Injury to Perineal Branch of Pudendal Nerve in Women: Outcome from Resection of the Perineal Branches

2017 ◽  
Vol 33 (06) ◽  
pp. 395-401 ◽  
Author(s):  
Eric Wan ◽  
Andrew Goldstein ◽  
Hillary Tolson ◽  
A. Dellon
Keyword(s):  
Sexual Function ◽  
Pudendal Nerve ◽  
Rating Scale ◽  
Athletic Injury ◽  
Nerve Blocks ◽  
Obturator Internus ◽  
Age At Surgery ◽  
Numeric Pain Rating Scale ◽  
Obturator Internus Muscle ◽  
The Mean

Background This study describes outcomes from a new surgical approach to treat “anterior” pudendal nerve symptoms in women by resecting the perineal branches of the pudendal nerve (PBPN). Methods Sixteen consecutive female patients with pain in the labia, vestibule, and perineum, who had positive diagnostic pudendal nerve blocks from 2012 through 2015, are included. The PBPN were resected and implanted into the obturator internus muscle through a paralabial incision. The mean age at surgery was 49.5 years (standard deviation [SD] = 11.6 years) and the mean body mass index was 25.7 (SD = 5.8). Out of the 16 patients, mechanisms of injury were episiotomy in 5 (31%), athletic injury in 4 (25%), vulvar vestibulectomy in 5 (31%), and falls in 2 (13%). Of these 16 patients, 4 (25%) experienced urethral symptoms. Outcome measures included Female Sexual Function Index (FSFI), Vulvar Pain Functional Questionnaire (VQ), and Numeric Pain Rating Scale (NPRS). Results Fourteen patients reported their condition pre- and postoperatively. Mean postoperative follow-up was 15 months. The overall FSFI, and arousal, lubrication, orgasm, satisfaction, and pain domains significantly improved (p < 0.05). The VQ also significantly improved (p < 0.001) in 13 (93%) of 14 patients. The NPRS score decreased on average from 8 to 3 (p < 0.0001). All four patients with urethral symptoms were relieved of these symptoms. Conclusion Resection of the PBPN with implantation of the nerve into the obturator internus muscle significantly reduced pain and improved sexual function in women who sustained injury to the PBPN.

scholarly journals Initial experience of complete laparoscopic radical nephroureterectomy combined with transvesical laparoscopic excision of distal ureter in patients with upper urinary tract cancer

2020 ◽  
Author(s):  
Makito Miyake ◽  
Nobutaka Nishimura ◽  
Katsuya Aoki ◽  
Chihiro Ohmori ◽  
Takuto Shimizu ◽  
...  
Keyword(s):  
Rating Scale ◽  
Upper Urinary Tract ◽  
Initial Experience ◽  
Radical Nephroureterectomy ◽  
Specimen Extraction ◽  
Distal Ureter ◽  
Laparoscopic Excision ◽  
Numeric Pain Rating Scale ◽  
The Mean ◽  
Pain Rating Scale

Abstract Background: Selecting the treatment procedure for cancer patients is a challenging task. We report our initial experience of complete laparoscopic radical nephroureterectomy (RNU) for patients with upper urinary tract urothelial cancer (UTUC).Methods: A total of four patients with UTUC underwent complete laparoscopic RNU combined with transvesical laparoscopic excision of the distal ureter using three 5-mm ports. Transvaginal specimen extraction was applied in female patients to reduce incisional pain and improve cosmesis. Peri-operative complications were evaluated using the Clavien–Dindo classification system. Postoperative pain was evaluated during hospitalization using a numeric pain rating scale (scales of 1 to 10). Patients who underwent retroperitoneal laparoscopic surgery combined with open excision of the distal ureter during the same period were included as a control group (conventional RNU, consisting of laparoscopic nephrectomy with open bladder cuff excision) for pain scale evaluation.Results: The novel surgery was successfully completed for all four patients (two males and two females). The mean pneumoperitoneum time for retroperitoneoscopic nephroureterectomy and specimen extraction was 174 min, while the mean pneumovesicum time for the ureteral orifice excision was 88 min. One male patient had bladder leakage at the suture site of the bladder wall, which lasted for two weeks. No patient experienced recurrent disease during the follow-up period (median, 10 months). Mild to moderate pain lasted for 5 or 6 days after RNU. A couple of days after surgery, the numeric pain rating scale of complete laparoscopic RNU and conventional RNU group reached its peak level at 3.0 ± 1.8 and 5.3 ± 2.8, respectively. There was no statistical difference in the degree of postoperative pain (P=0.31).Conclusions: We described our initial experience and outcome of complete laparoscopic RNU for UTUC. Further experience and research are required to determine whether this advanced laparoscopic technique yields better outcomes and has true clinical value.

