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Biomedical subjects

J Ramon

Publications and source records attributed to J Ramon.

At least 73 records · Page 4Linked to original sources
PubMed1992

[Artificial sphincter for urinary incontinence].

During the past 4 years 21 patients underwent implantation of the model AS-800 artificial urinary sphincter, 4 of whom underwent simultaneous implantation of an inflatable penile prosthesis. The mean age was 48 years (range 33-73). Incontinence was neurogenic in 12 (57%) and a complication of urologic surgery (mainly prostatectomy) in 9 (43%). In 8, in whom intermittent self-catheterization was planned, the sphincter cuff was implanted around the bladder neck, and in the other 13, around the bulbar urethra. The immediate postoperative course was uneventful in 18 (85%), but 2 (10%) had urinary tract infection and 1 had urinary retention. During a mean follow-up of 20 months (range 1-36), 19 (90%) were found to be continent (in 2 of them the cuff had had to be changed to a smaller size due to tissue atrophy), and 1 had suffered from urgency incontinence which disappeared with anticholinergic medication. In 2 with incontinence due to neurogenic bladder, the sphincter had became infected and had had to be removed; 1 of these 2 had undergone simultaneous augmentation cystoplasty. This experience resulted in a change in our policy: we now implant the sphincter and perform augmentation cystoplasty in 2 separate stages. We find implantation of the artificial urinary sphincter very effective treatment for urinary incontinence.

Adult↗
PubMed1992

Radical retropubic prostatectomy: morbidity and quality of life. Experience with 620 consecutive cases.

We describe our experience and complications of radical retropubic prostatectomy. From March 1983 through December 1990, 620 consecutive patients have undergone an anatomical radical retropubic prostatectomy for the treatment of prostatic carcinoma. The surgical technique we used is described. In 167 patients the procedure included preservation of the neurovascular bundles. There were no modifications in the surgical technique during this period. There were no operative deaths. Mean operating time was reduced from 3 hours in the first 100 patients to 1.5 hours in the last 220 patients. The average blood loss was reduced remarkably as well. There were only 3 cases of rectal injury, which were closed primarily and healed completely. One patient died of acute myocardial infarction 12 days after an uneventful operation. This patient accounted for the only perioperative death in our experience. Early complications occurred in 43 patients (6.9%), including only 2 cases (0.3%) of anastomotic urinary leakage. The late complication rate, excluding incontinence and impotence, was 1.3%. No patient was totally incontinent. Among the patients who were followed for 1 year or longer 95% achieved complete urinary control and 5% experienced stress urinary incontinence. Preservation of sexual function in patients who underwent a nerve-sparing operation was achieved in 71%. Our results indicate that radical retropubic prostatectomy can be performed with low morbidity and without affecting the quality of life in the majority of patients.

Aged↗
PubMed1992

The development of a technique to estimate the number of motor units in the urethral sphincter.

An electromyographic technique is presented that has been developed in an effort to quantitate the number of motor units in the urinary sphincter. Sphincter contraction was provoked by electrical stimulation and recorded with a catheter mounted electrode. Incremental stimulation produced corresponding increments of sphincter contraction that were recorded as the magnitude of the sphincter electromyogram. Estimates of the number of motor units in the sphincter were made by analysis of variance of a Poisson distribution. Using this method, the mean number of motor units in the sphincter of five dogs was estimated to be 129 with values ranging from 80 to 182. Anatomical correlation was sought by infiltrating this sphincter with horseradish peroxidase, which is taken up by axonal transport to stain the motor neurons in the spinal cord. The mean number of motor neurons was 229 with values ranging from 116 to 358. There are technical and physiologic explanations for the observed differences between the predicted and the actual number of motor neurons stained and this is addressed in the discussion.

Animals↗
PubMed1992

A 20-year experience with treatment of ectopic ureteroceles.

Between 1970 and 1990 a total of 37 patients (female-to-male ratio 3.6:1) was diagnosed and treated at our institution for ectopic ureterocele. Urinary tract infection was the most frequent mode of presentation (59%). Of the patients 54% were less than 3 years old at operation. Transurethral incision of ectopic ureterocele served only as a decompressive procedure for acutely ill infants and was followed with a high incidence (80%) of resultant vesicoureteral reflux. The elective surgical policy was individualized based on renal function and presence of vesicoureteral reflux. Overall results within the various groups were generally satisfactory regarding eradication of urinary tract infections, preservation of renal function and continence or treatment of vesicoureteral reflux. Upper pole heminephrectomy and partial ureterectomy were performed in 14 patients with 3 (21%) requiring reoperation, including only 2 (14%) subsequent reimplantations. Thus, we believe that an expectant approach to the lower urinary tract is well recommended in the majority of the patients with a poorly functioning ipsilateral renal segment. A modified technique of total reconstruction, performing only partial ureterectomy with double barrel reimplantation, was successful in 7 patients.

