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Biomedical subjects

J Susset

Publications and source records attributed to J Susset.

At least 19 recordsLinked to original sources
PubMed2006

Efficacy, tolerability and safety of darifenacin, an M(3) selective receptor antagonist: an investigation of warning time in patients with OAB.

This double-blind, randomised placebo-controlled, multicentre study evaluated the efficacy, tolerability and safety of 12 weeks' treatment with controlled release darifenacin 15 mg once daily (qd), in 445 patients with overactive bladder (OAB). The primary endpoint was warning time (time from first sensation of urgency to voiding), and secondary endpoints included urge incontinence episodes and volume voided. Darifenacin treatment resulted in numerical increases in warning time, but these were not significant compared with placebo -- highlighting difficulties in assessing this parameter. Significant improvements were seen with darifenacin vs. placebo in urge incontinence episodes/week, volume voided and quality of life (QoL). Darifenacin was associated with increases in urgency-free time (UFT; time between any void to the next urgency event) vs. placebo. Treatment was well tolerated; the most commonly reported adverse events were the typical antimuscarinic effects of dry mouth and constipation, both infrequently leading to discontinuation. This study demonstrated the difficulty in measuring warning time, due in part to its subjective nature; the authors believe further investigation is warranted to allow urgency to be better defined. Further investigation of UFT is required to determine its role in evaluating urgency. The study confirmed that darifenacin 15 mg qd is an effective and well-tolerated treatment for OAB, which improves QoL.

Adult↗
PubMed1999

Evaluation of a new once-daily formulation of oxbutynin for the treatment of urinary urge incontinence. Ditropan XL Study Group.

OBJECTIVES: To evaluate in a 1 6-center, single-treatment study once-daily controlled-release oxybutynin (Ditropan XL) for urinary urge incontinence. METHODS: Two hundred fifty-six participants with urge incontinence or mixed incontinence with a significant urge component were treated. After baseline measurements, participants converting from conventional oxybutynin started Ditropan XL at their previous oxybutynin dose; others started at 5 mg/day. Doses were adjusted until participants reached a maintenance dose that produced continence or the best balance between continence and side effects. This dose was continued for 12 weeks. Effectiveness was assessed by urinary diaries. RESULTS: Effectiveness was achieved across all doses studied (5 to 30 mg/day), with 70.8% of participants using maintenance doses of 5 to 15 mg/day. Mean urge incontinence episodes per week decreased from 18.8 at baseline to 3.9 in maintenance week 1, 2.7 in week 4, and 2.8 at the end of the study. For those participants who reported urge incontinence episodes at baseline but were free of urge incontinence at maintenance week 1, 31% remained free of urge incontinence at every subsequent assessment. Participants who converted from other medications showed symptomatic improvement after conversion. At some time during the study, 58.6% of participants reported dry mouth, with 23.0% of participants rating it moderate or severe. Only 1.6% of participants discontinued the medication because of dry mouth. CONCLUSIONS: Ditropan XL treatment reduced the number of incontinence episodes. Maximum benefit was demonstrated by maintenance week 4 and was sustained through 12 weeks of maintenance therapy.

Aged↗
PubMed1999

Clinical efficacy and safety of tolterodine compared to placebo in detrusor overactivity.

PURPOSE: We evaluated the efficacy, patient acceptability and side effect profile of tolterodine, a new antimuscarinic agent for treating bladder overactivity. MATERIALS AND METHODS: In our randomized, placebo controlled, parallel group study 123, 129 and 64 patients 18 years old or older with proved detrusor overactivity (idiopathic detrusor instability or detrusor hyperreflexia) were randomized to receive 1 or 2 mg. tolterodine, or placebo, respectively, twice daily for 12 weeks. Main outcome measures were number of voids per 24 hours, urine volume per void and episodes of urge incontinence per 24 hours on a frequency-volume chart with detailed recording of side effects. RESULTS: After 12 weeks of treatment mean number of voids per 24 hours plus or minus standard deviation decreased from 11.2 +/- 3.1 to 9.0 +/- 2.6 with the 2 mg. dosage (p = 0.0045 versus placebo). At this dose mean urine volume per void increased from 155 +/- 52 to 190 +/- 70 ml. (p <0.0001 versus placebo), while mean number of incontinence episodes per 24 hours decreased from 3.6 +/- 4.0 to 1.8 +/- 3.1 (p = 0.19 versus placebo). Similar efficacy was observed in patients receiving the 1 mg. dose. Severe dry mouth was reported by only 2, 1 and 2% of patients given the 1 and 2 mg. dose, and placebo, respectively. There was no clinical or electrocardiographic evidence of significant cardiac adverse events. CONCLUSIONS: Tolterodine administration resulted in a significant decrease in the frequency of voiding and improved voided volume but it was seldom associated with troublesome or severe side effects.

