Biomedical subjects

D Floratos

Publications and source records attributed to D Floratos.

5 recordsLinked to original sources

PubMed2000

Abdomino-perineal repair of recurrent and complex bladder neck-prostatic urethra contractures.

OBJECTIVE: To evaluate the effectiveness of abdomino-perineal repair in treating complex and recurrent bladder neck-prostatic urethra contractures. METHODS: The study included 6 patients retrospectively. Their ages ranged from 66 to 75 years (67.83+/-8.13, mean + SD). All presented with a long history of voiding difficulty and urinary incontinence. Prior to definitive treatment all the patients had been subjected to multiple unsuccessful transurethral resections of bladder neck-prostatic urethra contractures. They were all subjected to diagnostic work-up including retrograde and voiding urethrogram, urethroscopy and urodynamics. Finally all the patients underwent abdomino-perineal excision of the stenotic area and end to end anastomosis. All of them received simultaneously an artificial urinary sphincter insertion for concurrent sphincteric deficiency and three were subjected simultaneously to clam type ileocystoplasty for intractable detrusor instability. The follow-up ranged from 8 to 56 months (24.42+/-19.64, mean + SD). RESULTS: The actual surgical time ranged from 3.5 to 5.5 h (4.1+0.4, mean + SD). Five patients void satisfactorily remaining unobstructed through the entire follow-up period, while one has to empty his augmented bladder by means of clean intermittent self catheterization. Five patients are continent and one significantly improved. Major complications due to infection-erosion of the prosthetic material were encountered in one patient. CONCLUSIONS: Abdomino-perineal repair is an effective surgical procedure for the management of recurrent and complex bladder neck-prostatic urethra contractures, although it is time consuming and requires in the majority of cases combined techniques in order to achieve optimal results.

Aged↗

PubMed1999

Neurogenic bladder dysfunction due to Behçet's disease.

BACKGROUND: Behcet's disease is a chronic multisystem condition of unknown origin. Genitourinary tract involvement with genital apthous ulcers, epididymitis, urethritis and recurrent cystitis is encountered commonly. Neurogenic bladder dysfunction due to neural involvement of the syndrome, has been reported extremely rarely. METHODS: A case of neurogenic bladder dysfunction due to Behcet's disease is presented. The patient was 17-year-old young male with a long history of the disease and neurological affection, but with neglected lower urinary tract symptoms and urinary incontinence. The patient was diagnosed urodynamically to have hyperreflexic detrusor. RESULTS/DISCUSSION: After failure of medical treatment (oxybutynin chloride) the patient submitted to augmentation clam-type sigmoidocystoplasty. Four years postoperatively, the patient is dry, on clean intermittent self catheterization twice daily and he is practically asymptomatic from lower urinary tract symptoms.

Adolescent↗

PubMed1998

Transvaginal incisionless bladder neck suspension. A simplified technique for female genuine stress incontinence.

OBJECTIVES: Purpose of the present study is to evaluate the efficacy of a modified Gittes procedure in the management of Type I and Type II stress urinary incontinence of the female. PATIENTS AND METHODS: Thirty-two female patients with urodynamically proven Type I and Type II stress urinary incontinence had been subjected to transvaginal incisionless bladder neck suspension (modified Gittes procedure) from September 1991 to June 1996. Their mean age was 55.2 (32-78) years. The preoperative evaluation included provocative video-urodynamics and occasional profilometry to exclude Type III stress incontinence in certain cases. The procedure described by Gittes was performed with the modification of approaching the rectus fascia through two small suprapubic incisions instead of the percutaneous original Gittes puncture. RESULTS: The mean follow-up was 41 (10-66) months. Two of our patients had been lost from follow-up and were excluded from analysis. Of the remaining 30 patients, 26 (86.7%) are clinically continent. Six of them (20%) developed de novo postoperative urgency and/or urge incontinence due to bladder instability not present preoperatively. All six of them successfully managed with oral oxybutynin chloride. One diabetic patient was unable to void spontaneously and had to use the technique of clean intermittent self-catheterization (CISC) to evacuate her bladder. Of the remaining 4 (13.3%) incontinent patients, one was subjected to insertion of an artificial urinary sphincter (AUS) and one to a Burch colposuspension, both successfully. There were no major peri- or postoperative complications, with the exception of one patient with recurrent cystitis, who was treated with long-term chemoprophylaxis. CONCLUSION: The modified Gittes bladder neck suspension is a simple and effective procedure, with no major complications and thus a good alternative to abdominal approaches.

Adult↗

PubMed1998

Incontinence after surgery for benign prostatic hypertrophy: the case for complex approach and treatment.

OBJECTIVE: Whether incontinence after surgery for benign prostatic hypertrophy (BPH) requires simple workup and treatment or being a more complex condition and multifactorial in etiology requiring combined surgical techniques should be investigated in more detail. METHODS: We retrospectively reviewed the records of 56 patients referred to us for post-prostatectomy incontinence after surgery for BPH. All patients were subjected to urodynamics. Twenty-three (41.1%) patients required additional ascending urethrogram and/or cystourethroscopy, according to their associated symptomatology and the urodynamic findings, for a definitive diagnosis to be established. RESULTS: Twenty-four patients (42.8%) were found to have complex incontinence (either mixed or any type associated with bladder outlet stenosis), requiring combined treatment. Twenty-three (41.1%) had a simple type of incontinence, i.e., pure sphincter incompetence or unstable detrusor. Three patients had residual adenoma and 1 urethral stricture, while 5 patients (8.9%) remained unclassified. Thirty-seven patients were subjected to treatment, 27 (73%) of them to single-modality treatment (artificial urinary sphincter insertion, oxybutynin chloride, transurethral prostatectomy, optical urethrotomy) and the other 10 (27%) to combined treatment (artificial urinary sphincter insertion plus urethroplasty, ileocystoplasty, permanent urethral stent implantation etc.). The overall socially acceptable continence rate (cured plus significantly improved) of the patients subjected to artificial urinary sphincter insertion reached 85%, being better (90%) for the uncomplicated sphincter incompetence group. CONCLUSIONS: Incontinence after surgery for BPH represents a condition that requires careful evaluation. In a significant proportion of patients, a combination of prosthetic and reconstructive techniques is needed for an optimal result to be achieved.

Aged↗

PubMed1997

Combined reconstructive and prosthetic surgery in complicated lower urinary tract dysfunction.

PURPOSE: The combined use of the appropriate reconstructive technique and available prosthetic material was evaluated to achieve an optimal functional result in complicated lower urinary tract dysfunction. MATERIALS AND METHODS: The study included 16 male and 8 female patients. Urinary dysfunction was classified into 2 main categories: 1) neuropathic and 2) nonneuropathic. Of the patients 22 underwent some form of augmentation (21) or substitution (1) cystoplasty, 24 received an artificial urinary sphincter, 2 underwent abdominoperineal urethroplasty and 2 received a permanent urethral stent. One patient underwent renal transplantation and 1 received a penile prosthesis for concurrent impotence. RESULTS: A total of 20 patients (83.3%) became continent, 10 void spontaneously, while 14 must empty the bladder or pouch by clean intermittent self-catheterization. All patients have stable or improved renal function. CONCLUSIONS: Combined reconstructive and prosthetic surgery has an important role in the treatment of lower urinary tract dysfunction, with a high success rate and good quality of life.

Adolescent↗