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Biomedical subjects

François Haab

Publications and source records attributed to François Haab.

At least 19 recordsLinked to original sources
PubMed2006

Long-term treatment with darifenacin for overactive bladder: results of a 2-year, open-label extension study.

OBJECTIVE: To examine, in a 2-year, non-comparative, open-label extension study, the safety, tolerability and efficacy of darifenacin controlled-release (CR) 7.5/15 mg once daily in patients with overactive bladder (OAB) who completed two 12-week randomized, double-blind, placebo-controlled 'feeder' studies. PATIENTS AND METHODS: Patients entering the extension received darifenacin 7.5 mg once daily for 2 weeks, after which a voluntary increase in dose to 15 mg was permitted. Thereafter, patients could adjust the dose (either 7.5 or 15 mg). Safety and tolerability were assessed from adverse events (AEs) and discontinuations. Efficacy was determined using various endpoints. RESULTS: In all, 716 patients entered the extension (mean age 57.3 years; 85.1% women) and 475 (66.3%) completed it (1089.9 patient-years of exposure). Darifenacin was well tolerated with no significant safety concerns. The most commonly reported AEs were dry mouth and constipation (all-causality rates 23.3% and 20.9%, respectively), leading to discontinuation in 1.3% and 2.4% of patients, respectively. Constipation infrequently required intervention, and analysis of bowel-habit questionnaires revealed that the reporting of constipation was related to minor changes in bowel habit rather than true constipation. The efficacy of darifenacin was maintained, including significant improvements in the number of incontinence episodes/week (median change -84.4% at 2 years, P < 0.001 vs feeder-study baseline). After 2 years, > 40% of patients achieved a > or = 90% reduction in incontinence episodes/week. CONCLUSION: In the first published 2-year, open-label study of a CR antimuscarinic agent, darifenacin 7.5/15 mg once daily had a favourable safety, tolerability and efficacy profile during the long-term treatment of OAB. As such, darifenacin represents a valuable therapeutic option for OAB.

Adult↗
PubMed2006

Patient-perceived outcomes in the treatment of stress urinary incontinence: focus on urethral injection therapy.

Intervention for stress urinary incontinence (SUI) is generally focused on minimizing urinary leakage. However, the overall impact of SUI therapy on patients' quality of life is, arguably, more important than leakage outcomes. We performed a literature search to investigate the effect of urethral injection therapy on quality of life. Significant quality-of-life improvements have been observed with a number of injectable agents, while there is a distinct lack of correlation between subjective and objective outcomes. Two studies comparing urethral injection therapy with surgical intervention found superior objective efficacy with surgery, but no significant differences in quality-of-life improvements. Personal goals of patients undergoing urethral injection are yet to be explored, but there may be willingness to trade a lower success rate in favor of a more minor treatment procedure. In conclusion, quality-of-life improvements after urethral injection appear significant and comparable to those obtained with surgery. Further study of patients' own perceptions, pre- and posttreatment, would be valuable.

Collagen↗
PubMed2006

Influence of the severity of stress urinary incontinence on quality of life, health care seeking, and treatment: A national cross-sectional survey.

OBJECTIVES: To determine the prevalence of stress urinary incontinence (SUI) symptoms in women and to evaluate the severity of these symptoms and resulting functional impairment with regard to urinary symptoms, quality of life (QoL) impairment, medical care seeking, and care facilities. METHODS: A national population based, cross-sectional study in France was conducted through an anonymous questionnaire that was completed by telephone. A randomized sample was extracted from the French telephone directory, December 2002 to March 2003. The main outcome measures were symptom severity, functional impairment, non SUI-related urinary symptoms, Contilife QoL scale, medical care seeking, and treatment. In total, 6,675 women aged 18-70 were selected and 5,160 questionnaires were completed and analyzed. RESULTS: The point-prevalence of SUI symptoms was 19.5% (1.1% for individuals with severe symptoms; 2.8% for those with severe functional impairment). Symptom severity and functional impairment were associated with older age, longer duration of symptoms, higher frequency of comorbid urinary symptoms, and altered QoL (all p < 0.001). CONCLUSIONS: SUI symptoms are frequent in French women, causing embarrassment and negatively affecting their QoL. Though some could benefit from an effective therapy, only the most severely affected women who report SUI symptoms seek help and receive treatment.