Adult↗
PubMed1999

Once daily controlled versus immediate release oxybutynin chloride for urge urinary incontinence. OROS Oxybutynin Study Group.

PURPOSE: We compared the efficacy and safety of once daily controlled and immediate release oxybutynin for incontinence. MATERIALS AND METHODS: This multicenter, randomized, double-blind, active control, parallel study was designed to evaluate urge urinary incontinence episodes using a 7-day diary. RESULTS: A total of 97 women and 8 men 34 to 76 years old with urge incontinence or mixed incontinence with a clinically significant urge component were enrolled in the study. The number of weekly urge incontinence episodes decreased from 27.4 to 4.8 after controlled and from 23.4 to 3.1 after immediate release oxybutynin (p = 0.56), and total incontinence episodes decreased from 29.3 to 6 and from 26.3 to 3.8, respectively (p = 0.6). Weekly urge incontinence episodes from baseline to end of study also decreased to 84% after controlled and 88% after immediate release oxybutynin (p = 0.7). Continence was achieved in 41% of the controlled and 40% of the immediate release group (p = 0.9). Dry mouth of any severity was reported by 68 and 87% of the controlled and immediate release groups, respectively (p = 0.04), and moderate or severe dry mouth occurred in 25 and 46%, respectively (p = 0.03). CONCLUSIONS: Participants taking a single daily does of controlled release oxybutynin had similar reductions in urge incontinence and total incontinence episodes compared to those taking oxybutynin 1 to 4 times daily. A lower incidence of dry mouth was reported for controlled release oxybutynin.

Adult↗
PubMed1995

A predictive score index for the outcome of associated biofeedback and vaginal electrical stimulation in the treatment of female incontinence.

A group of 64 women with stress incontinence alone (20), urgency incontinence (7) and mixed incontinence (37) were treated during 12 sessions, each 20 minutes long, during 6 weeks with combined alternating biofeedback and intravaginal electrical stimulation. Of the patients 21 had a complete recovery, 20 recovered sufficiently to avoid other forms of treatment and 23 failed to respond to the treatment. Thus, the overall success rate for this treatment was 64%. Various physiological parameters were collected from each patient before the start of the treatment sessions. Patient age, estrogen status, detrusor hyperreflexia, intravaginal pressure, percent transmission of the abdominal pressure to the urethra, degree of intrinsic sphincter deficiency and compliance with therapy were significant factors affecting the success of treatment. A statistical analysis was performed on these measurements to generate a score index model capable of predicting the outcome of a treatment consisting of associated biofeedback and electrical stimulation. We present a reliable method for distinguishing between patients who will and will not respond to this form of treatment. The most significant variables predictive of a good reduction outcome are patient age, presence of estrogen, absence of detrusor instability and intrinsic sphincter deficiency, low urethral hypermobility and, most of all, compliance with treatment.

Adult↗
PubMed1993

[Urethral resistance and bladder contractility].

Urinary difficulty results from an imbalance between deux forces: expulsive and retentive forces. Prostatic hypertrophy for instance only represents one of these forces. This presentation describes the numerous factors responsible for detrusor contractility which has been often ignored in the assessment of prostatic hypertrophy. The notion of urethral resistance is explained as a ratio of pressure flow which represents the only way to assess the obstructive factor.

