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G Breda

Publications and source records attributed to G Breda.

At least 19 recordsLinked to original sources
PubMed2001

Future developments and perspectives in laparoscopy.

INTRODUCTION: As urologists head into the new millennium, it has become clear that laparoscopy will play a significant role in successful urologic practice. Issues that are addressed in this article include: (1) What are the new limits? (2) Technological advances. (3) Adequate training. (4) How to technically simplify the laparoscopic procedures? MATERIALS AND METHODS: To answer the stated questions a review of the literature has been undertaken together with interviews of the leading experts and laparoscopic working groups in urologic laparoscopy. The gathered information has been summarized and focussed with the aim of presenting the perspectives of laparoscopy in urology. RESULTS AND DISCUSSION: Standardized indications for laparoscopic urological surgery are benign nephrectomy, nephroureterectomy, cryptorchidism, adrenalectomy, renal cysts, lymphocele and bilateral or relapsing varicocele. Future indications might include living donor nephrectomy, partial nephrectomy and cyst decortication for adult polycystic kidney disease. Controversy exists about the laparoscopic treatment of malignancies in the urinary tract. Whereas pelvic lymph node dissection--even if performed with decreasing frequency--is accepted worldwide, retroperitoneal lymphadenectomy for low-stage testis cancer is currently performed only at few centers. The recent breakthrough in uro-oncological laparoscopic surgery has been laparoscopic radical prostatectomy changing our views on the limits of laparoscopic urology. Endoscopic suturing devices (i.e. Endostitch) are further being developed, and a prototype reapproximating micro-clips (VCS stapler) has been used to perform a uretero-ureterostomy laparoscopically in a porcine model. Nevertheless, the ability of endoscopic suturing using the standard equipment has still to be considered as a "conditio sine qua non". Improvements for tissue division and dissection include an electrosurgical snare to perform a partial nephrectomy, the development of a pneumodissector and hydrodissector. Robotics, including the AESOP 3000 and ZEUS represent a glimpse of the future. By positioning the optique in a voice-controlled full range motion mechanic arm, the image on the screen is very steady and the ergonomics of the surgeons is increased significantly. The da Vinci-System, however, is the first system that has translated all visions of telepresence surgery into clinical reality, recently also for laparoscopic radical prostatectomy. CONCLUSIONS: The future of laparoscopic urology is a two-tiered approach. On the first tier, the advancement of complex reconstructive and ablative surgery such as laparoscopic prostatectomy or, laparoscopic retroperitoneal node dissection, will be undertaken by referral centers of expertise. It is from these individuals that we will look to in order to separate what is feasible and what is reasonable. The second tier will be focusing on simplifying the procedure for the average urologist. As such, developments such as the pneumodissector, hydrodissection, and hand assistance will bring exstirpative laparoscopy into the realm of more urologists. What is critical is that the urologic community supports both groups of laparoscopists.

Education, Medical, Graduate↗
PubMed2000

AMS three-piece inflatable implants for erectile dysfunction: a long-term multi-institutional study in 200 consecutive patients.

OBJECTIVES: The aim of this study was to assess the longterm mechanical reliability of AMS (American Medical Systems) three-piece inflatable implants and their impact on patient-partner satisfaction in 200 consecutive patients with erectile dysfunction who underwent surgery in five different institutions. METHODS: Patient charts included in the study were collected and extensively assessed to record pre- and intraoperative data and postoperative complications. All patients and 120 partners were then seen often in the office at a mean follow-up of 59 months (range 6-130) and they were extensively questioned about function of the device and its impact on the couple's sexual life. RESULTS: At the long-term follow-up, 185 patients (92.5%) were still engaging in sexual intercourse with a mean frequency of 1.7/week. Patients and partners reported prosthetic erections as excellent, satisfactory or poor in 96 (48%), 100 (50%) and 4 (2%) cases, and in 20 (17%), 80 (66%) and 20 (17%) cases, respectively. Postoperative sexual activity was considered excellent, satisfactory or poor by 140 (70%), 44 (22%) and 16 (8%) patients and by 34 (28%), 81 (68%) and 5 (4%) partners, respectively. Reasons for patients' complaints included postoperative penile shortening in 60 (30%) cases and poor glandular engorgement in 40 (20%) cases. Partners' main complaint was unnaturalness of the prosthetic erection, a factor reported by 30 (25%) subjects. Complications requiring surgical exploration included infection in 12 patients (6%) and mechanical failure in 8 patients (4%). Kaplan-Meier estimates demonstrated significantly decreased mechanical survival for the Ultrex type of cylinders compared to the CX type of cylinders. CONCLUSIONS: AMS three-piece inflatable implants provide an overall patient and partner satisfaction rate of 92 and 96%, respectively. However, postoperative penile shortening and poor glandular engorgement were the causes of some complaints among the patient population as well as the unnaturalness of prosthetic erection among female partners. In the long-term, mechanically speaking, CX cylinders seem to be more reliable than the Ultrex ones.