Adolescent↗
PubMed2006

[Management of urinary tract infections in women. Epidemiologic survey of 7916 women in general practice].

OBJECTIVE: To evaluate the management of urinary tract infections in women by general practitioners and compare it with official French guidelines. METHODS: This survey enrolled 1587 general practitioners in France and 7916 adult women. Exclusion criteria for patients included: pregnancy, diabetes, neurogenic bladder, or urinary catheters. During the visit at which the diagnosis was made, physicians completed a questionnaire that included diagnostic and management details, in particular, prescription of further examinations. RESULTS: According to the French guidelines, 37% of women had an upper or complicated urinary tract infection, although one third of the complicated infections were so defined only by the patient's age (>65 years). Additional testing was prescribed for 36% of the women with acute uncomplicated cystitis. CONCLUSION: This study shows that the management of urinary tract infections in women does not comply with current guidelines, especially in cases of acute uncomplicated cystitis. The use of age alone as a complicating factor should be reconsidered.

Adolescent↗
PubMed2006

Management of the complications of the synthetic slings.

PURPOSE OF REVIEW: The aim of this article is to review the last year's literature on the management of vaginal erosion and obturator abscess with suburethral tapes in the treatment of female urinary incontinence. RECENT FINDINGS: During the past decade suburethral tapes have been approved in Europe for minimally invasive treatment of stress urinary incontinence. Consensus is, however, lacking regarding the material best suited for this surgery. Although the success rates with synthetic materials have been, in general, good, the risk of vaginal extrusion and urethral erosion is considerably greater, ranging from 0.2 to 22%. We report diagnosis and management of complications occurring after this procedure. The presenting symptoms, physical findings, diagnostic procedures, surgical treatments, and outcomes are analyzed. Pain, vaginal discharge, bleeding, recurrent urinary tract infections, and/or persistent stress urinary incontinence are suspected symptoms of vaginal erosion. All vaginal erosions are usually detected by physical examination; in cases of suspected pelvic abscess, magnetic resonance imaging is performed. Total tape removal is recommended in the majority of cases; however, patients have recurrence of incontinence. SUMMARY: Urogenital tract erosion and pelvic abscess are significant complications of suburethral tape; immediate symptom relief is expected after removal of the eroded sling.

Abscess↗
PubMed2005

Objective and subjective cure rates after trans-obturator tape (OBTAPE) treatment of female urinary incontinence.

OBJECTIVE(S): To evaluate the safety and efficacy of a thermally bonded nonwoven polypropylene mesh in a transobturator suburethral tape procedure (OBTAPE), Mentor-Porges, Le Plessis Robinson, France) for women with stress urinary incontinence. METHODS: Between January 2003 and January 2005, 129 consecutive women (mean age 57.2 years) underwent OBTAPE) in two academic centers. All the patients had stress urinary incontinence preoperatively. Detrusor instability was ruled out by cystometry. The women were evaluated 1, 6 and 12 months postoperatively. The objective cure rate was evaluated by clinical examination and the subjective cure rate was assessed using the KHQ and BFLUTS questionnaire. RESULTS: Mean follow-up was 17.2+/-4.7 months (range 4 to 28 months). The objective and subjective cure rates were respectively 89.9% and 77.5%. Most of the patients received general anesthesia (85.3%). Urinary retention was observed in two women (1.5%), necessitating tape adjustment. Voiding difficulties were observed in 7 cases (5.4%) necessitating intermittent self-catheterization for 4.2+/-2.4 days (range 1 to 7 days). Seven patients developed vaginal erosion (one with vaginal extrusion, and two with an obturator abscess). Complete mesh removal was necessary in 6 patients, four of whom had recurrent stress urinary incontinence. CONCLUSIONS: Our results suggest that the OBTAPE) is an effective treatment for women with stress urinary incontinence. However, vaginal mesh erosion occurred in 6.2% of women, and this implies the need for careful follow-up.

Adult↗
PubMed2005

An open, multicentre study of NASHA/Dx Gel (Zuidex) for the treatment of stress urinary incontinence.