Piriformis Syndrome and Other Nerve Entrapments of the Posterior Pelvis

2018 ◽  
Author(s):  
Aaron G. Filler
Keyword(s):  
Peripheral Nerve Injury ◽  
Pudendal Nerve ◽  
Cauda Equina ◽  
Piriformis Syndrome ◽  
Piriformis Muscle ◽  
Spinal Nerves ◽  
Nerve Entrapments ◽  
Obturator Internus ◽  
Surgical Options ◽  
Obturator Internus Muscle

Not every case of neurologically based pelvic/genital numbness/incontinence is due to cauda equina syndrome. Pelvic pain, incontinence, and sexual dysfunction can result from treatable peripheral nerve injury or entrapment affecting the pudendal nerves or impar ganglion. Learning the signs, physical exam findings, tests, and surgical options greatly expands a neurosurgeon’s range. The pudendal nerve and nerve to the obturator internus muscle arise after S2, S3, and S4 spinal nerves traverse the piriformis muscle. They exit the sciatic notch with the sciatic nerve but then re-enter the pelvis, where the pudendal nerve then gives off bladder, rectal, and genital branches.

scholarly journals Transition from Deep Regional Blocks toward Deep Nerve Hydrodissection in the Upper Body and Torso: Method Description and Results from a Retrospective Chart Review of the Analgesic Effect of 5% Dextrose Water as the Primary Hydrodissection Injectate to Enhance Safety

2017 ◽  
Vol 2017 ◽  
pp. 1-17 ◽  
Author(s):  
Stanley K. H. Lam ◽  
Kenneth Dean Reeves ◽  
An-Lin Cheng
Keyword(s):  
Neuropathic Pain ◽  
Analgesic Effect ◽  
Rating Scale ◽  
Stellate Ganglion ◽  
Upper Body ◽  
Pain Rating ◽  
Perineural Injection ◽  
Numeric Pain Rating Scale ◽  
The Mean ◽  
Pain Rating Scale

Deep nerve hydrodissection uses fluid injection under pressure to purposely separate nerves from areas of suspected fascial compression, which are increasingly viewed as potential perpetuating factors in recalcitrant neuropathic pain/complex regional pain. The usage of 5% dextrose water (D5W) as a primary injectate for hydrodissection, with or without low dose anesthetic, could limit anesthetic-related toxicity. An analgesic effect of 5% dextrose water (D5W) upon perineural injection in patients with chronic neuropathic pain has recently been described. Here we describe ultrasound-guided methods for hydrodissection of deep nerve structures in the upper torso, including the stellate ganglion, brachial plexus, cervical nerve roots, and paravertebral spaces. We retrospectively reviewed the outcomes of 100 hydrodissection treatments in 26 consecutive cases with a neuropathic pain duration of 16±12.2 months and the mean Numeric Pain Rating Scale (NPRS) 0–10 pain level of 8.3±1.3. The mean percentage of analgesia during each treatment session involving D5W injection without anesthetic was 88.1%  ±  9.8%. The pretreatment Numeric Pain Rating Scale score of 8.3±1.3 improved to 1.9±0.9 at 2 months after the last treatment. Patients received 3.8±2.6 treatments over 9.7±7.8 months from the first treatment to the 2-month posttreatment follow-up. Pain improvement exceeded 50% in all cases and 75% in half. Our results confirm the analgesic effect of D5W injection and suggest that hydrodissection using D5W provides cumulative pain reduction.

scholarly journals Initial experience of complete laparoscopic radical nephroureterectomy combined with transvesical laparoscopic excision of distal ureter in patients with upper urinary tract cancer

