Biomedical subjects

C Errando Smet

Publications and source records attributed to C Errando Smet.

At least 19 recordsLinked to original sources

PubMed2001

[Vesico-scrotal hernia with hypocontractile detrusor].

OBJECTIVE: To present a case of massive inguinoscrotal hernia associated with low detrusor contractility. METHODS/RESULTS: A 70-year-old male patient with a history of diabetes and a previous diagnosis of low contractile bladder presented with urinary retention. Acute renal failure secondary to ureteral obstruction and inguinal bladder herniation was diagnosed. The direct bilateral hernia was repaired. Postoperative urodynamic evaluation showed an acontractile bladder. Intermittent catheterization was started, with satisfactory functional result and improvement of renal function. CONCLUSIONS: Massive bladder hernia can present as acute renal failure without lower urinary tract obstruction. The underlying impaired detrusor contractility can be diagnosed by urodynamic evaluation. Surgical treatment, with self-catheterization if required, achieves good results with preservation of renal function.

Aged↗

PubMed2000

[Artificial sphincter in severe urinary incontinence: 9 years of experience].

OBJECTIVE: To present the results achieved with the artificial urinary sphincter in the treatment of 44 patients with severe urinary incontinence. METHODS: From April 1990 to December 1998, an artificial urinary sphincter was implanted in 44 patients with severe urinary incontinence, aged 21 to 82 years (mean 56). These patients were categorized into the following groups: Group A comprised 24 males, aged 37 to 82 years (mean 66), who had undergone previous prostatic procedures. Four of them had undergone radical retropubic prostatectomy. The remaining 20 had undergone a total of 34 de-obstructive procedures (mean 1.7 procedures/patient; range 1-3); 28 were endoscopic procedures and 6 open prostatectomy. One of them had a previous ileocystoplasty due to severely low compliance. Ten were completely incontinent and were using a condom catheter (7), penile clamp (2) or permanent indwelling Foley catheter (1). The rest used a mean of 3.7 pads per day. Group B comprised 11 males with a complex urologic history: 9 had neurogenic dysfunction, 1 had bladder exstrophy and 1 had a previous cystectomy and Studer neobladder. Eight were using a condom catheter. The cuff was placed in the bulbar urethra in 8 (4-4.5 cm) and in the bladder neck in 4 (9-10 cm). Group C comprised 9 women with type III stress incontinence after failed previous interventions (range 1-4, mean 2.7). All of these patients required at least 3 pads per day (mean 4.5). The cuff was placed in the bladder neck with diameters ranging from 5 to 10 cm. RESULTS: The mean follow-up was 28.5 months (range 8-96). One patient died two years after implantation of the artificial sphincter which was never activated. In group A, 83% are socially continent and 17 do not require pads. Three of the 20 patients with the artificial sphincter have undergone a total of 4 surgical revisions. In group B, the social continence rate was 63% with a 36% revision rate. Four patients required a complete change of the system. In group C, The continence rate with revision was 66%. One patient underwent two successive successful revisions and 3 required removal of the device, accounting for a failure rate of 33%. Definitive removal of the artificial sphincter was required in 3 females and 5 males. Aside from one male who refused a new implant, the rest were considered unsuitable for a new device. Six patients underwent at least one reoperation to change one or more parts of the system. Continence was recovered in 66% after the revision. CONCLUSIONS: The artificial urinary sphincter achieves a good continence rate in patients with severe incontinence, although careful patient follow-up is required.

Adult↗

PubMed1998

[Complete urodynamic office evaluation; a method for the delivery of health care].

