Biomedical subjects

Haim Matzkin

Publications and source records attributed to Haim Matzkin.

At least 37 records · Page 2Linked to original sources

PubMed2005

Childhood nocturnal enuresis in vulvar vestibulitis syndrome.

OBJECTIVE: To define correlations between vulvar vestibulitis syndrome (VVS) and childhood nocturnal enuresis and the effect of biofeedback therapy. STUDY DESIGN: Of 104 women diagnosed with VVS, 54 (30 with primary vulvar vestibulitis syndrome [PVVS] and 24 with secondary vulvar vestibulitis syndrome [SVVS], mean age 24.5 years) chose Glazer biofeedback therapy. Information on lower urinary tract symptoms was recorded at the initial and final visits. RESULTS: Eight of the 30 women with PVVS (26.6%) had a history of childhood enuresis as compared to none of the women with SVVS (p < 0.01). The 8 women developed lower urinary tract symptoms following biofeedback treatment. None of the women with SVVS had urinary symptoms before or following biofeedback therapy. The high, unstable baseline muscle tone revealed by the Glazer technique to be present in all VVS patients underwent substantial reduction and stabilization at the end of biofeedback therapy. CONCLUSION: Childhood nocturnal enuresis is apparently common among women with PVVS. New urinary symptoms may develop following biofeedback therapy for PVVS.

Adult↗

PubMed2005

[Endoscopic injection of dextranomer/hyaluronic acid for vesico-ureteral reflux--preliminary results].

BACKGROUND: Endoscopic injection is a minimal invasive treatment for vesico-ureteral reflux, an alternative for prophylactic antibiotics or open surgery. Concerns of safety were raised regarding traditional injectable materials used in the past. The recently introduced dextranomer/hyaluronic acid is a new biocompatable substance. Its safety and efficacy has been investigated and demonstrated. OBJECTIVES: To report our preliminary results with the endoscopic injection of dextranomer/hyaluronic acid. METHODS: Twenty nine pediatric patients of mean age 58 months (range 6-144) underwent endoscopic treatment. A total of 42 refluxing ureteral units were treated. Reflux grade was 2, 3, and 4 in 10, 24, and 8, respectively. The procedure was performed under general anesthesia, using a 9.5FR pediatric cystoscope and a semi-rigid needle. The substance was injected submucosally at the 6-o'clock position of the ureteral orifice. A mean of 0.87 ml of the substance was injected (range: 0.6-1.2). In the latter part of the series we injected a minimum of 1 ml for each ureter. During follow-up, ultrasonography and a voiding cystography were performed after 1 and 3 months respectively. RESULTS: Vesico-ureteral reflux resolved in 32/42 (76%) of the ureters. The rate of success was 10/10 (100%), 19/24 (79%) and 4/8 (50%) in reflux grades 2, 3, and 4, respectively. De-novo contralateral reflux was noted in 5 patients. A single complication occurred: acute venous bleeding originating in the injection site, which was managed endoscopically. CONCLUSIONS: Endoscopic injection of dextranomer/ hyaluronic acid is a safe and effective treatment. We recommend the injection of 1 ml, the entire volume available for each ureter.

Child↗

PubMed2004

Spermatic vein tumor thrombus in renal cell carcinoma.

Renal cell carcinoma has the tendency to form venous thrombi. This may involve the renal veins or the inferior vena cava and may extend cephalad/antegrade into the right atrium. We report a patient with renal cell carcinoma who had an intracaval tumor thrombus that had extended into the right spermatic vein. We believe this to be the first description in English literature of a histologically proven renal cell carcinoma thrombus in the spermatic vein.

Carcinoma, Renal Cell↗

PubMed2004

Refinements in treatment of large bladder calculi: simultaneous percutaneous suprapubic and transurethral cystolithotripsy.