Adult↗
PubMed1998

Transurethral electrovaporization of the prostate vs. transurethral resection. Results of a multicentric, randomized clinical study on 150 patients.

AIM OF THE STUDY: To evaluate clinical, urodynamic efficacy and safety of TURP and TVP in patients with symptoms due to obstructive benign prostatic hypertrophy with a prospective multicentric randomized study. MATERIALS AND METHODS: 150 patients with BPH, urodynamically obstructed, were randomized to receive TURP or TVP. At the end of the recruitment phase, 80 patients underwent TURP and 70 patients underwent TVP. Patients were clinically evaluated by the I-PSS score at months 0, 1, 3, 6 and 12. Preoperative evaluation included complete blood routine examination, PSA, transrectal ultrasound and pressure/flow studies. Pressure/flow studies were also performed after 3 months. RESULTS: There was no statistical difference between groups in any of the preoperative parameters. All patients were considered urodynamically obstructed at preoperative pressure studies. As for catheter days and hospitalization days, statistical differences between TVP and TURP were found; catheter days were 2.71 days (SE 0.12) in the TURP group vs. 1.9 (SE 0.24) in the TVP group (p < 0.000). Hospitalization was 4.7 days (SE 0.22) after TURP and 3.9 days (SE 0.24) after TVP (p < 0.000). Mean preoperative I-PSS score was 18.84 and 18.19 in the TVP and TURP groups, respectively. At 3, 6 and 12 months, IPSS was 5.52 and 5.50, 3.77 and 4.94, 3.52 and 4.04 for TURP and TVP, respectively. Mean preoperative peak flow rate (PFR) was 8.78 and 7.26 ml/s for TURP and TVP, respectively; after 3, 6 and 12 months, PFR was 19.21 and 18.8, 20.77 and 20.13, 20.30 and 20.31 ml/s, respectively. After 3 months, 6 patients in the TURP group (7.5%) and 7 patients in the TVP group (10%) were borderline obstructed. 1 patient in the TVP group (1.4%) was still obstructed and underwent TURP. As for complications, 4 patients (5.7%) in the TVP group had stress urinary incontinence after 12 months vs. 1 (1.25%) in the TURP group. DISCUSSION: The present study clearly demonstrates that TVP is as effective as TURP in relieving urinary obstruction due to BPH, it offers some advantages in terms of catheterization and hospital stay, but at the price of a higher incidence of postoperative urine incontinence. Technical improvements might solve this problem in the future, perhaps combining TVP with TURP of the apical tissue.

Aged↗
PubMed1997

Laparoscopic unroofing of adrenal cysts.

OBJECTIVES: This study was aimed to demonstrate the feasibility of laparoscopic conservative surgery of the adrenal gland in the treatment of adrenal cysts. METHODS: Two cases of laparoscopic decortication of symptomatic adrenal cysts with preservation of the adrenal parenchyma are presented. RESULTS: Surgery was uneventful in both cases and patients returned to preoperative activity within 10 days from the operation. At the 3-month follow-up, computerized tomography demonstrated the absence of any cystic recurrence and adrenal endocrine function was normal. These findings were confirmed at the 1-year follow-up by ultrasonography. CONCLUSIONS: Symptomatic adrenal cysts can be effectively and safely treated by laparoscopic unroofing, a minimally invasive procedure which leaves the nondiseased adrenal parenchyma intact.

Adolescent↗
PubMed1996

Correction of stress urinary incontinence: laparoscopy combined with vaginal suturing.

