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The study investigates the effectiveness of blind and ultrasound-guided epidural injections in Egyptian donkeys in the sacrococcygeal region, a topic of limited research, by comparing and assessing their onset in 20 healthy adult donkeys of both sexes. In the first group, we used ten cadaver donkeys that were humanely euthanized. In the second group, we used 10 live, healthy adult donkeys to assess the efficacy and time of analgesia onset for blind and ultrasound-guided epidural injections at the sacrococcygeal region. Cadavers were randomly designated to blind (n = 5) or US-guided (n = 5) epidural injections at the sacrococcygeal region in sternal recumbency in donkeys using Methylene Blue (1%) as a diagnostic marker for caudal epidural injection. The injection criteria were comparatively assessed between the two techniques of injection. Our findings comparing the blind and US-guided injection approaches showed substantially higher needle accuracy penetration to comparatively assess these two injection techniques. Both injection difficulties and trial numbers were significantly greater in blind techniques as opposed to US-guided procedures. US-guided injection procedures revealed the effectiveness of the time needed for perfect placement of the needle was significantly less than with a blind one. A shorter time for the onset of analgesia was achieved with the ultrasound-guided method, although the difference was not statistically significant (P < 0.09). In conclusion, the ultrasound-guided technique of the epidural injection provided a number of benefits over the blind one, including the capacity to directly view the needle and distribute local anesthetic and avoid unintentional vascular damage, in comparison with traditional blind techniques. Our study aims to enhance the accuracy and safety of epidural anesthesia injection at the sacrococcygeal space in Egyptian donkeys using ultrasound guidance in the veterinary surgical field. [ABSTRACT FROM AUTHOR]

Sacral neuromodulation (SNM) as an advanced form of neuromodulation technique, which has demonstrated significant efficacy in alleviating clinical symptoms for patients with pelvic floor dysfunction (PFD) who do not respond to conventional treatments. This paper provides a comprehensive review of the application and progress of SNM in the treatment of PFD. It covers its historical development, mechanisms of action, clinical applications, optimization of stimulation parameters, and several technological innovations that have facilitated its clinical adoption. The aim is to promote wider clinical application of SNM and offer more precise treatment options for patients. [ABSTRACT FROM AUTHOR]

Presacral tumors are extremely rare tumors in adults. Such lesions are often found incidentally. The strange presentation of lesions in the pre-sacral space and the ambiguity of its clinical presentation makes it difficult to establish its diagnosis as the first possibility. Given that several germ lines converge in this presacral space, it is possible to find a variety of lesions, one of the rarest being neuroendocrine tumors. We present a case of 34-year-old female diagnosed with pre-sacral mass that was surgically resected, with histologic studies showing a mature cystic teratoma with neuroendocrine tumor.

Surgical excision is the only radical treatment for presacral cysts, which are difficult and risky because of the complex anatomical structure around them, involving important blood vessels and nerves. Improper surgical procedures will lead to recurrence of presacral cysts after surgery, causing great pain to patients. With the deepening of clinical research on presacral cysts, some new problems have been found to be overcome. On the basis of the Chinese Expert Consensus on Standardized Treatment of Presacral Cysts (2021 edition), the Pelvic Tumor Integration Professional Committee of the Chinese Anti-Cancer Association organized authoritative experts in relevant professional fields including general surgery, gastrointestinal surgery, colorectal and anal surgery, gynecological oncology, bone and soft tissue surgery, neurosurgery, pathology, imaging and other departments, to formulate the Chinese Expert Consensus on the Standardized Diagnosis and Treatment of Presacral Cysts (2024 edition) after a consensus meeting. The 2024 consensus provides a comprehensive introduction to the following seven aspects, including the origin and pathology of presacral cysts, related anatomy and classification of surgery, diagnosis and differential diagnosis, surgical philosophy, surgical methods for excision, perioperative complications and management, follow-up, and subsequent treatment, and has reached a consensus after repeated discussions and revisions. Compared with the 2021 consensus, the main updates in the 2024 consensus include the following aspects: in the anatomy and classification section, the anatomical classification of high and low, single and multiple cysts of the presacral space has been added; in the surgical concept section, it is emphasized to protect the sacral nerves for presacral cysts with sacral variations; in the surgical approach section for excision, the surgical approach for different anatomical types of presacral cysts has been further clarified. For patients with preoperative enterocutaneous fistula, the use of gluteus maximus muscle flap to repair the fistula reduces the probability of preventive stoma. For suspected malignant presacral cysts, multidisciplinary consultation is required, and if radical resection is not possible, further biopsy is performed to clarify the pathology and develop a comprehensive treatment plan.

The most common site for a pilonidal sinus is the sacrococcygeal region, typically affecting hirsute males. Hair entrapment beneath the skin triggers a granulomatous reaction, leading to the formation of a sinus tract. Here, we present a rare case of concurrent pilonidal abscess in both the nape of the neck and the natal cleft. To date, only five similar cases have been reported in the literature, making this presentation unique.The patient, in his mid-30s, presented with recurrent swelling and discharging sinuses in both the nape of the neck and the intergluteal region. The surgical intervention included excision of the sinus tract in the neck and wide local excision with Limberg flap reconstruction in the sacrococcygeal region.One year post-surgery, the patient showed complete healing with no recurrence observed during follow-up., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2025. No commercial re-use. See rights and permissions. Published by BMJ Group.)