[Anatomical basis for perineal pain].
Explore the source record for details and available documents.
Brain↗
Biomedical subjects
J J Labat
Publications and source records attributed to J J Labat.
Anatomic basis of chronic perineal pain: role of the pudendal nerve.
Our anatomic findings have led us to define conflictual relations that may be encountered in their course by the pudendal n. and its branches. Starting from the clinical study of a group of patients suffering from chronic perineal pain in the seated position, we have defined, beginning with the cadaver, three possible conflictual settings: in the constriction between the sacrotuberal and sacrospinal ligaments; in the pudendal canal of Alcock; and during the straddling of the falciform process of the sacro-tuberal ligament by the pudendal n. and its branches. Consequently, considering so-called idiopathic perineal pain as an entrapment syndrome, the clinical and neurophysiologic arguments and infiltration tests have led us to define a surgical strategy which has currently given 70% of good results in 170 operated patients. Earlier diagnosis should improve on this.
Cadaver↗
[Bladder-sphincter disorders in patients with spinal cord injuries].
Improvement in the management of neuropathic bladders in spinal cord injury has considerably increased the life expectancy of these patients. The classical classification in central or peripheric neuropathic bladders, now leave place to a functional, clinical, and urodynamic classification. Three periods define the evolution of the neuropathic bladders: the initial period (drainage), the reeducation phase, and the stabilized period. Urodynamic investigations detect situations of risk (high intravesical pressures) and allow therapeutic adjustment. Intermittent catheterization has transformed neuro-urology and allowed deliberate choice of retention. Long term follow up is imperative (urodynamic study, echography, intravenous urography) to avoid secondary degradation.
Humans↗
Clean intermittent catheterisation from the acute period in spinal cord injury patients. Long term evaluation of urethral and genital tolerance.
Since its introduction by Lapides, clean intermittent catheterisation (CIC) has dramatically changed the urological management of spinal cord injury (SCI) patients. Since 1978 we have used CIC as a mode of drainage in the acute period, during the period of bladder retraining as a measurement of residual urine, and in some instances in the medium and long term. 12-14 Fr PVC catheters are used with lubricant. The objectives of this study were: first, in a population of 159 SCI patients (group 1), to evaluate the overall incidence of complications of CIC; Secondly to study two groups of patients: group 2 (n = 8) consisted of patients who had performed CIC for over 2 years before discontinuance; group 3 (n = 21) consisted of patients on CIC for over 5 years (mean length of use: 9.5 years). The reasons for acceptance of long term CIC, frequency of urinary tract infections, and rates of urethral strictures were evaluated. The analysis of group 1 showed a rate of lower urinary tract infection of 28% and of cytobacteriological infection of 60%. Chronic pyelonephritis was never observed and infection was always confined to the lower urinary tract which is in accordance with other studies. The rate of epididymitis and urethral stricture was 10% and 5.3% respectively. Sixty two per cent of group 2 remained incontinent, and 89% of group 3 showed a satisfactory degree of continence. The first factor for acceptance of long term CIC is continence, the second one is the ability to perform CIC independently. In group 3 we found a rate of urethral stricture of 19%, and of epidydimitis of 28.5%. These two complications (urethral tolerance and urethroprostatic infection) increased with the number of years on CIC. The method and the type of catheters used must also be considered. We need further studies of long term CIC in patients using non-reusable hydrophilic catheters from the acute period to see if these two complications can be prevented.
Acute Disease↗
[Frontal type dementia and amyotrophic lateral sclerosis. 3 cases with (HmPAO Tc99m) single-photon emission tomography study].
Three cases of rapid onset neuropsychological frontal dementia preceded the development of sporadic amyotrophic lateral sclerosis by 12 to 24 months. HmPAO Tc99m scintigraphy demonstrated hypoactivity in the cortex, predominantly in the frontal region. Three hypotheses are discussed: 1) coincidence between two degenerative diseases, Alzheimer's disease or Pick's disease and ALS; 2) an amyotrophic form of Creutzfeld Jakob disease; 3) pre-senile dementia associated with a motoneuron disease, a clinical pathology entity recently described by Mitzuyama.
Aged↗
[Prognosis and follow-up of neurogenic bladders. The essential contribution of urodynamics].
Explore the source record for details and available documents.
