ABSTRACT
Osteitis pubis is a rare, inflammatory condition involving the pubic symphysis. While osteitis pubis has been reported following many urological procedures, including those addressing bladder outlet obstruction such as transurethral resection of the prostate, it has never been reported after holmium laser enucleation of the prostate (HoLEP). Here, we detail the clinical course of a patient found to have osteitis pubis following HoLEP. This patient presented several weeks after surgery with non-specific, persistent symptoms of groin pain and difficulty ambulating, alerting our clinicians to consider osteitis pubis which was confirmed on MRI of the pelvis. While the majority of osteitis pubis cases are managed with locally invasive techniques, our patient's symptoms were successfully managed conservatively with Foley catheter placement, oral antibiotics and close follow-up. At 9 months postoperative, the patient has reported complete resolution of symptoms and continues to be followed closely.
Subject(s)
Arthritis , Laser Therapy , Lasers, Solid-State , Osteitis , Prostatic Hyperplasia , Transurethral Resection of Prostate , Male , Humans , Osteitis/diagnostic imaging , Osteitis/etiology , Pubic Bone/diagnostic imaging , Prostate , Lasers, Solid-State/therapeutic use , Arthritis/surgery , Laser Therapy/adverse effects , Treatment Outcome , Prostatic Hyperplasia/surgeryABSTRACT
ABSTRACT: Osteitis pubis is a common source of groin pain in athletes participating in sports requiring kicking, twisting, and pivoting movements. Athletes will present with progressive pain or discomfort in the pubic area or groin. There is usually point tenderness over the pubic symphysis and pain localizing to the adductor or rectus abdominis tendons. Conservative management often includes activity modification, oral medications, progressive rehabilitation, therapeutic ultrasound, steroid injections, and prolotherapy. Osteitis pubis can be refractory to conservative management and can keep an athlete sidelined for as long as 2 years. Platelet-rich plasma (PRP) injections have been used for pubic symphysis pain, but reports have focused on pathology affecting the rectus abdominis or hip adductor muscle tendons. In this article, we present a case of isolated osteitis pubis, without overlapping rectus abdominis or adductor tendon involvement, successfully treated with an ultrasound-guided PRP injection of the fibrocartilage.
Subject(s)
Athletic Injuries , Osteitis , Platelet-Rich Plasma , Athletic Injuries/complications , Athletic Injuries/diagnostic imaging , Athletic Injuries/therapy , Groin , Humans , Osteitis/diagnostic imaging , Osteitis/etiology , Osteitis/therapy , Pain , Pubic BoneABSTRACT
STUDY DESIGN: Case Report. BACKGROUND: Groin pain in athletes is considered a common condition among males participating in sports that require sprinting, twisting, pivoting and kicking activities. While the condition is considered self-limiting, it often keeps athletes away from sport for a prolonged period of time. Much controversy exists regarding the pathogenesis of groin pain. This conflict translates to disagreement regarding diagnostic criteria, reporting and management strategies. CASE PRESENTATION: a 28-year old recreational soccer player presented with a five-month history of groin pain that was resistant to passive care. With reference to the current conservative management literature, the athlete was progressed through an individualized multimodal program of care. OUTCOMES: Following 10-weeks of care, the athlete was able to return to sport participation pain-free. CONCLUSION: It is suggested that groin pain in athletes is likely multifactorial and therefore the management should reflect its multifactorial nature. Conservative therapy can evidently reduce the time to return to play however the benefits of incorporating plyometrics into the rehabilitation program should be investigated.
Subject(s)
Athletic Injuries , Groin , Adult , Athletes , Athletic Injuries/therapy , Humans , Male , Pelvic Pain/etiology , Pelvic Pain/therapy , Pubic BoneABSTRACT
Osteitis pubis is a rare but known complication of multiple urological procedures including transurethral resection of the prostate, prostate cryotherapy, photovaporisation of the prostate, high-intensity focused ultrasound treatment of the prostate, prostatectomy and cystectomy, especially in the context of salvage therapy for prostate cancer. Patients can present with significant often intractable pain secondary to this condition. We report a case of a patient with a history of radiation therapy and salvage cryoablation who presented with osteitis pubis, calcification of the prostatic tissue bed which was inseparable from the pubic symphysis. Treatment with salvage holmium laser enucleation of the prostate and holmium lithotripsy was demonstrated to be effective for palliative management of osteitis pubis from prostatic calcification ossifying into the pubic symphysis.
