Nonabsorbable polymer clip as a cause of chronic perineal pain after radical prostatectomy: Description of a case treated by transperineal approach

The occurrence of persistent perineal pain caused by surgical clips has rarely been described after radical prostatectomy (RP). We describe the case of a patient complaining of chronic perineal pain occurred soon after robotic RP, refractory to conventional medical therapy and exacerbated by the sitting position. Pain was related to a nonabsorbable polymer clip used to secure lateral pedicles. A transpeerineal approach was used to perform an hydrodissection of the rectovesical space at the level of the surgical clip combined with local injection of mepivacaine and betametasone. The patient experienced a clinically significant reduction of pain that remained stable at three months’ follow-up.

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The EPIC-26 domain scores after radical prostatectomy are associated with the personality trait of neuroticism

International Urology and Nephrology ◽

10.1007/s11255-020-02688-4 ◽

2020 ◽

Author(s):

Alv A. Dahl ◽

Sophie D. Fosså ◽

Bjørn Brennhovd ◽

Karol Axcrona

Keyword(s):

Radical Prostatectomy ◽

Personality Trait ◽

University Hospital ◽

Eysenck Personality Questionnaire ◽

Regression Analyses ◽

Clinically Significant ◽

High Level ◽

Relevant Factors ◽

Domain Scores

Abstract Purpose The personality trait of neuroticism represents vulnerability for mental distress to somatic health problems. There are few studies of neuroticism in prostate cancer patients. This study examines the levels of self-reported adverse effects (AEs) after robot-assisted radical prostatectomy (RALP) in Norwegian men with high or low levels of neuroticism. Neuroticism is also compared to relevant factors concerning their associations with various AEs. Methods Among 982 men who had RALP at Oslo University Hospital, Radiumhospitalet between 2005 and 2010, 79% responded to a mailed questionnaire in 2011. They rated AEs by completing the EPIC-26 questionnaire, and neuroticism on the Eysenck Personality Questionnaire (EPQ). Men with < 1 year’s follow-up, treatment failure, and incomplete EPQ responses were omitted, leaving 524 men for analysis. The EPQ responses were dichotomized into low and high level of neuroticism. Stepwise multivariate linear regression analyses were used for examination of associations with the EPIC-26 domain scores. Results High neuroticism was reported by 20% (95% CI 17–23%) of the patients. On the EPIC-26 dimensions men with high neuroticism had significantly lower mean scores than men with low neuroticism. Most of these between-group differences were clinically significant. In multivariate regression analyses, high neuroticism contributed significantly to all EPIC-26 domains. Conclusion Increased levels of AEs after RALP are significantly associated with high neuroticism. A short screening test should be added to the current EPIC-26 instrument to identify patients with high neuroticism. In these patients, pre-operative counseling should take into account their risk of increased AE experiences.

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Chronic Perineal Pain Related to Sacral Meningeal Cysts

Neurosurgery ◽

10.1227/00006123-199108000-00009 ◽

1991 ◽

Vol 29 (2) ◽

pp. 223-226 ◽

Cited By ~ 18

Author(s):

Erik Van de Kelft ◽

Michel Van Vyve

Keyword(s):

Ct Scan ◽

Perineal Pain ◽

Resonance Imaging ◽

Mri Scan ◽

Computed Tomographic ◽

Clinical Neurological Examination ◽

Chronic Perineal Pain ◽

Magnetic Resonance Imaging Mri ◽

Meningeal Cysts

Abstract Chronic perineal pain is an often encountered problem that is difficult to evaluate. Based on a series of 17 patients in whom urological, gynecological, and anorectal pathology was excluded, the authors compared magnetic resonance imaging (MRI) with computed tomographic (CT) scan with myelography in the investigation of chronic perineal pain. After a clinical neurological examination, patients underwent radiodiagnostic imaging of both techniques. Thirteen patients (76%) had one or more sacral meningeal cysts (MC) on MRI scan, whereas CT scan with myelography of the lumbar and sacral region revealed 7 patients (41%) with sacral MC. Sacral MC may be the etiology of chronic perineal pain in many instances, and MRI scan appears to be superior to CT scan with myelography in demonstrating sacral MC. Ten patients with sacral MC were operated on with moderate to excellent results 6 months after operation. Early postoperative results are encouraging, but further follow-up and larger series are required.