2020 ◽  
Author(s):  
Makito Miyake ◽  
Nobutaka Nishimura ◽  
Katsuya Aoki ◽  
Chihiro Ohmori ◽  
Takuto Shimizu ◽  
...  
Keyword(s):  
Rating Scale ◽  
Upper Urinary Tract ◽  
Initial Experience ◽  
Radical Nephroureterectomy ◽  
Specimen Extraction ◽  
Distal Ureter ◽  
Laparoscopic Excision ◽  
Numeric Pain Rating Scale ◽  
The Mean ◽  
Pain Rating Scale

Abstract Background: Selecting the best treatment procedure for cancer patients is a challenging task in clinical practice. Here, we report our initial experience of complete laparoscopic radical nephroureterectomy (RNU) for patients with upper urinary tract urothelial cancer (UTUC).Methods: We reviewed patients with UTUC who underwent complete laparoscopic RNU combined with transvesical laparoscopic excision of the distal ureter using three 5-mm ports. Transvaginal specimen extraction was applied in female patients to reduce incisional pain and improve cosmesis. Peri-operative complications were evaluated using the Clavien–Dindo classification system. Postoperative pain was evaluated during hospitalization using a numeric pain rating scale (scales of 1 to 10). Patients who underwent retroperitoneal laparoscopic surgery combined with open excision of the distal ureter during the same period were included as a control group (conventional RNU) for pain scale evaluation.Results: The novel surgery was successfully completed for all four patients (two males and two females). The mean pneumoperitoneum time for retroperitoneoscopic nephroureterectomy and specimen extraction was 174 min, while the mean pneumovesicum time for the ureteral orifice excision was 88 min. One male patient had bladder leakage at the suture site of the bladder wall, which lasted for two weeks. No patient experienced recurrent disease during the follow-up period. Mild to moderate pain lasted for 5 or 6 days after RNU. A couple of days after surgery, the numeric pain rating scale of complete laparoscopic RNU and conventional RNU group reached its peak level at 3.0 ± 1.8 and 5.3 ± 2.8, respectively. There was no statistical difference in the degree of postoperative pain (P=0.31, Mann Whitney U test).Conclusions: Few studies have reported on transvesical three-port bladder cuff excision for UTUC. Further experience and research are required to determine whether this advanced laparoscopic technique yields better outcomes and has true clinical value.

IMMEDIATE EFFECT OF KINESIOLOGY TAPING IN TREATING UNDISPLACED RIB FRACTURE PAIN

2015 ◽  
Vol 18 (02) ◽  
pp. 1550010 ◽  
Author(s):  
Aarti Sareen ◽  
Piyush Jain ◽  
Venus Pagare
Keyword(s):  
Rating Scale ◽  
Rib Fracture ◽  
Age Group ◽  
Pain Rating ◽  
Deep Breathing ◽  
Orthopedic Surgeon ◽  
Before And After ◽  
Numeric Pain Rating Scale ◽  
The Mean ◽  
Pain Rating Scale

Purpose: To determine the immediate effect of kinesiology taping in treating undisplaced rib fracture pain. Method: The study is a retrospective in which 10 Patients (5 females and 5 males) with 1 or 2 undisplaced middle rib fractured (5th, 6th, 7th) were included. The age group of the patients was 27–57 years. The diagnosis was made by the orthopedic surgeon and referred to Institute of Kinesiology Taping. Numeric pain rating scale readings were obtained and documented before and after the taping session. Results: A significant decrease in pain before and after the kinesiology taping was found both while deep breathing ([Formula: see text]0.001) and during coughing ([Formula: see text]0.001). The Mean[Formula: see text] S.D of NPRS reading in case of pre and post taping for deep breathing was 5.7[Formula: see text]0.95 and 4.4[Formula: see text]0.84, respectively and that for coughing was 7.2[Formula: see text]0.63 and 4.7[Formula: see text]1.16, respectively. Conclusion: Kinesiology taping has immediate effect in treating undisplaced middle rib fracture pain.

