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Douleurs périnéales et stimulations

  • Jérôme RigaudEmail author
  • Jean-Jacques Labat
  • Thibault Riant
  • Kevin Buffenoir

Résumé

Les douleurs pelvipérinéales chroniques sont caractérisées par leur chronicité (plus de six mois), l’absence de pathologie maligne et leur topographie. La douleur qui s’exprime au niveau de l’organe n’est pas toujours le témoin d’une maladie de l’organe mais c’est là qu’elle s’exprime, témoignant de dysfonction-nement de la régulation des messages douloureux du pelvis et du périnée, et débordent largement d’une systématisation organique ou neurologique. Les douleurs pelvipérinéales chroniques ne peuvent être abordées qu’à travers un démembrement clinique reposant tout d’abord sur l’élimination des pathologies lésionnelles régionales. C’est la négativité des bilans et surtout les données de l’interrogatoire qui permettent d’analyser cette douleur et de mieux en appréhender les mécanismes physiopathologiques [1]. La neuromodulation nerveuse est utilisée régulièrement en pelvipérinéologie pour la prise en charge de l’hyperactivité vésicale rebelle. La neuromodulation sacrée a été reconnue avec un marquage CE en Europe depuis 1994 et un marquage par la FDA aux États-Unis depuis 1997. La neuromodulation est également très utilisée dans la prise en charge de la douleur chronique mais essentiellement en stimulation médullaire1. Actuellement, la neuromodulation n’est pas reconnue dans le traitement spécifique des douleurs pelviennes chroniques. Le problème pour l’interprétation des résultats est une grande disparité dans les critères d’inclusion et de sélection des patients, et des critères de jugement et d’efficacité des traitements. Ce chapitre fait le point sur l’ensemble des neurostimulations en fonction des différents niveaux qui sont proposés et réalisés dans la prise en charge des douleurs pelviennes chroniques.

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Copyright information

© Springer-Verlag Paris 2014

Authors and Affiliations

  • Jérôme Rigaud
    • 1
    Email author
  • Jean-Jacques Labat
    • 1
  • Thibault Riant
    • 2
  • Kevin Buffenoir
    • 3
  1. 1.Clinique urologique et centre fédératif de pelvi-périnéologieCHU de NantesFrance
  2. 2.Unité d’évaluation et de traitement de la douleur Maurice Bensignorcentre Catherine de SienneNantesFrance
  3. 3.Service de neurochirurgieCHU de NantesFrance

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