Journal d'urologie
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The anatomic study of the pudendal nerve and its relation allows an approach of the mechanisms of compression likely to engender perineal neuralgia. Two conflictual zones are isolated: the first is linked to the clamp which is produced by the insertion of the sacro-epinous ligament on the ischial spine and the sacro-tuberal ligament; the second is linked to the falciform process of the sacrotuberal which threatens the nerve by its sharp upper edge. This conflict is particularly acute in a sitting position. ⋯ The anesthetic blocks of the pudendal nerve on the ischial spine only have a complimentary diagnostic value. The peridural blocks may also have an interesting therapeutic action (60% of good results 3 months later). In some persistent cases, the nerve has been decompressed firstly by perineal approach, but latterly by transguteal approach.
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Anesthetic technique in surgery for pheochromocytoma presents well recognized difficulties. Major complications (hypertensive crises, rhythm disturbances, collapse, pulmonary edema and hypoglycemia) can often be avoided by a good preoperative examination and full per-operative monitoring. The choice of drugs during anesthesia and per-operative resuscitation are discussed in this article together with particular situations such as pheochromocytoma in pregnancy or the per-operative discovery of a previously unrecognized pheochromocytoma.
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Renal abscess is rather an uncommon lesion caused predominantly by an urogenic infection. The authors report 21 cases in a period of 10 years. ⋯ The evolution of the therapeutic modes is studied, with a special reference to the percutaneous drainage which is to substitute the classical surgery of this abscess. For the authors, treated in the right time and in the right way, renal abscess is nowadays a benign lesion, preserving a good prognosis for the kidney and the patient.
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Emergency surgery in three cases of accidental urethral rupture during coitus involved suture of the tunica albuginea corpus cavernosum and immediate repair of the urethra under cover of a urethral guide and a cystostomy. The three perfect results obtained, with normal micturition and more particularly normal erections, together with data from reports in the published literature, strongly suggest the need for urgent repair of traumatic lesions of the corpora cavernosae during coitus. The possibility of a urethral rupture makes urgent operation even more essential, before the patient urinates, to avoid transformation of a traumatic hematoma into a urohematoma.