scholarly journals Comparison of L-Shape and Side-Lying Positions on Breastfeeding Outcomes among Mothers Delivered by Cesarean Section: A Randomized Clinical Trial

2021 ◽  
Vol 10 (3) ◽  
pp. 121-128
Author(s):  
Gunjot Arora ◽  
Prasuna Jelly ◽  
Rajlaxmi Mundhra ◽  
Rakesh Sharma
Keyword(s):  
Rating Scale ◽  
Assessment Tool ◽  
Block Size ◽  
Sampling Technique ◽  
Maternal Satisfaction ◽  
Medical Sciences ◽  
Significant Difference ◽  
Numeric Pain Rating Scale ◽  
The Mean ◽  
Rating Scale Data

Introduction: Ineffective breastfeeding techniques is one of the factors contributing to poor breastfeeding outcomes in post-cesarean mothers. To assist post-cesarean mothers to find a comfortable breastfeeding position, a trial was conducted to compare different positions of breastfeeding in these individuals. Methods: A randomized clinical parallel trial was carried out on primipara post-cesarean mothers admitted to All India Institute of Medical Sciences (AIIMS), Rishikesh, Uttarakhand, India. Participants were enrolled by convenience sampling technique, which was further randomized (block size= 4) and allocated to receive either "L" shape (n= 30) or side-lying (n= 30) position for breastfeeding. The assigned intervention was provided at least six times a day for four consecutive days. Data were collected using breastfeeding assessment Tool, maternal breastfeeding evaluation scale and numeric pain rating scale. Data were analyzed using SPSS software version 23. Results: The baseline characteristics of participants in both groups were similar. The mean comparison of breastfeeding outcome and maternal satisfaction indicated no significant difference between the two positions. However, the mean scores of maternal pain were statistically significant. Hence, it was inferred that the maternal pain was significantly less in post-cesarean mothers in "L" shape compared to side-lying. Conclusion: There is significantly less pain in post-cesarean mothers during breastfeeding in "L" shape than side-lying. Furthermore, maternal satisfaction and breastfeeding outcomes were found to be similar in both positions.

scholarly journals Initial experience of complete laparoscopic radical nephroureterectomy combined with transvesical laparoscopic excision of distal ureter in patients with upper urinary tract cancer

2020 ◽  
Author(s):  
Makito Miyake ◽  
Nobutaka Nishimura ◽  
Katsuya Aoki ◽  
Chihiro Ohmori ◽  
Takuto Shimizu ◽  
...  
Keyword(s):  
Rating Scale ◽  
Upper Urinary Tract ◽  
Initial Experience ◽  
Radical Nephroureterectomy ◽  
Specimen Extraction ◽  
Distal Ureter ◽  
Laparoscopic Excision ◽  
Numeric Pain Rating Scale ◽  
The Mean ◽  
Pain Rating Scale

Abstract Background: Selecting the treatment procedure for cancer patients is a challenging task. We report our initial experience of complete laparoscopic radical nephroureterectomy (RNU) for patients with upper urinary tract urothelial cancer (UTUC).Methods: A total of four patients with UTUC underwent complete laparoscopic RNU combined with transvesical laparoscopic excision of the distal ureter using three 5-mm ports. Transvaginal specimen extraction was applied in female patients to reduce incisional pain and improve cosmesis. Peri-operative complications were evaluated using the Clavien–Dindo classification system. Postoperative pain was evaluated during hospitalization using a numeric pain rating scale (scales of 1 to 10). Patients who underwent retroperitoneal laparoscopic surgery combined with open excision of the distal ureter during the same period were included as a control group (conventional RNU, consisting of laparoscopic nephrectomy with open bladder cuff excision) for pain scale evaluation.Results: The novel surgery was successfully completed for all four patients (two males and two females). The mean pneumoperitoneum time for retroperitoneoscopic nephroureterectomy and specimen extraction was 174 min, while the mean pneumovesicum time for the ureteral orifice excision was 88 min. One male patient had bladder leakage at the suture site of the bladder wall, which lasted for two weeks. No patient experienced recurrent disease during the follow-up period (median, 10 months). Mild to moderate pain lasted for 5 or 6 days after RNU. A couple of days after surgery, the numeric pain rating scale of complete laparoscopic RNU and conventional RNU group reached its peak level at 3.0 ± 1.8 and 5.3 ± 2.8, respectively. There was no statistical difference in the degree of postoperative pain (P=0.31).Conclusions: We described our initial experience and outcome of complete laparoscopic RNU for UTUC. Further experience and research are required to determine whether this advanced laparoscopic technique yields better outcomes and has true clinical value.

