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F E Martins

Publications and source records attributed to F E Martins.

6 recordsLinked to original sources
PubMed1997

Adverse prognostic features of collagen injection therapy for urinary incontinence following radical retropubic prostatectomy.

PURPOSE: We identified and characterized predictive factors associated with an unfavorable outcome of collagen injection therapy in post-radical prostatectomy incontinence. MATERIALS AND METHODS: A total of 46 patients, 49 to 85 years old (mean age 67) and incontinent after radical retropubic prostatectomy, underwent a mean of 2.8 transurethral injections of collagen (mean cumulative volume injected 31 ml.). Preoperatively, all patients underwent fluoroscopic multichannel video urodynamics including determination of Valsalva's leak point pressure. Stress urinary incontinence was subjectively graded as 1 (0 to 1 pad per day), 2 (2 to 3 pads per day) and 3 (greater than 3 pads per day). Patient age, duration and severity of pretreatment incontinence, presence of detrusor instability and anastomotic strictures, number of injections, total volume of collagen delivered and the impact of a nerve sparing procedure plus adjuvant radiation therapy were assessed and correlated with treatment outcome. RESULTS: Of the patients 11 (24%) became completely dry (9 after 3 or fewer treatments), 21 (41%) improved (17 after 3 or fewer treatments) and 14 (30%) showed no benefit (after more than 3 treatments). Of the 14 patients in whom treatment failed 6 had undergone adjuvant radiation treatment, pretreatment urinary incontinence was grade 3 in all, and concomitant detrusor instability was present in 11 (79%). All patients had received more than 3 treatments (mean total volume injected 37 ml.). CONCLUSIONS: Notwithstanding the need for multiple treatments, the prospect for cure by collagen injection of the post-radical prostatectomy incontinent patient is significantly affected by the severity of pretreatment incontinence, concomitant detrusor overactivity and exposure to radiation therapy. Age, duration of incontinence, presence of mild to moderate anastomotic strictures and a nerve sparing technique did not seem to influence treatment outcome.

Aged↗
PubMed1997

Visual erotic stimulation test for initial screening of psychogenic erectile dysfunction: a reliable noninvasive alternative?

PURPOSE: We determined the role and validity of visual erotic stimulation using RigiScan monitoring as a more physiological and cost-effective diagnostic modality for primary noninvasive screening of psychogenic versus organic impotence. We also clarified the correlation between erotic and pharmacological erections, and their diagnostic usefulness in the clinical routine. MATERIALS AND METHODS: A total of 76 impotent patients and 20 potent controls were entered into the study. A detailed medical and sexual history was obtained, and psychological evaluation and minimally invasive diagnostic studies were done, including a 15-minute visual erotic stimulation test, intracavernous pharmacological stimulation with 10 micrograms. prostaglandin E1 and penile duplex ultrasound. Responses to each test were interpreted blindly and independently of each other, and of the results of the psychological evaluation. Visual erotic stimulation results were then correlated with the results of intracavernous pharmacological stimulation and penile duplex ultrasound, and validity assessments were also obtained. RESULTS: Results of the visual erotic stimulation test confirmed the clinical diagnosis in 10 of the 14 patients (71%) with psychogenic impotence (71% sensitivity and 96% specificity). There was a 97% correlation with the clinical diagnosis of predominantly organic dysfunction (97% sensitivity and 71% specificity). However, characterization of the etiological inferences based on visual erotic stimulation findings was poor. CONCLUSIONS: A positive response to visual erotic stimulation is strongly indicative of a predominantly psychogenic cause of erectile dysfunction. In combination with patient sexual history and pharmacological erection testing, visual erotic stimulation can be performed as an initial, minimally invasive test for cost-effective screening of psychogenic impotence.

Adult↗
PubMed1996

Diffuse veno-occlusive dysfunction: the underlying hemodynamic abnormality resulting in failure to respond to intracavernous pharmacotherapy.

