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

We describe the case of a young woman with anterior sacral meningocele (ASM), initially identified during a routine ultrasound examination and subsequently diagnosed using magnetic resonance imaging (MRI). ASM is a rare disorder characterized by uni- or multilocular extensions of the meninges from the sacral spinal canal to the retroperitoneal presacral space. Common symptoms include lower back and pelvic pain, constipation, difficulties in defecation, dysmenorrhea and dyspareunia, and urinary incontinence, retention or urgency. Perineal and lower-extremity paresthesias may present when nerve roots are affected. Despite its more posterior location, ASM can mimic an ovarian cyst or other adnexal cystic mass, and in the obstetric patient can present a mechanical obstacle to delivery with a risk of rupture and infection during labor and delivery. Although it is a rare condition, we feel that awareness of the etiology, presentation and imaging characteristics of ASM is of importance and have therefore carried out a review of the literature, taking into account case findings and the obstetric and gynecological management of this disorder.
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PMID:Anterior sacral meningocele: management in gynecological practice. 1778 29

Pelvic floor abnormalities often impact significantly the quality of life and result in a variety of symptoms, including chronic pelvic pain, fecal incontinence, and obstructed constipation. Fluoroscopic defecography and MR defecography enable identification of rectocele, rectal prolapse, enterocele, sigmoidocele with high prevalence in female patients with obstructed constipation, fecal incontinence, and chronic pelvic pain. In this manuscript, we describe the techniques and indications of the two techniques of defecography. We discuss the abnormalities of the posterior pelvic floor compartment at the origin of constipation, incontinence, chronic pelvic pain. Finally we compare the data obtained by clinical examination and defecography, remembering that 50% of enterocele and 100% of sigmoidocele are missed at clinical examination.
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PMID:[Role of defecography in female posterior pelvic floor abnormalities]. 1803 77

Voiding dysfunction, which includes incontinence, retention, and chronic pelvic pain, is a relatively frequent problem that can be difficult to manage. Neuromodulation via stimulation of the sacral nerves has been shown to improve these symptoms, although the exact mechanisms remain elusive. Techniques for nerve stimulation may vary, depending on the disease, location of pain, and the patient's anatomy. In addition to placement of electrodes on the sacral nerve roots, modulation has also been reported by peripheral branches of the sacral nerves including the pudendal and posterior tibial nerves. Newer surgical techniques have significantly decreased the morbidity of the procedures and increased the probability of a successful outcome.
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PMID:Sacral nerve stimulation: neuromodulation for voiding dysfunction and pain. 1816 89

CYSTOURETHROSCOPY: Cystourethroscopy is not recommended in the initial work-up of urinary incontinence except in the following circumstances: Microscopic or macroscopic haematuria requiring screening for an associated tumour especially in the presence of risk factors for urothelial tumour (smoking, occupational exposure). Signs of bladder irritation in the absence of urinary tract infection. Unexplained bladder or pelvic pain. Recurrent urinary tract infections. Discordance between clinical features and urodynamic assessment, which fails to reproduce the symptoms described by the patient. Work-up of a failure, recurrence or complication of urinary incontinence surgery. Suspected urogenital fistula. TEST FOR STERILE URINE: A test for sterile urine is recommended in the following situations: Woman with urge or mixed urinary incontinence. Elderly woman who regularly uses pads for urinary incontinence, regardless of the type of urinary incontinence. Before performing a urodynamic assessment or cystoscopy. This test can be performed by urine dipsticks or urine culture. URINE CYTOLOGY: Is not recommended in the assessment of pure urinary stress incontinence. But is recommended in the presence of signs of bladder irritation in the absence of urinary tract infection, microscopic haematuria, risk factors for bladder tumour (smoking, occupational exposure). And must be performed on concentrated urine by a urocytopathologist. PERINEAL ELECTROPHYSIOLOGICAL STUDIES: Perineal electrophysiological studies are not recommended in the investigation of non-neurological female urinary incontinence.
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PMID:[Recommendations for endoscopic, laboratory and electrophysiological examinations in the investigation of non-neurological female urinary incontinence]. 1821 40

This report encompasses a representative survey of the German feminine population. The aim of this survey is to assess subjective gynaecological complaints. These were registered by the newly constructed "Giessen Subjective Complaints List - for women". This questionnaire measures specific gynaecological complaints of several body areas (excretion, pelvic pain, breast, vulva, menses). Participants included n = 1 093 women between the age of 14 and 77 years. The highest complaint rates of the study participants were observed in the area of menstrual symptoms. Overall, 31 % (n = 206) of the surveyed women indicated that they suffered somewhat, extensively, or highly from menstrual complaints (e. g. painful menstruation or menorrhagia). These menstrual symptoms were significantly higher in younger women (14-45 yr.). Symptoms of other complaint areas (excretion, e. g. urinary incontinence; breast, e. g. sensitivity) were slightly less dominant than menstrual symptoms with 17 % (n = 186) and 13 % (n = 128) respectively. It was shown that subjective gynaecological complaints show a typical age-dependent developmental course. They represent the major psychosocial topic of the current phase of life for each woman. This study is a contribution to the epidemiology of subjective gynaecological complaints in the German feminine population.
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PMID:[A German survey of subjective gynaecological complaints]. 1879 81

