ABSTRACT
Objective: The aim of this article is to present examples of patients in whom piriformis muscle (PM) and sciatic nerve (SN) variations were detected by a diagnostic ultrasound (US)-guided examination and were successfully diagnosed and treated for piriformis syndrome (PS) by US-guided injections. Clinical Features: This series includes 4 cases. In case 1, a 30-year-old woman with a 7 numeric rating scale (NRS) score for pain (on a 0-10 scale) was evaluated for complaints of left gluteal pain radiating to the thigh for 5 years and right gluteal pain for 2 years. Case 2 involves a 32-year-old man with a 7 NRS score presenting with left gluteal pain radiating to his leg for 1 year. The third case presents a 37-year-old man who had pain (6 NRS score), numbness, and discomfort radiating from the right hip to the leg that lasted for 7 years. Finally, in case 4, a 23-year-old male patient was examined with deep gluteal paresthesia and discomfort on the left side for 1 year. Intervention and Outcome: Diagnostic US evaluation of the gluteal region for each patient revealed anatomical variations of the SN. In 3 of the cases, corresponding contralateral US images demonstrated similar anatomic variations. Diagnosis of PS in each patient was made by US-guided injection. After the injection of 4 cm3 of lidocaine 2% into the PM, the patients' complaints resolved almost fully. Conclusion: The anatomical variations of the SN and PM might be a facilitating factor for myofascial pain syndrome in PS. These cases demonstrate that SN variations could be visualized with the help of diagnostic US.
ABSTRACT
PURPOSE: To evaluate the effects of previous ipsilateral open renal stone surgery (ORSS) on outcomes of extracorporeal shockwave lithotripsy (SWL) in adults with renal stones. MATERIALS AND METHODS: A total of 2097 renal units with renal stones underwent SWL treatment at our institution between March 1997 and February 2013. One thousand eight hundred thirty-nine (87.7%) of these had no history of ORSS and were categorized as group 1, and 258 (12.3%) patients having history of ipsilateral ORSS were categorized as group 2. Characteristics of patients, stone and treatment, stone-free, and complications rates were documented in detail and compared in each group. These groups were also subclassified into four subgroups according to the stone location. RESULTS: The stone-free rates were statistically higher in group 1 than group 2 (73.2% and 61.6%, respectively). There were no differences between groups regarding the complications and steinstrasse. The stone-free rate of SWL for stones located at lower calix has significant difference according to groups 1 and 2 (64% vs 48.4%, p = 0.001). Logistic regression analysis showed that history of ORSS increased SWL failure rate 1.39 times. CONCLUSION: Overall stone-free rates after SWL treatment was found to be significantly lower in patients with the history of ORSS than in patients without, and this finding was significantly prominent for lower calix stones. We believe that retrograde intrarenal surgery or mini- /micro-percutaneous nephrolithotripsy, despite its possible difficulties in accessing due to anatomical changes, might be a good alternative for SWL.