Follow-Up Studies↗
[Perineal pain and lesions of the internal pudendal nerves].
A number of chronic pain syndromes in the perineal area can be related to pudendal nerves suffering. The constancy of symptoms among various patients, and in duration for a particular one, alterations revealed by electrophysiologic studies, pain relief by diagnostic blocks, data from anatomic studies, preliminary results of medical and surgical applied therapies, give consistent arguments for possible organic lesions of pudendal nerves.
Female↗
[Essential perineal-scrotal pains].
Explore the source record for details and available documents.
Female↗
[Bibliography of a year in urodynamics and neuro-urology].
Explore the source record for details and available documents.
Aged↗
[Perineal pain and involvement of the internal pudendal nerves].
A number of chronic pain syndromes in the perineal area can be related to pudental nerves suffering. The constancy of symptoms among various patients, and in duration for a particular one, alterations revealed by electrophysiologic studies, pain relief by diagnostic blocks, data from anatomic studies, preliminary results of medical and surgical applied therapies, give consistent arguments for possible organic lesions of pudental nerves.
Chronic Disease↗
[Current urological management of traumatic paraplegia].
The management of patients with neurological dysfunctions of the bladder and the sphincter is considerably modified in recent years. The concept of "neurogenic bladder" has evolved due to new fundamental neurophysiological research following the advances of urodynamic investigations and medical imaging techniques as well as progress in drug therapy, surgical treatment and re-education. The current management of a traumatic paraplegia should therefore be prospective and must try to determine prognostic factors.
Combined Modality Therapy↗
[Neuralgia of the pudendal nerve. Anatomo-clinical considerations and therapeutical approach].
The anatomic study of the pudendal nerve and its relation allows an approach of the mechanisms of compression likely to engender perineal neuralgia. Two conflictual zones are isolated: the first is linked to the clamp which is produced by the insertion of the sacro-epinous ligament on the ischial spine and the sacro-tuberal ligament; the second is linked to the falciform process of the sacrotuberal which threatens the nerve by its sharp upper edge. This conflict is particularly acute in a sitting position. The relation between the trunk of the nerve, its branches and these zones of conflict may explain the clinical observations. The electrophysiological investigations (detection of neurogenic muscles of the perineal floor. Increased sacral latency, pudendal nerve terminal motor latency) confirm the diagnosis. The anesthetic blocks of the pudendal nerve on the ischial spine only have a complimentary diagnostic value. The peridural blocks may also have an interesting therapeutic action (60% of good results 3 months later). In some persistent cases, the nerve has been decompressed firstly by perineal approach, but latterly by transguteal approach.
Electrophysiology↗
[Clinical, neurophysiologic and therapeutic remarks from anatomic data on the pudendal nerve in some cases of perineal pain].
Clinical observations in patients suffering from positional perineal pain have led us to performing an anatomical study of the pudendal nerve in order to demonstrate compression of this nerve trunk by elements likely to compress it in the sitting position. Thus we observed that the falciform process of the sacrotuberous ligament may act in this way. Besides helping us to understand the clinical symptoms, this anatomical study allowed choosing the technique we found most appropriate for the anatomical conditions observed out of the various neurophysiological examinations described in the literature. Lastly, we describe the surgical technique that allows releasing the trunk of the pudendal nerve under an operating microscope.
Evoked Potentials, Somatosensory↗
[Ischemia of the anterior horn of the spinal cord].
Ischemia of the motoneurons in the anterior horn is a well known pathological entity. Their clinical signs and symptoms are similar to those of amyotrophic lateral sclerosis. Evidence by selective angiography of angiomas of the spinal cord or compression or deviation of Adamkiewicz artery may be suggestive of an initial vascular lesion. Various data (knowledge of development or lesions during experimental ischemia, selective electrophysiologic analysis of anterior horn neurons, evidence of precise circumstances of spinal vascular disorder or spinal arteriography) suggest that anterior horn ischemia is a multiple aspect phenomenon. Our 4 cases illustrate this hypothesis and demonstrate under confirmed vascular circumstances the different clinical aspects of anterior horn ischemic lesions. In addition to typical amyotrophic paralysis unusual or misleading symptoms may occur such as claudication, paroxysmal contractures or progressive spastic paraparesis. Investigations required and possible treatment of the lesions are simplified by awareness of these various clinical aspects.
