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Journal of Clinical Medicine May 2021Optimal development of a fetus is made possible due to a lot of adaptive changes in the woman's body. Some of the most important modifications occur in the... (Review)
Review
Optimal development of a fetus is made possible due to a lot of adaptive changes in the woman's body. Some of the most important modifications occur in the musculoskeletal system. At the time of childbirth, natural widening of the pubic symphysis and the sacroiliac joints occur. Those changes are often reversible after childbirth. Peripartum pubic symphysis separation is a relatively rare disease and there is no homogeneous approach to treatment. The paper presents the current standards of diagnosis and treatment of pubic diastasis based on orthopedic and gynecological indications.
PubMed: 34072828
DOI: 10.3390/jcm10112443 -
The Journal of Sexual Medicine Jun 2015Accurate data regarding the size of the erect penis are of great importance to several disciplines working with male patients, but little high-quality research exists on...
INTRODUCTION
Accurate data regarding the size of the erect penis are of great importance to several disciplines working with male patients, but little high-quality research exists on the subject, particularly in different ethnic groups and for erect penis size.
AIM
The aim of this study was to create a nomogram of erect penile dimensions in a large sample of Middle Eastern men.
METHODS
A retrospective cohort study of 778 men (mean age 43.7; range 20-82) attending urological outpatient clinics in Saudi Arabia was conducted. Exclusion criteria were age under 18 years, a presenting complaint of small or short penis, Peyronie's disease or complaint of congenital curvature, clinical hypogonadism, and previous penile surgery or trauma.
MAIN OUTCOME MEASURES
Three erect penile dimensions following induction of erection using intracavernosal injection of Quadrimix.
RESULTS
Mean patient body mass index (BMI) was 29.09 (standard deviation [SD] 5.76). The mean suprapubic skin-to-penile tip erect length was 12.53 cm (SD 1.93); the mean erect length from the symphysis pubis to the penile tip was 14.34 cm (SD 1.86); and the mean erect shaft circumference was 11.50 cm (SD 1.74). A nomogram was constructed and statistical analysis performed, demonstrating a weak negative correlation between BMI and erect penile length measured from the suprapubic skin (r = -0.283, P < 0.000) but not from bone to tip, and a weak negative correlation between age and both erect penile length measurements (skin to tip r = -0.177, P < 0.0005; bone to tip r = -0.099, P = 0.006).
CONCLUSION
A nomogram for Middle Eastern men can be used as a standard when advising men with small penis anxiety. The importance of measuring erect size and allowing for infra-pubic fat interference in measurement is emphasized. We envisage that this tool can be used to educate and reassure concerned men about the size of their penises.
Topics: Adult; Body Mass Index; Humans; Male; Middle Aged; Nomograms; Organ Size; Outcome Assessment, Health Care; Penile Erection; Penis; Pubic Bone; Retrospective Studies; Saudi Arabia
PubMed: 25904106
DOI: 10.1111/jsm.12894 -
Knee Surgery, Sports Traumatology,... Dec 2017Adductor longus injuries are complex. The conflict between views in the recent literature and various nineteenth-century anatomy books regarding symphyseal and...
PURPOSE
Adductor longus injuries are complex. The conflict between views in the recent literature and various nineteenth-century anatomy books regarding symphyseal and perisymphyseal anatomy can lead to difficulties in MRI interpretation and treatment decisions. The aim of the study is to systematically investigate the pyramidalis muscle and its anatomical connections with adductor longus and rectus abdominis, to elucidate injury patterns occurring with adductor avulsions.
METHODS
A layered dissection of the soft tissues of the anterior symphyseal area was performed on seven fresh-frozen male cadavers. The dimensions of the pyramidalis muscle were measured and anatomical connections with adductor longus, rectus abdominis and aponeuroses examined.
RESULTS
The pyramidalis is the only abdominal muscle anterior to the pubic bone and was found bilaterally in all specimens. It arises from the pubic crest and anterior pubic ligament and attaches to the linea alba on the medial border. The proximal adductor longus attaches to the pubic crest and anterior pubic ligament. The anterior pubic ligament is also a fascial anchor point connecting the lower anterior abdominal aponeurosis and fascia lata. The rectus abdominis, however, is not attached to the adductor longus; its lateral tendon attaches to the cranial border of the pubis; and its slender internal tendon attaches inferiorly to the symphysis with fascia lata and gracilis.
CONCLUSION
The study demonstrates a strong direct connection between the pyramidalis muscle and adductor longus tendon via the anterior pubic ligament, and it introduces the new anatomical concept of the pyramidalis-anterior pubic ligament-adductor longus complex (PLAC). Knowledge of these anatomical relationships should be employed to aid in image interpretation and treatment planning with proximal adductor avulsions. In particular, MRI imaging should be employed for all proximal adductor longus avulsions to assess the integrity of the PLAC.
