-
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 -
Journal of Ultrasound Sep 2011There is considerable confusion over the word "pubalgia" with regard to the definition and the etiological causes of this condition. The term pubalgia should be used to...
There is considerable confusion over the word "pubalgia" with regard to the definition and the etiological causes of this condition. The term pubalgia should be used to indicate disabling pain affecting the pubic region in people who practise sports. Pubalgia affects 10% of those who practise sports and it is particularly prevalent in football players. According to the literature, about 40% of cases of pubalgia are caused by overuse of the symphysis pubis with progressive lesions affecting the rectus abdominal muscles, adductors (rectal-adductor syndrome) and the symphysis itself (osteitis pubis and joint injury). An initial study of the tendons is carried out by ultrasound (US) whereas magnetic resonance imaging (MRI) should be performed to study the bones and joints.Another 40% of cases of pubalgia are caused by "sports hernia" defined as anteroinferior abdominal wall insufficiency. These alterations can only be identified at dynamic US examination.About 20% of cases of pubalgia are caused by diseases of the neighboring structures or joints such as diseases of the hip, iliopsoas, hamstring, sacred iliac or nerves, or by urogenital diseases.
PubMed: 23396870
DOI: 10.1016/j.jus.2011.06.005 -
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 -
British Journal of Sports Medicine Jan 2011The authors examined the most current evidence for treatment options in athletes with osteitis pubis and osteomyelitis pubis, attempting to determine which options... (Review)
Review
OBJECTIVES
The authors examined the most current evidence for treatment options in athletes with osteitis pubis and osteomyelitis pubis, attempting to determine which options provide optimal pain relief with rapid return to sport and prevention of symptom reoccurrence.
METHODS
Three databases-MEDLINE, Cochrane Database of Systematic Reviews and CINAHL-were searched using the OVID interface for all years between 1985 and May 2008. References were analysed from included studies, and additional relevant articles were obtained for inclusion. Inclusion criteria included (1) humans only, (2) subjects had no apparent risk factors for development of osteitis pubis or osteomyelitis of the pubic symphysis other than athletic involvement, (3) both physical exam findings and diagnostic imaging were used to confirm either diagnosis, and (4) a definitive treatment strategy was identifiable for management of osteitis pubis or osteomyelitis of the pubic symphysis. In total, 25 articles were included in the review.
RESULTS
There were no randomised controlled trials identified with this study's search strategy. A total of 195 athletes were diagnosed as having osteitis pubis (186 males, nine females) and treated with either conservative measures/physical therapy, local injection with corticosteroids and/or local anaesthetic, dextrose prolotherapy, surgery or antibiotic therapy. Six case reports/series described conservative treatment measures (physical therapy, rest, non-steroid anti-inflammatory drugs). Four case series explored the use of corticosteroid injections in treatment. One case series described the use of dextrose prolotherapy as a treatment modality. Six case series described various surgical techniques (pubic symphysis curettage, polypropylene mesh placement and pubic bone stabilisation) in treatment. Ten case reports/series (10 subjects) outlined antibiotic treatment of osteomyelitis of the pubic symphysis.
CONCLUSIONS
The current medical literature shows only level 4 evidence of the treatment for osteitis pubis in 24 case reports/series in athletes. Without any direct comparison of treatment modalities, it is difficult to determine which individual treatment option is the most efficacious. Further study comparing the different treatment options is necessary to determine which modality provides the fastest return to sport.
Topics: Adolescent; Adult; Anti-Inflammatory Agents; Athletic Injuries; Female; Humans; Male; Osteitis; Osteomyelitis; Physical Therapy Modalities; Pubic Symphysis; Sports; Young Adult
PubMed: 18812419
DOI: 10.1136/bjsm.2008.050989 -
The Pan African Medical Journal 2017Septic arthritis of the pubis symphysis is rare and difficult to diagnose. The objective of our study was to describe the biological, clinical, radiological and...
Septic arthritis of the pubis symphysis is rare and difficult to diagnose. The objective of our study was to describe the biological, clinical, radiological and therapeutic aspects of this disease. This is a retrospective study of 4 cases of septic arthritis of the pubic symphysis collected in the Department of Rheumatology and Orthopaedics in Sousse in Tunisia over a period of 16 years (2000-2016). Our population consists of 3 women and one men. The mean age was 47 years (18-83). Clinical signs of appeal were inflammatory groin pain, pubic pain and fever. Symptoms appeared after forceps delivery in 2 cases, after surgery on the pelvis in one case and in a context of sepsis in one case. Radiographs showed pubic disjunction with irregular shoreline in all cases. CT performed in all patients and MRI in 2 patients showed erosions of the banks of the pubic symphysis with infiltration of the soft parts in all cases. The causative organisms were isolated in 3 cases by biopsy of soft tissue abscess under CT in 2 cases and vaginal swab in one case. Identified germs were staphylococcus aureus Méti-S (n=1), proteus mirabilis (n=1) and varied flora (n=1). The treatment consisted of appropriate antibiotics in all cases and surgical drainage of soft tissue abscess resistant to medical treatment in 2 cases. The outcome was favorable in all cases. Diagnosis of septic arthritis of the pubic symphysis is based on clinic supported by microbiologic culture results, image methods, and proteins augment during acute phase.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Arthritis, Infectious; Biopsy; Drainage; Female; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Pubic Symphysis; Retrospective Studies; Tomography, X-Ray Computed; Tunisia; Young Adult
PubMed: 28690730
DOI: 10.11604/pamj.2017.26.215.12204 -
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 -
CMAJ : Canadian Medical Association... Apr 2021
Topics: Accidents, Traffic; Adult; Bandages; Emergency Service, Hospital; First Aid; Hematoma; Humans; Motorcycles; Pubic Symphysis Diastasis; Radiography, Abdominal; Sacroiliac Joint; Tomography, X-Ray Computed
PubMed: 33903137
DOI: 10.1503/cmaj.201114-f -
Annals of Anatomy = Anatomischer... Jul 2021Conflicting anatomical reports and the little attention given to the pubic ligaments impede the interpretation of radiological and clinical examinations on groin pain....
BACKGROUND
Conflicting anatomical reports and the little attention given to the pubic ligaments impede the interpretation of radiological and clinical examinations on groin pain. Morphometric data on the pubic ligaments are lacking.
METHODS
The muscular relations of the symphysis pubis were examined in layered dissection (n = 10), hemipelves (n = 60) and (un)stained plastinated body slices of body donors (n = 3). The sagittal and coronal areas, width, mean and maximum thickness of pubic ligaments were determined.
RESULTS
The adductor longus, brevis, rectus abdominis and pyramidalis muscles are attached to the anterior pubic ligament (APL). The adductor brevis and gracilis muscle are connected to the inferior pubic ligament (IPL). The IPL and superior pubic ligament (SPL) are thicker than the APL and posterior pubic ligament (PPL). The PPL is the thinnest pubic ligament. The APL has a larger sagittal area in women than in men compared to the IPL. The SPL and IPL are thicker in men compared to women.
CONCLUSION
The APL is the ligamentous anchor for the originating and inserting muscles. Investigations of the pubic ligaments might help to determine symphysis instability or severity of injury and should be included as a further criterion for surgical management.
Topics: Female; Humans; Ligaments; Ligaments, Articular; Male; Muscle, Skeletal; Pubic Symphysis; Thigh
PubMed: 33582299
DOI: 10.1016/j.aanat.2021.151698