Child↗
PubMed1992

Low loop cutaneous ureterostomy and subsequent reconstruction: 20 years of experience.

Between 1970 and 1990 we constructed low loop cutaneous ureterostomies in 50 patients with grossly dilated collecting systems. Patient age ranged from 6 days to 3 years. The indication for all urinary diversions was an anomaly of the lower urinary tract associated with marked ureteral dilatation considered to require decompression because of either urinary tract infections or renal functional impairment. Clinical and radiological followup was maintained between establishment of the cutaneous ureterostomy and complete reconstruction, and revealed marked improvement indistinguishable from that obtained by high diversions. Undiversion was performed after 3 to 69 months, usually simultaneously with definitive correction of the underlying anomaly. The main advantage of our presented technique is the opportunity to resect the distal ureteral limb and to perform simple ureteroneocystostomy using the proximal limb. Besides its technical simplicity, this technique obviates possible complications that may be attributed to ureteral anastomosis and compromised blood supply, thus, it is well recommended.

Child, Preschool↗
PubMed1992

Etiology of acute scrotum at surgical exploration in children, adolescents and adults.

Between January 1970 and December 1989, 171 patients underwent scrotal exploration for acute scrotum (an acute painful swelling of the scrotum or its content), at our hospital. Of 70 children scrotal explorations, torsion of appendages was found in 33 cases (47%). Torsion of testis was found in 24 patients (34%). Of the 84 adolescent scrotal explorations performed, 72 (86%) had torsion of testis, and 8 (9%) had torsion of appendages. Of 17 adults, torsion of testis was found in 15 cases (88%). These results clarify that unnecessary explorations are much more common in children (66%) than in adolescents and adults (14%). We therefore suggest using radionuclear scans and/or Doppler ultrasound to facilitate clinical diagnosis in the children group.

Acute Disease↗
PubMed1992

Radical prostatectomy in the management of stage A carcinoma of the prostate.

A total of 115 patients (29 with stage A1 and 86 with stage A2 prostate cancer) underwent radical retropubic prostatectomy. Residual cancer was found in the radical prostatectomy specimens in 11 of the 29 stage A1 patients (38%) and in 66 of the 86 stage A2 patients (77%). Fourteen percent of the stage A1 patients and 29.5% of the stage A2 patients had pathological evidence of disease extension beyond the confined prostate. No perioperative death occurred and no patient suffered rectal injury or was totally incontinent. Early postoperative complications occurred in 6 patients (5%). There were no late complications. Complete urinary control was achieved in 111 patients (96.5%) and stress urinary incontinence was present in 4 patients (3.5%). Sexual function was preserved in 21 of the 26 patients (81%) who underwent a nerve-sparing radical prostatectomy. Follow-up ranged from 12 to 84 months with a mean of 30 months. All patients were alive at the time of this study and only 3 patients suffered disease progression. These 3 patients were among the stage A2 group and had pathological evidence of tumor extension beyond the prostatic capsule. Twenty-six patients who also had evidence of disease extension were alive without evidence of disease. These data demonstrate that patients with stage A disease are at risk for disease progression if left untreated and with a morbidity as low as that achieved in our series, radical prostatectomy should remain an optimal option for tumor control in these patients.

Adenocarcinoma↗
PubMed1992

Preservation of urinary continence and potency after cystoprostatectomy.

Between 1980-1989 a total of 349 patients underwent one-stage radical cystoprostatectomy and an orthotopic bladder substitution. 278 patients underwent the Camey I bladder replacement and in 71 patients a detubularized ileal loop was utilized (Camey II). 75 patients underwent a potency-sparing cystectomy (32 patients of the Camey I and 43 patients of the Camey II groups). All patients were followed at least one year and had continence and potency assessment. Among the patients who underwent the Camey I procedure, 66% achieved daytime continence and 21% night-time continence 6 months after surgery. One year after surgery 86% of patients had normal continence during the day and 47% was continent during the night. 14% of patients had episodes of day-time incontinence one year after surgery. Among the patients who underwent the Camey II bladder replacement 86% achieved day-time continence and 59% night-time continence 6 months after surgery. At one year after surgery 91% was continent during the day, 72% was dry during the night and only 9% had episodes of diurnal incontinence. Potency was achieved in 24 of 32 patients (75%) with the Camey I bladder substitution, and in 34 of the 43 patients (79%) with the Camey II bladder substitution. Our data demonstrate that excellent rates of continence and potency are achievable in the post-cystectomy population. Patients with the Camey II bladder replacement achieve continence earlier than patients with the Camey I bladder substitution. Diurnal continence is slightly better after the Camey II procedure, one year after surgery, but the difference is not statistically significant. Nocturnal continence is significantly better with the Camey II bladder substitution.

