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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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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Microscopic abscesses of the prostate (< 1 cm) are usually treated by antibiotics with good prostatic diffusion, such as fluoroquinolones, for a minimum of 4 to 6 weeks. Complementary surgical drainage is generally required for larger abscesses or in case of an unfavourable course. The main points of discussion in the literature are the type of drainage and the incision that should be performed. ⋯ CT-guided percutaneous drainage (perineal or transrectal), or more frequently transrectal ultrasound-guided drainage, now allows rapid and effective evacuation of the abscess, without the need for general anaesthesia. The perineal route allows a simple J stent to be left in place for several days to ensure complete drainage, but it is not universally accepted. Transurethral exposure is indicated for periurethral prostatic abscesses.
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Penile trauma is uncommon, but can be serious due to its urinary and sexual complications. After reviewing the literature, the authors examined three types of trauma of particular interest because of the specificity of the lesions induced and their treatment. The circumstances of onset, the various lesions observed, the complementary investigations required, and the therapeutic modalities are studied for each type of trauma. ⋯ Strangulations can lead to ulceration of the skin and urethral fistula. The causes of strangulation are varied, including the very unusual case of strangulation by a hair in a young circumcised boy. Automutilations of the penis are rare, but, after psychiatric assessment, microsurgical reimplantation can be performed with good functional and aesthetic results.