Prog Urol
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Pudendal nerve trauma is a rare complication of orthopaedic and traumatological surgery, which occurs after traction of the pelvis on an orthopaedic table fitted with a pelvic support. This trauma is generally due to crushing of the nerve against the central part of the table or stretching of the pudendal nerve due to excessive traction during fractures of the femur. the urological consequences of this neurological trauma present in the form of disorders of perineal sensitivity, which usually rapidly resolve spontaneously, or vesicosphincteric and/or erectile disorders, which have a more pejorative course and which can sometimes persist. ⋯ Surgical decompression, rarely indicated, can be necessary in the case of serious and persistent sensory or motor lesions. Patients must be clearly informed about this possible neurological complication before an operation on the orthopaedic table as part of good surgical practice.
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Retrospective evaluation of the prognostic value of pretreatment PSA, PSA nadir and PSA half-life compared to grade and stage after treatment of prostate cancer by radiotherapy. ⋯ A nadir PSA level less than 0.5 ng/ml, a PSA half-life greater than 6 months and a Gleason score less than 7 were predictive of a low risk of biochemical recurrence and prolonged survival after treatment by exclusive radiotherapy, in our patients.
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Case Reports
[Subcapsular spontaneous hematoma of the kidney of non-tumor origin (report of 5 cases)].
Spontaneous subcapsular haematoma (SCH) of the kidney is a rare condition, secondary to kidney tumours in more than 50% of cases. Nephrectomy is justified in the presence of tumour or uncontrolled haemorrhage. When the aetiology cannot be determined, thin-slice CT follow-up of the patient's kidney can be performed. ⋯ A retropelvic aneurysm was responsible for the haematoma in one case; polyarteritis nodosa was the cause of bleeding in another case and the aetiology could not be determined in two cases. All patients were managed surgically. Nephrectomy was performed in 3 cases and simple evacuation of the haematoma was performed in 2 cases.
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A critical literature review allows an analysis on chronic constipation evaluation and on the association with anatomical or functional pelvic perineal disorders, the link with a pudendal neuropathy being frequent. The dyschezia clinical diagnosis must be completed by X-ray and manometric examinations to well determine the respective part of anatomical and/or functional disturbances. ⋯ The diagnosis must be made with a complete electrophysiological assessment and not only with the pudendal nerve latency terminal motor latency measurement. These pelvic-perineal disorders have plurifactorial aetiologies, they are linked together without univoqual chronology, each one may be the cause or the consequence of the other, and self-worsening evolution may occur.
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To define the therapeutic approach to ureteric stones. ⋯ SWL is the reference treatment for stones of the lumbar ureter. Ureteroscopy is justified after failure of ESWL for stones of the pelvic and iliac ureter, as it gives excellent results.