Adolescent↗
[Changes in bladder contractility in spinal cord diseases].
Changes in bladder contractility were studied by repeated cystomanometry in 147 patients suffering from central medullary lesions of sudden onset, including 93 cases of spinal shock. The morphology of contraction was always modified in the same fashion though intermediate stages were apparent, some being quite characteristic of neurological dysfunction. This process, which ends in a phasic contraction reproduces the stages of ontogenesis. When contractions are present, but do not produce complete bladder emptying, spontaneous improvement is unlikely in the presence of a complete lesion; sphincterotomy should therefore be considered at an early stage.
Adolescent↗
[Long-term efficacy of anticholinergic and alpha-blockader drugs on the detrusor muscle in children with myelomeningocele].
Pharmacological agents, essentially anticholinergic and alpha-blocking drugs, occupy an important place in the stabilization of congenital neurogenic bladders. In actual fact, the functional characteristics of the detrusor, contractility, compliance and functional capacity, are important factors in the prognosis of these neurogenic bladders, both for the future of the upper urinary tract and for the possibilities of continence. This behaviour of the detrusor may be pharmacologically modified not only by anticholinergic drugs, but also by alpha-blockers due to the adrenergic innervation of foetal bladders by short neurones. This study compared the activity of these 2 drugs prescribed separately over a minimal period of 2 years to 54 children with congenital neurogenic bladder. The amplitude of vesical contraction was reduced in about 75% of cases with both drugs, but this result was obtained more rapidly with anticholinergic drugs than with alpha-blockers. No escape phenomenon over time was observed. Anticholinergic drugs were more effective on phasic contractions while alpha-blockers were more effective on rhythmic contractions. In contrast, they had an insignificant action on hypertonia. The increase in functional vesical capacity was 4 times greater with anticholinergic drugs than with alpha-blockers, possibly because of a simultaneous reduction in peripheral resistance with alpha-blockers.
Adolescent↗
[Factors of the urinary prognosis of myelomeningoceles].
Based on a retrospective series of 200 patients with myelomeningocele followed over a period of 3 to 17 years (mean = 9.02 years), the authors define the prognostic elements of the radiographic and urodynamic assessment. Their aim was to define a population at risk presenting a possibility of deterioration of the upper urinary tract. The mean age at the time of the first assessment by the authors was 12 years (range: 2 to 38 years), at which time the upper urinary tract was not dilated in 73% of cases and dilated in 27% of cases. Evaluation of the clinical course revealed that 7% of the upper tracts were dilated at the first consultation and only 1% of them remained so, 26% became dilated secondarily and 67% were never dilated throughout the observation period. The last cystometric assessment provided the following mean values: --for the overall population (200 patients): a premicturating pressure (P2) of 32 cm of water and a compliance (CPL) of 20 ml/cm of water; --for the population in which the upper tract was dilated at the last consultation (54 patients): a P2 of 45 cm of water and a CPL of 7 ml/cm of water; --for the population in which the upper tract was not dilated at the last consultation (146 patients): the P2 was 27 cm of water and the CPL was 24 ml/cm of water. These 2 parameters therefore appeared to be essential and their prognostic value should be evaluated.(ABSTRACT TRUNCATED AT 250 WORDS)
Adolescent↗
[How to examine an non-contractile bladder].
Bladder contractility is dependent on the quality of the detrusor muscle and its innervation, and acontractility can therefore result from muscular or neurologic dysfunction. Etiologic factors involved in this functional disorder include collagen overload of the bladder wall and/or denervation or inhibition phenomena. Cystometric conditions necessary and sufficient for recognition of the disorder are indicated, the stop-test being an indispensable exploration to establish diagnosis. The Lapidès test is reliable when peripheral neurologic lesions are involved but the lesion must be complete; for incomplete lesions greater sensitivity is obtained with electrophysiologic tests such as analytic electromyography, sacral evoked potentials or rapid cystometry. Tests using an alpha-blocker allow recognition and lifting of reflex inhibition, particularly in neurologic patients with high level lesions. Proof of the psychogenic nature of the retention in hysterical patients is more difficult to obtain, and a specific test is not available, apart from histology, for diagnosis of bladder collagenosis.
Electrophysiology↗