OBJECTIVE: The Zuidex system facilitates non-endoscopic urethral injection for stress urinary incontinence (SUI). It comprises four pre-filled syringes of non-animal stabilised hyaluronic acid/dextranomer (NASHA/Dx) gel and an Implacer device. This open, 12-month study was performed to evaluate the safety and efficacy of this system in women with SUI. METHODS: Patients were aged > or =18 years with a history of SUI for > or =12 months (hypermobility and/or intrinsic sphincter deficiency), had failed prior non-invasive therapy and were invasive-therapy naïve. Up to two treatments with NASHA/Dx gel were permissible (re-treatment was offered at week 8). Positive response to treatment was defined as a reduction in provocation test leakage of > or =50% compared with baseline. Efficacy was also measured by 24-hour pad weight test leakage, and number of incontinence episodes/24 hours. RESULTS: A total of 142 patients were enrolled, with a mean age of 55.7 years. The response rate was 78% at week 12, and 77% at month 12. Significant reductions in median provocation test leakage, 24-hour pad-weight test leakage and number of incontinence episodes/24 hours were observed at all time-points. At month 12, the median decreases from baseline in these three variables were 93%, 89% and 67%, respectively. Treatment-related adverse events were of a nature expected with urethral injection - most were transient, and of mild or moderate intensity. CONCLUSIONS: Treatment with NASHA/Dx gel produced large, statistically significant reductions in urinary leakage sustained over 12 months and was well tolerated. These findings suggest that NASHA/Dx gel could be considered as an early intervention in treatment-naïve cases of SUI.

Adult↗
PubMed2005

Stress incontinence injection therapy: what is best for our patients?

OBJECTIVE: Urethral injection (periurethral/intraurethral bulking) is an established, minimally invasive therapy for stress urinary incontinence (SUI). This review aims to determine which women should potentially benefit from, and be considered as candidates for, injection therapy and to elucidate what we are trying to achieve. METHODS: Based on MEDLINE database searches, all aspects of urethral injection were examined, including patient selection, safety, injection technique, efficacy, quality of life, goals and cost. RESULTS: Such therapy has a low complication rate, improves or cures about 3 out of 4 women, as shown in mainly short-term studies, and improves patients' quality of life. It can be used in the majority of patients with uncomplicated SUI. Therefore, injection therapy may be considered as a first-line treatment option for patients who have failed conservative therapy such as pelvic floor exercises and who decline or have a contraindication for pharmacological treatment. However, the decision of whether to use this type of treatment must be based on an informed discussion between the physician and patient--this dialogue should incorporate questions about patients' own treatment goals. Injection therapy appears to have the profile required to meet patients' goals, based on the findings that a procedure with an improvement in incontinence, minimal short-term risk, no long-term risk, and performed in a clinic, would be acceptable. CONCLUSION: Investigating and trying to achieve patients' own treatment goals will ultimately enable us to do what is best for our patients, but current evidence suggests that injection therapy is a valid option worth discussing with many patients.

Biocompatible Materials↗
PubMed2005

Cough anal reflex: strict relationship between intravesical pressure and pelvic floor muscle electromyographic activity during cough. Urodynamic and electrophysiological study.

PURPOSE: Cough and more generally abdominal strain determine a pelvic floor contraction which allows an increase in sphincter pressure to prevent leakage during stress. Many electrophysiological studies have demonstrated this reflex (formally cough anal reflex). We postulated that the perineal muscle contraction following cough is not a simple binary response but proportional to the intensity of the cough. MATERIALS AND METHODS: A total of 16 women (mean age 52 years) without neurological disease or stress urinary incontinence, referred for frequency and urgency without urge incontinence, underwent urodynamic investigation. Vesical pressure was compared to electromyographic activity of the anal sphincter during 4 successive coughs of different intensity, namely gentle, moderate, strong and very strong efforts. These 4 graded coughs were repeated at 0, 100, 200, 300 and 400 ml of filling during cystometry. RESULTS: All patients were able to determine a graded cough at each level of filling. In all patients and at each level of filling a strict relationship between intravesical pressure (intensity of cough) and integrated electromyographic value was demonstrated. The greater the intensity of the cough the greater the electromyographic response of the anal sphincter. There is a strict correlation between vesical pressure and integrated electromyographic value at rest at O (R2 = 0.983) or at 100 ml (R2 = 0.970), 200 (R2 = 0.918) or 300 ml (R2 = 0.960). Bladder filling does not modify the responses. CONCLUSIONS: Pelvic floor muscle contraction increases with the importance of intra-abdominal pressure generated during stress. This gradual adaptation of pelvic floor muscles is probably 1 of the main factors which contributes to stress urinary and fecal continence in women. It must be preprogrammed by the central nervous system to maintain continence during various stresses.