Topics: Aged; Cadaver; Groin; Humans; Ligaments, Articular; Male; Middle Aged; Pubic Symphysis; Rectus Abdominis
PubMed: 28866812
DOI: 10.1007/s00167-017-4688-2 -
Clinical Anatomy (New York, N.Y.) Nov 2023The interpubic cavity (cleft) is a narrow, slit-like, oval-shaped cavity which has frequently been described within the fibrocartilaginous interpubic disc. The aim of... (Review)
Review
The interpubic cavity (cleft) is a narrow, slit-like, oval-shaped cavity which has frequently been described within the fibrocartilaginous interpubic disc. The aim of this article is to thoroughly analyze what is known about the interpubic cavity. The following three scientific databases (PubMed, Web of Science and Google Scholar) were systematically searched. Combinations of the search terms "interpubic cleft", "interpubic cavity", "symphysis pubis cleft", "symphysis pubis cavity" and "symphysis cleft sign" were used. All databases were searched from inception until August of 2022. Searching of the three databases resulted in 711 hits, of which 280 remained after checking for duplicates. In the first step, 152 studies were excluded due to irrelevant content. Thus, 128 proceeded to the second step, of which 23 were finally selected for meeting the objectives of this review. Until now the reason for the cavity forming remains unclear. The interpubic cavity is present in the anterior portion of the interpubic disc, within 2 mm from its anterior margin. There is no predilection in the craniocaudal dimension. The secondary cavity is usually called a "cleft sign". The results of our scoping review summarize information about the interpubic cavity. Its composition and morphology are still not well understood.
Topics: Humans; Pubic Symphysis
PubMed: 36959758
DOI: 10.1002/ca.24041 -
Radiologie (Heidelberg, Germany) Apr 2023Groin pain in athletes can have various causes. Radiologically, osteitis pubis and clefts with affection of the interpubic disc as well as muscle and tendon tears near... (Review)
Review
CLINICAL/METHODICAL ISSUE
Groin pain in athletes can have various causes. Radiologically, osteitis pubis and clefts with affection of the interpubic disc as well as muscle and tendon tears near the pubic bone can be clearly identified.
STANDARD RADIOLOGICAL METHODS
Magnetic resonance imaging (MRI) is the imaging modality of choice, as well as single-leg stand imaging (flamingo view radiographs), and where appropriate symphysography.
METHODICAL INNOVATIONS
Optimized MRI sequence protocol with oblique (axial oblique) slices parallel to the linea arcuata of the iliac bone is recommended. High-resolution MRI sequences and symphysography can detect superior and secondary cleft formation. Instabilities of the pubic symphysis can be diagnosed using flamingo view radiographs.
PERFORMANCE
The MRI findings of osteitis pubis and clinical symptoms correlate. The presence of parasymphyseal bone marrow edema is the earliest morphological sign of acute osteitis pubis on MR imaging. Edema in the periosteal tissue and isolated muscle lesions next to the symphysis are generally associated with more severe clinical symptoms.
ACHIEVEMENTS AND PRACTICAL RECOMMENDATIONS
Close communication between radiologists and the referring physicians is indispensable when planning an adequate imaging protocol, and precise knowledge of the clinical symptoms in the case of clinical suspicion of osteitis pubis allows for a reliable diagnosis and provides important prognostic information.
Topics: Humans; Groin; Osteitis; Pelvic Pain; Athletes; Edema
PubMed: 36715718
DOI: 10.1007/s00117-023-01117-8 -
Journal of Rehabilitation Research and... 2015Symphysis pubis diastasis (SPD) is an infrequent complication of labor that can impair womens' general health through failure of the passive stability of the pelvic... (Review)
Review
Symphysis pubis diastasis (SPD) is an infrequent complication of labor that can impair womens' general health through failure of the passive stability of the pelvic girdle. Although conservative approaches are often used to decrease symptoms and interpubic separation, notably few studies have analyzed the effect of these methods on managing the symptoms of women with SPD. The purpose of this study was to review the available literature on the conservative treatment of SPD during pregnancy and labor. A computer-based search using PubMed, PEDro, and CINAHL was performed up to November 2014. We selected all studies that considered women with SPD during pregnancy or labor and treated them with conservative methods and excluded those that included surgical intervention. Eighteen studies were selected, most of which were case reports. Although the overall results of conservative treatment were unclear because of the type and design of the obtained studies, most of the studies reported bed rest in the lateral decubitus position and a pelvic girdle as basic treatments. Additionally, the few clinical trials reported recommended additional physiotherapy, including strengthening and stabilizing exercises, to reduce SPD symptoms.
