PubMed Health⌕ Search

Biomedical subjects

Emmanuel Chartier-Kastler

Publications and source records attributed to Emmanuel Chartier-Kastler.

36 records · Page 2Linked to original sources
PubMed2005

[Place of duloxetine in the treatment of stress urinary incontinence].

Urinary incontinence is a public health problem, as more than three million women in France are concerned by this problem. The prevalence of stress urinary incontinence is about 40% among these women. Duloxetine is a molecule developed for the oral treatment of stress urinary incontinence. It is a serotonin and norepinephrine reuptake inhibitor, which acts by increasing urethral sphincter tone. In several phase III trials, duloxetine administered orally at a high dose of 80 mg per day, significantly reduced episodes of incontinence. Total scores on the Incontinence Quality of Life questionnaire (I-QOL) were more markedly improved by duloxetine than by placebo. Nausea was an adverse effect observed in more than 25% of cases and required discontinuation of treatment in some patients. However, the encouraging preliminary results of duloxetine in this indication must be confirmed during phase IV post-marketing clinical trials.

Clinical Trials as Topic↗
PubMed2004

European experience of 200 cases treated with botulinum-A toxin injections into the detrusor muscle for urinary incontinence due to neurogenic detrusor overactivity.

OBJECTIVES: To present a comprehensive experience with botulinum-A toxin (BTA) injected into the detrusor muscle in patients with spinal cord injuries/diseases causing neurogenic incontinence. METHODS: Ten European medical centers provided the results of 231 patients with neurogenic detrusor overactivity who were treated with BTA. 300 units of Botox (Allergan Inc.) were injected cystoscopically into the detrusor muscle at 30 different locations, while sparing the trigonum. Urinary continence status, concomitant anticholinergic medication use and patient satisfaction were recorded. Key urodynamic parameters (reflex volume, maximum detrusor pressure during voiding, detrusor compliance and maximum cystometric bladder capacity) at baseline and at the first and second urodynamic follow-up examinations were analyzed. RESULTS: By the time of the initial (mean 12 weeks after injection) as well as at the second urodynamic follow-up examinations (mean 36 weeks after injection), the mean cystometric bladder capacity (p < 0.0001) and the mean reflex volume (p < 0.01) increased significantly, while the mean voiding pressure (p < 0.0001) decreased significantly. The mean bladder compliance had increased significantly (p < 0.0001) by the first follow-up examination and non-significantly by the time of the second follow-up. No injection related complications or toxin related side effects were reported. The patients considerably reduced or even stopped taking anticholinergic drugs without recurrence of reflex incontinence and were satisfied with the treatment. CONCLUSIONS: This retrospective European multicenter study presents the most extensive experience to date with BTA injections into the detrusor muscle to treat neurogenic incontinence due to detrusor overactivity and confirms that this new treatment is safe and valuable. Significant improvement of bladder function corresponds with continence and the subjective satisfaction indicated by the treated patients.

Botulinum Toxins, Type A↗
PubMed2004

Urethral stent for the treatment of detrusor-sphincter dyssynergia: evaluation of the clinical, urodynamic, endoscopic and radiological efficacy after more than 1 year.