Adult↗
PubMed2005

[How to identify the neck of a caliceal diverticulum in flexible ureterorenoscopy].

A caliceal diverticulum corresponds to a cavity communicating with the renal excretory tract via a neck. Surgical treatment is required when the caliceal diverticulum is symptomatic with repercussions on the patient's quality of life. A retrograde approach via holmium:YAG laser ureterorenoscopy has been recently used to treat the stone and externalize the caliceal diverticulum into the pyelocaliceal cavities. The problem raised by this approach is identification of the diverticular neck. The objective of this technical note is to describe a technique to facilitate identification of the diverticular neck.

Diverticulum↗
PubMed2005

[Intraurethral injections of Zuidex: evaluation of the morbidity of the technique in the treatment of female urinary incontinence].

OBJECTIVE: To evaluate the feasibility and morbidity of intraurethral injections of dextranomer/hyaluronic acid (Zuidex), performed under local anaesthesia as an outpatient procedure in the treatment of female urinary incontinence. MATERIAL AND METHODS: Twenty one patients with a mean age of 67 years (range: 29-93 years) presenting urinary incontinence related to sphincter incompetence were treated by intraurethral injection of Zuidex. Injections were performed with the Implacer system provided with the product under local anaesthesia. RESULTS: For nine of these patients (43%), a second injection after 6 weeks was performed due to an insufficient result on incontinence. A total of 30 injections were therefore performed. No significant problem was observed during the injections. Three injections (10%) were difficult because of a short urethra. In 7 cases (23%), the patient reported pain during the injection. In 3 cases (10%), macroscopic haematuria was observed after treatment and another 4 cases (13%) developed lower urinary tract infection. Six patients (20%) developed transient acute urinary retention with resumption of micturition after 24 to 48 hours. CONCLUSION: Intraurethral injection of Zuidex has the advantage of being minimally invasive and can be performed under local anaesthesia, as an outpatient procedure, with good safety and a low complication rate. Resumption of spontaneous voiding must be monitored in view of the risk of urinary retention. The long-term results have not yet been evaluated.

Adult↗
PubMed2005

[How to avoid accumulation of stone fragments in the lower calix during flexible ureterorenoscopy].

Flexible ureterorenoscopy combined with Holmium:YAG laser is an emerging technology that already has its place among the urologist's treatment options for the management of urinary stones. The main indication for the technique is renal stones, particularly lower caliceal stones. After mobilization of the stone in the renal pelvis or upper caliceal group, fragmentation is achieved by Holmium:YAG laser and the largest fragments are removed. When small fragments persist that are difficult to extract, the patient's blood is injected into the lower caliceal group to obtain a blood clot This clot then fills the lower caliceal group and prevents secondary accumulation of residual stone fragments, facilitating elimination of fragments towards the ureter. This article describes this technique.

Humans↗
PubMed2004

Tension-free vaginal tape and associated procedures: a case control study.

OBJECTIVES: We compare objective and subjective cure rates after tension-free vaginal tape procedures performed alone or in conjunction with vaginal procedures. METHODS: One hundred eighty-six women underwent a tension-free vaginal tape procedure for stress or mixed urinary incontinence. One hundred women treated with tension-free vaginal tape alone (group 1) were compared with 40 women treated with tension-free vaginal tape and concomitant vaginal hysterectomy (group 2), and 46 patients treated with tension-free vaginal tape and pelvic floor reconstruction (group 3). Patient outcomes, surgical difficulties and complications are reported. Postoperative voiding diaries, standing stress-test results, and patient satisfaction were compared. RESULTS: There were no significant differences among the three groups in terms of age, menopausal status, BMI, previous incontinence surgery, or the type and degree of incontinence. Parity was significantly higher in the group treated with tension-free vaginal tape and pelvic floor reconstruction ( p=0.04 ). The overall perioperative complication rate was 15.6%. Women treated with tension-free vaginal tape and hysterectomy (group 2), and those treated with tension-free vaginal tape and pelvic floor reconstruction (group 3) had a significantly higher incidence of bladder injury (17.9% and 13%, respectively, versus 5% in group 1; p=0.05 ). Estimated blood loss and the frequencies of postoperative urgency and voiding disorders did differ significantly between women treated with tension-free vaginal tape alone and those who underwent associated procedures. The mean follow-up time was 24.5+/-2.6 months. No difference in the objective cure rate was found between the tension-free vaginal tape group and the other two groups (93% versus 97.5% and 91.1%; p=0.3 ). No difference in the subjective cure rate was found between the tension-free vaginal tape group and the groups undergoing associated procedures (72% versus 72.5% and 68.8%; p=0.4). CONCLUSION: Pelvic floor defects, benign uterine disorders and stress urinary incontinence can be safely treated with tension-free vaginal tape and vaginal procedures during the same surgical procedure.