Adult↗
PubMed1991

Long-term results of simple and radical nephrectomy for renal cell carcinoma.

From 1974 to 1983, simple and radical nephrectomies were performed at the Chaim Sheba Medical Center (Tel Hashomer, Israel) for renal cell carcinoma. The authors reviewed 109 cases that were followed for a period ranging from 5 to 14 years. Simple nephrectomy was performed in 55 patients, and 54 patients underwent radical nephrectomy. The selection of the surgical procedure was based on the surgeon's preference and not on the basis of clinical stage, age, or sex. The surgical results and survival rates were assessed according to the pathologic stage of the tumors. Among patients with Stage I tumor, radical nephrectomy produced better survival rates at 5 and 10 years (P = 0.03); however, when the non-cancer deaths were excluded, the difference in survival was not statistically significant. For Stage I tumors the survival free of disease at 5 years was better for the radical nephrectomy group, but this difference was not statistically significant. No difference was noticed in the local recurrence rate between the two groups. Nephrectomy in patients with Stage IV disease did not alter survival regardless of the type of operation.

Aged↗
PubMed1991

Increased serum alkaline phosphatase activity: a possible indicator of renal damage.

Increased levels of serum alkaline phosphatase (ALP) (E.C.3.1.3.1.) were observed in 25 patients with various urological conditions involving the kidneys: malignancy, complicated nephrolithiasis, and surgical and percutaneous manipulations. Other possible sources for increased ALP level, mainly hepatic and osseous, were excluded by history, laboratory tests, and liver and bone imaging. Studies of isoenzymes of ALP did not show a distinctive pattern. ALP levels returned to the normal range by treating the underlying lesions involving the kidney: nephrectomy, complete removal of stones, or removal of nephrostomy. The increase in serum ALP activity may be derived from the injury to the brush border membrane of the renal tubular cells. Renal function impairment and contrast media induced nephrotoxicity may also be responsible for the increased serum ALP. Serum ALP may be a marker for involvement of the kidneys in pathological processes and an indicator of complete treatment. This clinical observation is worthy of further study.

Adult↗
PubMed1991

Transvaginal needle suspension procedures for recurrent stress incontinence.

The results of transvaginal needle suspension in 36 patients with stress urinary incontinence who failed previous operation were reviewed. Eighteen patients underwent a Stamey endoscopic needle suspension, and a Peyrera-Raz cystourethropexy was performed on the remainder. Recurrent stress incontinence was confirmed by history, physical examination, and urodynamic studies. Cure rates of 78 percent for the Stamey procedure and 83 percent for the Raz operation were achieved. Excluding patients with voiding dysfunction or urge incontinence postoperatively due to bladder instability, the failure rates were 6 percent and 11 percent, respectively. Analysis of the results according to the preoperative maximal urethral pressures demonstrated that low-pressure urethras if accompanied with urethrovesical hypermobility have no impact on the results if the anatomic abnormality was corrected adequately by the needle suspension. Thus, the transvaginal needle suspension was found to be highly effective in patients with low-pressure urethras, who failed previous operation, but had persistent bladder neck hypermobility, and suggests that this method of surgical repair should be the first choice in this selected group.

Female↗
PubMed1991

Chronic hematocele complicating renal failure and hemodialysis.

A patient with a recent history of genitourinary tuberculosis, chronic renal failure and hemodialysis presented with a slow growing scrotal swelling that had enlarged during the last 3 years. Physical examination and sonography were suspicious for testicular tumor, and surgical exploration and inguinal orchiectomy were performed. Ultimately the mass proved to be a chronic hematocele, a rare complication of uremic coagulopathy and hemodialysis. Because hematocele may clinically and sonographically resemble a testicular tumor, the proper management of a complex multiseptated scrotal mass without obvious history suggestive of hematocele is surgical exploration and orchiectomy. Awareness of this common presentation may obviate orchiectomy.

Adult↗
PubMed1991

Cystourethrometric findings in patients with detubularized right colonic segment for bladder replacement.

