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J E Batista Miranda

Publications and source records attributed to J E Batista Miranda.

17 recordsLinked to original sources
PubMed2001

[Vesico-scrotal hernia with hypocontractile detrusor].

OBJECTIVE: To present a case of massive inguinoscrotal hernia associated with low detrusor contractility. METHODS/RESULTS: A 70-year-old male patient with a history of diabetes and a previous diagnosis of low contractile bladder presented with urinary retention. Acute renal failure secondary to ureteral obstruction and inguinal bladder herniation was diagnosed. The direct bilateral hernia was repaired. Postoperative urodynamic evaluation showed an acontractile bladder. Intermittent catheterization was started, with satisfactory functional result and improvement of renal function. CONCLUSIONS: Massive bladder hernia can present as acute renal failure without lower urinary tract obstruction. The underlying impaired detrusor contractility can be diagnosed by urodynamic evaluation. Surgical treatment, with self-catheterization if required, achieves good results with preservation of renal function.

Aged↗
PubMed2000

[Artificial sphincter in severe urinary incontinence: 9 years of experience].

OBJECTIVE: To present the results achieved with the artificial urinary sphincter in the treatment of 44 patients with severe urinary incontinence. METHODS: From April 1990 to December 1998, an artificial urinary sphincter was implanted in 44 patients with severe urinary incontinence, aged 21 to 82 years (mean 56). These patients were categorized into the following groups: Group A comprised 24 males, aged 37 to 82 years (mean 66), who had undergone previous prostatic procedures. Four of them had undergone radical retropubic prostatectomy. The remaining 20 had undergone a total of 34 de-obstructive procedures (mean 1.7 procedures/patient; range 1-3); 28 were endoscopic procedures and 6 open prostatectomy. One of them had a previous ileocystoplasty due to severely low compliance. Ten were completely incontinent and were using a condom catheter (7), penile clamp (2) or permanent indwelling Foley catheter (1). The rest used a mean of 3.7 pads per day. Group B comprised 11 males with a complex urologic history: 9 had neurogenic dysfunction, 1 had bladder exstrophy and 1 had a previous cystectomy and Studer neobladder. Eight were using a condom catheter. The cuff was placed in the bulbar urethra in 8 (4-4.5 cm) and in the bladder neck in 4 (9-10 cm). Group C comprised 9 women with type III stress incontinence after failed previous interventions (range 1-4, mean 2.7). All of these patients required at least 3 pads per day (mean 4.5). The cuff was placed in the bladder neck with diameters ranging from 5 to 10 cm. RESULTS: The mean follow-up was 28.5 months (range 8-96). One patient died two years after implantation of the artificial sphincter which was never activated. In group A, 83% are socially continent and 17 do not require pads. Three of the 20 patients with the artificial sphincter have undergone a total of 4 surgical revisions. In group B, the social continence rate was 63% with a 36% revision rate. Four patients required a complete change of the system. In group C, The continence rate with revision was 66%. One patient underwent two successive successful revisions and 3 required removal of the device, accounting for a failure rate of 33%. Definitive removal of the artificial sphincter was required in 3 females and 5 males. Aside from one male who refused a new implant, the rest were considered unsuitable for a new device. Six patients underwent at least one reoperation to change one or more parts of the system. Continence was recovered in 66% after the revision. CONCLUSIONS: The artificial urinary sphincter achieves a good continence rate in patients with severe incontinence, although careful patient follow-up is required.

Adult↗
PubMed1998

[Complete urodynamic office evaluation; a method for the delivery of health care].

INTRODUCTION: The goal of the study was to evaluate the usefulness of the complete urodynamic office evaluation. This assistance modality consists on the realisation in the same moment of the clinical chart, physical examination, urodynamic study, report, therapeutic indications, program of other complementary studies, hospitalisation or discharge from the outpatient office. PATIENTS AND METHODS: During 1 year complete urodynamic office evaluation was performed to 100 patients (87 female, 13 male) All patients were directed to our department to perform a urodynamic test, most of them due to incontinence. Different kinds of urodynamic tests were performed in 91 patients, with a medium of 2 studies per test. Abnormalities were detected in 59 cases. RESULTS: After the complete urodynamic office evaluation, 16 patients were programmed for surgery, 26 were discharged from outpatient office, 37 were directed to follow up in the outpatient setting, 2 were hospitalised, and 19 were lost of follow up. CONCLUSIONS: The complete urodynamic office evaluation allowed us to get the diagnostic and therapeutic approach in 98% of patients, employing a standard of 90 minutes. Twenty six percent of patients could be discharged from our center. Sixteen patients were operated on following this unique visit, that means an important reduction in the usual assistance delay.

Adult↗
PubMed1998

[Percutaneous urethral suspension with bone anchorage (Vesica) in the treatment of stress urinary incontinence. Results after a year of follow-up].