OBJECTIVES: To present a combined endourologic approach to treat bladder calculi consisting of simultaneous percutaneous suprapubic and transurethral cystolithotripsy. METHODS: We report on a series of 12 consecutive patients with bladder stone burdens of 40 mm or greater. Percutaneous 30F access was obtained under cystoscopic control. Fragmentation and stone removal were performed simultaneously by two urologists using a Swiss lithoclast, holmium laser, and/or ultrasound lithotriptor through both percutaneous and transurethral routes. Suprapubic and transurethral catheters were placed postoperatively. RESULTS: Twelve patients with a median age of 66 years (range 33 to 80) were treated by simultaneous percutaneous suprapubic and transurethral cystolithotripsy. Six underwent transurethral resection of the prostate at the completion of stone clearance. The median stone size was 60 mm (range 40 to 80), and the median lithotripsy time was 56 minutes (range 45 to 70). The median postoperative hospitalization was 2.7 days (range 2 to 5), and complete stone clearance was achieved in all cases. One patient, who underwent concomitant transurethral resection of the prostate, developed urinary retention 1 week postoperatively and was successfully treated by temporary transurethral catheterization. One patient with a positive urine culture preoperatively developed fever on the first postoperative day and was treated with intravenous antibiotics according to the antibiogram results for 5 days. No other complications had occurred after a median follow-up of 10 months (range 3 to 15). CONCLUSIONS: Simultaneous percutaneous suprapubic and transurethral cystolithotripsy appears to be a safe approach for the management of large bladder calculi and may shorten the total fragmentation time. It can be combined with transurethral resection of the prostate without prolonging hospitalization. The simultaneous use of two modalities of stone fragmentation represents an effective and minimally invasive way of treating large bladder calculi.

Adult↗

PubMed2004

Endourologic procedures combined with other surgical and urologic interventions--early experience.

OBJECTIVES: To assess the feasibility of performing endourologic interventions combined with other operations during the same operative session. METHODS: Eighteen patients underwent simultaneous operations endourologically for upper urinary tract pathologic findings and other surgical and urologic indications. The operating time, technical feasibility, operative success, complications, hospital stay, and patient satisfaction were analyzed. RESULTS: The average patient age was 63 years (range 40 to 83). Five patients underwent percutaneous nephrolithotomy combined with either contralateral laparoscopic nephrectomy, contralateral open nephrectomy, radical retropubic prostatectomy, inguinal/umbilical hernia repair, transurethral resection of prostate, or cystolithotripsy. Thirteen patients underwent 15 retrograde endoscopic procedures (13 for stone disease and 2 for diagnostic purposes) that were combined with open contralateral nephrectomy, inguinal hernia repair, circumcision, closure of ileostomy, transurethral resection of bladder tumor, excision of lymphoma of thigh, drainage and sclerozation of hydrocele, or percutaneous gastrostomy. All procedures were successfully completed without complications. The average hospital stay was 5 days (range 3 to 6) in the percutaneous nephrolithotomy group and 2 days (range 1 to 5) in the retrograde endoscopic procedure group. The duration of hospitalization was related to the more complex operation; combining the procedures did not prolong it. The average follow-up was 11 months (range 3 to 24). All patients were highly satisfied because they were spared the need for more than one surgical session. CONCLUSIONS: Our results support the concept of performing simultaneous endourologic procedures and other operations during one surgical session. This approach obviates the need for repeated anesthesia, patient inconvenience, the psychological stress related to multiple operations, and reduces the total hospital stay.

Adult↗

PubMed2004

Are indications for prostatectomy in octogenarians the same as for younger men?

Prostatectomy for benign hypertrophy of the prostate is usually performed to alleviate lower urinary tract symptoms (LUTS). We assessed indications for and risks of prostatectomy in men 80 years of age and compared them to those for younger men in order to determine whether indications for prostatectomy in octogenarians are different than these for younger men. Medical records of 171 men comprised of 84 patients >80 years of age (mean 84.4) and 87 patients <65 years of age (mean 60.6) who underwent prostatectomy for benign prostate hypertrophy were reviewed. Data regarding indications for surgery, American Society of Anesthesiologists system grade, anesthesia and surgery performed, duration of hospitalization and intrahospital postoperative complications were obtained. The respective indications for surgery in the very elderly and younger patients were: urinary retention with indwelling catheter in 46 (55%) and 34 (39%) (p < 0.04), LUTS in 32 (38%) and 52 (59%) (p < 0.005), and gross hematuria in 6 (7%) and 1 (1.2%). Transurethral prostatectomy was performed in 47 elderly patients (56%) and in 30 young patients (34.5%). The other patients in each group underwent open (suprapubic prostatectomy) surgery. The overall complication rate was significantly higher in the elderly group (39% vs 22%, p < 0.05), with major complications occurring only in this group. Indications for surgery were different for octogenarians than for younger men. Morbidity and mortality rates were significantly higher among the elderly men. Age appears to be an independent risk factor for complications associated with prostatectomy.