scholarly journals Subthalamic Nucleus Stimulation in Pediatric Isolated Dystonia: A 10-Year Follow-up

2020 ◽  
Vol 47 (3) ◽  
pp. 328-335
Author(s):  
Wenying Xu ◽  
Hongxia Li ◽  
Chencheng Zhang ◽  
Bomin Sun ◽  
Yiwen Wu ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Subthalamic Nucleus ◽  
Rating Scale ◽  
Motor Score ◽  
Age At Surgery ◽  
Short And Long Term ◽  
The Mean ◽  
Stn Dbs

ABSTRACT:Objective:To evaluate the short-term and long-term clinical effectiveness and safety of subthalamic nucleus deep brain stimulation (STN-DBS) for medically intractable pediatric isolated dystonia.Methods:Using a longitudinal retrospective design, we assessed the clinical outcomes of nine patients who underwent STN-DBS for treatment-refractory pediatric isolated dystonia one decade ago (mean age at surgery: 15.9 ± 4.5 years). The primary clinical outcome used was assessed by retrospective video analyses of patients’ dystonia symptoms using the Burke–Fahn–Marsden Dystonia Rating Scale (BFMDRS). Clinical assessments were performed at baseline, 1-year follow-up (1-yr FU), and 10-year follow-up (10-yr FU). Adverse side effects, including surgery-related, device-related, and stimulation-related effects, were also documented.Results:After STN-DBS surgery, the mean improvement in the BFMDRS motor score was 77.1 ± 26.6% at 1-yr FU and 90.4 ± 10.4% at 10-yr FU. Similarly, the mean BFMDRS disability score was improved by 69.5 ± 13.6% at 1-yr FU and by 86.5 ± 13.9% at 10-yr FU. The clinical improvements gained at 10-yr FU were significantly larger than those observed at 1-yr FU. Negative correlations were found between the duration of disease to age at surgery ratio (DD/AS) and the improvements in the BFMDRS motor score and total score at 1-yr FU and 10-yr FU.Conclusion:To our knowledge, this study provides the first clinical evidence for the short- and long-term effectiveness and safety of STN-DBS for pediatric isolated dystonia. Additionally, putative evidence is provided that earlier STN-DBS intervention in patients with refractory pediatric isolated dystonia may improve short- and long-term clinical outcomes.

Construct Validity of the Chinese Version of the Disabilities of the Arm, Shoulder and Hand Questionnaire (DASH-HKPWH)

2005 ◽  
Vol 30 (1) ◽  
pp. 29-34 ◽  
Author(s):  
E. W. C. LEE ◽  
M. M. H. CHUNG ◽  
A. P. S. LI ◽  
S. K. LO
Keyword(s):  
Construct Validity ◽  
Rating Scale ◽  
Pearson Correlation ◽  
Principal Component ◽  
Principal Component Factor Analysis ◽  
Sf 36 ◽  
Convergent And Divergent Validity ◽  
Numeric Pain Rating Scale ◽  
The Mean ◽  
Pain Rating Scale

The study evaluated the construct validity of the Chinese Hong Kong version of the disabilities of the arm, shoulder and hand questionnaire (DASH-HKPWH). Three hundred and thirty four patients with a broad range of upper extremity disorders were recruited into the study. Each completed DASH-HKPWH and SF-36 forms and their pain intensity (numeric pain rating scale) and grip strength were also measured. The mean DASH-HKPWH score was 40 (SD = 20). Principal component factor analysis identified a single factor, which accounted for 47% of the total variance. Pearson correlation was applied to assess convergent and divergent validity of the DASH-HKPWH by comparison with the above-mentioned subjective and objective measurements. Our findings were comparable to the DASH of other languages.

Sign in / Sign up

Export Citation Format

Share Document