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Biomedical subjects

Gustav Kiss

Publications and source records attributed to Gustav Kiss.

5 recordsLinked to original sources
PubMed2006

Predictive value of initial urodynamic pattern on urinary continence in patients with myelomeningocele.

AIMS: To investigate whether the initial urodynamic pattern may predict urinary continence and the need for adjunctive incontinence surgery in patients with myelomeningocele. PATIENTS AND METHODS: One hundred and twenty-three patients with myelomeningocele were included in our retrospective study. The patients were divided based on the urodynamic pattern at initial evaluation into four categories: overactive detrusor with overactive (spastic) sphincter (group 1, n = 43), overactive detrusor with underactive/acontractile sphincter (group 2, n = 37), underactive/acontractile detrusor with overactive (spastic) sphincter (group 3, n = 8), and underactive/acontractile detrusor with underactive/acontractile sphincter (group 4, n = 35). Urinary continence status at the last follow-up and the need for adjunctive incontinence surgery were compared between the four groups. RESULTS: Mean follow-up was 10 years and mean age at the last follow-up 17 years. A socially acceptable continence status (continent or socially dry) was achieved in 74% and was significantly different among the four groups (P = 0.023): 86% and 87% of the patients in group 1 and 3 became continent or socially dry, but only 57% and 74% of those in group 2 and 4, respectively. Although none of the patients in group 3 underwent adjunctive incontinence surgery compared to about 25% in the other groups, statistically the difference was not significant (P = 0.48). CONCLUSIONS: The initial urodynamic pattern is very useful in counseling families by predicting urinary continence in patients with myelomeningocele. The chances of becoming continent or at least socially dry are best for patients with overactive (spastic) sphincter.

Adolescent↗
PubMed2006

Early proactive management improves upper urinary tract function and reduces the need for surgery in patients with myelomeningocele.

AIMS: To investigate whether upper urinary tract function and the need for surgery in patients with myelomeningocele depends on the timing of initiating neurourological management. PATIENTS AND METHODS: One hundred thirty-three patients with myelomeningocele were included in our retrospective study. The patients were divided based on age at the initial evaluation into three categories: from day of birth to age 2 (group 1, n = 67), from age 3 to age 10 (group 2, n = 44), and after age 10 (group 3, n = 22). Upper urinary tract function and the need for surgery with the intention to preserve or normalize the upper urinary tract function were compared between the three groups. RESULTS: Mean follow-up was 11, 10, and 9 years in group 1, 2, and 3, respectively. The upper urinary tract function was normal in 91%, 80%, and 82% at the initial evaluation (P = 0.194) and in 99%, 86%, and 86% at the last follow-up (P = 0.012) in group 1, 2, and 3, respectively. Following failure of conservative therapy only, the proportions of patients undergoing surgical interventions with the intention to preserve or normalize the upper urinary tract function was significantly (P = 0.0002) different among the three groups: 15%, 34%, and 59%, respectively. CONCLUSIONS: Early proactive management improves upper urinary tract function and reduces the need for surgery in patients with myelomeningocele in the long-term. Therefore, initiation of proactive neurourological management as early as possible, ideally from the day of birth, is strongly recommended.

Adolescent↗
PubMed2005

New tined lead electrode in sacral neuromodulation: experience from a multicentre European study.

The use of a new tined lead electrode for sacral neuromodulation (SNS) was evaluated in a European study including 127 patients with chronic voiding dysfunction. The tined lead can be implanted during the first stage of the SNS procedure, which makes a longer test period possible before implanting the pulse generator in a second stage. Implantation of the tined lead was performed under local anaesthesia in 89% of patients. Screening lasted on average 30 days. Screening with the tined lead was considered successful by the physicians in 77% of patients (n=72). In 74% of first stage patients (n=70), at least 50% improvement in the main symptoms versus baseline was obtained. This was sustained for up to 6 weeks. All of these patients received the pulse generator in a second stage. The outcome of this study supports the use of the tined lead electrode as a screening tool in SNS therapy.

Adult↗
PubMed2005

Prolonged sacral neuromodulation testing using permanent leads: a more reliable patient selection method?

OBJECTIVE: To assess the effect of prolonged sacral neuromodulation testing using permanent leads comparing the usual evaluation period of 4 to 7 days to a prolonged evaluation period of a minimum of 14 days. PATIENTS AND METHODS: A consecutive series of 20 patients (16 females and 4 males) undergoing prolonged sacral neuromodulation testing using permanent leads between September 2000 and March 2004 were evaluated retrospectively. 10 suffered from urgency-frequency syndrome, 3 from urge incontinence and 7 from non-obstructive chronic urinary retention. Key bladder diary variables at baseline, after the usual and prolonged evaluation period and at the last follow-up were compared. RESULTS: The median age was 52 years (interquartile range (IQR) 38-59) and the median evaluation period 28 days (IQR 18-29). 16 of the 20 patients (80%) had successful prolonged sacral neuromodulation testing and underwent the implantation of the IPG that was placed in the anterior abdominal wall in 6 and in the upper buttock in 10 patients. The eligibility for IPG implantation was significantly (p=0.031) increased from 50% after the usual to 80% after the prolonged evaluation period. At a median follow-up of 22 months (IQR 12-34), sacral neuromodulation was successful in 14 (88%) of the 16 IPG implanted patients but failed in 2. CONCLUSIONS: Prolonged sacral neuromodulation testing using permanent leads is more reliable for accurate patient selection than the usual evaluation period. Therefore, this method is strongly recommended and suggested to become the standard test procedure.

Abdominal Wall↗