Age Factors↗

PubMed2004

Efficacy of the Duet lithotripter using two energy sources for stone fragmentation by shockwaves: an in vitro study.

PURPOSE: To evaluate the efficacy of the Duet lithotripter's novel design of two independent spark-plug generator/reflector systems focused at a common F2. The apparatus allows either simultaneous delivery of shockwaves from both generators (resulting in a per-shock energy delivery at F2 equal to that delivered by its single generator at about 24 kV), alternating (between the two generators), or single-generator delivery of shockwaves at various energy levels and rates. MATERIALS AND METHODS: Eighty-five phantom gypsum stones (volume 786 mm3 each) were placed in a net-like basket and immersed in a specially designed waterbath coupled with the Duet lithotripter (Direx Medical Systems Ltd., Petach Tikva, Israel). Shockwaves were delivered at rates of either 60 or 120 per minute and at intensities of 16 or 22.8 kV (electrohydraulic). Energy was delivered either separately from each generator, in an alternating mode, or simultaneously from both generators. The number of shocks required to fragment the stones sufficiently to allow all of the pieces to fall through the basket holes (complete fragmentation) was recorded. RESULTS: The number of shocks required for complete fragmentation in the alternate mode (120 shocks/min, each generator rate 60/min; 22.8kV) was lower than with the single generator, 112 +/- 19 v 134 +/- 18 (at a rate of 120/min; 22.8 kV). The simultaneous mode of dual generator shockwave delivery was more effective than the traditional single generator (114 +/- 28 shocks at a rate of 120/min, 16 kV v 159 +/- 40 shocks at a rate 120/min; 22.8kV). CONCLUSION: The Duet lithotripter is more effective when used in a simultaneous or alternating mode than is the classical single mode of shock delivery, with the added benefit of shorter treatment time.

Calcium Sulfate↗

PubMed2004

Emerging nephron sparing treatments for kidney tumors: a continuum of modalities from energy ablation to laparoscopic partial nephrectomy.

PURPOSE: The current global medical trend toward minimally invasive treatment for various tumors has generated special interest in several minimally invasive options in the management of kidney tumors. We discuss the role of nephron sparing surgery by less invasive options than the time-honored partial nephrectomy, and the current multitude of energy based tumor ablative methods. MATERIALS AND METHODS: We searched the English literature following the introduction of nephron sparing surgery, with special attention to various emerging minimally invasive surgical and ablative alternatives. RESULTS: Laparoscopic partial nephrectomy can be performed safely following the surgical oncology principles established by open partial nephrectomy. Initial results from the various energy based modalities, most notably cryoablation, indicate that high local control rates can be achieved. However, caution is advised since viable tissue has been observed after minimally invasive ablative therapies. Available data, while promising, are still lacking for long-term followup. CONCLUSIONS: Compared to open partial nephrectomy the laparoscopic approach offers similar cancer-free survival rates. However, the procedure requires highly skilled surgeons. Of the energy based ablative treatments cryoablation followed by radio frequency ablation offers the most meaningful results, with promising local control rates indicated in some series. These methods can be performed less invasively than partial nephrectomy and require less surgical expertise. We anticipate that these modalities will be formalized into urological practice and serve as a single continuum of care, customized according to disease and surgical expertise.

Cryosurgery↗

PubMed2004

Concomitant use of sildenafil and a vacuum entrapment device for the treatment of erectile dysfunction.