INTRODUCTION: The goal of the study was to evaluate the usefulness of the complete urodynamic office evaluation. This assistance modality consists on the realisation in the same moment of the clinical chart, physical examination, urodynamic study, report, therapeutic indications, program of other complementary studies, hospitalisation or discharge from the outpatient office. PATIENTS AND METHODS: During 1 year complete urodynamic office evaluation was performed to 100 patients (87 female, 13 male) All patients were directed to our department to perform a urodynamic test, most of them due to incontinence. Different kinds of urodynamic tests were performed in 91 patients, with a medium of 2 studies per test. Abnormalities were detected in 59 cases. RESULTS: After the complete urodynamic office evaluation, 16 patients were programmed for surgery, 26 were discharged from outpatient office, 37 were directed to follow up in the outpatient setting, 2 were hospitalised, and 19 were lost of follow up. CONCLUSIONS: The complete urodynamic office evaluation allowed us to get the diagnostic and therapeutic approach in 98% of patients, employing a standard of 90 minutes. Twenty six percent of patients could be discharged from our center. Sixteen patients were operated on following this unique visit, that means an important reduction in the usual assistance delay.

Adult↗

PubMed1998

[Percutaneous urethral suspension with bone anchorage (Vesica) in the treatment of stress urinary incontinence. Results after a year of follow-up].

OBJECTIVES: Evaluation of efficacy of percutaneous bladder neck suspension with bone anchors in women with stress incontinence with no previous treatment. PATIENTS AND METHODS: Fourteen women (mean age 48, range 37-74) were operated. All had a stable bladder and objective leakage, either by pad test of by physical examination. Ten were evaluated by a incontinence questionnaire. Mean incontinence time before the procedure was 3.9 years. All needed pads (mean 3.3 pads/day). The surgical technique is described. RESULTS: Mean surgical time was 80 minutes. In three patients there was bladder perforation during the procedure, that was solved by delaying the catheter withdraw. Mean postoperative stay was 4.2 days, with good tolerance, and one patient was discharged with a cystostomy. After a minimum follow-up of one year (mean 17.5 months), eleven patients have improved their continence (6 dry, 5 socially acceptable incontinence < pads/day) and 3 have recurrence. Postoperative pad test was < or = 10 g in patients without improvement and over 20 g in patients who failed. Mean postoperative total score in the questionnaire decreased from 10.1 to 2.5 in patients who improved and didn't change in patients who failed. CONCLUSION: Percutaneous bladder neck suspension is a useful alternative to open interventions, due to its low morbidity and lower postoperative stay.

Adult↗

PubMed1997

[Orthotopic bladder replacement: I. Physiopathology of orthotopic bladder replacement with intestine].

OBJECTIVE: To analyze the physiopathological principles of utilizing the bowel for orthotopic bladder substitution and their effects on metabolism, function and continence. METHODS: The world literature is reviewed and our experience of 100 cases is described in the third part of this study. RESULTS/CONCLUSION: To reduce the metabolic changes, utilization of colonic or ileal segments with a maximum length of about 40 cm is advocated. This length of detubulized intestinal segment permits creating an ample, low pressure reservoir with an antireflux mechanism. The precise incidence of neoplastic degeneration of the ileal and colonic reservoirs is not known, but appears to be lower for the ileal neobladder.

Humans↗

PubMed1997

[Quantification of urine leaks: standardized one-hour pad test].

OBJECTIVE: To assess the feasibility and diagnostic performance of the one hour pad test proposed by ICS. PATIENTS AND METHODS: The pad test was performed in 20 women referred for incontinence. Five were included in a surgical protocol and 15 had inconsistent medical history. Their mean age was 52.5 years, the mean time of incontinence was 3.4 years and they used a mean of 3.5 pads/day. Six showed leakage on physical examination (PE) and 2 during previous cystometry. RESULTS: The test is well tolerated and lasts one hour and 15 minutes. The test was positive in 17 (mean leakage = 168 g). Leakage was not related to duration of incontinence, number of pads or cystometric capacity. A weak negative correlation (r = -0.52) was found between leakage and voided volume on uroflowmetry performed after the test. All patients who leaked on PE had a positive test and a significantly higher leakage compared to patients who didn't leak on PE. CONCLUSION: The pad test is a feasible outpatient procedure in the context of a Urodynamics Unit, providing objective information on leakage in most patients.

