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D Porru

Publications and source records attributed to D Porru.

34 records · Page 2Linked to original sources
PubMed1997

Urinary tract dysfunction in multiple sclerosis: is there a relation with disease-related parameters?

The lower urinary tract is affected by multiple sclerosis in many patients. We screened urologically and neurologically 120 patients with a confirmed diagnosis of multiple sclerosis. The mean age was 42 years (range 22 to 69 years). Urodynamic investigation as well as neuro-urophysiological investigations were performed in all patients. Renal ultrasound was used to study morphology, and excretory urogram (IVU) was used to assess renal function and the upper urinary tracts in 105 patients. Obstructive symptoms were found more commonly than irritative symptoms. The urinary symptoms were found to be related to disease duration and not to disability status. Urodynamic abnormalities were statistically significantly related to disease duration (X2 = 38.51; P = 0.0001), and to the disability status (X2 = 76.70; P = 0.0001). Few patients, only 3.3%, had upper urinary tract dilatation. With medical management, hydronephrosis disappeared in all of the patients and did not recur. A combination of oral pharmacological agents and clean intermittent catheterization was used in the majority of the patients. We conclude that lower urodynamic abnormalities can be present in every patient with multiple sclerosis, and appear to be related to disease duration and disability status, thus early treatment based upon urodynamic evaluation and close follow-up can reduce morbidity and improve the quality of life.

Adult↗
PubMed1997

Results of treatment of refractory interstitial cystitis with intravesical hyaluronic acid.

Interstitial cystitis is a chronic benign disease of the bladder that causes bothersome and debilitating symptoms and mainly affects women. Since interstitial cystitis (IC) might result from a defective glycosaminoglycan layer of the bladder epithelium, we conducted a trial of hyaluronic acid (HA), used intravesically, to test its activity in the treatment of this disease. A total of 10 patients with typical findings of IC were included. Following bladder catheterisation, the patients received a dose of 40 mg, weekly for 6 weeks, and then monthly. Response to therapy was evaluated by comparing the pre-treatment and post-treatment symptom scores and voiding diaries. There was a 30% positive response rate at week 6, which was maintained until week 24. No significant local or general side-effects were noted during the course of treatment. Although we recorded a low incidence of success in our group of patients, the results of our limited study were satisfactory in the group of responsive patients (30%), who had no relapses during the observation period of 6 months. The intravesical administration of HA was well tolerated in all cases.

Administration, Intravesical↗
PubMed1997

Severe recurrent ureteral stricture: the combined use of an anterograde and retrograde approach in the prone split-leg position without X-rays.

We report on a 50-year-old woman first treated by us in 1990 for uroseptic fever. Urography showed occlusion of the terminal tract of the lower third of the left ureter. The patient was submitted to successful left ureteroneocystostomy (UNCS). Three months later, she had a relapse of uroseptic fever, and urography showed right ingravescent dilation and excellent functional activity of the left urinary tract. Right UNCS was performed. A further relapse on the right side was again treated with UNCS and psoas-hitch bladder, but both the dilation and the occlusion persisted. Considering the state of the patient, and in order to remove the right nephrostomy that had been applied in the meantime, and to reduce the state of inflammation in view of further surgery, it was decided to treat the right ureteral total stenosis with ureteroscopic resection through the ureter facilitated by an other luminous flexible ureteroscope inserted upstream via nephrostomy. This technique is based on concepts searching for stenotic ureteral zones in transplanted kidneys, with the help of an adequate luminous catheter. An X-ray follow-up 9 months later evidenced that the maneuver was totally successful.

Anastomosis, Surgical↗
PubMed1997

Nocturnal enuresis and daytime wetting: a multicentric trial with oxybutynin and desmopressin.

OBJECTIVE: Different etiopathological mechanisms of enuresis are today under study, and different therapies and drugs have been proposed. The Italian Multicentric Trial was undertaken in twelve pediatric and urological centers in order to assess the efficacy of two of the most popular drugs, desmopressin (DDAVP) and oxybutynin. METHODS: 114 enuretic patients were enrolled in the study. After a 2-week observation period, 66 patients with primary monosymptomatic enuresis were treated with DDAVP, 30 micrograms/day intranasally, for 6 weeks, 48 patients with enuresis and voiding dysfunction were randomly assigned to a protocol with oxybutynin alone or oxybutynin plus DDAVP. The efficacy of the two drugs was measured in terms of reduction of wet nights per week during the 6-week treatment period and a 2-week follow-up period. Children with 0-3 dry nights/week were considered as nonresponders. RESULTS: Patients with monosymptomatic enuresis treated with DDAVP reported a significantly lower number of wet night during treatment than during the baseline period, with 79% showing a 'good' (6-7 dry nights/week) or 'intermediate' response (4-5 dry nights/week). Of the patients with diurnal voiding disturbances and enuresis, those treated with oxybutynin alone had a 54% success rate. The patients treated with both oxybutynin and DDAVP showed a better response, with a 71% rate of success. CONCLUSIONS: The efficacy of the two drugs is confirmed in patients carefully selected on the clinical basis of voiding disturbances. In patients with enuresis and voiding dysfunction, the reduced urinary output and the lower bladder filling rate due to DDAVP can reduce uninhibited bladder contractions, thus enhancing the oxybutynin action.

