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Biomedical subjects

D Beurton

Publications and source records attributed to D Beurton.

At least 37 records · Page 2Linked to original sources
PubMed1997

Combined modified rectus fascial sling and augmentation ileocystoplasty for neurogenic incontinence in women.

PURPOSE: We assessed results of a combined modified rectus fascial sling procedure and augmentation ileocystoplasty in women with neurogenic urinary incontinence. MATERIALS AND METHODS: We prospectively evaluated 21 patients (mean followup 28.6 months). RESULTS: A total of 20 patients (95.2%) was dry during the day on intermittent catheterization and none had difficulty with catheterization. Subsequently surgery was necessary in 1 case for perforation of the augmented bladder. CONCLUSIONS: A combined modified rectus fascial sling procedure and augmentation ileocystoplasty are safe and effective when all available pharmacological treatments and clean intermittent catheterization have failed.

Adolescent↗
PubMed1996

Reappraisal of endoscopic sphincterotomy for post-traumatic neurogenic bladder: a prospective study.

PURPOSE: We assessed the results of endoscopic sphincterotomy in patients with detrusor-sphincter dyssynergia secondary to spinal cord injury. MATERIALS AND METHODS: A prospective study was done of 92 patients with a mean followup of 20.6 months. RESULTS: The morbidity rate was 10.9%. Results demonstrated objective (assessed by the decrease in voiding pressure) and subjective (expressed by the patient) improvement in quality of micturition in 83.7% and 73% of the cases, respectively. Subjective autonomic dysreflexia resolved in 93.2% of the cases. CONCLUSIONS: Sphincterotomy is a useful and effective therapeutic method for neurogenic bladder when all available pharmacological treatments and clean intermittent catheterization have failed.

Adult↗
PubMed1996

[Augmentation ileocystoplasty in neurologic bladder].

OBJECTIVE: The authors evaluated the results of augmentation ileocystoplasty in patients presenting with neurogenic urinary incontinence. MATERIALS AND METHODS: A prospective study was conducted in 36 patients (25 women, 11 men) 30 of whom simultaneously underwent a bladder neck continence procedure. The mean follow-up was 32.2 months. RESULTS: Daytime continence was obtained in 32 patients (88.8%). Thirty patients (83.3%) were continent a night. The upper urinary tract did not deteriorate. One patient developed bladder stones and 2 presented a vesical perforation. Urodynamic studies showed an increased functional bladder capacity and compliance (p < 0.001) and loss of uninhibited bladder contractions. CONCLUSION: Augmentation ileocystoplasty is an effective and reliable surgical procedure after failure of conservative management. However, long-term complications can occur and regular surveillance is necessary.

Adolescent↗
PubMed1995

Transrectal and transurethral hyperthermia versus sham treatment in benign prostatic hyperplasia: a double-blind randomized multicentre clinical trial. The French BPH Hyperthermia.

OBJECTIVE: To compare the safety and efficacy of hyperthermia for the treatment of benign prostatic hyperplasia (BPH), by either the transrectal or transurethral approach, relative to sham treatment. PATIENTS AND METHODS: Two hundred patients from seven urological departments were randomized and treated in a single centre. Principal inclusion criteria were a peak flow rate (PFR) < 15 mL/s and residual urine < 300 mL/s. Comparisons were made between transurethral hyperthermia (TUH) and transurethral sham (TUS) and between transrectal hyperthermia (TRH) and transrectal sham (TRS) 12 months after treatment. Outcome was assessed by improvements in the Madsen score and PFR, and the incidence of side-effects. RESULTS: After 12 months, 145 patients were evaluated; 12 patients withdrew during treatment, 43 withdrew during follow-up and two were lost to follow-up. Withdrawals were mainly due to side-effects during treatment (17% in the TRH and 1.5% in the TUH group) and to a lack of improvement during follow-up (14% in the TUH group, 19% in the TUS, 15% in the TRH and 10.5% in the TRS group received other treatments for BPH). Complications during treatment consisted mainly of local pain, urethral bleeding, urethral pain and acute retention, and were five times more frequent in the TRH than the TUH group (34% versus 6%). There was no improvement in PFR after TUH and TRH (response < 20%). Only TUH improved the Madsen score (TUH, +50% and TUS, +17%). CONCLUSION: Hyperthermia was not an effective treatment for BPH.

Aged↗
PubMed1994

[A modified cervico-prostatic incision technic in hypertrophic adenoma in young subjects desiring to preserve ejaculation].