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ECMO and Sepsis. If Differences Could Be Due to Chance Alone, Are Trends Worth Discussing?

PEDIATRICS ◽

10.1542/peds.90.1.128b ◽

1992 ◽

Vol 90 (1) ◽

pp. 128-129

Author(s):

JAMES R. HOCKER ◽

PIPPA M. SIMPSON ◽

GERARD P. RABALAIS ◽

DAN L. STEWART ◽

LARRY N. COOK

Keyword(s):

Sample Size ◽

Medical Therapy ◽

Study Design ◽

Therapeutic Strategies ◽

Retrospective Data ◽

Significant Difference ◽

Conventional Medical Therapy ◽

Streptococcal Sepsis ◽

Clinically Significant ◽

Group B

In Reply.— We agree with Dr Weiss that from a purely statistical standpoint, our retrospective data do not offer proof that ECMO is superior to conventional medical therapy in improving the survival of neonates with overwhelming group B streptococcal sepsis. If this study had more power (ie, more patients), a statistically significant difference may have been noted. Of course, with this particular study design, we had no control over sample size. It is up to the reader to decide if there is a clinically significant difference between the two therapeutic strategies.

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Transsacrococcygeal Approach to Ganglion Impar Block for Management Of Chronic Perineal Pain: A Prospective Observational Study

January 2018 - Pain Physician ◽

10.36076/ppj.2007/10/661 ◽

2007 ◽

Vol 5;10 (9;5) ◽

pp. 661-666 ◽

Cited By ~ 3

Author(s):

Dr. Gokul R. Toshniwal

Keyword(s):

Perineal Pain ◽

Rank Test ◽

Presentation Time ◽

Signed Rank Test ◽

Chronic Perineal Pain ◽

The Mean ◽

Time Required ◽

Ganglion Impar Block ◽

Ganglion Impar

Background: The ganglion impar or ganglion of Walther is a solitary retroperitoneal structure at the level of sacrococcygeal junction. It provides the nociceptive and sympathetic supply to the perineal structures. Chronic Perineal Pain (CPP) has been effectively managed by ganglion impar block. In this study we analyze the feasibility, safety, and efficacy of ganglion impar block by transsacrococcygeal approach. Design: An observational report. Methods: In this prospective study, 16 consecutive patients who required ganglion impar block for CPP were followed for two months. After informed and written consent, the ganglion impar was blocked under aseptic precautions, using a transsacrococcygeal approach. The Visual Analogue Scale for pain (VAS) at presentation time required for the pain to reduce by 50% to be considered effective and VAS was recorded at different time points during 2-month follow-up, and time required to perform the procedure, number of attempts, and any complications were also noted. Results: All the blocks were effective with a mean duration of 12±3 minutes for 50% reduction in VAS. The mean duration required to perform the procedure in neurolytic block patients was 7.8±2 minutes and 5.7±1minutes in therapeutic block patients. There were no adverse events. All the patients had significant pain relief during 2 month follow-up (P <0.05 compared to baseline). The mean VAS at 2 months was about 2. Statistical analysis was done by using paired “t”/Wilcoxon signed rank test. Conclusion: A transsacrococcygeal approach for a ganglion impar block is a technically feasible and safe technique. We recommend this technique for neurolysis or radiofrequency ablation of the ganglion impar and for diagnostic blocks, especially when the diagnosis and further plan of management is dependent on the response of the diagnostic block. Key words: Sympathetically mediated perineal pain, ganglion impar block, transsaccrococcygeal approach

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