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(A) T2-weighted MRI and (B) T1-weighted MRI showing second sacral dysplasia and the absence of the remaining lower sacrum and coccyx. MRI = magnetic resonance imaging.
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Rationale:
Congenital absence of either a part of or the entire sacrum is rare, and only a few such cases have been reported until now. Most cases showed vertebral, pelvic, neurological, and visceral abnormalities, and the cases were usually quite serious. Only in rare cases was there urine retention without other symptoms.
Patient concerns:
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Context 1
... bladder (Fig. 1). A urodynamic study showed detrusor underactivity, considering a neurogenic bladder. He was admitted to the Department of Orthopedic Surgery, and physical examination revealed the absence of a coccyx. Magnetic resonance imaging (MRI) findings showed sacral canal thickening, an abnormal nerve and sacral canal, and sacrum dysplasia (Fig. 2). Genetic testing revealed the transcription factor Brachyury (T) gene had no mutations. From the imaging features, it was determined that urinary retention was caused by congenital absence of a section of the sacrum and sacral nerve, which led to bladder detrusor dysfunction. To improve the symptoms, indwelling urinary catheter was ...
Citations
... Clinical manifestations include inability to urinate autonomously, bladder filling and distending pain in the lower abdomen. If effective treatment is not provided to recover the autonomous urination function of bladders, some patients may demand indwelling catheter again, which affects the prognosis and severely compromises their quality of life (QOL) (Wu et al. 2018). Presently, many treatments are available for women with UR after a pelvic surgery, including low-frequency electrical stimulation (LFES) (Mardani et al. 2018), pelvic floor muscle exercises (PFME) (Deffieux et al. 2015), psychotherapy, massage, acupuncture and moxibustion, which have definite effects (Meister et al. 2017). ...
This study was to explore the efficacy of low-frequency electrical stimulation (LFES) combined with preventative pelvic floor muscle exercises (PPFME) and knowledge-attitude-practice model (KAP model) in women with urinary retention (UR) after a pelvic surgery and the effect on quality of life (QOL). The clinical data of 153 women hospitalized with UR after a pelvic surgery from January 2015 to June 2019 were retrospectively analyzed and divided into the Control Group (CG, n=45, LFES+PPFME) and the Study Group (SG, n=108, LFES+PPFME+KAP model) according to the different treatment methods. Following indicators were compared between the two groups: clinical efficacy, time to first urination, urine output, rate of extubation in 3D, rate of repeated intubation, urodynamic indicators before and after treatment, postvoid residual (PVR), bladder compliance (BC), maximal flow rate (Q-max), pressure of detrusor at Pdet-Q-max (Pdet-Q-max), changes in QOL, incidence of urinary tract infection, and length of stay (LOS). Compared to CG, SG showed higher overall response rate (ORR) and rate of extubation in 3D, shorter time to first urination, higher urine output, lower rate of repeated intubation and incidence of urinary tract infection, and shorter LOS (P<0.05); both groups achieved improvements in urodynamic indicators and QOL score after treatment (P<0.05); the urodynamic indicators and QOL score in SG were better than the CG’s (P<0.05). LFES combined with PPFME and KAP model is effective in treating women with UR after a pelvic surgery by efficaciously improving patients’ urination and QOL.
