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Biomedical subjects

H Bruschini

Publications and source records attributed to H Bruschini.

At least 19 recordsLinked to original sources
PubMed2005

Traditional suburethral sling operations for urinary incontinence in women.

BACKGROUND: Traditional suburethral slings are surgical operations used to treat women with symptoms of stress urinary incontinence. OBJECTIVES: To determine the effects of traditional suburethral slings on stress incontinence alone or stress with other types of urinary (mixed) incontinence in comparison with other management options. SEARCH STRATEGY: We searched the Cochrane Incontinence Group Specialised Trials Register (searched 22 December 2004), The UK National Research Register (Issue 1, 2001) and the reference lists of relevant articles. We hand searched the proceedings of the Brazilian Congress of Urology from 1991 to 2003, inclusive. SELECTION CRITERIA: Randomised or quasi-randomised trials that included traditional suburethral slings for the treatment of stress or mixed urinary incontinence. DATA COLLECTION AND ANALYSIS: All three reviewers independently extracted data from included trials onto a standard form and assessed trial methodological quality. The data abstracted were relevant to predetermined outcome measures. Where appropriate, a summary statistic was calculated: a relative risk for dichotomous data and a weighted mean difference for continuous data. MAIN RESULTS: Thirteen trials were identified including 760 women of whom 627 were treated with suburethral slings. Five compared suburethral slings with open abdominal retropubic colposuspension (Burch/Marshall-Marchetti-Krantz) and one compared suburethral slings with needle suspension (Stamey). In six trials, different types of suburethral sling were compared with each other. Nine types of slings were included (Teflon, polytetrafluoroethylene, prolene used for transvaginal tape (TVT), porcine dermis, lyophilised dura mater, fascia lata, vaginal wall, autologous dermis and rectus fascia). There were no comparisons of suburethral sling with anterior repair, laparoscopic retropubic suspension, peri-urethral injections or artificial sphincters. One trial compared surgery (including slings) with anticholinergic medication.There were no statistically significant differences between traditional slings and other types of continence surgery, or between one type of traditional sling and another sling. Confidence intervals around the estimates were wide, reflecting the few data available, and so clinically important differences could not be ruled out. AUTHORS' CONCLUSIONS: The data on sub urethral sling operations remain too few to address the effects of this type of surgical treatment. Few trials are reported by authors in a complete fashion and most information came from abstracts presented in annual meetings. The broader effects of suburethral slings could not be established since trials did not include appropriate outcome measures such as general health status, health economics, pad testing, third party analysis and time to return to normal activity level. Data obtained from thirteen trials did not provide reliable estimates because of their sizes, and heterogeneity of designs, populations studied, and types of comparisons made. Reliable evidence on which to judge whether or not suburethral slings are better or worse than other surgical or conservative management is currently not available.

Female↗
PubMed2000

Suburethral sling operations for urinary incontinence in women.

BACKGROUND: Suburethral slings are surgical operations used to treat women with urinary incontinence. They were originally designed for recurrent stress incontinence, but have also been used recently for primary cases. OBJECTIVES: To determine the effects of suburethral slings on stress or mixed urinary incontinence in comparison with other management options. SEARCH STRATEGY: We searched the Cochrane Incontinence Group's trials register, The National Research Register and the reference lists of relevant articles. We hand searched the proceedings of the Brazilian Congress of Urology from 1991 to 1999, inclusive. Date of most recent search: January 2000. SELECTION CRITERIA: Randomised or quasi-randomised trials that included suburethral slings for the treatment of urinary incontinence. DATA COLLECTION AND ANALYSIS: Both reviewers independently extracted data from included trials onto a standard form and assessed trial methodological quality. The data abstracted were relevant to predetermined outcome measures. Where appropriate, a summary statistic was calculated: a relative risk for dichotomous data and a weighted mean difference for continuous data. MAIN RESULTS: Five trials were identified including 206 women - 126 treated with suburethral slings and 80 with other procedures. Three compared suburethral slings with open abdominal retropubic suspensions (Burch/Marshall-Marchetti-Krantz) and one compared suburethral slings with needle suspension (Stamey). In the fifth trial, different types of suburethral sling were compared with each other. Six types of slings were included (Teflon, polytetrafluoroethylene, Goretex, porcine dermis, lyophilized dura mater and rectus fascia). There were no comparisons of suburethral sling with anterior repair, laparoscopic retropubic suspension, peri-urethral injections, artificial sphincters or conservative management. There is one ongoing trial with Tension-free Vaginal Tape (TVT) versus Burch colposuspension, results expected in August 2000. For each outcome data were available only from individual trials. There were no detectable differences in terms of voiding dysfunction, urge incontinence or detrusor instability between suburethral slings and abdominal or needle suspensions, but the data were few and the confidence intervals wide. More peri-operative complications were reported after suburethral slings than after needle suspension (9/10 vs 2/10; RR 4.5, 95% CI 1.3 to 15.8), and length of stay was longer after sling operations than after abdominal or needle suspension. In the trial which compared autologous (rectus fascia) with synthetic (Goretex) slings, 11/32 vs 2/16 women had not improved after a year (RR 2.75, 95% CI 0.69 to 10.95), but fewer had complications (0/32 vs 5/16; RR 0.05, 95% CI 0 to 0.8). Two women in the second group had late sling erosion of the urethra requiring removal of the Goretex, although their incontinence remained cured. REVIEWER'S CONCLUSIONS: There were few data available to compare suburethral sling operations with other surgical management (abdominal and needle suspension, or different types of slings). In general, the quality of trials was poor with no clear method of randomisation, small numbers of women studied, short follow-up and scanty information on outcome measures. There is not enough evidence on which to judge whether suburethral slings are better or worse than other surgical or non surgical managements.

