicular conflict. The absence of spinal symptoms and the beginning of pain in the buttocks and not in the lumbar region should reorient the etiologic search. Once a tumor of the nerve trunk has been ruled out (rarely responsible for pain other than that caused by tumor pressure), a myofascial syndrome should be explored searching for clinical, electrophysiological, and radiological evidence of compression of the sciatic trunk by the piriform muscle but also the obturator internus muscle. Hamstring syndrome may be confused with this syndrome. Treatment is first and foremost physical therapy. Failures can be treated with classical CT-guided infiltrations with botulinum toxin. Surgery should only be entertained when all these solutions have failed.


Assuntos
Nádegas , Ciática/patologia , Nádegas/inervação , Nádegas/patologia , Diagnóstico Diferencial , Humanos , Dor/diagnóstico , Dor/etiologia , Dor/patologia , Traumatismos dos Tendões/diagnóstico , Traumatismos dos Tendões/patologia
19.
Prog Urol ; 19(6): 420-6, 2009 Jun.
Artigo em Francês | MEDLINE | ID: mdl-19467462

RESUMO

AIMS: Obturator neuralgia is a pain which is ill-defined and particularly less well-known to practitioners. Here we report on the etiologies, the treatment and the results of conservative laparoscopic treatment by neurolysis of the obturator nerve in cases of obturator neuralgia. PATIENTS AND METHOD: Thirteen patients (15 nerves) who had obturator neuralgia have been treated in our service since 2005. The etiologies were idiopathic (four cases), following surgery for an inguinal hernia (two cases), trauma of the pelvis (one case), a TVT strip (three cases) and a TOT strip (three cases). The diagnosis was based on the pain, which was neuropathic, of the antero-internal side of the thigh. It was confirmed under block anesthetic by tomodensitometry using a posterior approach. The treatment consisted of laparoscopic neurolysis. RESULTS: The patients suffered pain measured at a rate of 8/10 on the visual analogical scale before the operation. In each case, neurolysis was carried out by transperitoneal laparoscopy by dissecting the nerve and sectionning the scarring fibrosis where the prothesis was in contact. In the idiopathic cases, the liberation of the nerve was carried out by a section of the internal obturator muscle and of the obtured membrane, allowing for the blocked canal to be widened. Seventeen months later, a rate of improvement of at least 50% of pain was found in 77% of cases (10/13), of whom pain had totally disappeared in 54% of cases (7/13). There was no improvement at all for 23% of cases (3/13). CONCLUSION: The mini-invasive conservative treatment of obturator neuralgia by laparascopic neurolysis of the obturator nerve, after confirmed diagnosis by selective infiltration allowed for a rate of 75% of improvement to be obtained after a period of 17 months.


Assuntos
Laparoscopia , Neuralgia/cirurgia , Nervo Obturador/cirurgia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neuralgia/etiologia , Medição da Dor
20.
Adv Tech Stand Neurosurg ; 32: 41-59, 2007.
Artigo em Inglês | MEDLINE | ID: mdl-17907474

RESUMO

Perineal pain is the basis of presentation to different specialities. This pain is still rather unknown and leads the different teams to inappropriate treatments which may fail. For more than twenty years, we have seen these patients in a multidisciplinary consultation. Our anatomical works have provided a detailed knowledge of the nervous supply of the perineum which allowed us to propose the description of an entrapment syndrome of the pudendal nerve. Other disturbances of different origins were highlighted helping colleagues to a better analysis of this enigmatic painful syndrome. Cadaveric studies have been done to guide treatments by blocks and surgery if necessary according to well defined criteria. A randomized prospective study validated the surgery. The retrospective study concluded that two thirds of the patients improved after treatment. New anatomical concepts are leading us to enlarge the field of this type of surgery, with the hope of improving the success rate.


Assuntos
Síndromes de Compressão Nervosa/cirurgia , Neuralgia/cirurgia , Procedimentos Neurocirúrgicos/métodos , Períneo , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Síndromes de Compressão Nervosa/complicações , Síndromes de Compressão Nervosa/patologia , Neuralgia/etiologia , Neuralgia/patologia , Estudos Retrospectivos , Resultado do Tratamento
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