Topics: Analgesics; Bed Rest; Braces; Female; Humans; Patient Positioning; Physical Therapy Modalities; Pregnancy; Pubic Symphysis Diastasis
PubMed: 26560443
DOI: 10.1682/JRRD.2014.12.0302 -
Zhongguo Xiu Fu Chong Jian Wai Ke Za... Dec 2023To review the research progress of pubic symphysis diastasis and provide effective reference for orthopedic surgeons in the diagnosis and treatment of pubic symphysis... (Review)
Review
OBJECTIVE
To review the research progress of pubic symphysis diastasis and provide effective reference for orthopedic surgeons in the diagnosis and treatment of pubic symphysis diastasis.
METHODS
The anatomy, injury mechanism, treatment, and other aspects of pubic symphysis diastasis were summarized and analyzed by reviewing the relevant research literature at domestically and internationally in recent years.
RESULTS
The incidence of pubic symphysis diastasis is high in pelvic fractures, which is caused by the injury of the ligaments and fibrocartilage disc around the pubic symphysis by external force. The treatment plan should be individualized according to the pelvic stability and the needs of patients, aiming to restore the stability and integrity of the pelvis and improve the quality of life of patients after surgery.
CONCLUSION
At present, the research on pubic symphysis diastasis still needs to be improved. In the future, high-quality, multi-center, and large-sample studies are of great significance for the selection of treatment methods and the evaluation of effectiveness for patients with pubic symphysis diastasis.
Topics: Female; Humans; Fractures, Bone; Pelvis; Pubic Symphysis; Pubic Symphysis Diastasis; Quality of Life; Biomedical Research
PubMed: 38130199
DOI: 10.7507/1002-1892.202306093 -
The Veterinary Clinics of North... Jul 2017In properly selected dogs, juvenile pubic symphysiodesis improves joint congruity, decreases hip laxity, and can reverse or prevent progression of degenerative joint... (Review)
Review
In properly selected dogs, juvenile pubic symphysiodesis improves joint congruity, decreases hip laxity, and can reverse or prevent progression of degenerative joint disease in the hips. To be effective, surgery must be done at a young age and in hips that are only mildly to moderately lax. Juvenile pubic symphysiodesis is best viewed more as a preemptive procedure than as a strictly therapeutic one. Dogs considered to be at risk for hip dysplasia should be screened with Ortolani testing at 12 weeks of age, with further imaging and perhaps surgery to follow for those who have a positive Ortolani sign.
Topics: Animals; Dog Diseases; Dogs; Hip Dysplasia, Canine; Joint Instability; Orthopedic Procedures; Pubic Symphysis; Treatment Outcome
PubMed: 28576272
DOI: 10.1016/j.cvsm.2017.03.004 -
The Journal of the American Academy of... Jul 2017Chronic anterior pelvic ring instability can cause pain and disability. Pain typically is localized to the suprapubic area or inner thigh; often is associated with lower... (Review)
Review
Chronic anterior pelvic ring instability can cause pain and disability. Pain typically is localized to the suprapubic area or inner thigh; often is associated with lower back or buttock pain; and may be exacerbated by activity, direct impact, or pelvic ring compression. Known etiologies of chronic anterior pelvic ring instability include pregnancy, parturition, trauma, insufficiency fractures, athletics, prior surgery, and osteitis pubis. Diagnosis often is delayed. Physical examination may reveal an antalgic or waddling gait, tenderness over the pubic bones or symphysis pubis, and pain with provocative maneuvers. AP pelvic radiographs may demonstrate chronic degenerative changes at the pubic symphysis or nonhealing fractures. Standing single leg stance (flamingo view) radiographs can demonstrate pathologic motion at the pubic symphysis. CT may be useful in assessing posterior pelvic ring involvement. The initial management is typically nonsurgical and may include the use of an orthosis, activity modification, medication, and physical therapy. If nonsurgical modalities are unsuccessful, surgery may be warranted, although little evidence exists to guide treatment. Surgical intervention may include internal fixation alone in select patients, the addition of bone graft to fixation, or symphyseal arthrodesis. In some patients, additional stabilization or arthrodesis of the posterior pelvic ring may be indicated.
Topics: Chronic Disease; Fracture Fixation, Internal; Fractures, Stress; Humans; Joint Instability; Osteitis; Pain; Pelvic Bones; Pubic Symphysis; Radiography
PubMed: 28574938
DOI: 10.5435/JAAOS-D-15-00338