Subject(s)
Osteitis , Pubic Symphysis , Transurethral Resection of Prostate , Humans , Male , Prostate , Pubic Bone , Pubic Symphysis/diagnostic imagingABSTRACT
Pubic osteomyelitis is a rare and often late-onset complication of radiation therapy and surgery for vulvar and vaginal carcinoma. It typically presents with vulvar pain, fever, vaginal discharge and/or gait disorders. Pubic osteomyelitis is often accompanied by fistulas or wound dehiscence in the pelvic area. Its accurate diagnosis and treatment are challenging and require a multidisciplinary team effort. In our patients, multiple combined surgical procedures, long-term antibiotic treatment and days to weeks of hospital admission were necessary to treat pubic osteomyelitis. We emphasise the importance of timely and adequate diagnosis and multidisciplinary approach resulting in a course of treatment that is as effective as possible, limiting the impact on quality of life, which is generally high in this group of patients.
Subject(s)
Carcinoma/therapy , Chemoradiotherapy, Adjuvant/adverse effects , Osteomyelitis/therapy , Radiation Injuries/therapy , Surgical Wound/therapy , Vulvar Neoplasms/therapy , Adult , Anti-Bacterial Agents/therapeutic use , Arthrodesis , Bone Transplantation , Carcinoma/pathology , Female , Humans , Leeching , Magnetic Resonance Imaging , Middle Aged , Osteomyelitis/diagnosis , Osteomyelitis/etiology , Patient Care Team , Pubic Bone/diagnostic imaging , Pubic Bone/radiation effects , Pubic Bone/surgery , Radiation Injuries/diagnosis , Radiation Injuries/etiology , Sacroiliac Joint/diagnostic imaging , Sacroiliac Joint/radiation effects , Sacroiliac Joint/surgery , Skin Transplantation , Surgical Wound/complications , Treatment Outcome , Vulva/pathology , Vulva/surgery , Vulvar Neoplasms/pathologyABSTRACT
AIM: This study aimed to compare the prevalence of pelvic musculoskeletal dysfunctions in women with and without Chronic Pelvic Pain (CPP). MATERIALS &METHODS: A total of 84 women with and without CPP (42 in each group), participated in this cross-sectional analytical study. After collecting demographic information, clinical examinations were carried out to compare pelvic musculoskeletal dysfunctions between two groups. Kolmogorov-Smirnov (K-S) goodness-of-fit, Independent t, X2 and Pearson correlation tests were used for data analysis. Values of p < 0.05 were considered statistically significant. FINDINGS: Significant differences were found in the asymmetric iliac crest and pubic symphysis height (45.2% vs 9.5%), positive sacroiliac provocation and positive Carnett's tests (50% vs 4.8%), (p < 0.05). CPP Patients exhibited more tenderness at Levator ani, Piriformis, and Obturator Internus muscles, also higher degrees of pelvic inclination (p < 0.05). CONCLUSION: Higher frequency of pelvic musculoskeletal dysfunctions in women with CPP suggests the value of routine musculoskeletal examinations for earlier diagnosis of musculoskeletal originated CPP and effective management of these patients.
Subject(s)
Chronic Pain/physiopathology , Musculoskeletal Diseases/physiopathology , Pelvic Pain/physiopathology , Adult , Chronic Pain/epidemiology , Cross-Sectional Studies , Female , Humans , Ilium/physiopathology , Middle Aged , Musculoskeletal Diseases/epidemiology , Pain Measurement , Pelvic Floor/physiopathology , Pelvic Pain/epidemiology , Pubic Bone/physiopathology , Young AdultABSTRACT
Transurethral resection of the prostate (TURP) surgery is standard treatment for symptomatic benign prostatic hyperplasia when medical therapy has failed. We describe a rare case of osteitis pubis secondary to a prostato-symphocoele sinus after standard bipolar TURP surgery. We also discuss diagnostic techniques and management strategies, and provide an insight into the aetiology of this rare phenomenon. Conservative management with intravenous antibiotics and an indwelling catheter was successful in our case. Treatment in more severe cases may include laparotomy with peritoneal or omental interposition or open retropubic radical prostatectomy to remove the entire sinus tract.