Adult↗

PubMed1997

[Orthotopic bladder substitution: II. Types and complications].

OBJECTIVE: In the last two decades, attention has been focused on the design of continent urinary diversion and orthotopic neobladder in an attempt to find the ideal bladder substitute. The more commonly utilized techniques of orthotopic bladder replacement are described and the urodynamic aspects and complications are analyzed. METHODS: The series of Studer, Hautmann, Kock, Pagano, Thuroff (Mainz Pouch) and Goldwasser and the relevant literature on this subject were reviewed. RESULTS/CONCLUSION: To date, similar functional results have been achieved by the different techniques of bladder substitution, although different intestinal segments are utilized. A longer follow-up is warranted to determine which is the ideal technique of bladder substitution.

Cecum↗

PubMed1997

[Orthotopic bladder replacement: II. Functional results and complications in patients with Studer-type ileal neobladder].

OBJECTIVE: Since 1988, 100 Studer ileal low pressure urinary reservoirs have been performed at our institution. The functional results and the complications observed in these patients are presented. METHODS: Patients submitted to radical cystectomy and lower urinary tract reconstruction with the Studer technique from 1988 to 1994 were retrospectively studied. All patients were males, their mean age was 60 years (37-75) and the mean follow-up was 18 months (6-72). The isoperistaltic ileal segment as antireflux mechanism was utilized in 97 cases and intussusception of the ileal segment to which the ureters were anastomosed in 3 cases. Reinsertion of the ureter was done using the Wallace technique in 90 cases and by direct fixation according to a personal technique (H.V.) in 10 cases. Anastomosis of the neobladder and the urethra was done with the end of the second suture of the orthotopic reservoir. The neurovascular bands were preserved in 21 patients less than 60 years old with tumor stage T2-T3a, according to the technique described by Walsh and Mostwin (1984). RESULTS: One patient died early postoperatively from sepsis. The early complications included urinoma (4%), urinary fistula (3%), intestinal fistula (2%), pulmonary complications (4%), pelvic hematoma (1%) and intestinal obstruction (3%). Only 4 of these patients required surgical resolution of the complication. The late complications included stricture of neobladder-urethra anastomosis (6%), lithiasis in neobladder (4%), ureteroileal stricture (8%), 5 renal units were lost, chronic urinary retention (5%), symptomatic metabolic acidosis (1%) and urinary infection (14%). Thirteen of these patients with late complications required surgery. At 6 months' minimum follow-up, 90% of the patients were continent during the day and 60% during the night. Overall, 36% of the patients recovered erection postoperatively; 76% of the patients with preserved neurovascular bands recovered erection. Forty-four percent of the patients claimed they had a satisfactory sexual activity postoperatively. CONCLUSION: The Studer neobladder permits voiding through the urethra, preservation of the upper urinary tract, the urinary infection rate is acceptable, the complication rate is low and it offers patients continence rates that allow them to have a good quality of life.

Adult↗

PubMed1997

[Radical nephrectomy following heart transplantation].

Renal cell carcinoma (RCC) is a common neoplasm of the urinary tract, that is nowadays often diagnosed incidentally. The risk of developing neoplasms in immunosuppressed patients is well documented. The increasing rate of heart transplantation, and the complementary studies required in the follow up of those patients probably will increase the detection rate of RCC in this population. Due the lack of published reports about the management and evolution of RCC in these patients, we performed a radical nephrectomy, on a immunosuppressed patient without evidence of recurrence 24 moths after surgery.

Heart Transplantation↗

PubMed1997

[Retropubic urethral suspension. A surgery "without complications"?].

OBJECTIVE: To describe a case of bladder neck suspensión with special reference to the complications associated with this procedure. METHODS/RESULTS: Herein we describe a patient who developed most of the reported associated complications following two bladder neck suspension procedures: bilateral ureteral ligation, osteitis pubis, retropubic hematoma, eventration and recurrence of urinary stress incontinence. Finally, after two reoperations, the complications were resolved and the patient is continent. CONCLUSIONS: Bladder neck suspension is usually associated with a low complication rate. However, associated complications may appear in the same patient, accounting for a significant morbidity.