PURPOSE: Men not entirely satisfied with erectile function after separate use of sildenafil or a vacuum entrapment device (VED) are usually given more invasive alternatives. This prospective study was designed to evaluate the efficacy of concomitant use of sildenafil and a vacuum entrapment device in men not satisfied with erectile function while using each of these treatment modalities separately. MATERIALS AND METHODS: A total of 161 patients suffering from erectile dysfunction for at least 6 months were evaluated and treated with 100 mg sildenafil and a VED each as monotherapy. The 41 patients not satisfied with erectile function while using either modality alone were treated with concomitant use of sildenafil and a VED. The International Index of Erectile Function and global assessment question about satisfaction from treatment were used to evaluate satisfaction before and after each treatment. RESULTS: All 41 patients stated on the global assessment question that they had a greater level of satisfaction with the results of combined treatment than with each treatment alone (p <0.0001). Older (age greater than 60 years) participants reported better overall satisfaction. There was no correlation between treatment outcome and erectile dysfunction etiology or between satisfaction from treatments and the order in which they were given and the pretreatment scores for the International Index of Erectile Function domains. CONCLUSIONS: Combined use of sildenafil and a VED may be offered to patients not satisfied when either treatment is used alone.

Adult↗

PubMed2004

Midline dorsal plication technique for penile curvature repair.

PURPOSE: Most penile curvature repair techniques involve excision of the tunica albuginea and mobilization of the neurovascular bundles. Recent neuroanatomical studies of the neurovascular bundles have demonstrated the distribution of nerve fibers and identified the 12 o'clock position as the only nerve-free position. We present the results of penile curvature repair with the midline dorsal penile plication technique. MATERIALS AND METHODS: A total of 45 penile plication procedures were performed in 43 pediatric patients, of whom 39 had mild to moderate and 4 had severe curvature. Eight patients had previously undergone penile curvature repair. After the induction of an artificial erection test a 4 or 5-zero polypropylene plication suture was placed at the point of maximal curvature at the 12 o'clock position. RESULTS: Of patients with mild to moderate curvature 97% underwent a successful initial procedure. Satisfactory results were achieved in only 2 of the 4 patients with severe curvature. Two of the 3 initial failures were successfully reoperated using the same technique. The procedure was successful in all 8 patients who had previously undergone operation for curvature repair. CONCLUSIONS: Midline dorsal penile plication is a safe, simple to perform procedure that achieves excellent results in patients with mild to moderate curvature. It is a useful technique in patients in who previous repairs have failed. We suggest other repair techniques for severe curvature.

Adolescent↗

PubMed2004

Does sildenafil enhance quality of nocturnal erections in healthy young men? A NPT-RigiScan study.

OBJECTIVE: To assess the effect of sildenafil on nocturnal erectile function (EF) in young healthy volunteers with normal sexual function (SF) according to the International Index of Erectile Function (IIEF) questionnaire. METHODS: Thirty-three young (mean age 21 +/- 0.3 years; range 18-25) healthy volunteers not taking any medications who had normal SF and an EF domain >26 on the IIEF questionnaire were evaluated. Erectile function was assessed using the RigiScan (Dacomed Corp., MN, USA) during three nights: night 1 = adaptation to the NPT-Rigiscan apparatus, night 2 = baseline recording of eight parameters, and night 3 = recordings after ingestion of sildenafil 100 mg. Data on the number of erections, erection duration, minimal and maximal base tumescence, minimal and maximal tip tumescence, and base and tip rigidity were analysed using anova with repeated measures. RESULTS: A statistically significant improvement in all eight parameters was observed as a result of sildenafil administration: number of erections from 3.1 +/- 0.7 to 4.0 +/- 0.7 (P < 0.05), erection time 22 +/- 3.5 to 34.2 +/- 5.9, minimal base tumescence 8.2 +/- 0.8 to 8.7 +/- 0.8, maximal base tumescence 12.1 +/- 0.7 to 14.2 +/- 0.7, base rigidity 75.6 +/- 3.1 to 81.6 +/- 3.6, tip rigidity 70.6 +/- 1.5 to 75.9 +/- 3.1, minimal tip tumescence 5.9 +/- 0.5 to 6.5 +/- 0.6, and maximal tip tumescence 8.6 +/- 0.6 to 11.7 +/- 0.7 (P < 0.0001 for each of the last seven parameters). The mean sleep duration, 7.3 hours (range 6.30-9.20 hours), was similar for both nights of recording. CONCLUSIONS: Sildenafil increases the quality and number of nocturnal erections as tested by the NPT-RigiScan in young healthy volunteers with normal EF.