PURPOSE: We studied the intermediate-term clinical, urodynamic, endoscopic and radiological efficacy of the Ultraflex urethral stent (Boston Scientific Co., Boston, Massachusetts) for the treatment of detrusor-sphincter dyssynergia (DSD) in spinal cord injured patients. MATERIALS AND METHODS: A total of 47 consecutive men presenting with DSD due to spinal cord injury (39) or various spinal cord diseases (9) were treated with the Ultraflex stent. DSD was demonstrated by urodynamic assessment with electromyographic recording of the striated urethral sphincter muscle activity. RESULTS: Postoperatively, all patients voided by reflex. The number of patients with symptomatic postoperative urinary tract infection decreased significantly (p <0.001). Urodynamic assessment (mean followup +/- SD 2.2 +/- 1.3 years) showed reduction of mean peak detrusor pressure from 65.7 +/- 27.8 to 46.4 +/- 28.8 cm H2O (p <0.005) and reduction of mean residual urine from 231.6 +/- 168.1 to 70.3 +/- 85.6 ml (p <0.0005). Mean urethral closing pressure was markedly reduced from 73.9 +/- 40.9 to 23.8 +/- 25.1 cm H2O (p <0.0005). Mean endoscopic followup was 1.7 +/- 1.1 years. Mean percentage of epithelialization was 90.8% +/- 19.7%, and no obstructive granulation tissue or stone encrustation was observed inside the stent. On ultrasound signs of hydronephrosis persisted in only 1 of 8 patients. There were no immediate postoperative complications. Complementary bladder neck incision was performed in 21% of patients. CONCLUSIONS: The Ultraflex stent appears to be effective for intermediate-term treatment of DSD on the basis of clinical, urodynamic, endoscopic and radiological parameters.

Adult↗
PubMed2004

Sacral neuromodulation for refractory detrusor overactivity in women with an artificial urinary sphincter.

PURPOSE: We assessed the efficacy of sacral neuromodulation as an alternative therapeutic option in women with an artificial urinary sphincter (AUS) who had de novo irritative urinary symptoms (urgency/frequency) refractory to conventional treatment. MATERIALS AND METHODS: Between 1984 and 2002 we implanted an AUS in 350 women and detrusor overactivity developed in 14. Six of the 14 patients responding positively to a percutaneous nerve evaluation test (greater than 50% subjective/objective improvement) were implanted with an S3 neuromodulator within 42.8 weeks (range 21 to 106) of AUS implantation. Followup included analysis of the voiding diary, a pad test and urodynamic assessment. RESULTS: After 30.5 months followup (range 14 to 40) 1 patient was dry, 4 were improved and treatment failed in 1. At 12 months mean voiding frequency daily had decreased from 17 (range 12 to 23) to 8 (range 4 to 12) and the mean number of leakages episodes daily had decreased from 14.7 (range 8.5 to 17) to 6 (range 4 to 10). Mean voided volume had increased from 121.7 (range 90 to 170) to 180 ml (range 120 to 225), mean first desire to void volume had increased from 117 (range 88 to 190) to 183 ml (range 130 to 275) and mean functional bladder capacity had increased from 325 (range 200 to 530) to 372 ml (range 250 to 580). Uninhibited bladder contractions had resolved in 4 of 5 patients. CONCLUSIONS: In women who already have an AUS with urge incontinence sacral neuromodulation can help resolve symptoms. Because this therapy does not compromise the potential for future treatment, it appears to be an alternative option in these patients. It can postpone or avoid more mutilating surgery and self-catheterization.

Adult↗
PubMed2004

[Functional consequences and complications of surgery for female stress urinary incontinence].

OBJECTIVE: The functional consequences and complications of surgical treatment offemale stress urinary incontinence (SUI) are not systematically reported in clinical trials. The authors present a practical review of the results of the surgical techniques most frequently used for the treatment of SUI. MATERIALS AND METHODS: An exhaustive literature search concerning the various surgical techniques for female SUI, their results, and their complications, was performed using MEDLINE (1966-2003) and the PUBMED search engine. Some papers presented by expert teams at international congresses were also included. In view of the diversity and weakness of the published results, a specific classification of the consequences of this surgery was adopted, comprising treatment failures, immediate (0 to 48 hours), early (before 6 weeks) and late (after 6 weeks) surgical complications, and impact on quality of life. RESULTS: The best long-term success rate was observed for bladder neck slings. Prolene suburethral sling is a new promising technique, with an objective cure rate of more than 80%, but the publishedfollow-up does not exceed 3 years. Immediate complications included intraoperative bleeding, retropubic haematoma, urinary tract lesions, intestinal lesions, and complications related to the operative position. Early complications consisted of infections, pubic osteomyelitis, urinary fistula, sequelae of nerve lesions, and transient postoperative urinary retention. Late complications were induced voiding disorders, including dysuria, chronic urinary retention and detrusor instability, de novo genital prolapse, sexual disorders, chronic pain, chronic urinary tract infections and complications related to the use of biomaterials, including screws, synthetic tape, and artificial urinary sphincter. The quality of life after SUI surgery, although only rarely studied, was globally and constantly improved. CONCLUSION: This review of the literature shows that no operation presents satisfactory results for all patients. Knowledge of the functional consequences and complications, although interesting, does not have any real value for the choice of a particular operation. Patient information implies mastery of all techniques and the choice of treatment must be determined case by case. This review provides a classified system of validated and detailed information, essentialfor the information of candidates for this functional surgery.