The treatment of bladder neck obstruction by transurethral resection of the prostate is responsible for retrograde ejaculation, which is poorly tolerated by our younger patients. Bladder neck incision, initially proposed as treatment for bladder neck sclerosis and for small prostates, was performed according to a modified technique in 36 patients with a mean age of 57.6 years (range: 41-72 years), with benign prostatic hypertrophy less than 30 grams and wishing to retain antegrade ejaculation. This technique consists of creating a deep groove with the resector hook extending from the ureteric orifice to 5 mm above the verumontanum, incising the full thickness of the detrusor and prostatic urethra as far as the retrocervical fat. This preserves a supramontanal ring of urethral muscle whose contraction during orgasm prevents retrograde ejaculation of semen. Resection of the median lobe was also performed in 8 patients, while sparing the cervical muscular ring. The mean follow-up was 2.4 years (range: 4-84 months). Dysuria was very considerably improved in 32 patients (91.5%), with a Madsen score of less than 2. Antegrade ejaculation was preserved in 32 patients (91.5%). Two patients had to undergo secondary prostatic resection because of persistent dysuria (these 2 patients retained antegrade ejaculation). Unilateral bladder neck incision, sparing a supramontanal muscular ring is an easy, rapid technique with low morbidity, effective in the treatment of prostatism due to a small prostate (less than 30 grams). It is the operation of choice in young patients with small prostates who wish to retain antegrade ejaculation.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

[A review of 72 renal artery stenoses in a series of 715 kidney transplantations in children].

In a series of 715 renal transplantations performed between 1973 and 1989, 72 cases of renal artery stenosis (RAS) in 69 children (9.7%) were managed at Hôpital Necker Enfants Malades. Forty cases of RAS were treated exclusively by antihypertensive drugs. A good result was obtained in 82.5% of cases. Thirty three transluminal angioplasties (TLA) were performed in 23 children with 26 RAS. A good clinical result was obtained in 15 children with a total of 17 stenoses, corresponding to a success rate of 65%. Transluminal dilatation of anastomotic stenoses always failed. There were no cases of transplant thrombosis. Eleven RAS were operated, including 5 after failure of TLA. Eight patients (73%) obtained a clinical improvement. There were 2 postoperative thromboses. Antihypertensive treatment must be administered in every case. If medical treatment fails, and with the exception of anastomotic stenoses, TLA should be the first-line procedure, while surgery is reserved for failures of TLA and for anastomotic stenoses.

Adolescent↗
PubMed1994

[Antenatal diagnosis of obstructive uropathies: state of the art].

The development of ultrasonography has allowed the antenatal diagnosis of various forms of obstructive uropathy. The diagnosis of urinary tract dilatation is now possible by the 15th week of pregnancy. More recently, the study of foetal urine biochemistry has defined the prognostic factors of the course of postnatal renal function. The authors define and limit the current indications for the various antenatal interventions on the basis of the combination of antenatal ultrasonography and foetal urine biochemistry.

Dilatation, Pathologic↗
PubMed1994

[Characteristic aspects of vascular complications in renal transplantation in children].

In a series of 859 transplantations performed in children and adolescents from January 1973 to December 1992, vascular thrombosis accounted for 18% of all graft losses (2nd cause of graft failure), and 57% of early failures (within 2 months). Renal veins and arteries were equally affected. The young age of the donors and recipients constituted the main risk factor, thrombosis accounting for 40 and 37% respectively of all graft losses in donors and recipients < 5 years old. This explained the lower survival rate of these age groups after grafting, as reported in most published pediatric series. The prophylactic use of a low molecular weight heparin in high-risk grafts may help to decrease its incidence. A renal artery stenosis, located a few cm beyond the anastomosis in 2/3 of cases, was observed in 10% of grafts. Often severe hypertension (HBP) with cerebral complications, responsible for permanent sequelae in some cases, was the prominent symptom. Anti-hypertensive drug therapy was sufficient to control HBP in 40 cases out of 72, and in 10 of these, a spontaneous regression of the stenosis was remarked within a few months after repeated angiography. Transluminal angioplasty was used on 26 stenosis and was effective in 2/3 of cases; the recurrence rate, however, was 27%.

Adolescent↗
PubMed1993

[Renal transplantation in children under five years of age. Experience at the Hopital des Enfants-Malades].