Adolescent↗

PubMed2003

Efficacy of sildenafil as adjuvant therapy to selective serotonin reuptake inhibitor in alleviating premature ejaculation.

OBJECTIVES: To evaluate the efficacy of sildenafil and selective serotonin reuptake inhibitor in alleviating premature ejaculation (PE) in patients in whom other treatments had failed. METHODS: Healthy men evaluated for primary PE graded their ejaculation on a scale of 0 to 8 (0 = almost never, 8 = almost always). The intravaginal ejaculatory latency time (IVELT) was graded on a scale of 0 to 3 (0 = longer than 5 minutes, 3 = shorter than 1 minute). The 138 men who scored their PE as 4 or greater and IVELT as 2 or greater comprised the study group. Psychological and behavioral counseling was provided during the study. PE was graded using the same scales 3 months after the initiation of each treatment. Topical 5% lidocaine ointment comprised the initial treatment: dissatisfied patients (PE grade 4 or greater, IVELT 2 or greater), took one tablet of paroxetine 20 mg for 30 days and then one tablet 7 hours before intercourse. Sildenafil was added to the treatment of patients dissatisfied with paroxetine alone. RESULTS: The mean initial PE grade was 5.67 +/- 0.13 and that for IVELT was 2.9 +/- 0.19 for all participants (mean age 28.7 years). Thirty-eight reported improvement (PE grade 2.0 +/- 0.8, P <0.01; IVELT 0.13 +/- 0.34, P <0.001) after local lidocaine application. Of the 100 treated with paroxetine, 42 reported improvement (PE grade 2.5 +/- 0.1, P <0.01; IVELT 0.28 +/- 0.46, P <0.001), and 56 of the remaining 58 who were treated with a combination of paroxetine and sildenafil reported improvement (PE grade 1.78 +/- 0.23, P <0.001; IVELT 0.16 +/- 0.37, P <0.001). Two patients remained dissatisfied with all treatment modalities. CONCLUSIONS: Sildenafil combined with paroxetine and psychological and behavioral counseling alleviated PE in patients in whom other treatments failed.

Administration, Topical↗

PubMed2003

Does shock wave lithotripsy of renal stones cause cardiac muscle injury? A troponin I-based study.

OBJECTIVES: To investigate whether shock wave lithotripsy (SWL) causes cardiac muscle injury that alters the levels of troponin I plasma, a cardio-specific enzyme shown to be useful in diagnosing cardiac muscle injury because of its high specificity. METHODS: Patients treated by SWL for renal stones participated in the study. They had undergone a baseline 12-lead electrocardiogram (ECG) a few days earlier. One day after SWL, they were queried about any chest discomfort, blood was drawn for evaluation of troponin I and creatine kinase with isoenzymes (CK-MB), and an ECG was carried out. RESULTS: Thirty-two patients (21 men and 11 women, mean age +/- SD 51.0 +/- 10.6 years) comprised the study group. Fourteen SWL treatments were on the right side and 18 on the left. The mean number of shock waves was 2859 +/- 202. The mean time to evaluation after SWL was 22.3 +/- 1.3 hours. None of the patients reported chest discomfort. The mean value was 6.6 +/- 9.2 mU/mL for CK-MB and 0.02 l +/- 0.04 ng/mL for troponin I. No ECG changes suggestive of myocardial injury were evident. None of the 5 patients who experienced ventricular extrasystoles during SWL had any evidence of cardiac muscle injury. CONCLUSIONS: We evaluated the symptoms, perioperative ECG changes, and cardiac troponin I and CK-MB plasma levels in patients who underwent SWL for renal stones and did not identify any myocardial damage. Troponin I plasma levels were not elevated after this procedure and, therefore, remain suitable for evaluation of patients complaining of chest pain after SWL.