Biocompatible Materials↗
PubMed2004

[Genito-sexual dysfunction in patients with a medullary lesion].

Multiple dramatic consequences follow medullary lesions. Not only are voluntary motor control and sensitivity of the body segment below the lesion lost, but it also becomes impossible to control erection and ejaculation as well as urinary and faecal continency. The first investigations into genito-sexual function in paraplegics have brought about the idea, commonly admitted in the medical world, that this kind of patient is impotent and sterile. Fortunately this idea is disappearing gradually and many data have demonstrated that appropriate treatment is required and some therapies efficient. This is particularly important in the case of the population concerned, namely young men in 70% of the cases, since the usual age bracket at trauma is between 25 and 35 years old. At this time of life, sexual activity is often at its peak, so that the fertility potential becomes erased.

Adult↗
PubMed2004

[Neurogenic bladder: pathophysiology of the disorder of compliance].

Bladder compliance is defined by the ratio of the increase of intravesical pressures to the increase of volume (_V/_P). The pathophysiology of disorders of compliance in neurogenic bladder is still poorly elucidated. It can be evaluated in terms of three elements: 1) The natural history of the appearance of these disorders in neurogenic bladders. Clinical experience shows the existence of prognostic factors that determine the development of these disorders, such as the voiding mode adopted (self-catheterization/hetero-catheterization versus indwelling catheter), the level of the spinal cord lesion (suprasacral versus sacral, incomplete versus complete, and cauda equina lesions), and the presence of meningomyelocele. 2). Data derived from conservative management of these disorders in neurogenic bladders: urethral dilatation, various sphincterotomies, bladder disafferentation, alpha-blockers, vanilloids (resiniferatoxin and capsaicin), intra-detrusor botulinum toxin and intrathecal baclofen, have demonstrated a marked improvement of disorders of compliance associated with neurogenic bladder 3). Data derived from experimentations. Morphometric studies on animal or human bladder strips have demonstrated an increased expression of proteolytic enzymes and endogenous tissue inhibitors of metalloproteinases (MMP-1) and type III collagen mRNA in hypocompliant neurogenic bladders. Reduction of bladder wall blood flow, bilateral section of hypogastric nerves in rats, study of the bladders of spinalized rats, and reduction of oestrogenic hormone impregnation, show that these conditions induce loss of the viscoelastic properties of the bladder With the arrival of new treatments, active on afferent and/or efferent pathways or even on the central nervous system, it is very important to further our understanding of the pathophysiology of disorders of compliance in neurogenic bladders. Reversibility of these disorders constitutes a major therapeutic challenge and its functional consequences make it a critical prognostic factor for the outcome of neurogenic bladder

Animals↗
PubMed2003

[Use in daily urological practice of an ultrasound device for measuring bladder volume].