The authors review the published techniques of laparoscopic colposuspension combined with vaginal suturing. Particular emphasis is given to their own technique, first published in 1992, and to that of Harewood (1993), which is similar. Both involve a Burch-like colposuspension using a technique similar to that of Gittes and Loughlin. This is possible looking inside the pelvis through a laparoscope and using a handle-needle. Published results are similar (about 70% success rate), but the authors point out that the Breda technique is simpler, cheaper, and less time consuming (only one trocar instead of three) and has had a longer follow-up (up to 3 years instead of 19 months). The authors review many other similar techniques reported between 1993 and 1995 with good results but based on rather limited experience. The conclusion is that the laparoscopic technique with vaginal suturing seems a promising way to approach stress urinary incontinence in the female patient.

Female↗
PubMed1996

[Respiratory failure caused by myopathy in severe sepsis].

OBJECTIVE: To describe a generalized myopathic disorder occurred in the convalescence phase of illness of a critically ill patient. SETTING: Neurological Intensive Care Unit. PATIENT: A 43-year-old man with acute leukoencephalopathy and severe sepsis complicated by sustained and prolonged cardiovascular, respiratory and renal failure. After 15 days of complete respiratory autonomy, the patient presented an acute ventilatory failure associated with generalized muscle weakness. Neither a relapse of sepsis nor neurological worsening were detected. MEASUREMENTS AND RESULTS: Electromyogram resulted in normal conduction velocity in both motor and sensitive nervous fibers. Muscular biopsy showed marked fiber size variability with several hypotrophic fibers type II fiber grouping, several areas of degeneration-necrosis with macrophage invasion, dishomogeneous oxidative enzymatic activity, no increase in glycogen or lipid content. CONCLUSIONS: These results excluded critical illness polyneuropathy and all the other known myopathies. Prolonged period of sepsis with multiple organ failure can result in a direct generalized myopathy. This possibility should be kept in mind while treating long term critically ill survivors.

Adult↗
PubMed1996

[Laparoscopic surgery of stress urinary incontinence in women].

The Authors carried out a literature review on stress urinary incontinence (SUI) treatment using laparoscopy or pelvioscopy. They report their experiences in using a pubo-vaginal percutaneous colposuspension assisted by pelvioscopy. Of 22 treated patients, there was a total correction of the incontinence in 15 patients. (68.12%) with a median follow-up of 18.6 months. They report also their first experience with the Retzius plasty of Manhes by laparoscopy (3/4 patients treated are continent, 1/4 has recurrent SUI during times of stress). They conclude that laparoscopy and pelvioscopy treatment can be valid alternatives to traditional surgery if made on selected patients.

Female↗
PubMed1994

Urolume in urethral stenosis: Italian Club of Minimally Invasive Urology experience.

A multicenter study of the patients in whom the Urolume has been implanted has been among the actions undertaken by the Italian Club of Minimally Invasive Urology (UMICLUB). For each patient, a computer information format has been prepared containing evaluation data related to the preoperative period, the endoscopic procedure, and follow-up. The collected data were computerized through unifunctional and multifunctional analysis. Of the 82 patients recruited, 76 were followed for a period ranging from 1 to 40 months. Urinoflow results dramatically improved after implantation of the endoprosthesis: peak flow rates increased by 310%, while mean flow rates increased by 294%. Incontinence and dribbling were found in 4% and 20% of the patients, respectively, and were independent of the distance between the external sphincter and the Urolume prosthesis and of the stent number and length. The cross-data elaboration seems to indicate a statistically significant relation between urethral preparation before Urolume implantation and stricture recurrence, with recurrence being more frequent after dilation. Significant correlations have not been noticed between stenosis etiology, urinary infection, type of anesthesia, and recurrence; between the type of anesthesia, stent length, and duration of hospitalization; or between stent number and position and pain. The impact of the Urolume prosthesis on sexual activity was marginal by all three measures considered (pain during erection, coitus, and ejaculation).

Adult↗
PubMed1994

Stage A1 prostate cancer: follow-up with digital rectal exploration, prostate markers, fine-needle aspiration, ultrasonographically guided needle biopsy and biopsies of the residual prostate with resectoscope.

From January 1985 to December 1990, we performed 921 TURP and 23 retropubic adenomectomies. In 70 patients (7.4%) histological examination revealed an incidental carcinoma of the prostate (stage A), 51 of which (72.8%) were A1 and 19 (27.2%) stage A2. In our classification A1 covers cases with < 3 G1 focal lesions [Boxer, 1977]. Thirteen of the A2 cases underwent radical prostatectomy: 1 pT1G1-2, 9 pT2G1-2, 3 pT3G2 (TNM 1978); the remaining 6 were given palliative treatment. The 51 stage A1 patients were recalled for follow-up evaluation, only 20 came for checking. They were reassessed by means of DRE, markers, prostate cytologic aspiration, echo-guided transperineal needle biopsy and resection of the prostatic cavity. Our experience seems to suggest that, if we define A1 as < 3 G1 chips or less, this stage is to be considered an incidental illness that seems not to require further treatment, but only a policy of surveillance with yearly markers, DRE and echo-guided needle biopsy.