OBJECTIVES: Evaluation of efficacy of percutaneous bladder neck suspension with bone anchors in women with stress incontinence with no previous treatment. PATIENTS AND METHODS: Fourteen women (mean age 48, range 37-74) were operated. All had a stable bladder and objective leakage, either by pad test of by physical examination. Ten were evaluated by a incontinence questionnaire. Mean incontinence time before the procedure was 3.9 years. All needed pads (mean 3.3 pads/day). The surgical technique is described. RESULTS: Mean surgical time was 80 minutes. In three patients there was bladder perforation during the procedure, that was solved by delaying the catheter withdraw. Mean postoperative stay was 4.2 days, with good tolerance, and one patient was discharged with a cystostomy. After a minimum follow-up of one year (mean 17.5 months), eleven patients have improved their continence (6 dry, 5 socially acceptable incontinence < pads/day) and 3 have recurrence. Postoperative pad test was < or = 10 g in patients without improvement and over 20 g in patients who failed. Mean postoperative total score in the questionnaire decreased from 10.1 to 2.5 in patients who improved and didn't change in patients who failed. CONCLUSION: Percutaneous bladder neck suspension is a useful alternative to open interventions, due to its low morbidity and lower postoperative stay.

Adult↗
PubMed1997

[Quantification of urine leaks: standardized one-hour pad test].

OBJECTIVE: To assess the feasibility and diagnostic performance of the one hour pad test proposed by ICS. PATIENTS AND METHODS: The pad test was performed in 20 women referred for incontinence. Five were included in a surgical protocol and 15 had inconsistent medical history. Their mean age was 52.5 years, the mean time of incontinence was 3.4 years and they used a mean of 3.5 pads/day. Six showed leakage on physical examination (PE) and 2 during previous cystometry. RESULTS: The test is well tolerated and lasts one hour and 15 minutes. The test was positive in 17 (mean leakage = 168 g). Leakage was not related to duration of incontinence, number of pads or cystometric capacity. A weak negative correlation (r = -0.52) was found between leakage and voided volume on uroflowmetry performed after the test. All patients who leaked on PE had a positive test and a significantly higher leakage compared to patients who didn't leak on PE. CONCLUSION: The pad test is a feasible outpatient procedure in the context of a Urodynamics Unit, providing objective information on leakage in most patients.

Adult↗
PubMed1997

[Urinary stress incontinence in women under 40 years of age].

OBJECTIVE: To analyze the therapeutic approach in young females with stress urinary incontinence. METHODS: A retrospective study was conducted on 35 females less than 40 years of age who had undergone surgery for stress urinary incontinence. These patients had a mean follow-up of 3.5 years (range one month to 18 years) and a previous history of 3.9 years mean duration. Retropubic urethral suspension according to the MMK or Burch procedure was performed in all patients. RESULTS: 65.7% became completely continent, 20% were continent for at least two months, and 1.43% continued to be incontinent after surgery. The postoperative complication rate was 31%; of these complications, 4 referred inguinal pain and there were 3 cases of wound infection. Those who had a failed procedure showed no changes with respect to their preoperative urodynamic status, although two patients presented clinical features of urgency. The best surgical results were achieved in the older patients, although the differences were not statistically significant. However, statistically significant differences were found for the time to surgery; i.e., the patients with a shorter history of urinary incontinence remained incontinent after surgery. CONCLUSION: Surgical treatment of stress urinary incontinence in females less than 40 years of age achieves satisfactory results, with a success rate similar to that of the general population regardless of the age, and appears to be closely related with the period of time the patient has been incontinent before undergoing surgery.

Adult↗
PubMed1997

[Retropubic urethral suspension. A surgery "without complications"?].

OBJECTIVE: To describe a case of bladder neck suspensión with special reference to the complications associated with this procedure. METHODS/RESULTS: Herein we describe a patient who developed most of the reported associated complications following two bladder neck suspension procedures: bilateral ureteral ligation, osteitis pubis, retropubic hematoma, eventration and recurrence of urinary stress incontinence. Finally, after two reoperations, the complications were resolved and the patient is continent. CONCLUSIONS: Bladder neck suspension is usually associated with a low complication rate. However, associated complications may appear in the same patient, accounting for a significant morbidity.

Aged↗
PubMed1997

[Vesico-ureteral reflux associated with detrusor instability].

OBJECTIVE: The aim of this study was to determine the urodynamic characteristics of patients with vesico-ureteral reflux (VUR) and detrusor instability (DI) followed by medical treatment. PATIENTS AND METHODS: The urodynamic and cystographic findings in a group of 24 patients between 4 and 18 years of age (mean 7.6 years) with a simultaneous diagnosis of VUR and DI were reviewed. All of them presented with recurrent urinary tract infections. Twenty were female of whom eight also had enuresis and daytime symptoms. Mean follow-up was 40 months (range 18-97 months). VUR was diagnosed by voiding cystourethrogram and classified according to the grades proposed by the "International reflux study on children". RESULTS: All but 6 patients had at least a 15% reduction in age-adjusted capacity. No relationship was observed between the severity of VUR (measured as the addition of reflux grades in both units of each patient) and reduction in bladder capacity or compliance. Seven patients had upper tract damage (either scars or a decrease in size or function on the renogram). Upper tract damage was significantly more frequent in patients with bilateral reflux (regardless of the type of DI). Patients with unilateral reflux and sustained instability had significantly less upper tract damage. Results of treatment are reported separately. CONCLUSIONS: In these patients, the severity of VUR did not seem to have an impact on bladder capacity or compliance. The risk factors for upper tract damage in this series differ from those found by other authors.