INTRODUCTION: Bladder volume estimation is an everyday necessity in urology, especially for evaluation of the postvoid residual volume (PVR). The Bladder-Scan is a portable, noninvasive ultrasound device for bladder volume estimation. This study was designed to assess the value of the Bladder-Scan to measure PVR in routine hospital urological practice. MATERIAL AND METHODS: A prospective study was conducted from 1/12/1999 to 30/4/2000 with systematic use of the Bladder-Scan to measure PVR. Four operators performed three consecutive measurements of PVR and noted the following data: age, gender, history, type of disease and place of examination. The main endpoint was the need to use a complementary investigation to confirm or invalidate the result obtained. RESULTS: PVR was determined in 250 consecutive patients (167 males, 83 females): 191 patients admitted to the urology department, 36 patients seen in the emergency room and 23 patients seen in other departments of the hospital. PVR was estimated to be between 0 and 400 cc (median: 72 cc) for 181 patients (72%), between 400 cc and 750 cc (median: 521 cc) in 50 patients (20%) and between 750 cc and 1000 cc (median: 942 cc) for 19 patients (8%). A control of the measurement was required for 27% of patients (68/250) using catheterism (n = 53) or sonography (n = 15). In this sub-group, the value of the ICC (intra-class correlation coefficient) for the measurement of the bladder volume using the Bladder-Scan and measurement of the volume controlled by sonography or catheterism was of 0.9888 (significance < 0.0001/nil hypothesis ICC = 0). CONCLUSION: The Bladder-Scan provides a "third hand" in the urologist's daily practice, by supplying a reliable and rapid assessment of bladder volume for volumes < 750 cc. It is a good tool for the evaluation of postvoid residual volume.

Diagnostic Techniques, Urological↗
PubMed2003

[Organization and innervation of striated muscle fibers of the striated sphincter in the rat].

OBJECTIVES: To determine the organization of striated muscle fibre (FMS) of the rat striated sphincter (SS) and to characterize the motor endplates (MEP). MATERIAL AND METHODS: The urethras of 30 male and female rats were studied. Two thousand hematein-eosin stained serial sections and 800 sections simultaneously stained for MEPs and nerve endings were studied. RESULTS: The SMFs of the SS are organized in the urethral wall in four symmetrical bands. MEPs are predominantly found in the cranial third of the SS (22 MEPs per section). Sixty sixteen per cent of MEPs were situated in the lateral regions. Motor units were composed of a maximum of five SMFs. CONCLUSION: The SMFs of the SS are organized in four symmetrical bands. Myoconnective insertions of SMFs emphasize the importance of the connective tissue in their contractile action. They are innervated by a single MEP, in the same way as skeletal striated muscle fibres. In the SS, MEPs are predominantly located laterally to the right and to the left. The specific organization of motor units suggests an original mechanism of reinforcement of muscle contraction of the SS.

Animals↗
PubMed2003

[Cavernosal metastases from bladder tumour after cystoprostatectomy].

OBJECTIVE: To evaluate the predictive factors for cavernosal metastases after cystoprostatectomy for transitional cell bladder cancer. MATERIAL AND METHOD: Between February 1998 and January 2002, 61 men were treated by cystectomy for transitional cell bladder cancer (56 total cystoprostatectomies and 5 partial cystectomies). Five patients (8%) subsequently developed cavernosal metastases. The assessment criteria were classified into three categories: clinical history, histological findings on the operative specimen and follow-up data. RESULTS: The metastasis was observed an average of 8.4 months (range: 3-17) after cystoprostatectomy. Three of the 5 patients had a history of transurethral procedure at the same time as resection of a high-grade invasive bladder tumour: a urethral recurrence concomitant with the penile metastasis was observed in these cases. In 4 out of 5 cases, the bladder tumour was multifocal, involving the bladder neck, extensive and high-grade (> or = pT3 G3). Vascular tumour emboli were detected on the cystoprostatectomy specimen in 4 cases. All urethral sections performed during cystectomy were negative. All 5 patients died with a mean survival of 7 months (range: 1 to 21 months). CONCLUSION: The development of penile metastases after cystectomy appears to be frequently associated with the presence of extensive tumour (> or = pT3) on the operative specimen, involving the bladder neck, with a high histoprognostic grade and with the presence of tumour embolus. No transurethral procedures should be performed at the same time as resection of an obviously invasive bladder tumour. Health urethral sections do not exclude the risk of penile metastases.