Subject(s)
Osteitis , Prostatic Hyperplasia/surgery , Transurethral Resection of Prostate , Anti-Bacterial Agents/therapeutic use , Diagnosis, Differential , Doxycycline/therapeutic use , Humans , Magnetic Resonance Imaging , Male , Osteitis/diagnosis , Osteitis/drug therapy , Osteitis/etiology , Postoperative Complications , Pubic Bone , Transurethral Resection of Prostate/methods , Trimethoprim, Sulfamethoxazole Drug Combination/therapeutic use , Urinary Catheterization , Vancomycin/therapeutic useABSTRACT
PURPOSE: Pubic symphysitis (PS) after urological operations is uncommon. This is a systematic single-institution review of patients with transurethral resection of the prostate (TUR-P) with the aim to determine the incidence of PS after TUR-P and to identify a risk profile. MATERIALS AND METHODS: In the past 15 years, 12,118 transurethral operations were performed in our department, 33.4% (n = 4045) were TUR-P, and 84.6% (n = 3421) had routine suprapubic trocar placement. A systematic retrospective analysis identified 12 patients, who developed PS (0.297%). RESULTS: Median age was 69.5 years (64-83). All patients had voiding difficulties. Urine culture had been positive in three cases. All 12 TUR-Ps were monopolar resections, and n = 11 patients had a suprapubic trocar. Median resection weight was 47.5 g (10-100). Two patients had a perforation of the capsule. Histopathological examination revealed chronic prostatitis in nine cases. After 1.0 ± 1.2 months, all patients developed pain in the pubic region. All patients underwent MRI, which suggested PS. Symptomatic and antibiotic medications were administered. Final outcome was resolution of symptoms in all patients after 3.8 ± 5.6 months. No patient retained voiding difficulties. CONCLUSION: PS remains a rare complication after TUR-P. We could not identify a single cause for developing PS. In our study, suprapubic trocar placement (11/12), chronic prostatic inflammation (9/12), previous UTI (3/12) and extended resection (2/12) were overrepresented. Inflammatory, thermic and/or surgical damage of the capsule may be causative. Patients require antibiotic and symptomatic medication. However, prognosis for remission is excellent.
Subject(s)
Osteitis/epidemiology , Postoperative Complications , Prostatic Diseases/surgery , Pubic Bone , Transurethral Resection of Prostate/adverse effects , Aged , Aged, 80 and over , Germany/epidemiology , Humans , Incidence , Magnetic Resonance Imaging , Male , Middle Aged , Osteitis/diagnosis , Osteitis/etiology , Retrospective StudiesABSTRACT
Osteitis pubis among soccer athletes is a disabling painful condition and it is difficult to manage without integrating a multimodal treatment approach. There is limited scientific evidence on the effectiveness of exercise in treating Osteitis pubis especially when it progress to a chronic painful condition. The purpose of this case report is to discuss the successful multimodal physiotherapeutic management for a 15-year old soccer athlete diagnosed with stage-IV Osteitis pubis. Land and water based active core muscle strengthening exercises, Proprioceptive neuromuscular facilitation techniques (PNF) and Manual Therapy are some of the essential components incorporated in multimodal intervention approach with emphasis to water based strength and endurance training exercises. The athlete was able to make progress to a successful recovery from his chronic painful condition and accomplished the clearly established clinical outcomes during each phase of rehabilitation.
Subject(s)
Athletes , Osteitis/therapy , Physical Therapy Modalities , Pubic Bone , Severity of Illness Index , Soccer , Adolescent , Combined Modality Therapy , Exercise Therapy , Humans , Male , Muscle Strength/physiology , Musculoskeletal Manipulations , Osteitis/rehabilitation , Treatment OutcomeABSTRACT
Athletic osteitis pubis is a painful and chronic condition affecting the pubic symphysis and/or parasymphyseal bone that develops after athletic activity. Athletes with osteitis pubis commonly present with anterior and medial groin pain and, in some cases, may have pain centred directly over the pubic symphysis. Pain may also be felt in the adductor region, lower abdominal muscles, perineal region, inguinal region or scrotum. The pain is usually aggravated by running, cutting, hip adduction and flexion against resistance, and loading of the rectus abdominis. The pain can progress such that athletes are unable to sustain athletic activity at high levels. It is postulated that osteitis pubis is an overuse injury caused by biomechanical overloading of the pubic symphysis and adjacent parasymphyseal bone with subsequent bony stress reaction. The differential diagnosis for osteitis pubis is extensive and includes many other syndromes resulting in groin pain. Imaging, particularly in the form of MRI, may be helpful in making the diagnosis. Treatment is variable, but typically begins with conservative measures and may include injections and/or surgical procedures. Prolotherapy injections of dextrose, anti-inflammatory corticosteroids and a variety of surgical procedures have been reported in the literature with varying efficacies. Future studies of athletic osteitis pubis should attempt to define specific and reliable criteria to make the diagnosis of athletic osteitis pubis, empirically define standards of care and reduce the variability of proposed treatment regimens.
