Biomedical subjects

D Barbalias

Publications and source records attributed to D Barbalias.

4 recordsLinked to original sources

PubMed2001

Urologic manifestations of multiple sclerosis: proposed treatment algorithms.

PURPOSE: A detailed clinical management of the urological manifestations of multiple sclerosis (MS) is presented as it is practiced in our department, and therapeutic algorithms are constructed. MATERIALS AND METHODS: One hundred and ten patients were consecutively and prospectively studied with a clinical syndrome of MS. ranging in age from 32 to 65 years of age. Clinical diagnosis of the voiding dysfunction associated with MS was classified as a malfunction causing either problems of bladder evacuation, or storage, or a combination of both. RESULTS: All patients were initially managed in a conservative way avoiding surgical procedures and following primarily pharmacologic treatment, because of the quite common reversibility of MS. The detailed management of the related voiding dysfunction is given by the proposed algorithms. CONCLUSIONS: Our purpose was to present the algorithms that can help the practicing physician to come to reasonable conclusions as to therapeutical choices directed to specific pathophysiologic characteristics of voiding dysfunction related to MS.

Adult↗

PubMed2001

Clinical management of the neurourological syndrome associated with multiple sclerosis and correlations to grade of the disease.

PURPOSE: In this study a detailed clinical management is presented as it is practiced in our department, and possible correlations between grade of the disease and therapeutic responses are examined. MATERIALS AND METHODS: One hundred and ten patients were consecutively and prospectively studied with a clinical syndrome of MS, ranging in age from 32 to 65 years of age. Clinical diagnosis of the voiding dysfunction associated with MS was classified as a malfunction causing either problems of bladder evacuation, or storage, or a combination of both. Therapeutic responses of the voiding dysfunction were correlated with grade of the disease. Mean follow up period was 54 months. RESULTS: All patients were initially managed in a conservative way avoiding surgical procedures and following primarily pharmacologic treatment, because of the quite common reversibility of MS. A possible correlation of response to treatment according to grade of the disease was studied. There was significant difference in the response to drug treatment among patients of different grades favoring grade 1 patients with both storage and evacuation voiding dysfunction. CONCLUSIONS: Our suggested treatment has secured the conversion of a high pressure into a low pressure vesicourethral system, thus obviating possible risk factors for the upper urinary tract and the bladder itself. Therapeutic responses were dependent upon the grade of the disease.

Adult↗

PubMed2001

Vesicourethral dysfunction associated with multiple sclerosis: correlations among response, most prevailing clinical status and grade of the disease.

PURPOSE: In the present study we have performed a correlation of the most prevailing clinical conditions of multiple sclerosis (MS) with overall drug response and the grade of the disease. MATERIALS AND METHODS: One hundred and ten patients were consecutively and prospectively studied with a clinical syndrome of MS, ranging in age from 32 to 65 years of age. In the present study we evaluated the patients with DESD (n = 35), detrusor hyperreflexia (n = 32), and/or low compliance (n = 8). The latter three conditions were considered as the most threatening, and thus a correlation with the drug response and the grade of the disease was attempted. RESULTS: All patients were initially managed in a conservative way avoiding surgical procedures and following primarily pharmacologic treatment, because of the quite common reversibility of MS. Our results suggest that there is no correlation between the prevailing clinical status and drug response (p = 0.06) or grade of the disease (p = 0.07). The only statistically significant correlation was seen between grade of the disease and overall drug response (p < 0.0001) CONCLUSIONS: Therapeutic responses were dependent upon the grade of the disease. The continuation of this study recruiting more patients into various subgroups of voiding dysfunction will further validate the statistical correlations among disease grade and therapeutic responses.

Adult↗

PubMed1997

Use of slings made of indigenous and allogenic material (Goretex) in type III urinary incontinence and comparison between them.

OBJECTIVE: To evaluate the use of Goretex pubovaginal sling and compare the results with a typical indigenous material graft made of rectal fascia. METHODS: We have prospectively evaluated 48 consecutive patients in a randomized fashion in whom a sling procedure was performed to treat their type III incontinence. Sixteen women had a vesicourethral suspension (VUS) by a Goretex sling and another group of 32 patients, comparable in age range and medium age with the previous group, had a similar VUS by a sling from the rectus abdominis fascia. Both groups were evaluated urodynamically 6 and 30 months later. RESULTS: In the first group, cure of incontinence was observed in 87.5% and in the remaining patients it was significantly improved. In 2 patients there was an erosion of the urethra and the Goretex sling had to be removed 3.5 years later. Three other women remained dry but complained of occasional irritative symptoms. In the remaining 11 there was no erosion and the excellent postoperative result was maintained. In the group with fascial slings there was no erosion observed and in general they had less irritative symptoms. Cure or improvement of incontinence was comparable with the first group when studied 6 months after surgery, but there was a significant difference in the 30 months postoperative evaluation. CONCLUSIONS: Use of a Goretex sling provides better long-term results even though it is associated with somewhat increased morbidity.

Adult↗