PURPOSE: We established hemodynamic predictors of response to intracavernous pharmacotherapy. MATERIALS AND METHODS: Specific characterization and quantification of hemodynamic abnormalities of the cavernous arterial inflow and corporeal veno-occlusive mechanism associated with failure to respond to intracavernous pharmacotherapy were performed retrospectively in 69 patients with nonendocrinological impotence. We investigated atherosclerotic vascular risk factors, duplex ultrasonography peak systolic and end diastolic velocities (10 micrograms. prostaglandin E1), and dynamic infusion cavernosometry and cavernosography parameters (60 mg. papaverine and 6 mg. phentolamine). RESULTS: The patients were stratified by severity of the various hemodynamic parameters encountered and mean dose required for response. Response subsequently was characterized as excellent (75% or greater rigid erections) in 36 patients, adequate (erections sufficient for intromission) in 17 and poor or absent in 16. Psychogenic, neurogenic and mild vasculogenic causes were noted in patients with an excellent response. The adequate responses included all 3 cases with mild to moderate vascular etiologies whereas patients with a poor or no response had only severe venogenic and combined arteriogenic and venogenic etiologies. Mean flow-to-maintain values plus or minus standard deviation of 9.7 +/- 3.7, 10.8 +/- 9.5 and 59.5 +/- 24.2 ml. per minute were demonstrated in the excellent, adequate and poor or no response groups, respectively. There was a good correlation between mean flow-to-maintain values and mean doses of our standard vasoactive solution (r2 = 0.88, p < 0.0001). Pharmaco-cavernosography demonstrated diffuse or pan-cavernous corporeal veno-occlusive dysfunction in the poor or no response group. CONCLUSIONS: Corporeal veno-occlusive dysfunction alone or combined with arterial disease is the specific hemodynamic abnormality causing nonresponse to intracavernous pharmacotherapy. Diffuse drainage, particularly involving the glans penis and corpus spongiosum, is greatly predictive of a poor or no response, reflecting the underlying cavernous smooth muscle myopathy and collagen degenerative alterations in these patients with end-organ failure.

Adult↗
PubMed1995

Post-operative risk factors associated with artificial urinary sphincter infection-erosion.

OBJECTIVE: To determine the incidence of infection-erosion associated with the implantation of artificial urinary sphincters (AMS 800) in a high-risk group of patients (post-major pelvic surgery/radiotherapy), and to emphasize the commonly neglected risk factors associated with this complication. PATIENTS AND METHODS: One-hundred-and forty-five male patients aged 55-79 years (mean 71) who had had an AMS 800 artificial sphincter implanted between January 1987 and November 1993 were reviewed. All patients had undergone meticulous surgical technique, intra-operative shave and rigorous scrub, and were given peri-operative antibiotics. The mean follow-up was 34.3 months (range 1-83). RESULTS: Infection-erosion occurred in 13 patients (9%), of whom 10 are currently available for follow-up. One patient died of his underlying disease (bladder cancer) and two were lost to follow-up. All 13 patients had undergone radical pelvic surgery (radical retropubic prostatectomy, radical cystectomy and abdominoperineal resection); seven patients had also received radiation therapy. Cultures of the infected AMS 800 devices revealed a pleomorphic group of organisms, specifically enteric, Gram-positive and anaerobic organisms. The risk of infection-erosion was found to be increased in the presence of two main factors, improper urethral catheterization and urethral endoscopic manipulation with an activated AMS 800 artificial sphincter in place and exposure to radiation. At the time of revision, nine of the 13 patients were found to have positive urine cultures. CONCLUSION: Despite all the precautions taken, there remains a group of patients who are still at a higher risk of infection-erosion due to adverse circumstances that distort the anatomy of the perineal area, impair the host defence mechanisms, and ultimately enable the establishment of the infection-erosion complex. Radiotherapy is known to increase the likelihood of non-mechanical complications, specifically infection-erosion. Extreme care must be taken so that avoidable iatrogenic factors such as improper urethral catheterization and endoscopic manipulation with an activated AMS 800 device in situ are not the cause of 'failure'.

Aged↗
PubMed1995

Artificial urinary sphincter in patients following major pelvic surgery and/or radiotherapy: are they less favorable candidates?

Between January 1988 and December 1992 the AMS800* artificial urinary sphincter was inserted in 81 men with urinary incontinence due to major pelvic surgery and/or radiation therapy. Radical retropubic prostatectomy had been performed in 38 men, radical retropubic prostatectomy with adjuvant radiation in 28, definitive radiation therapy for prostatic carcinoma in 5, abdominoperineal resection with adjuvant radiation in 1 and radical cystectomy with orthotopic urinary diversion in 8, while 1 suffered major pelvic trauma with urethral rupture. A bulbar urethral cuff was used exclusively, with pressure regulating balloons of 51 to 60 and 61 to 70 cm. water. The interval for primary activation ranged from 4 to 12 weeks (mean 7.7), with all irradiated patients waiting 12 weeks. Surgical revision was required in 38% of the patients totaling 43 operations. Inadequate cuff compression after presumed urethral atrophy secondary to hypovascularity accounted for 74% of the procedures, whereas infection with or without erosion necessitated 8 revisions, mostly attributable to improper placement elsewhere of an indwelling catheter after the artificial urinary sphincter had been activated. Mechanical malfunction was responsible for 7% of the revisions. Overall, socially acceptable continence was achieved in 91% of the study population. Despite a significantly greater need for revision in this high risk group (38% versus 22% in the literature for low risk groups) with meticulous surgical and sterile techniques as well as diligent followup, the long-term outcome in terms of continence and device survival may be excellent regardless of the underlying etiology. We conclude that use of the AMS800 artificial sphincter for significant male urinary incontinence is undoubtedly the most efficacious treatment currently available for which even the most adverse candidate should not necessarily be excluded.

Adult↗