Aged↗

PubMed1997

[Efficacy of oxybutynin chloride in children with vesico-ureteral reflux and detrusor instability].

OBJECTIVE: The purpose of this study was to assess the urodynamic (UD), radiological (VCUG) and clinical outcome in patients with detrusor instability (DI) and vesico-ureteral reflux (VUR). PATIENTS AND METHODS: UD and VCUG findings in 24 patients between 4 and 18 years of age (mean 7.6 years) with a simultaneous diagnosis of VUR and DI were reviewed. All presented with recurrent urinary tract infections (UTI). Twenty were female of whom 8 also had enuresis and daytime symptoms. Ten had bilateral VUR, making a total of 34 units. Mean follow-up was 40 months (range 18-97 months) and at least 2 UD studies were done. Treatment consisted of oxybutinin chloride (OC) and chemoprophylaxis. RESULTS: Treatment lasted an average of 31 months with an average dose of 11 mg/day. There was a statistically significant improvement in UTI rate, enuresis score and UD parameters [CysCap, volume at 1st contraction, maximum contraction and compliance (comp)]. Thirteen patients achieved stable bladders and 9 had some UD improvement (3 with low compliance and 2 with less severe DI), leaving 2 with unchanged DI. Reflux disappeared in 20 units and was downgraded in 6. VUR improvement coincided with the cases of UD improvement. Persistence of DI was always associated with persistent VUR. CONCLUSIONS: Oxybutinin treatment can be long, but UD and VUR improvement run parallel in most cases. The rare discrepant cases point towards a multifactorial ethology in this condition.

Adolescent↗

PubMed1997

[Diagnosis of bladder neck obstruction in women].

Bladder outlet obstruction in women is a rare entity, and difficult to diagnose. In our series most of the patients had previous history of gyneco-obstetric or urological procedures. Cystometry enabled us to diagnose the coexistence of bladder instability and obstruction in 48% of the patients. We did not find statistically significant differences between the patients with and without BI in terms of degree of obstruction measured by uroflowmetry and pressure/flow studies. Pressure/flow studies and Uroflowmetry had been the essential key in the diagnosis of obstruction in our series. Cysto-urethrography and urethroscopy were normal in over 50% of patients. The urethral calibration was abnormal in 16% of the cases.

Adolescent↗

PubMed1996

[Evolutive orchiepididymitis or ischemic testis?: that is the question].

We report a case of deferred acute scrotum in a young teenager. Even though initially the aetiological diagnosis seemed clear (partially treated epididymo-orchitis), glandular viability remained uncertain due to ultrasound findings and the time elapsed since initial diagnosis. Colour Doppler Ultrasound is examined as the most useful ancillary method in differential diagnosis in this setting, as well as the different ultrasound findings in subsequent stages of spermatic cord torsion and epididymo-orchitis. Possible testicular ischaemia in this clinical setting is emphasized, explaining its pathophysiology.

Child↗

PubMed1996

[Urethral condyloma in the male: experience with 48 cases].

OBJECTIVES: To review our experience in the diagnosis and treatment of urethral condylomata. METHODS: From June, 1977 to November, 1994, 64 patients with condyloma acuminatum were treated at our institution. Forty-eight cases who had received no previous treatment were analyzed. The main reason for consultation was the appearance of an exophytic lesion in the meatus. Most of the condylomata were located in the navicular fossa. Treatment was by electrocoagulation in 24 patients, photocoagulation with the Nd:YAG laser in 21 and other treatment modalities were utilized in 3 patients. To determine the incidence of recurrence and response to therapy, we analyzed the data of 34 patients with a minimum follow up of 2 months and a mean of 16 months. RESULTS: 36% had associated cutaneous condylomata. Urethroscopy detected 14.2% of the lesions that were undetectable by eversion of the meatus. Recurrence was observed in 35.2%. There were no differences for recurrence or complications between patients submitted to electrocoagulation and those who were treated by laser photocoagulation. CONCLUSIONS: Condyloma acuminatum of the urethra is uncommon. Urethroscopy is useful in making the diagnosis and for post-treatment follow up control evaluation. Electrocoagulation and Nd:YAG laser photocoagulation are useful in the treatment of this condition. Recurrence is frequently observed in patients with extensive lesions.