Adolescent↗
PubMed1997

[Efficacy of oxybutynin chloride in children with vesico-ureteral reflux and detrusor instability].

OBJECTIVE: The purpose of this study was to assess the urodynamic (UD), radiological (VCUG) and clinical outcome in patients with detrusor instability (DI) and vesico-ureteral reflux (VUR). PATIENTS AND METHODS: UD and VCUG findings in 24 patients between 4 and 18 years of age (mean 7.6 years) with a simultaneous diagnosis of VUR and DI were reviewed. All presented with recurrent urinary tract infections (UTI). Twenty were female of whom 8 also had enuresis and daytime symptoms. Ten had bilateral VUR, making a total of 34 units. Mean follow-up was 40 months (range 18-97 months) and at least 2 UD studies were done. Treatment consisted of oxybutinin chloride (OC) and chemoprophylaxis. RESULTS: Treatment lasted an average of 31 months with an average dose of 11 mg/day. There was a statistically significant improvement in UTI rate, enuresis score and UD parameters [CysCap, volume at 1st contraction, maximum contraction and compliance (comp)]. Thirteen patients achieved stable bladders and 9 had some UD improvement (3 with low compliance and 2 with less severe DI), leaving 2 with unchanged DI. Reflux disappeared in 20 units and was downgraded in 6. VUR improvement coincided with the cases of UD improvement. Persistence of DI was always associated with persistent VUR. CONCLUSIONS: Oxybutinin treatment can be long, but UD and VUR improvement run parallel in most cases. The rare discrepant cases point towards a multifactorial ethology in this condition.

Adolescent↗
PubMed1997

[Diagnosis of bladder neck obstruction in women].

Bladder outlet obstruction in women is a rare entity, and difficult to diagnose. In our series most of the patients had previous history of gyneco-obstetric or urological procedures. Cystometry enabled us to diagnose the coexistence of bladder instability and obstruction in 48% of the patients. We did not find statistically significant differences between the patients with and without BI in terms of degree of obstruction measured by uroflowmetry and pressure/flow studies. Pressure/flow studies and Uroflowmetry had been the essential key in the diagnosis of obstruction in our series. Cysto-urethrography and urethroscopy were normal in over 50% of patients. The urethral calibration was abnormal in 16% of the cases.

Adolescent↗
PubMed1994

[Post-nephrectomy duodeno-cutaneous fistula resolved with parenteral nutrition and octreotide (somatostatin analogue)].

After a right nephrectomy of ischemic kidney, a high-output duodenal fistula developed on the third postoperative day. Sixteen days of total parenteral nutrition were unsuccessful, so octreotide (a synthetic analogue of somatostatin) was added (0.1 mg subcutaneously every 8 hours). The output decreased progressively and the fistula closed completely 9 days thereafter.

Cutaneous Fistula↗
PubMed1994

Urologic interconsultation in a general hospital: analysis of 100 consecutive consultations.

One hundred consecutive interconsultations were made on 89 patients during a two and a half month period to the Urology Service by physicians from a 970-bed General Hospital (excluding Uropediatrics, Nephrology and Renal Transplantation). Sixty percent were on males. The mean age was 61 (range 16-96 years) and 62% were 61 or older, a higher rate than that reported for an ambulatory population. Three consultations were considered inappropriate, and 37 urgent or very urgent. The most common cause was acute urinary retention (21%), followed by genitourinary bleeding (18%). Overall, catheters were involved in 35% of the consultations. The medical departments made 61 interconsultations, 33 came from surgical departments and 6 from the emergency department. The causes and implications of consultation are analyzed.

Adolescent↗
PubMed1992

[Drug-induced fever caused by prophylactic isoniazid in bladder instillations with BCG].

We present of one patient with isolated pharmacological fever probably caused by Isoniazid given prophylactically 24 hours prior to each vesical instillation with BCG as maintenance therapy for in situ vesical carcinoma. The fever appeared in two occasions before the instillation and did not returned once the drug was discontinued. We Review this adverse effect which may lead to diagnostic error.

Administration, Intravesical↗
PubMed1991

[English and Spanish nomenclature of catheters and other urological instruments].

We analyze names given to urologic devices that are apparently similar in English and Spanish but with different meanings. The translation of the commonest terms for instruments and some problematic words are reviewed. Although some of the equivalents are a convention, it is interesting to know the more widely used nowadays.

Terminology as Topic↗