Despite the frequent association of urinary tract infection with vesicoureteral reflux and urinary calculi, since vesicouretal reflux is induced by bladder stones, the coexistence of vesicoureteral reflux and bladder stones is rare. Because of its occurrence in children belonging to poor socioeconomic groups, it is believed to be a deficiency disorder. Most cases of bladder stones occur between the ages of 2 and 5 years. Common clinical presentations of bladder stones include urinary dribbling and enuresis, frequency of micturition, pain during micturition, pelvic pain and hematuria. We report the occurrence of a large bladder stone in a boy, who experienced intermittent Lower abdominal pain and urinary incontinence, both during the day and at night. He had been diagnosed with enuresis and treated in pediatric clinics for 1 year. Delayed diagnosis resulted in bladder stone formation. The stone was larger than 2.5cm and open vesicolithotomy was therefore selected as the best and safest treatment choice. His symptoms disappeared after surgery. Thorough metabolic and environmental evaluations of such cases are required on an individual basis. Bladder stones should be considered as a possible diagnosis in children presenting with urinary incontinence.
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PMID:A boy with a large bladder stone. 1905 22

Botulinum neurotoxins (BoNTs) are well known for their ability to potently and selectively disrupt and modulate neurotransmission. BoNT is currently undergoing regulatory evaluation for urological disorders in the United States and the European Union and is not FDA approved for urologic use. Overactive bladder (OAB) and benign prostatic hyperplasia (BPH) are common urologic conditions characterized by urinary frequency, urgency, nocturia, urge incontinence and, in the case of BPH, decreased urine flow that are currently being evaluated in clinical trials with BoNT-A. Interstitial cystitis (IC) is a chronic condition in which patients describe urinary frequency, urgency and associated bladder/pelvic pain. In the two former conditions, BoNT-A is currently being evaluated in Phase II or Phase III clinical trials as a therapeutic agent. Evidence for BoNT in the treatment of IC is limited to small case series. The purpose of this article is to provide up to date clinical evidence regarding the use of BoNT to treat these three urologic problems. For the sake of clarity, BoNT-A describes the use of Botox unless otherwise specified. In addition, when describing OAB, two sub-populations exist: those with OAB of neurogenic origin (NDO) and those with OAB of unknown (idiopathic) origin (IDO).
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PMID:Botulinum toxin in the treatment of OAB, BPH, and IC. 1926 90

Tension-free alloplastic slings (TFAS) have revolutionized surgery for female stress urinary incontinence for more than 15 years. The procedure is easy to perform, minimally invasive with short operation time in an ambulatory setting, and has proven efficacy comparable to the gold standard procedure of retropubic colposuspension.Possible TFAS complications are potentially underestimated with respect to prevalence and manageability. We report our experience with major complications following TFAS and mesh implantation in patients referred to our interdisciplinary continence center. Patient history, risk factors, and preoperative diagnostics were analyzed for development of individualized treatment strategies. Overcorrections with formation of postvoid residual (PVR) can occur in retropubic TFAS as well as in transobturator TFAS. However, the most prevalent and challenging complication is de novo urgency. Major complications like urethrovaginal fistula, sling arrosions of the urethra, bladder, and vagina as well as infected gangrene and complete urethral loss requiring urinary diversion were seen at a frequency suggesting underrepresentation of these complications in the literature. The large amount of implanted artificial mesh material used for pelvic organ prolapse (POP) correction represents a particular challenge in cases of dyspareunia or persisting pelvic pain.Complication management has to be based on cystoscopic, urodynamic, and physical examination findings to be individualized to each patient and must take potential risks of recurrent incontinence or persisting complaints into account.To prevent TFAS or mesh complications, every patient should have tried all conservative treatment options and should be completely evaluated (including urodynamics) preoperatively. Artificial meshes should only be used in cases of prolapse recurrence or in otherwise inoperable patients. Postoperative urodynamics may help to document treatment success and to identify and quantify complications.
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PMID:[Management of complications after sling and mesh implantations]. 1939 Aug 37

Up to 6% of women sustain severe perineal lacerations that involve the anal sphincters during vaginal delivery. When they occur obstetric anal sphincter injuries (OASI) may be accompanied by significant morbidity. Therefore, it is important to detect these injuries promptly and for experienced staff to perform sound repair. This report retrospectively assesses a series of seven women with OASI who were managed at a tertiary level hospital in Jamaica over a period of 28 months. Unfavourable details of management that may have adversely affected outcomes were sought from the various cases treated The incidence of OASI was low (0.2%). There were five third degree and two fourth degree lacerations. After these injuries were repaired, three patients (43%) experienced morbidity such as chronic pelvic pain (43%), anal incontinence (29%), dyspareunia (23%) and recto-vaginal fistulae (14%). In order to improve the outcomes at this institution, several aspects of current care can be improved. Operative repair of these injuries should be delayed until senior staff is available to supervise OASI repair. Both methods of sphincter repair are reasonable options but the use of rapidly absorbable sutures is not appropriate. Finally, prophylaxis against wound infections can be achieved by administering a single dose of intravenous second or third generation cephalosporin at the time of induction of anaesthesia.
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PMID:Management of obstetric anal sphincter injuries at the University Hospital of the West Indies. 1956 79

The bladder stone formation due to intravesical mesh erosion of tension-free vaginal tape (TVT) is an infrequent complication. We report a case of 73 years old woman, treated in two occasions by means of the positioning of a TVT with the intention of treating its urinary incontinence. The symptoms, of a year of evolution, was characterized by disuria, pelvic pain, diarrea and constitutional syndrome. RM showed bladder stone fixed to bladder wall. The extraction of the bladder stone was made by the section of the polypropilene mesh on which the calculi had been developed. 6 months later, control cystoscopy revealed complete healing of bladder mucosa.
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PMID:[Development of bladder stone following a tension-free vaginal tape procedure: a case report]. 1971 56


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