Adult↗

PubMed2003

Iodine-125 brachytherapy for localized prostate cancer and urinary morbidity: a prospective comparison of two seed implant methods-preplanning and intraoperative planning.

OBJECTIVES: To compare morbidity between two currently used iodine-125 seed implantation techniques for the treatment of localized prostate cancer. METHODS: Iodine-125 brachytherapy was used in 300 consecutive men with localized prostate cancer. Two seed implant techniques were used: preplanning, using preloaded needles, and intraoperative planning, using a Mick applicator. A comparison was made between the groups for urinary morbidity. The International Prostate Symptom Score was assessed prospectively among all patients. Computed tomography-based implant quality parameters were correlated with lower urinary system morbidity. RESULTS: The median follow-up was 30 months. In both treatment groups, the International Prostate Symptom Score increased significantly for about 9 to 12 months and returned to baseline thereafter. The International Prostate Symptom Scores reached a higher level and remained at a higher level for a longer period in the intraoperative group. Although the differences were statistically significant, they were of mild clinical importance. Overall, the incidence of acute retention and the need for surgery was very low in both groups (2% and 1%, respectively). No differences were noted between the two groups. Significantly better computed tomography-based implant dosimetry parameters were noted with the intraoperative method. A positive correlation (P < 0.001) was found between the dosimetry parameters and symptom severity. CONCLUSIONS: This prospective study reports the first large-scale comparison of urologic outcomes after two different seed implant techniques. Both were associated with very low urinary retention rates or other grade 3 or greater urologic morbidity. Almost all men had worse urinary symptoms for the first 6 to 9 months, regardless of the seed implant technique used. Patients treated with the intraoperative method demonstrated toxicity for a longer duration. Because of the much better gland isodose coverage and greater doses delivered in the intraoperative seed implantation, we favor this method.

Adenocarcinoma↗

PubMed2003

Comparison between two iodine-125 brachytherapy implant techniques: pre-planning and intra-operative by various dosimetry quality indicators.

PURPOSE: To prospectively compare two widely used seed implant techniques: pre-planning and intra-operative planning, based on 1 month post-implant CT-based evaluation. METHODS: We report results of a detailed 1 month post-operative dosimetric evaluation and comparison between 142 consecutive men with prostate adenocarcinoma treated by the pre-planning methodology and 214 men treated with the real-time, intra-operative seed implant method. RESULTS: Baseline parameters patient's age, Gleason score, clinical stage, and gland volume were similar in both groups (p>0.05). Length of physicist time and operating room team time were more than double in the pre-planned group compared to the intra-operative one (205 vs 100 min). Based on day 30 post-implant CT, for patients treated with the pre-planning method, mean V90, V100 and V150 (percent prostate volume receiving 90, 100 and 150% of the prescribed dose) were 67.5, 58.35 and 21.5%, respectively, while for the intra-operative group they were 97.9, 95.2 and 45%, respectively (p<0.01). Mean D90, expressed as percent of target matched peripheral dose (minimal dose covering 90% of the gland volume) was 53% for the pre-planned group and 114% for the intra-operative group of men (p<0.01). Short-term morbidity was minimal in both groups and did not correlate with the technique employed. CONCLUSIONS: This large-scale comparison of implant adequacy favours real-time intra-operative method. While all dosimetric parameters are significantly better with this method, no increased early morbidity was noted. Longer-term PSA-based clinical outcome should substantiate our contention of the superiority of the intra-operative method when compared to the pre-planning one.

Adenocarcinoma↗

PubMed2003

Is intravenous urography a prerequisite for renal shockwave lithotripsy?