Administration, Intranasal↗
PubMed1997

The International Continence Society "Benign Prostatic Hyperplasia" Study: the botherosomeness of urinary symptoms.

PURPOSE: We assessed the bothersomeness of lower urinary tract symptoms as reported by men, and investigated relationships among occurrence, degree of problem caused and age. MATERIALS AND METHODS: Questionnaire data from 1,271 men presenting with lower urinary tract symptoms in 12 countries were analyzed. Statistical methods included distributions, cross tabulations, chi-square analysis and Spearman's rank correlation coefficients. RESULTS: Although prevalence and bothersomeness were moderately positively related, voiding symptoms were the most prevalent whereas the most bothersome were predominantly storage symptoms, including incontinence. While prevalence showed a broadly decreasing trend with age, bothersomeness was relatively unrelated to age. CONCLUSIONS: These findings suggest that symptom occurrence alone does not necessarily reflect the degree to which patients are bothered by lower urinary tract symptoms. Therefore, when deciding on treatment it is important not only to consider the presence and frequency of lower urinary tract symptoms but also the bother that they cause.

Aged↗
PubMed1996

Behçet's disease and the neuropathic bladder: urodynamic features: case report and a literature review.

We report on a 16-year old patient with a neuropathic bladder secondary to Behçet's disease, which is an uncommon vasculitis usually involving venules. The genitourinary manifestations of this disease are discussed, a neuropathic bladder being a rare complication of the involvement of the nervous system. Urodynamic assessment is important when voiding dysfunction is present; three patients previously reported revealed a bladder function changing from normal detrusor to overactivity. Our patient showed early and severe involvement of the nervous system, and detrusor areflexia two years after the onset of the disease. Spontaneous voiding was restored two months after urological management (intermittent catheterization) was started.

Adolescent↗
PubMed1996

Evaluation of bladder contractility in men undergoing transurethral resection of the prostate.

OBJECTIVE AND METHODS: We analyzed preoperative and postoperative urodynamic parameters in 26 patients who underwent transurethral prostatic resection with the aid of a computer program. The parameters URA, W and Wmax were evaluated: URA affords a monitoring of the removal of obstruction, while Wmax and W function monitor changes in detrusor contractility, which appear significant after prostatic resection in obstructed patients. RESULTS: Many patients had a fading contraction, that is detrusor contractility decreased during micturition: in most of them the removal of obstruction restored this pattern to normal. CONCLUSION: Evaluation of these parameters is recommended for preoperative assessment and postoperative follow-up.

Follow-Up Studies↗
PubMed1995

Ureterolithotripsy in children.

OBJECTIVES: The pediatric application of ureteroscopy was initially hindered by the size of the instruments and the fear of damaging the urethra and ureterovesical junction during endoscopic maneuvers. This review of our experience is focused on the usefulness of thin and ultrathin ureteroscopes such as the 7 F Gautier rigid ureteroscope with rod lens optics (Wolf) or the new, ultrathin 4.8 F Wolf ureteroscope, semirigid, fiberoptic, in conjunction with atraumatic sources of energy such as pulsed dye laser or ballistic lithotripter, for the treatment of ureteral stones in children. METHODS: Between 1989 and 1994, we performed ureteroscopy and ureterolithotripsy on 7 children less than 10 years old. There were 6 male patients and 1 female patient, with a mean age of 6 years (range, 3.5 to 10). We used the pulsed dye laser Pulsolith and the ballistic lithotripter Lithoclast, the Gautier (Wolf) rigid, rod lens ureteroscope (7 F), without the sheath or the blunt needle 4.8 F semirigid (Wolf), fiberoptic ureteroscope. In all cases a double pigtail ureteral catheter was left in situ. RESULTS: In all 7 cases, the treatment was successful without early or delayed complications. In particular, no case of vesicoureteral reflux was observed in any of the children during subsequent follow-ups. CONCLUSIONS: This article demonstrates the feasibility of ureteroscopy and ureterolithotripsy in children less than 10 years old with ureteral stones. We believe that because of the fragility of the ureter in the pediatric age group, ureteroscopic maneuvers should be performed and handled by experienced endourologists in well-equipped centers.

Child↗
PubMed1994

Standard and extramural ambulatory urodynamic investigation for the diagnosis of detrusor instability-correlated incontinence and micturition disorders.

