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Query: UMLS:C0030794 (pelvic pain)
 4,056 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Neuromodulation in one form or another has been studied for decades for various disease states. Although its mechanism of action remains un-explained, numerous clinical success stories suggest it is a therapy with efficacy and durability. Controlled studies have led to the approval of sacral neuromodulation for urinary urgency and frequency, urinary retention, and urinary urge incontinence. The future holds hopeful possibilities for the application of neuromodulation, namely in the areas of interstitial cystitis, in-tractable pain syndromes, fecal incontinence and constipation, spinal cord injury, and erectile dysfunction. Neuromodulators have also been used in nonurologic conditions, including chronic headaches and intractable chest pain. In adults and children, in the neurologically intact and neurologically impaired, neuromodulation has been shown to improve the quality of life of those suffering chronic disease states. Neuromodulation is changing the future of urology. Treatment of voiding dysfunction and likely other disorders, such as pelvic pain, sexual dysfunction, and bowel disorders, will no longer rely only on medications that are "OK" or destructive-reconstructive procedures that suffer from significant complications. Rather, by modulating the nerves, the urologists will treat these disorders in a minimally invasive fashion and neuromodulation will become the first-line therapy before any major surgery is undertaken.
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PMID:Expanding indications for neuromodulation. 1569 77

The aim of this study was to compare total and subtotal abdominal hysterectomy for benign indications, with regard to urinary incontinence, postoperative complications, quality of life (SF-36), constipation, prolapse, satisfaction with sexual life, and pelvic pain at 1-year postoperative. Eighty women chose total and 105 women chose subtotal abdominal hysterectomy. No significant differences were found between the 2 operation methods in any of the outcome measures at 12 months. Fourteen women (15%) from the subtotal abdominal hysterectomy group experienced vaginal bleeding and three women had their cervix removed.
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PMID:Total versus subtotal hysterectomy: an observational study with one-year follow-up. 1573 Mar 68

The purpose of this study was to determine the frequency of incontinence in men and women in different age groups. In a representative survey, 883 men and 1,182 women with a mean age of 50 years (18-92 years) were studied based on standardized questionnaires on physical and psychological complaints, and quality of life. Participants suffering from involuntary loss of urine were considered "incontinent". The frequency of incontinence strongly increased with age, from 6.9% among the 18-40 year old population to 9.5% among the 41-60 year olds and 23% over the age of 60 years. Women complained more frequently of incontinence (15%) than men (9.5%; total of 12.6% in the population). The majority of the participants with incontinence also suffered from urinary urge, multiple disorders of digestion, pelvic pain and sexual dysfunction. There was also a strong increase in exhaustion, gastric pain, joint pain and cardiac complaints. The younger participants were more strongly affected by incontinence. When patients complain of incontinence, strong impairments in physical and psychological well-being, and quality of life are to be expected.
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PMID:[Prevalence of urinary incontinence in the German population]. 1574 5

The aim of this cross-sectional study was to compare single with repeated high-intensity focused ultrasound (HIFU) treatment in patients with localized prostate cancer, regarding treatment-related morbidity. A number of 223 consecutive patients with localized prostate cancer were treated with HIFU. Among them, 174 (78%) patients had one treatment, while 49 (22%) needed a second treatment. The patients' status and treatment-related side effects were followed up. The complications rates after one HIFU in 223 patients were: urinary tract infection 0.4%, chronic pelvic pain 0.9%, infravesical obstruction 19.7%, stressincontinence 7.6%, impotence 49.8%. Among the 49 patients who received a second HIFU therapy, the cumulative incontinence rate (12.2%; P = 0.024) and cumulative impotence rate (55%; P < 0.001) were significantly increased. Although there is an increase in morbidity if transrectal HIFU is repeated, the risk of side effects related to additional HIFU sessions in the case of primary treatment failure is still low.
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PMID:Morbidity associated with repeated transrectal high-intensity focused ultrasound treatment of localized prostate cancer. 1685 Mar 40

Stamey bladder neck suspension is thought to be an excellent procedure for stress urinary incontinence in selected groups of patients. However we must not ignore the complications of this procedure. We report a case of a patient who developed a delayed reaction with bladder wall erosion to the Dacron buttress used in Stamey urethropexy 19 years before. She was presented with pelvic pain and persisting irritative bladder symptoms. The treatment of choice was cystoscopic removal of suture and buttress. Tissue intolerance is a common problem with the use of different kinds of biomaterials in incontinence surgery. Careful cystourethroscopy is essential for early diagnosis and treatment if pain, infections and severe irritative symptoms occur postoperatively.
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PMID:Delayed reaction to the Dacron buttress used in Stamey bladder neck suspension. 1686 95