From 1976 through 1991, 50 renal transplants (with 7 kidneys from living related donors and 43 cadaver kidneys) were performed in 47 children under five years of age (range 11 to 59 months) at the Enfants-Malades Hospital, Paris, France. Donor age ranged from 3 months to 53 years. Six of the seven kidneys from living related donors are currently functioning after a follow-up of 6 months to 8 years, whereas actuarial survival of cadaver kidneys was 70% at one year and 66% at five years. The main cause of graft loss was vascular thrombosis (40% of lost kidneys). In the most recent years of the study period, graft survival was substantially improved by routine prophylactic anticoagulant therapy with low-molecular weight heparin: one-year graft survival rate was 83% in the 23 children grafted between 1989 and 1991. Posttransplantation growth was closely related to quality of graft function: among the 29 children with sufficiently long follow-up the 19 patients with normal renal function exhibited normal or catch-up growth, whereas the ten patients with chronic renal failure or recent rejection had poor growth. Complications were uncommon with the exception of hypertension. Mortality rate was 12%, i.e., only slightly higher than in older pediatric kidney recipients. Achievement at school was normal in most cases (with a lag in only five patients). Provided effective therapy is given to prevent the main adverse outcome (i.e., vascular thrombosis), renal transplantation does not involve excessive risks even in infants as young as one year of age.

Actuarial Analysis↗
PubMed1993

[Urinary lithiasis after kidney transplantation. Experience at a pediatric center].

BACKGROUND: Urologic complications are still a frequent and significant problem in renal transplant recipients. The search for risk factors is therefore mandatory. MATERIAL AND METHODS: 652 renal transplantations were performed in children and adolescents between January 1973 and December 1988. 33 patients (5%) developed urolithiasis; their files were retrospectively analysed at the same time as the files of 28 patients transplanted during the same period and having similar ages, reasons for transplantation and immunosuppressive therapy. RESULTS: The stones contained calcium in 27 patients and uric acid in 6. The first symptoms were hematuria (27 times) with or without dysuria (9 cases), urine retention (2 cases) and anuria (2 cases). Repeated urine infections frequently led to the use of imaging techniques that permitted diagnosis. Urolithiasis was responsible for urinary obstruction in 13 cases; 9 of these required surgery. The course was always good without any modification of renal functions. The main risk factors were local: ureteral reimplantation on intestinal bladder, use of nonresorbable stitches and repeated urinary infections. Metabolic factors were less frequent and included hypercalciuria (18 cases) and hyperparathyroidism (2 cases). CONCLUSIONS: Some of the risk factors such as urinary infections, changes in the metabolism of phosphorus and calcium or insufficient diuresis, can be prevented. Repeated imaging techniques during the follow-up are mandatory.

Adolescent↗
PubMed1993

[Urethro-cervico-cystopexy using aponeurotic colposuspension: an original technic in the treatment of stress urinary incontinence. Apropos of 32 long-term reviewed cases].

This is an original technique for the treatment of isolated urinary stress incontinence without associated cystocele, designed to obtain a good result, stable in the long term, which avoids dysuria and phenomena of bladder irritation (frequency, urgency) inherent to suspension cervicopexy. It consists of a Gobell-Stoeckel operation, modified at two points: retrocervical dissection exclusively via a retropubic incision and fixation of a band of aponeurosis to the vagina before fixing it to Cooper's ligament to prevent compression of the posterior lip of the bladder neck. Thirty two patients with a mean age of 56 years (range: 41-83 years) were operated by this technique between 1986 and 1991. Sixteen of the 32 patients (50%) had a history of previous pelvic surgery: 14 hysterectomies, 4 cures of urinary stress incontinence, 4 cures of cystocele. Stress incontinence was associated with urgency in 25% of cases. Five patients developed 7 minor early complications: 3 benign parietal complications, 4 cases of transient urinary retention. The mean duration of indwelling catheterisation was 4 days (range: 2-6 days) and the mean length of hospital stay was 8 days (range: 6-20 days). The mean follow-up was 32 months (range: 12-70 months). Perfect continence was achieved in 91% of cases. 69% of patients obtained an excellent result (normal continence, no dysuria, no urgency), 19% obtained a moderate result (normal continence, but slight dysuria and/or urgency) and 12% obtained a poor result (2 cases of urge incontinence, 1 case of late incontinence secondary to a neurological lesion and 1 case of permanent incomplete retention requiring endoscopic section of the strip of aponeurosis). On the basis of these good long-term results, the authors propose this technique for the treatment of urinary stress incontinence in postmenopausal and/or previously operated women.

Adult↗