Forty-six patients were evaluated for complaints of urinary incontinence or voiding disorders. Diagnostic testing included a detailed history, physical examination, urine analysis, and urodynamic studies consisting of a conventional urodynamic test (S.I.) including provocative manoeuvres and extramural ambulatory urodynamic monitoring (e.a.m.). We compared the pre-classification diagnoses obtained from the medical history with both urodynamic tests. Conventional cystometry detected detrusor instability in 8 patients out of 16 with a history of urgency, while a normal detrusor behaviour was observed in the other 8. "Provocative" manoeuvres yielded an additional 13.3%. Extramural ambulatory monitoring confirmed the diagnosis in the 8 patients with hyperactivity and revealed detrusor instability in a further 7. E.a.m. proved adequate in 93.7% of patients with symptoms of detrusor instability. In the group of patients with urinary stress incontinence (USI) e.a.m. revealed detrusor instability in 18.7% of the patients, but did not significantly improved the diagnostic results obtained by S.I. Coughing was the most effective stimulus to objectify stress incontinence. The comparison of the results obtained with S.I. and those obtained with home e.a.m. will probably lead to a more rational use of both methods. Our data confirm the promising impact of ambulatory urodynamic investigation.

Adult↗
PubMed1994

Orthotopic ileal bladder substitute after radical cystectomy: urodynamic features.

Urodynamic investigation was performed in 12 men, 3 to 8 months after cystoprostatectomy for bladder cancer and bladder substitution, using a detubularized ileal segment as described by Studer-Zingg. All patients underwent a standard urodynamic evaluation and extramural ambulatory urodynamic monitoring (e.a.m.). Ten patients were continent by day and 3 were incontinent during the night to a degree that necessitated use of a condom catheter. Three patients awakened every 3 hours to void and 6 had to void 1-2 times nightly. The residual urine was over 100 ml in 3 patients; it was low or absent in the remainder. Micturition was achieved by straining, with a maximum flow rate of 13 ml per second or greater, except in 2 patients. In 2 patients a urethral narrowing was found at the urethro-ileal anastomosis, and in 1 of them an incoordination between the neobladder and the pelvic floor required the use of a urethral catheter and a subsequent protocol of pelvic floor rehabilitation. The incidence of nocturnal incontinence was 56.6%. In 2 patients urethral pressure profile revealed hypotonia, with a maximum urethral closure pressure (MUCP) < 45 cm H2O. During e.a.m. study pressure values in the neobladder usually ranged below 15 cm H2O and exceeded 35 cm H2O in only 1 patient who complained of daytime and nocturnal incontinence. Neobladder compliance was normal in all cases. In order to achieve a complete rehabilitation after operation, the patient should be instructed to follow a careful training in order to prevent overdistention of the neobladder by voiding at regular intervals and to obtain continence.

Aged↗
PubMed1994

Behaviour and urodynamic properties of orthotopic ileal bladder substitute after radical cystectomy.

The study included 18 men, submitted to urodynamic investigation 9-18 months after cystoprostatectomy for bladder cancer and bladder substitution with a detubularized ileal segment as described by Studer-Zingg. Sixteen patients were continent by day and 3 were incontinent during the night so as to require the use of a condom catheter. The residual urine was over 100 ml in 3 patients, while it was low or absent in the remainder. Micturition was performed by straining, and maximal flow rates were normal, although the pattern was intermittent. The incidence of nocturnal incontinence was 55.5%. Measurement of the urethral pressure profile revealed a shortened functional length, and low pressure was found in 3 patients, with a maximum urethral closure pressure < 45 cm H2O. During extramural ambulatory urodynamic monitoring, pressure values in the neobladder usually ranged below 20 cm H2O and exceeded 34 cm H2O in only 2 patients who complained of daytime and nocturnal incontinence. The urodynamic features of the neobladder in patients who underwent radical cystoprostatectomy and bladder replacement with a detubularized ileal segment indicate low pressure at high-level filling.

Aged↗
PubMed1994

Urodynamic changes in benign prostatic hyperplasia patients treated by transurethral microwave thermotherapy.

Our study describes the results obtained in 44 patients with benign prostatic hyperplasia (BPH) who underwent transurethral microwave thermotherapy (TUMT) and their follow-up at 12 months. Prostatron, a prostatic TUMT device which comprised a microwave heat generator and a cooling system, was used at our centre. Forty-four out of the 60 patients given the treatment had a 12-month follow-up to be evaluated. The evaluation of subjective symptoms, according to the Boyarsky symptom score, demonstrated a significant rate of response (p < 0.0005). The analysis of pressure-flow recordings demonstrated a reduction of mean detrusor opening pressure (p < 0.0005), a reduction of detrusor pressure at maximum flow 12 months after treatment (p < 0.0005) and an improvement of mean values of maximum flow after treatment (p < 0.0005). This study shows that TUMT, though it cannot be considered an alternative to surgical or endoscopic therapy of BPH for severely obstructed patients, can produce improvement of both subjective and objective parameters of mild prostatic bladder outflow obstruction.

Aged↗
PubMed1991

Fournier's disease. Report of a case and review of the literature.

We report a case of Fournier's gangrene affecting a 77-year-old man. The patient was found to have decompensated diabetes mellitus that had been ignored before the onset of the disease. Several authors have described earlier a dramatic, explosive disease, leading to severe prostration within a few hours. Most of the recent cases, like this patient, have had a more insidious course, with symptoms beginning several days before hospitalization. Forty-five days after surgical debridement under spinal anesthesia and daily local treatment the scrotum was completely healed. The etiology and pathogenesis of this infrequent disease are discussed.

Aged↗