Urodynamic evaluation was performed in 13 men 4 to 18 months after cystoprostatectomy and bladder replacement using a detubularized right colonic segment. All patients are continent by day and only 3 are incontinent during the night to a degree that necessitates use of a condom catheter. Two patients awaken every 2 to 3 hours to void and the remainder have nocturia comparable to normal men of their age. The residual volume was 0 to 70 ml. The urethral closure pressure was normal, and in 3 patients studied preoperatively and postoperatively no significant change was observed other than shortening of the profile length. Maximal flow rates were normal although the pattern was intermittent. In 2 patients no cystoplasty contractions were recorded and in all but 2 patients the amplitude of the contractions was less than 40 cm. water. Simultaneous bladder and urethral pressure recordings during bladder filling demonstrated no change in urethral pressure in 10 patients. Although creation of a reservoir with a low pressure and careful preservation of the infraprostatic urethra are important for continence in these patients, we believe that the absence of normal sacral route reflexes after cystoprostatectomy is an important contributing cause to nocturnal incontinence.

Colon↗
PubMed1991

Increased urinary mucus production: a sequela of cystography following enterocystoplasty.

Early postoperative urinary mucus secretion was evaluated in 13 consecutive patients who underwent lower urinary tract reconstruction with incorporation of bowel segments, and the effect of intravesical infusion of sodium diatrizoate and meglumine diatrizoate in aqueous solution (Urografin 30%) was assessed. The mean volume of urinary mucus extracted before and immediately after cystography increased from 1.4 to 9.6 ml., respectively (p less than 0.0001). We conclude that mucus excretion increases significantly immediately following cystography during the early postoperative period. During that critical time cystography may cause potential hazards of mucus retention and catheter obstruction, which should be anticipated and treated promptly.

Adult↗
PubMed1991

Repair of pelvic fracture posterior urethral defects using an elaborated perineal approach: experience with 74 cases.

A total of 74 patients with posterior urethral distraction defects (1.5 to 7 cm. long) that followed pelvic fracture was managed by a 1-stage perineal repair. End-to-end anastomosis was performed in all cases but in 66 a variety of surgical maneuvers were necessary to accomplish a tension-free anastomosis. These techniques, which included distal urethral mobilization, corporeal body separation, inferior pubectomy and supracrural urethral rerouting, were resorted to in a sequential manner as needed. Excellent results were achieved in 96% of the cases. These surgical techniques are described and discussed.

Adolescent↗
PubMed1991

Radical prostatectomy in the management of stage-A carcinoma of the prostate.

A total of 115 patients (29 with stage A1 and 86 with stage A2 prostate cancer) underwent radical retropubic prostatectomy. Residual cancer was found in the radical prostatectomy specimen in 11 of the 29 stage-A1 patients (38%) and in 66 of the 86 stage-A2 patients (77%). 14% of the stage-A1 patients and 29.5% of the stage-A2 patients had pathological evidence of disease extension beyond the confined prostate. No perioperative death occurred and no patient suffered rectal injury or was totally incontinent. Early postoperative complications occurred in 6 patients (5%). There were no late complications. Complete urinary control was achieved in 111 patients (96.5%) and stress urinary incontinence was present in 4 patients (3.5%). Sexual function was preserved in 21 of the 26 patients (81%) who underwent a nerve-sparing radical prostatectomy. Follow-up ranged from 12 to 84 months with a mean of 30 months. All patients are alive, and only 3 patients suffered disease progression. These 3 patients were among the stage-A2 group and had pathological evidence of tumor extension beyond the prostatic capsule. 26 patients who also had evidence of disease extension are alive without evidence of disease. These data demonstrate that patients with stage-A disease are at risk for disease progression if left untreated and, with morbidity as low as achieved in our series, radical prostatectomy should remain an optimal option for tumor control in these patients.

Adenocarcinoma↗
PubMed1990

Hydration feature of urinary compounds. Evidence for molecular abnormality in calcium oxalate urolithiasis.

Proton-relaxation-time measurements were performed on lyophilized urine samples collected from 11 recurrent calcium oxalate stone-formers, 9 uric acid stone-formers, 9 patients with various urological disorders, and 20 normal individuals. The T1 and T2 relaxation times were determined using a Bruker PC Multispec at 20 MHz at 37 degrees C for measurements of lyophilized sample and thereafter during gradual controlled rehydration. The prolongation of the relaxation times as a function of rehydration was found to differ significantly (P less than 0.005) between, on the one hand, the calcium oxalate stone-formers and, on the other hand the normal, uric-acid stone-formers, and patients with other urological disorders. Water compartmentalization was then calculated according to the fast proton diffusion model. At most of the experimental points during rehydration process, significantly (P less than 0.001) less water was bound to the compounds of urine from calcium oxalate stone-formers than that obtained from normal individuals. The variations in the bound hydration water may have been associated with possible changes in the structure or configuration of the compounds present in the urine of the different groups. The results reflect differences in the urinary content and/or properties of normal subjects and calcium oxalate stone-formers, and indicate that the mechanism of bound water relaxation is in some way specific to the pathophysiological state of urine.

Adult↗