Peripheral Neuropathies of the Lower Urinary Tract Following Pelvic Surgery and Radiation Therapy
Jacques Corcos, Gilles Karsenty, Thomas Kessler, David Ginsberg in Essentials of the Adult Neurogenic Bladder, 2020
Extirpative pelvic surgery is indicated for the treatment of multiple malignancies, most commonly colorectal, cervical, endometrial, and prostate cancers. The primary focus of these surgeries is complete resection of disease with adequate lymphadenectomy for diagnostic and therapeutic purposes. However, the autonomic nerves of the pelvis are intimately associated with the target organs. The superior hypogastric plexus is at or above the limits of most pelvic dissections, at the aortic bifurcation. The hypogastric nerves originate at the first sacral vertebra and travel in the presacral space toward the lateral rectum. In a study of female cadavers, branches of hypogastric nerves were 0–0.5 mm from the midpoint of the uterosacral ligament.6 The inferior hypogastric plexus is only 1–3 cm lateral to the rectum and upper third of the vagina.6 The pelvic nerves enter the plexus posteriorly by traveling along the coccygeus muscle.6 While many surgeries of the retroperitoneum and spine may risk peripheral nerve injury, here we focus on the procedures with the highest risk of causing lower urinary tract peripheral neuropathy.
Diagnosis of Chronic Fatigue Syndrome
Jay A. Goldstein in Chronic Fatigue Syndromes, 2020
Rectal exam is helpful in CFS to make the diagnosis of proctalgia fugax. This disorder is usually a myofascial pain syndrome of the levator am. Many patients report sudden severe episodes of rectal pain which are usually brief, but may last as long as a half-hour or so. This problem, formerly consigned to the psychosomatic “waste-basket” until it was conceptualized and examined properly, is surprisingly common if one asks. It does not usually accompany burning rectal dysesthesias, another cardinal symptom of somatization disorder, although it may. Trigger point elimination techniques are helpful in treating proctalgia fugax. Levator ani trigger points, as well as those in the coccygeus muscle, can cause coccygeal pain, common in CFS. Stretch, post-isometric relaxation, massage, and high voltage pulsed galvanic stimulation are treatment modalities suitable for pelvic floor trigger points.
Vaginal Approach to Fixation of Vaginal Apex
Linda Cardozo, Staskin David in Textbook of Female Urology and Urogynecology - Two-Volume Set, 2017
(b) Figure 85.1 (A) Left hemipelvis. The sAcrospinous ligAment covered by the coccygeus muscle extends from the ischiAl spine to the sAcrum. The pudendAl neurovAsculAr structures pAss beneAth the sAcrospinous ligAment At the ischiAl spine. The inferior gluteAl Artery pAsses between the sciAtic nerve And the sAcrospinous ligAment. (b) The roots of the sciAtic plexus converge obliquely towArd the subpyrAmidAl cAnAl thAt is limited superiorly by the pyrAmidAl muscle And inferiorly by the sAcrospinous ligAment itself (1 = sAcrospinous ligAment). (A: From Thompson J et Al., Obstet Gynecol, 94, 973, 1999. With permission; b: redrAwn from www.websurg.com with courtesy of M. Cosson And IUGA.)
Influence of psychiatric disorders and chronic pain on the surgical outcome in the patient with chronic coccydynia: a single institution’s experience
Published in Neurological Research, 2020
Kristopher A. Lyon, Jason H. Huang, David Garrett
Given the strong association of psychiatric disorders in patients suffering from coccydynia, it is reasonable to consider a neuroanatomic reason that may relate these variables. Closely associated with the coccyx, the coccygeal plexus arises from the ventral primary rami of the S4, S5, and Co1 nerve roots along with contributions from the sacral sympathetic trunk [18]. The coccygeal plexus then goes on to give rise to nerves that innervate the sacrococcygeal joint, anococcygeal ligament, sacrotuberous ligament, and inconsistently, the coccygeus muscle [19]. Overactivity of these nerves may lead to increased tension or spasm of the muscles or tendons taking their origin off the coccyx. Therefore, as part of the pre-operative workup, many patients often seek physical therapy to include intra-rectal digital massage of the levator ani, coccygeus, and pyriformis muscles with or without nerve blocks using corticosteroids or local anesthetics injected into this region [20].
Related Knowledge Centers
- Ischium
- Levator Ani
- Muscle
- Piriformis Muscle
- Pudendal Nerve
- Pelvic Floor
- Pelvis
- Coccyx
- Sacrum
- Sacrospinous Ligament