Aged↗
PubMed1994

Intermediate intensive units: definition, legislation and need in Italy.

This paper deals with the definition of intensive care medicine and the organization of different levels of care; intermediate and high level. The organization, facilities and personnel for intermediate care are discussed. The available public data on the organization of intensive medicine and modifications planned by the Legislator are considered. Finally, the usefulness of intermediate care and an estimate of the actual need, based on prospective multicentre ad hoc studies, are discussed.

Health Services Needs and Demand↗
PubMed1993

Laparoscopic nephrectomy with vaginal delivery of the intact kidney.

The first case of laparoscopic nephrectomy in Italy is described. The patient was a 51-year-old woman with a small, nonfunctional, tuberculous left kidney. The organ, once detached from its lumbar site, was brought in to the pelvic cavity and extracted from the body via a posterior colpotomy. In this way, the integrity of the organ is preserved, hence, this could be the preferable route when dealing with a little kidney tumor in a woman.

Female↗
PubMed1992

Treatment of hydrocele: randomised prospective study of simple aspiration and sclerotherapy with tetracycline.

Following reports in the literature on the efficacy of tetracycline sclerotherapy in the treatment of hydroceles, we carried out a randomised prospective study of 45 patients (50 hydroceles), comparing simple evacuation with tetracycline sclerotherapy. The results revealed no statistically significant difference in the percentage of success between the 2 groups, but complications were more common in the patients treated with tetracycline. The good results reported by other authors in non-randomised studies are, therefore, not confirmed.

Adolescent↗
PubMed1991

Nomogram for penile biothesiometry.

Three hundred and fifty men, aged between 17 and 80 years, with normal sexual anamnesis and without any neurological pathology, underwent finger (index) and penile biothesiometry using a biothesiometer. Tabular and graphical nomograms were obtained according to age and instrumental values. The use of the above-mentioned nomograms is an effective aid in detecting each individual case.

Adolescent↗
PubMed1990

[Cost-benefit relationship between endoscopic resection (TURP) and open surgery (Millen) in prostatic hypertrophy ].

Evaluation of the cost/benefit relationship between TURP (50 cases) and Millin (30 cases). The factors considered are as follows: average post-operative hospitalization, average catheterisation time, average operation time, cost of materials, number of operators employed, number of transfused blood units. The post-operative hospitalization relating to the two kinds of operation varies considerably with a difference of 5.15 days less for the TURP, while the average catheterisation time doesn't seem to be affected. Blood transfusion was necessary in the 43.3% (0.75 unit/patient) of cases for the Millin compared to the 14% (0.26 unit/patient) for the TURP. Evaluation of economical advantages between TURP and Millin shows a relationship of 1:2.3 in favour for of TURP.

Aged↗
PubMed1987

[Epididymitis in adults. Retrospective study of 110 cases].

A review was conducted of 110 cases of epididymitis, most of these patients (71.9%), especially those under 50 years of age, having negative urine cultures: this appears to confirm the high frequency of Chlamydia T infection in the age group 20 to 50 years when sexual activity is at its maximum. Urinary output was normal in 60 of 79 patients and urography exploration provided normal results in 69 of the 110 patients (63%), particularly in those under 50. It is concluded, therefore, that urography is not necessary in patients under 50 but remains necessary in those in older age groups.

Acute Disease↗
PubMed1985

Echography in vena cava invasion from renal tumors.

The last 4 cases of our case series of renal cell carcinoma (RCC) with caval or cavo-atrial invasion were studied by ultrasonography (US), computerized tomography (CT scan), arteriography (AG) and venocavography (VC) (inferior and/or superior). A comparison is made with these different methods, with particular emphasis on (US). The authors' conclusions are that ultrasound may replace anterograde inferior cavography in the evaluation of thrombotic extension and, in addition, it seems to be capable of eliminating the false-positives or -negatives of this method. AG and VC are no longer necessary to determine the cavo-atrial extension of a tumor thrombus from RCC when US and CT scan are available and are correctly integrated.

Aged↗