ABSTRACT
Urinary incontinence is a common complication following radical prostatectomy, as the surgery disturbs critical anatomical structures. This study explored how pudendal nerve (PN) injury affects urinary continence in male rats. In an acute study, leak point pressure (LPP) and external urethral sphincter electromyography (EMG) were performed on six male rats with an intact urethra, the urethra exposed (UE), the PN exposed (NE), and after PN transection (PNT). In a chronic study, LPP and EMG were tested in 67 rats 4 days, 3 weeks, or 6 weeks after sham PN injury, PN crush (PNC), or PNT. Urethras were assessed histologically. Acute PNT caused a significant decrease in LPP and EMG amplitude and firing rate compared to other groups. PNC resulted in a significant reduction in LPP and EMG firing rate 4 days, 3 weeks, and 6 weeks later. EMG amplitude was also significantly reduced 4 days and 6 weeks after PNC. Neuromuscular junctions were less organized and less innervated after PNC or PNT at all timepoints compared to sham injured animals. Collagen infiltration was significantly increased after PNC and PNT compared to sham at all timepoints. This rat model could facilitate preclinical testing of neuroregenerative therapies for post-prostatectomy incontinence.
Subject(s)
Peripheral Nerve Injuries , Pudendal Nerve , Urinary Incontinence, Stress , Urinary Incontinence , Male , Rats , Animals , Urinary Incontinence, Stress/etiology , Urinary Incontinence, Stress/pathology , Rats, Sprague-Dawley , Pudendal Nerve/pathology , Disease Models, Animal , Peripheral Nerve Injuries/complications , Urinary Incontinence/complicationsABSTRACT
La coccigodinia es un síndrome que se presenta con frecuencia en las consultas de Reumatología en forma de dolor en punta terminal del coxis, empeorando habitualmente al sentarse. Aunque la causa más frecuente es la postraumática local, existen diversas causas de dolor en el coxis. Presentamos un caso inhabitual en el que la coccigodinia comenzó poco después de instaurar un sistema de anticoncepción por anillo vaginal y remitió completamente al retirar este sistema (AU)
Coccydynia is a syndrome that rheumatologists encounter frequently in the form of tailbone pain, which is usually worse when sitting. Although the most common origin is trauma, there are several other possible causes of pain in the coccyx. We present an unusual case in which coccydynia developed shortly after the insertion of a contraceptive vaginal ring and remitted completely upon removal of this system (AU)
Subject(s)
Humans , Female , Adult , Contraceptive Devices, Female/adverse effects , Pain/complications , Joint Instability/complications , Pudendal Nerve/pathology , Coccyx/injuries , Pelvic Floor/injuries , Pelvic Floor/pathology , Diagnosis, DifferentialABSTRACT
La neuralgia del pudendo es una causa infradiagnosticada de dolor neuropático en la zona perineal. Se produce a raíz del atrapamiento del nervio pudendo en algún punto de su trayecto. Su diagnóstico de sospecha es fundamentalmente clínico y se confirma mediante electromiografía y/o la mejoría tras infiltraciones perineurales. El tratamiento recomendado es inicialmente conservador y, si fracasa, quirúrgico. La rehabilitacio¿n tanto precirugía como después de la intervención quirúrgica tiene un papel importante en esta patología, aunque la pauta a seguir no está bien establecida. Como médicos rehabilitadores debemos tener en cuenta el atrapamiento del nervio pudendo como posible causa de dolor crónico en la región genital. Presentamos los casos de 2 pacientes diagnosticadas de neuralgia del pudendo que fueron derivadas a nuestra consulta de rehabilitación ambulatoria para valoración de tratamiento (AU)
Pudendal neuralgia is an underdiagnosed cause of neuropathic pain in the perineal area. It is caused by pudendal nerve entrapment at some point. Diagnosis is mainly clinical, and confirmation is by electromyography and/or improvement after perineural infiltration. The recommended treatment is initially conservative and, if unsuccessful, surgery can be performed. Pre- and post-surgical rehabilitation plays an important role in this disease, although there is still no well-established protocol. Specialists in physical medicine and rehabilitation should consider pudendal nerve entrapment as a cause of chronic pain in the genital region. We present the cases of two patients diagnosed with pudendal neuralgia who were referred to our clinic for treatment evaluation (AU)
Subject(s)
Humans , Female , Adult , Middle Aged , Pudendal Nerve/pathology , Neuralgia/complications , Neuralgia/rehabilitation , Neuralgia/therapy , Electromyography/instrumentation , Electromyography/methods , Electromyography , Pain Management/methods , Pain Management/trends , Massage/methods , Tomography/methods , Muscle Stretching Exercises/methods , Muscle Stretching Exercises/trends , Electric Stimulation Therapy/instrumentation , Electric Stimulation Therapy/methods , Electric Stimulation TherapyABSTRACT
Objetivo. Presentar un algoritmo de manejo del dolor perineal crónico severo con sospecha de neuralgia del trigémino. Casos. Se presentan 3 casos clínicos con etiología y evolución clínica diversa. Discusión. Análisis de los criterios diagnósticos y tratamientos vigentes. Evaluación de los casos a la luz del algoritmo de diagnóstico y tratamiento propuesto (AU)
Objective. To describe a new algorithm for the management of severe chronic perineal pain/pudendal neuralgia. Cases. We report 3 clinical cases with different etiologies and outcomes. Discussion. We analyze the diagnostic criteria and treatments and evaluate the rational management of these patients according to the algorithm (AU)