Subject(s)
Cystostomy/methods , Laparoscopy , Nephrectomy/methods , Pyelonephritis/surgery , Urinary Retention/surgery , Female , Humans , Middle AgedABSTRACT
The authors report 8 cases of disorders of the bladder and sphincter in neurosyphylis. Urodynamic study suggested preponderant damage to the sensory pathways and in particularly the posterior roots. The most common clinical manifestation was dysuria or chronic retention, these occasionally being signs of neurological disease.
Subject(s)
Neurosyphilis/complications , Urinary Bladder, Neurogenic/etiology , Urinary Bladder/physiopathology , Urination Disorders/etiology , Adult , Aged , Humans , Male , Middle Aged , Urinary Bladder, Neurogenic/physiopathology , Urination Disorders/physiopathology , UrodynamicsABSTRACT
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). As in any nerve tunnel syndrome, pre-existing neuropathy constitutes a predisposing factor and should therefore be identified. 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.
Subject(s)
Neuralgia/etiology , Perineum/innervation , Aged , Chronic Disease , Evoked Potentials , Female , Humans , Male , Middle Aged , Nervous System Diseases/complications , Nervous System Diseases/physiopathology , Neuralgia/physiopathology , Perineum/diagnostic imaging , Perineum/physiopathology , Syndrome , Tomography, X-Ray ComputedABSTRACT
The authors propose a new pathophysiological and diagnostic approach to detrusor hyperactivity by the study of the isometric pressure obtained during the stop-test. This test consists of the sudden interruption of micturition by voluntary contraction of the striated urethral sphincter, resulting in sudden contraction of the bladder against the closed sphincter. This isometric contraction is equal to 20 to 30 cm of water. The increase in the pressure (delta P) between the basal micturition pressure and the absolute value of the isometric pressure (P iso) reflects the contractile force of the detrusor. The progressive return to the basal micturition pressure reflects the relaxation of the detrusor, which is the sum of visco-elastic properties and the mechanisms of cortico-sub-cortical neurological inhibition. Calculation of the isometric area (delta P X T/2), where T represents the time taken to return to the initial pressure, allows cases of central neurological hyperactivity (isometric area always greater than 100) to be distinguished from cases of detrusor hyperactivity of mechanical origin (isometric area less than 80). These data have been confirmed in a series of 30 patients.
Subject(s)
Isometric Contraction , Muscle Contraction , Muscle, Smooth/physiopathology , Urinary Bladder Diseases/diagnosis , Urination , Adolescent , Adult , Aged , Female , Humans , Hydrostatic Pressure , Male , Middle Aged , Urinary Bladder Diseases/physiopathologySubject(s)
Herpes Zoster/complications , Urinary Bladder, Neurogenic/etiology , Adult , Female , Humans , PerineumABSTRACT
The sacral spinal cord is one of the main sites of integration of bladder and anal sphincter and sexual function. Clinical tests (bulbocavernous reflex, perineal reflexes) are often inadequate and urodynamic investigations (cystomanometry, urecholine test, Susset's test) are sometimes unhelpful. The integrity of this structure is essential for normal sphincter function and disease at this level (or of its afferent or efferent limbs) produces a peripheral type of disorder. Sacral evoked potentials are an electrophysiological means of testing the bulbocavernous reflex by external stimulation of the dorsal nerve of the penis or clitoris and recording by a needle bipolar electrode in the striated muscle of the sphincter or the bulbocavernous muscle. An objective study of the sacral reflex are (S2, S3, S4) can thus be performed. One hundred and ten patients have undergone this investigation. Normal latency established in a series of 26 healthy volunteers was less than 42.1 ms. Prolongation of this interval is a sign of disease of the reflex are and correlated with urinary or sexual problems in 46 cases of clinical or electrical peripheral neuropathy. The reflex time was normal in all patients with CNS disease (32 cases) and an impotence of psychological origin (6 cases).
Subject(s)
Central Nervous System Diseases/diagnosis , Peripheral Nervous System Diseases/diagnosis , Sexual Dysfunction, Physiological/etiology , Spinal Cord/physiopathology , Urination Disorders/etiology , Adult , Aged , Alcoholism/complications , Central Nervous System Diseases/complications , Erectile Dysfunction/etiology , Evoked Potentials , Female , Humans , Male , Middle Aged , Peripheral Nervous System Diseases/complications , Reflex, Abnormal/diagnosis , Sacrococcygeal Region , Sexual Dysfunction, Physiological/physiopathology , Urination Disorders/physiopathologyABSTRACT
In the operation described the second jejunal loop is isolated through an horizontal incision linking the tips of the 12 th ribs. The ends of the loop are then anastomosed with the sub-pyelic ureters and the resulting V-shaped conduit is brought to the skin. The main complication is a salt-deficiency syndrome due to the physiology of the isolated jejunal loop. The loss of salt may be troublesome in patients with pre-existing renal insufficiency. This syndrome is corrected by oral administration of sodium chloride.
Subject(s)
Pelvic Neoplasms/complications , Urinary Diversion/methods , Female , Humans , Jejunum/surgery , Male , Middle Aged , Ureter/surgery , Urinary Diversion/adverse effects , Water-Electrolyte Imbalance/etiologyABSTRACT
The authors report a case of retroperitoneal lymphatic dissemination of a seminoma without any demonstrable primary testicular tumour. Irradiation of the patient led to complete cure, apparently stable with two years' follow up. The authors explored both sides of the scrotum clinically and surgically without finding any testicular tumour. A brief review of the literature reveals three possibilities: --lymphatic metastasis of an infraclinical testicular seminoma, --extra-nodal retroperitoneal metastasis of a testicular tumour, --retroperitoneal seminomatous tumour developing in embryonic rests of germinal tissue which might possibly be complicated by a retroperitoneal lymph node metastasis. The case of the authors falls within the precise context of lymph node metastases of an undemonstrated testicular tumour.
Subject(s)
Dysgerminoma/secondary , Retroperitoneal Neoplasms/secondary , Testicular Neoplasms/diagnosis , Adult , Diagnosis, Differential , Dysgerminoma/diagnosis , Humans , Lymphatic Metastasis , MaleSubject(s)
Echinococcosis/surgery , Kidney Diseases/surgery , Aged , Echinococcosis/diagnosis , Humans , Kidney Diseases/diagnosis , MaleABSTRACT
This case emphasizes the value of: 1. Treatment of malignant hypertension with the combination of hemodialysis and beta-blockers. 2. Supra-selective arterial embolization in inaccessible intra-renal aneurysms or those difficulty accessible to surgery.