Adolescent↗

PubMed1996

[Endoscopic surgery of bladder diverticulum].

OBJECTIVE: To assess the endoscopic treatment of a vesical diverticulum by incision of the diverticulum opening and mucous fulguration associated to infravesical deobstructive surgery. METHOD: The procedure was performed in 30 male patients with flowmetry-documented infravesical obstruction. Results were radiologically evaluated, with patients being assigned to one of 3 groups: diverticulum disappearance; size reduction greater than 50% and persistence or size reduction lower than 50%. RESULTS: Disappearance of diverticulum was verified in 15 patients, size reduction greater than 50% in 9 patients, and persistence or size reduction lower than 50% in 6 patients. The complications rate in this series was 6.6%. CONCLUSIONS: Endoscopic treatment of a vesical diverticulum with the technique used in our series, was shown to be effective, particularly in diverticula with diameter under 50 mm, and was associated to low morbidity and short hospital stay.

Adult↗

PubMed1996

[Analysis of 895 consultations for hematuria in the emergency department in an urology unit].

OBJECTIVE: To study efficacy of our diagnostic approach in patients with haematuria, as well as the information provided by the different tests. PATIENT AND METHODS: The computerization of our emergency department, and the study of the data base have permitted us to study retrospectively 722 cases of hematuria seen at our center over a period of 10 months. The relation between the benign or malignant etiology of the hematuria, and the presence or absence of associated symptoms and the intensity of the hematuria is shown, as well as the relation between the intensity of the hematuria and the decrease in the hemoglobin rates detected. RESULTS: Fifty eight percent of the 722 patients, 39% of them due to neoplasm. The intensity of had one symptom only hematuria was significantly superior in the patients with the final diagnosis of neoplams. The accomplishment of reactive strip, basic imaging techniques and urine sediment has permitted in our series to direct the diagnosis in 67.3% of patients. Cystoscopy has shown great efficacy in diagnosing the cases of monosymptomatic hematuria with normal radiological studies. CONCLUSION: Monosymptomatic hematuria deserves a work-up to rule out malignancy. Reactive strip, urine sediment, KUB and ultrasonography allow to direct the diagnosis in most cases.

Adolescent↗

PubMed1994

[Emphysematous cystitis with inversion of the contrast and urine levels inside a bladder diverticulum in computerized tomography].

We report a case of emphysematous cystitis in a 70-year-old male with acute urinary retention. Patient evaluation included a CT scan that disclosed a large diverticulum in the bladder and inverted contrast medium-urine level. We discuss the possible causes of this unique, paradoxic and infrequent finding, which often indicates the presence of infectious sediment in the bladder.

Aged↗

PubMed1994

Urologic interconsultation in a general hospital: analysis of 100 consecutive consultations.

One hundred consecutive interconsultations were made on 89 patients during a two and a half month period to the Urology Service by physicians from a 970-bed General Hospital (excluding Uropediatrics, Nephrology and Renal Transplantation). Sixty percent were on males. The mean age was 61 (range 16-96 years) and 62% were 61 or older, a higher rate than that reported for an ambulatory population. Three consultations were considered inappropriate, and 37 urgent or very urgent. The most common cause was acute urinary retention (21%), followed by genitourinary bleeding (18%). Overall, catheters were involved in 35% of the consultations. The medical departments made 61 interconsultations, 33 came from surgical departments and 6 from the emergency department. The causes and implications of consultation are analyzed.

Adolescent↗