Carcinoma, Transitional Cell↗
PubMed2003

[Treatment of urge incontinence by sacral neuromodulation in two patients with artificial sphincters].

Patients with stress urinary incontinence due to major sphincter incompetence are sometimes treated by artificial urinary sphincter (AUS). Some patients with AUS subsequently develop urge incontinence that is refractory, to pharmacological treatments. Sacral neuromodulation could constitute an alternative treatment in these cases. The authors report two patients treated by the combined use of these two implants with a follow-up of 24 months. The efficacy of sacral neuromodulation in this indication appears to be satisfactory. The presence of the AUS does not appear to modify the action of the neuromodulator.

Aged↗
PubMed2002

[Incontinence and voiding disorders].

Urinary continence and micturition are functions which require the integrity of the organs (bladder, urethra, voluntary and involuntary sphincters) and the neural pathways responsible for micturition (parasympathetic), continence (sympathetic), and their control and coordination. Save the incontinence associated with vesico-vaginal fistulae in women, or overflow incontinence associated with a distended bladder in chronic retention, the three principal clinical forms of incontinence are: stress incontinence, urge incontinence and mixed incontinence, combining the two mechanisms. Voiding difficulties causing discomfort on urination, or even retention (chronic or acute), are the reflection of an imbalance between bladder contraction (reduction) and urethral resistance (augmentation). The management of a voiding disorder systematically requires an understanding of the pathophysiological mechanism involved and the search for the aetiology (often multifactorial), so as to adapt the appropriate medical and/or surgical management.

Aged↗
PubMed2002

[Epidemiology of urological emergencies in a teaching hospital].

OBJECTIVES: To quantitatively evaluate the emergency activity of a teaching hospital urology department. To determine the epidemiology of urological medical and surgical emergencies. MATERIAL AND METHOD: Single-centre prospective study conducted in one of the 9 teaching hospital urology departments of the Paris region equipped with an emergency room. The on-call team consisted of an intern and a hospital student on the spot, a Senior Registrar on call. Evaluation was based on daily computer records of all consultations performed by the intern outside of the urology department, and all emergency surgical operations performed during the out-of-hours period (8:00 p.m. to 8:00 a.m.). RESULTS: A total of 1,715 consultations were performed, 15.6% of which required admission to hospital. Eleven per cent of consultations in the emergency department were transferred from another centre. Emergency surgery was performed in 5% of cases. 37 multi-organ harvests and 54 renal transplantations were also performed during this same period. Mean age: 53.18 years (range: 15-100). 12% of patients were over the age of 80 years. Sex-ratio: 78% of males, 22% of females. The most frequent presenting complaint was low back pain (25%). The diseases most frequently encountered were infectious (19.2%). 30% of emergency surgical operations were performed for drainage of obstructive pyelonephritis. Bladder tumours were the cancers most frequently responsible for emergency consultations (35%) and traumatology represented 8.7% of emergency consultations. CONCLUSION: Urological emergencies in a teaching hospital constitute a distinct clinical activity, which requires specific material and human resources. This exhaustive study could be used as a basis for review of the organization of the management of urological emergencies.

Adolescent↗
PubMed2001

CT diagnosis of ureteral fibroepithelial polyps.

We report a case of fibroepithelial polyp of the ureter with serial CT examinations. Progressive growth of the fibroepithelial polyp was documented by CT within a period of 62 months. Excretory phase contrast-enhanced CT images accurately contributed to the diagnosis of ureteral fibroepithelial polyp and allowed limited surgical resection. Accurate imaging assessment of ureteral fibroepithelial polyps is essential for a conservative surgical approach and/or observation alone.

Diagnosis, Differential↗