Ann Urol
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Perineal nerve injury due to stretching is caused by excessive traction on the distal motor branches of the pudendal nerve that innervate the perineum and anus. These injuries can occur in a number of morbid conditions (prolapsus, anorectal dyschezia, pelvic surgery) and induce denervation of the pelvic floor that very probably modifies the resistance of the sphincters. ⋯ Diagnosis can be established by electrophysiologic studies of the perineum, particularly by measurements of distal pudendal nerve motor latencies. The authors report a series of sixty patients with stretch-induced neuropathy.
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Perineal neuralgia is characterised clinically by pain (burning type of perineal pain) exacerbated in the sitting position. It is secondary to impairment of the internal pudendal nerve in its musculo-osteo-aponeurotic tunnel composed by the ischium and the obturator internus muscle (ischiorectal fossa or pudendal canal). ⋯ The diagnosis of pudendal tunnel syndrome is confirmed by perineal electrophysiological investigations (detection of neurogenic muscles of the perineal floor, increased sacral latency). Treatment consists of infiltration, possible repeated, of the pudendal tunnel with a sustained-release corticosteroid under CT guidance.
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An adductor contraction secondary to obturator nerve stimulation can occur during transurethral resection of a lateral bladder lesion and then can induce bladder perforation or hamper complete resection. Many technique have been advocated but they are ineffective or unreliable. Obturator nerve blockade in the obturator canal by local anesthesia with control by nerve stimulator can prevent these complications. The technique described, has been used in 12 patients it is reliable, fast and easy to perform.
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Two cases of pelvic hematoma following prostatic biopsy and prostatic massage are reported. They are rare complications of very common urological acts. The diagnosis, treatment and prevention of these complications are discussed.
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The CT scan provides a reliable evaluation of the inferior vena cava, especially since the development of second and third generation scanners. It can readily detect congenital malformations and obstructive anomalies complicating renal cancer and it is also able to determine the tumoral or thrombotic nature of the venous obstruction. This excellent definition of the vessel reduces the indications for caval angiography to a few exceptional cases.