Subject(s)
Athletic Injuries , Cumulative Trauma Disorders , Osteitis , Pubic Symphysis , Athletic Injuries/diagnosis , Athletic Injuries/epidemiology , Athletic Injuries/etiology , Athletic Injuries/therapy , Cumulative Trauma Disorders/diagnosis , Cumulative Trauma Disorders/epidemiology , Cumulative Trauma Disorders/etiology , Cumulative Trauma Disorders/therapy , Diagnosis, Differential , Groin , Humans , Magnetic Resonance Imaging , Osteitis/diagnosis , Osteitis/epidemiology , Osteitis/etiology , Osteitis/therapy , Pain/etiology , Pubic BoneSubject(s)
Conjunctivitis/drug therapy , Conjunctivitis/parasitology , Emollients/therapeutic use , Eyelashes/parasitology , Petrolatum/therapeutic use , Phthirus , Administration, Topical , Adult , Animals , Emollients/administration & dosage , Female , Hair , Humans , Petrolatum/administration & dosage , Pubic BoneABSTRACT
No disponible
Subject(s)
Humans , Male , Aged , Relapsing Fever/etiology , Osteitis/diagnosis , Pubic Bone/pathology , Postoperative Complications/diagnosis , Transurethral Resection of Prostate/adverse effectsABSTRACT
OBJECTIVE: To show, using a laboratory model, the inherent problems and test the validity of viewing actual pubis symphysis misalignment via plain film radiography in humans. STUDY DESIGN: In vitro experiment of pubic bone and pubis symphysis model alignment as determined through projected imaging with collimated light. RESULTS: The shadows cast by plastic models did not accurately reflect the physical reality. The image representations of the pubic bones with significant misalignment appeared as "normal." Some of the misalignments were viewed in the exact opposite alignment on the projected image as compared with the physical reality. CONCLUSIONS: This study provides evidence that misalignment of the pubic bones cannot be reliably viewed on a standard anteroposterior lumbopelvic radiograph. The results show the potential for missed diagnoses of clinical significance. Additional research on pelvic joint dysfunction and imaging problems is needed.
Subject(s)
Arthrography , Joint Instability/diagnostic imaging , Models, Anatomic , Pubic Bone/diagnostic imaging , Pubic Symphysis/diagnostic imaging , Arthrography/standards , HumansABSTRACT
El objetivo del presente artículo es el estudio de la fisiología de la pubertad femenina, con descripción del concepto de pubertad, su cronología, las etapas del desarrollo puberal y los cambios hormonales que acontecen desde la lactancia a la niñez, en la prepubertad y en la pubertad
The aim of this review is the study of female puberty physiology with the description of the puberty concept, its chronology, the several stages of puberty development, and the hormonal changes in the different stages
Subject(s)
Female , Adolescent , Humans , Puberty/physiology , Sexual Maturation/physiology , Fertility/physiology , Hormones/physiology , Hypothalamo-Hypophyseal System/physiology , Breast/physiology , Gonadotropins/physiology , Estrogens/physiology , Menarche/physiology , Puberty, Precocious/physiopathology , Hypothalamus/physiology , Pubic Bone/growth & development , Pubic Bone/physiology , Glycoprotein Hormones, alpha Subunit/physiologyABSTRACT
No disponible
Subject(s)
Humans , Osteitis/complications , Osteomyelitis/complications , Pubic Bone/physiopathologyABSTRACT
No disponible
Subject(s)
Female , Male , Humans , Bone Diseases/prevention & control , Pubic Bone/injuries , Primary Prevention/methods , Athletic Injuries/prevention & controlABSTRACT
A 47-year-old woman suffered from gait disturbance due to back pain and muscle weakness. Laboratory data showed serum hypophosphatemia, elevated alkaline phosphatase, and a normal level of ionized calcium. Radiological examinations revealed multiple pathologic fractures in the ribs and pubic rami. She had had no episode of familial or any other notable disorder, and so she was initially treated with medication for adult-onset osteomalacia. However, 19 years later (when she was 66 years old), she noticed a soft-tissue tumor in her buttock. The tumor was excised. The histological features were those of glomangiopericytoma characterized by both glomus tumor-like and hemangiopericytoma-like structures. After removal of the tumor, her symptoms disappeared immediately. Laboratory data normalized 8 months later. To our knowledge, this is the first report of oncogenic osteomalacia caused by glomangiopericytoma.