Female↗
PubMed1988

Incontinent epispadias: surgical treatment of 38 cases.

We review 38 cases of surgically corrected incontinent epispadias with a followup of 5 months to 18 years. In 20 cases the Leadbetter, in 8 the Tanagho and in 8 the Young-Dees techniques of bladder neck reconstruction were used. Of 3 patients with minimal (15 to 25 ml.) bladder capacity the Arap procedure was performed in 1, while small constriction of the bladder neck to improve the bladder capacity and compliance was done in 2. In 1 of the latter patients a 60 ml. capacity was achieved and a secondary Leadbetter operation provided an excellent result. Continence was attained after the initial operation in 18 patients, followup is too short to determine the result in 3 and 15 did not acquire urinary control. Revision of the bladder neck plasty was performed in 11 patients, which resulted in continence in 4 and partial continence in 2. Among 34 patients with an adequate followup 22 (73.3 per cent) are continent and 8 (26.4 per cent) are incontinent. The results were similar with the 3 techniques.

Adolescent↗
PubMed1985

Sacral agenesis: why is it so frequently misdiagnosed?

Thirty-four patients with sacral agenesis were seen from 1954 to 1983, cases of meningomyelocele excluded. Five recognizable and consistent patterns of bone malformation were identified. Urodynamic examinations were done in 10 of the 34 patients. Their evaluation and response to treatment are analyzed; we tried to determine and establish the possible causes for its late diagnosis and consequences regarding the upper urinary tract.

Abnormalities, Multiple↗
PubMed1980

Urethral pull-through operation and long-term follow-up.

Pull-through urethroplasty is appropriate for acute or delayed treatment of lesions of the membranous and proximal bulbar urethra. the length of the stricture itself appears to be more important in predicting success than the precipitation event which produces the stricture.

Follow-Up Studies↗
PubMed1979

Peyronie disease: surgical treatment with muscular aponeurosis.

A new method for surgical correction of Peyronie disease by grafting autologous muscular aponeurosis was tried in 4 patients. Early results were encouraging, with disappearance of penile curvature and of pain on erection. The urologist can perform the operation without the assistance a plastic surgeon must usually give when dermal grafts are used.

Humans↗
PubMed1979

Micturition and the male genitourinary response to sacral root stimulation.

The sacral roots, because of their anatomic and functional organization, are well suited to chronic stimulation. Data from our previous experiments on female dogs suggested that effective voiding responses to stimulation could be obtained by using the ventral root of S2, the sacral nerve in canines with the greatest detrusor representation. Elimination of dorsal root afferents from the stimulus field was essential to the minimization of spinal reflex activity. A selective somatic neurotomy was also necessary to attenuate maximally sphincter activity. In the male, the presence of the prostate gland, the greater urethral length, and the erectile response to stimulation might result in compression of the urethra, compromising micturition. Sacral root stimulation was thus studied using both spinalized and nonspinalized male dogs; the results are discussed with a view toward the applicability of sacral root stimulation to effect micturition in male paraplegics, who comprise the largest percentage of this group of patients.

Animals↗
PubMed1979

Urinary bladder and sphincter responses to stimulation of dorsal and ventral sacral roots.

The sacral spinal roots have a long intraspinal yet extradural pathway that makes them ideal for electrode implantation for the control of micturition. In the hope of identifying a specific motor pathway to the bladder within these roots, a study of 10 mongrel female dogs was undertaken: bladder and sphincter responses to stimulation of individual sacral roots, and to stimulation of the dorsal and ventral components of each root, were recorded urodynamically. The root producing greatest detrusor response was then divided into its motor and sensory components, and the central and peripheral ends of the latter were stimulated. We found that sphincter resistance to bladder emptying was diminished by removing the afferent dorsal roots from the stimulus field. The physiologic implications of this finding are discussed.

Afferent Pathways↗
PubMed1979

Sacral root stimulation in controlled micturition. Peripheral somatic neurotomy and stimulated voiding.