Case-Control Studies↗
PubMed2004

[Spontaneous renal haematoma: diagnostic and therapeutic approach in 7 cases].

OBJECTIVE: Spontaneous renal haematomas are rare. The authors discuss the aetiological diagnosis and management of these haematomas. MATERIAL AND METHODS: Seven cases (3 females and 4 males) of spontaneous renal haematoma were managed between July 1999 and December 2002 and the case files were studied retrospectively. RESULTS: The circumstances of discovery were nonspecific. One patient presented with haemorrhagic shock. Radiological work-up comprised abdominal ultrasound and CT scan in almost every case. Ultrasound failed to demonstrate the aetiological diagnosis. CT revealed the cause of bleeding in 7 cases. MRI was performed in 4 cases, but urgent angiography was not performed. Four total nephrectomies were necessary, while two patients were treated by conservative surgery. One patient was simply followed by repeat CT scan. The short-term course was favourable with a mean follow-up of 23 months. CONCLUSION: Spontaneous renal haematomas raise 2 problems, that of their aetiology: tumours are the commonest causes (angiomyolipoma and renal cell carcinoma), and that of their management. Three therapeutic approaches are possible: radical surgery in the case of uncontrollable bleeding, conservative surgery or surveillance in the absence of a life-threatening emergency and when the aetiological diagnosis has not been established. Rigorous and repeated radiological surveillance can identify the cause of the bleeding allowing conservative surgery to be performed when indicated.

Aged↗
PubMed2004

[Distribution of surgical operations for female stress urinary incontinence in parisian public hospitals in 2002-2003].

OBJECTIVE: To determine the surgical practices for the treatment of female stress urinary incontinence (SUI) in Parisian public hospitals (AP-HP) over a 12-month period. MATERIAL AND METHODS: 25 gynaecology (n=16) and urology (n=9) departments in Parisian teaching hospitals were surveyed by postal questionnaire concerning their surgical practice for female SUI. The survey concerned all operations performed between 1st' September 2002 and 31st August 2003 inclusive. The questionnaire concerned the number of operations, the type of operation, the type of suburethral tape and the incision used for placement of these tapes. RESULTS: The participation rate in the survey was 88% (22 out of 25 departments). The total number of surgical operations for SUI was 1,224: 586 in gynaecology (47.9%) and 638 in urology (52.1%). The distribution of techniques was as follows: 1,028 suburethral slings by prosthetic tape (83.9%), 106 retropubic colposuspensions (8.7%), 70 artificial sphincters (5.7%), 13 subcervical slings (1.1%) and 7 transurethral injections (0.6%). The distribution of tapes was as follows: 614 TVT (59.7%), 217 T.O.T. (21.1%), 111 SPARC, (10.8%) 40 PROLENE (3.9%), 27 URETEX (2.6%), 7 PELVICOL (0.7%), 6 SIS (0.6%) and 6 IVS (0.6%). Surgical approaches consisted of an ascending retropubic approach in 60.2% of cases, a transobturator approach in 26.9% of cases, a descending retropubic approach in 10.8% of cases and a prepubic approach in 2.1% of cases. CONCLUSION: Ascending retropubic TVT represented the majority of operations for female stress urinary incontinence performed in Parisian public hospitals in 2002-2003. The obturator approach represented almost one-third of surgical approaches for suburethral tape placement.

Female↗