PURPOSE: To determine whether intravenous urography (IVU) is a prerequisite for shockwave lithotripsy (SWL) of renal stones by addressing whether using non-contrast-enhanced CT (NCCT) instead of IVU for delineating urinary tract anatomy is associated with post-SWL complications. PATIENTS AND METHODS: Thirty-eight patients treated by SWL (Econolith 2000) for radiopaque renal stones underwent either IVU or NCCT. Twenty patients with normal urinary tracts or with mild hydronephrosis proximal to the stone on urography comprised the IVU group. Eighteen patients who underwent NCCT and plain abdominal (KUB) films and had urinary tract systems similar in appearance to the IVU group comprised the NCCT group. The two groups were of similar mean age (45.75 years, range 24-73 years; and 49.0 years, range 26-72 years, respectively) and had a similar mean stone size (10.1-10.2 mm). Patients with internal ureteral or nephrostomy catheters were excluded. Information on episodes of intractable renal colic, urinary tract infections, and hospitalization was recorded at follow-up 2 to 6 weeks post-SWL. RESULTS: The IVU and NCCT patients had similar mean stone fragmentation rates (80% and 74%, respectively) at 2 to 6 weeks post-SWL. Four IVU patients (20%) had intractable renal colic. One NCCT patient (5.5%) had a urinary infection. Complication and hospitalization rates in the two groups were not significantly different (P = 0.34; Fisher' exact test). CONCLUSIONS: Using only NCCT before SWL was not associated with higher complication rates. Thus, IVU is not a prerequisite for SWL of radiopaque renal stones in patients with a normal urinary tract anatomy as seen on NCCT.

Adult↗

PubMed2003

Immediate closure of nephrostomy tube wounds using a tissue adhesive: a novel approach following percutaneous endourological procedures.

PURPOSE: We assessed the feasibility of immediate sealing of nephrostomy tube wounds after percutaneous surgery using a tissue adhesive. MATERIALS AND METHODS: The study represents a prospective series of 27 consecutive percutaneous procedures. After nephrostographic exclusion of infrarenal urinary obstruction the nephrostomy tubes were removed and the wound edges were glued together using 2-octyl cyanoacrylate. The wound was covered by gauze to assess the efficiency of sealing and the patients were followed clinically. Another consecutive series of 20 patients who had been treated during 6 months before the current study were used for comparison. The nephrostomy wound in this group was dressed and left to close spontaneously. RESULTS: A total of 27 percutaneous procedures were performed in 25 patients with a median age of 51 years (range 9 to 77). There were 26 cases of percutaneous nephrolithotomy for an average stone burden of 32.6 mm. (range 16 to 70) and 1 pediatric case of percutaneous antegrade balloon dilation of ureteral stricture related to Cohen reimplantation. Median size of the nephrostomy tubes was 16Fr (range 12Fr to 24Fr) and they were maintained a median of 4 days (range 1 to 16) postoperatively. Urinary leakage ceased immediately after tissue adhesive application in all cases. One patient in whom renal colic developed secondary to edema of the ureteral orifice underwent temporary stenting in retrograde fashion. There were no additional complications at a median followup of 5 months (range 3 to 7). The study group had a significantly shorter hospital stay than the wound dressing group (p <0.001). CONCLUSIONS: Wound sealing following nephrostomy tube removal using 2-octyl cyanoacrylate appears to be a safe, simple and efficient method for immediate abolishment of urinary leakage. This novel approach avoids patient and medical personnel inconvenience, permitting early release from the hospital without physical and social limitations related to persistent wound urinary discharge.

Adolescent↗

PubMed2003

Biotechnology and drug discovery: from bench to bedside.

New biotechnology and drug discovery technologies are facilitating the rapid expansion of the clinical drug chest, empowering clinicians with a better understanding of disease as well as novel modalities for treating patients. Important research tools and themes include genomics, proteomics, ligand-receptor interaction, signal transduction, rational drug design, biochips, and microarrays. Emerging drug classes include monoclonal antibodies, cancer vaccines, gene therapy, antisense strands, enzymes, and proteins. In this article, we review these topics and illustrate their potential impact by presenting an overview of promising drugs in the pipeline. Clinicians who use these novel treatments must become familiar with these trends.

Biotechnology↗