Subject(s)
Buttocks , Fractures, Spontaneous/diagnostic imaging , Fractures, Spontaneous/etiology , Glomus Tumor/complications , Glomus Tumor/pathology , Hemangiopericytoma/complications , Hemangiopericytoma/pathology , Osteomalacia/diagnosis , Osteomalacia/etiology , Pubic Bone/injuries , Rib Fractures/diagnostic imaging , Rib Fractures/etiology , Soft Tissue Neoplasms/complications , Soft Tissue Neoplasms/pathology , Aged , Alkaline Phosphatase/blood , Back Pain/etiology , Biopsy , Calcium/blood , Female , Glomus Tumor/blood , Glomus Tumor/surgery , Hemangiopericytoma/blood , Hemangiopericytoma/surgery , Humans , Immunohistochemistry , Muscle Weakness/etiology , Phosphorus/blood , Radiography , Soft Tissue Neoplasms/blood , Soft Tissue Neoplasms/surgeryABSTRACT
OBJECTIVE: To discuss the case of a patient with a pelvic stress fracture and the differential considerations among patients presenting with hip and/or groin pain. FEATURES: A 42-year-old woman had hip pain after running. Initial radiograph of the pelvis was negative. Subsequent films showed a right inferior pubic ramus stress fracture. Stress fractures of the pelvis are relatively uncommon, accounting for only 1% to 2% of all stress fractures. INTERVENTION AND OUTCOME: Treatment included high-velocity, low-amplitude chiropractic manipulation, ultrasound, and stretching of the psoas and piriformis muscles. After 8 weeks, care was discontinued because the patient's hip pain had resolved. The pelvic fracture was left to heal with time. After 1 year, the patient still had delayed union of the fracture. CONCLUSION: When predisposing factors are present, such as osteoporosis and rheumatoid arthritis, pelvic stress fracture should be suspected in patients with groin or hip-area pain. However, because pelvic stress fractures are relatively rare, radiographic studies are often postponed, making diagnosis difficult.
Subject(s)
Fractures, Stress/diagnostic imaging , Manipulation, Spinal , Pelvic Pain/therapy , Pubic Bone/injuries , Adult , Chiropractic/methods , Diagnosis, Differential , Female , Fractures, Stress/complications , Humans , Pelvic Pain/etiology , Pubic Bone/diagnostic imaging , Radiography , Radionuclide Imaging , Risk Factors , Running/injuriesSubject(s)
Pneumatosis Cystoides Intestinalis/diagnosis , Precursor Cell Lymphoblastic Leukemia-Lymphoma/complications , Subcutaneous Emphysema/diagnosis , Vulva , Female , Humans , Hyperbaric Oxygenation , Infant , Pneumatosis Cystoides Intestinalis/complications , Pneumatosis Cystoides Intestinalis/therapy , Pubic Bone , Radiography, Abdominal , Subcutaneous Emphysema/complications , Tomography, X-Ray ComputedABSTRACT
This article considers the issue of suprapubic catheterization and the subsequent care of the client. The conditions and situations where suprapubic catheterization may be used are outlined. A review of the literature on this important subject suggests that there is little research/evidence-based practice to support some current-day practices. The review addresses such issues as what suprapubic catheterization is and how it is carried out. Key issues such as avoidance of infection, the need for dressings and care of the insertion site are discussed. In particular, the gynaecological field is explored to highlight concern about variations and discrepancies in approaches to care of the patient with a suprapubic catheter in situ. Finally, a call is made for practitioners to base their care on research findings or evidence-based practice rather than tradition, ritual or heresy.