Stimulation of the sacral ventral roots with the largest detrusor representation was found to be moderately successful for bladder emptying in acute canine experiments. However, removal of spinal reflexes arising from sacral root stimulation did not eliminate sphincteric resistance. For that reason ventral roots were stimulated after peripheral somatic neurotomy. Unilateral pudendal nerve sectioning was compared with selective sectioning of the somatic fibers of S2, the root with the greatest detrusor representation in canines. Both were equally effective in significantly reducing outlet resistance. Selective nerve section has one advantage: it preserves more of the nerve pathways involved in reflexogenic erection.

Animals↗
PubMed1978

Feasibility of inducing micturition through chronic stimulation of sacral roots.

Past attempts at inducing micturition in paraplegics by electric stimulation of the spinal cord micturition center have been generally unsuccessful. Failure has most often resulted from inability to separate the response of the detrusor from that of the sphincter. Because the sacral nerves provide some organizational specificity over the spinal cord and are practically suited to chronic stimulation, experiments were carried out in dogs to find out whether or not stimulation of these roots could induce micturition. Results of acute dog studies did suggest that micturition might effectively be performed by stimulation of the ventral root of the sacral nerve having the greatest detrusor representation. Specificity of bladder response was improved by dividing somatic fibers peripherally. Selected division of somatic fibers from the sacral root stimulated was compared with complete pudendal neurotomy. (The former procedure has the advantage of preserving perineal sensation.) The principles learned from the acute studies were then applied to "chronic" dogs--5 paraplegic and 1 normal. Effective voiding was achieved on a long-term basis. Over-all results were very encouraging. Further research is necessary before application of this technique to humans can be considered.

Animals↗
PubMed1978

The male genitourinary sphincter mechanism in the dog.

In an effort to locate and characerize a genital sphincter in the male posterior urethra, the intraluminal changes in urethral pressure under both sympathetic and parasympathetic stimulation were studied. It appears that the urethra has a specific genital sphincteric length corresponding to the supramontanal portion. The urethral length is seemingly under sympathetic control, so that backflow of semen does not occur during ejaculation. The urinary sphincter apparently involves the entire posterior urethra and is primarily under parasympathetic influence.

Angiotensin Amide↗
PubMed1978

Neurologic control of prostatic secretion in the dog.

A model to record the volume of prostatic secretion was developed. The influence of both divisions of the autonomic nervous system on the prostate by pharmacologic stimulation and blockade, and by direct electrical nerve stimulation was observed. The prostate responded to parasympathetic stimulus by increasing secretion. Under sympathetic stimulation, the secretion collected in the acini and ducts was expulsed into the urethra by contraction of the smooth muscle fibers surrounding these structures. A correlation between these findings and the normal sexual function may be made: Early in the excitation phase there is parasympathetic activity with increased secretion. With onset of orgasm and emission, sympathetic activity initiates the contractile activity of the genital duct system and the prostatic muscular element. As a result, the secretion is transported to the prostatic urethra (emission) to be later ejaculated by the genital skeletal musculature of the perineum, mainly the ischiocavernosus and bulbospongiosus.

Angiotensin II↗
PubMed1977

Feasibility of localizing ectopic testes by 131I-labeled luteinizing hormone scintigraphy.

A new method for localizing ectopic testes preoperatively was investigated in rats. Twenty hours after administration of iodine-131 luteinizing hormone the position of normal descended testes was easily identified by scintigraphy. Clinically, this technique may offer a noninvasive and practical means of locating testes undetected by palpation. The complexity and hazards of the surgical intervention to follow would thus be greatly reduced.

Animals↗
PubMed1977

Cystostomy drainage: its efficacy in preventing residual urine and infection.

Residual urine volume was measured in patients with cystostomy drainage by injecting phenolsulfonphthalein in saline solution through the tube. Subsequent drainage yielded an average volume of 25 ml. residual urine. The cause for the presence of residual urine and its consequences--promotion of infection--are discussed.

Diuresis↗
PubMed1977

Effect of urethral stretch on urethral pressure profile.

Urethral pressure profiles were recorded in anesthetized dogs with the urethra in both the relaxed and stretched positions. Similar studies were done with fresh specimens of intact dog bladder and urethra removed en bloc. Clinical studies were performed on women during surgical correction of stress incontinence. The pressure profiles reflected the intrinsic smooth muscular activity of the urethra, inasmuch as they were all obtained under full relaxation by anesthesia and with the abdomen open. In all cases, functional as well as anatomical lengths of the urethra were increased with stretch. The rise in urethral closure pressure was most marked in the proximal third of the urethra. Changes were more notable in women with stress incontinence than in the normal dog. Similar results were noted in the in vitro studies. Length-tension properties of smooth and striated muscles offer a clear explanation for the rationale and effectiveness of surgical procedures done for the correction of stress incontinence.

Animals↗