Pelvic floor weakness is characterized by abnormal symptomatic displacement of pelvic organs. It represents a complex clinical problem most commonly seen in middle-aged and elderly parous women. Its diagnosis remains difficult in many cases, since these disorders typically present with nonspecific symptoms, such as pelvic pain, incontinence and constipation. Fluoroscopic colpocystodefecography has been proven to surpass physical examination in the detection and characterization of functional abnormalities of the anorectum and surrounding pelvic structures. Similarly, MR defecography, performed either with an open- or closed-configuration unit, appears to be an accurate imaging technique to assess clinically relevant pelvic floor abnormalities. Moreover, MR defecography negates the need to expose the patient to harmful ionizing radiation and allows excellent depiction of the surrounding soft tissues of the pelvis. In this manuscript, we review the techniques and indications of MR defecography, and illustrate the MRI features of a vast array of morphologic and functional pelvic floor disorders, with emphasis on the posterior pelvic compartment (anorectum).
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PMID:Dynamic MR defecography of the posterior compartment: Indications, techniques and MRI features. 1714 52

Genitourinary changes following childbirth and pregnancy are common, and include urinary and anal incontinence, pelvic pain, sexual dysfunction, and pelvic organ prolapse. At present, it is unclear whether or not these changes are a result of the pregnancy itself or the mode of delivery (cesarean section or vaginal birth). In this article, the authors aim to describe genitourinary postpartum pelvic floor changes, and review the literature regarding the impact of pregnancy or childbirth on these changes. Data is needed that compare the effects of pregnancy alone, cesarean delivery (labored and unlabored), and vaginal birth, so that physicians can better advise patients about the postpartum genitourinary tract changes they might expect.
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PMID:Postpartum genitourinary changes. 1714 56

Repeated deliveries might disturb the levator function and increase defecation disorders. In this prospective study, we determined the electric activity of the levator ani muscle (LAM) in nullipara, multipara, grand multipara, and great grand multipara (20 subjects for each group). Multiparity, grand multiparity, and great grand multiparity were defined as women having 2 - 5, 6 - 9, and 10 and over deliveries, respectively. The number of deliveries of multipara, grand multipara and great grand multipara were 4.05 +/- 1.14 (2 - 5), 7.55 +/- 1.23 (6 - 9) and 12.2 +/- 2.16 (10 - 17), respectively. All women were asked whether they had experienced constipation, fecal or urinary incontinence, and/or pelvic pain. All women were also evaluated for pelvic organ prolapse. Electromyography (EMG) of the LAM at rest and on contraction was recorded. EMG is an electrical recording of muscle activity. Constipation, incontinence and pelvic organ prolapse were encountered in multipara, grandmultipara and great grand multipara women. The LAM EMG at rest and on contraction in the nullipara was accepted as control. Both the resting and contractile activities of the LAM were as follows: nullipara > multipara > grand multipara > great grand multipara. These findings indicate that levator dysfunction and defecation disorders are increased with repeated deliveries because of pudendal and/or levator ani nerve injury and traumatic injury to the LAM occurred with the mechanical stresses of vaginal deliveries.
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PMID:Impaired function of the levator ani muscle in the grand multipara and great grand multipara. 1714 3

Since 2001 magnetic stimulation therapy has been available in Germany for treating urinary incontinence as an alternative to traditional electrical stimulation therapy. The results of 83 patients who underwent magnetic stimulation therapy for stress incontinence, OAB, and pelvic pain syndrome were evaluated. The results differed depending on the underlying disease. Patients with stress incontinence who could not properly contract pelvic floor muscles before could do so in 74% when clinically evaluated and patients with OAB symptoms improved in 54% as assessed by objective and subjective criteria, whereas patients with pelvic pain syndrome only benefited in 23%. Comparison of the results according to age revealed no significant difference between patients >65 years and younger patients.
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PMID:[Magnetic stimulation of the pelvic floor in older patients. Results of a prospective analysis]. 1735 34

Patients with obstructed defecation complain of an inability to initiate rectal emptying, incomplete evacuation, pelvic pressure or excessive straining at stool. The pathophysiologic features of obstructed defecation include an increased anterior-posterior diameter of the rectum, decreased rectal compliance and an increased sensory threshold volume. Recently, there has been interest in the transanal resection of the rectum for obstructed defecation with the development of endoanal staplers and techniques specifically for these purpose. Stapled transanal rectal resection (STARR), in the only large series reported, decreased the anterior-posterior diameter of the rectum, restored rectal compliance and decreased the rectal sensory threshold with an associated improvement in incomplete evacuation in 81.1%, digital assistance to defecate in 83.4%, pelvic pain in 43.3%, and the need for laxatives 43.3% of patients. Risks of the procedure included stenosis in 3.3%, urgency in 1.1% and incontinence of flatus in 1.1% of patients. These data suggest that the STARR procedure is an effective management option for obstructed defecation with an acceptable risk of complications.
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PMID:Stapled transanal rectal resection (STARR) for rectocele. 1739 Jan 65


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