Female↗
PubMed1993

[Psychogenic dysuria].

Psychogenic urinary retention is not uncommon. Urodynamic studies demonstrate the absence of organicity allowing us to concentrate and define psychological causes. Sexual abuse is the most frequent but also, depression, hysteria and numerous inhibitory factors of educational origin.

Adolescent↗
PubMed1993

[Female urethral syndrome].

The urethral syndrome is probably the most frequent reason for urological consultation among women. Chronic non-specific urethritis and hypoestrogenism with resulting vaginal and urethral atrophy appear to be responsible. A summary of pathophysiology and treatment of the syndrome is presented.

Bacterial Infections↗
PubMed1993

[Factors of female urinary incontinence].

The history, physical examination and complementary investigations must be directed towards analysis of the multiple factors responsible for urinary incontinence, whose relative roles differ from one patient to another. Treatment is primarily directed towards factors which are the easiest to correct. Urethral and vesical factors are summarised in this brief introductory article.

Clinical Protocols↗
PubMed1981

Cavernous hemangioma of vesical neck.

A thirty-six-year-old woman who had obstructive lower tract symptoms since childhood was found to have a contracted vesical neck. Transurethral resection of the vesicle neck showed a hidden cavernous hemangioma of the vesical neck. She was completely free of symptoms for six years. Indications for transurethral resection of vesical neck are discussed.

Adult↗
PubMed1980

Studies of female urethral pressure profile. Part I. The normal urethral pressure profile.

The urethral pressure profile is influenced by the degree of patient relaxation, which explains marked variations in measured pressure values among normal subjects, as well as the frequent lack of reproducibility in a given subject. The quality of relaxation can be estimated by observing the difference between maximum resting and maximum holding pressures. The most reproducible parameters are 1) the total urethral length, 2) the length to the point of maximum pressure and 3) the ratio of area to the point of maximum pressure over total area. Changes in intravesical volume do not produce significant differences in peak pressure, total area or area to maximum pressure. When subjects were asked to strain the pressure in the proximal urethra increased by 60% of the intravesical pressure observed, even in the absence of a vesical neck opening.

Adult↗
PubMed1980

Studies of female urethral pressure profile. Part II. Urethral pressure profile in female incontinence.

Most pressure values, except U1 and areas under the curve, were significantly lower in the 456 curves obtained in 38 incontinent women than in normal subjects. Standard deviations of all parameters are important because of variations in the degree of patient relaxation, explaining a large overlapping zone in which curves from the incontinent and the normal groups are superimposed. There are 3 factors that cause a reduction in urethral pressure profile: 1) aging and menopause (which are attributed to reduction in urethral compliance), 2) multiparity and 3) previous significant urogynecological operations. Besides urethral compliance urethral pressure profile studies allow measurement of 5 other components of the urethral resistance: 1) the degree of patency of the vesical neck, 2) the maximum voluntary sphincter contraction, 3) the functional urethral length, 4) the facilitatory urethral relaxation reflex and 5) the degree of urethral displacement to some extent. Separate measurements of each urethral factor should allow a more accurate analysis of urethral resistance and, consequently, enhance the quality of therapeutic indications in the management of female incontinence.

Adult↗
PubMed1979

Renal pedicle injury in the multiple injured patient.

Renal pedicle injuries were associated with multiple system trauma and a mortality rate of 42 per cent in 31 patients seen from 1959 to 1978. These injuries were to the renal artery in 14 patients, branches of the renal artery in 5, renal vein in 8, and renal artery and vein in 4. Priority of treatment for life-threatening associated injuries resulted in delayed diagnosis of the renal pedicle injury, which was not optimal for preservation of functioning renal tissues. Since 1968 an immediate excretory urogram has been performed for hematuria or a perirenal hematoma found during laparotomy for associated injuries. This study has resulted in the early diagnosis of renal pedicle injuries and immediate vascular repair has been attempted in 6 patients. Three of these patients survived with no hypertension on followup. A repaired renal vein in 1 patinet resulted in normal renal function and renal arteries were repaired in the other 2 patients with reduced renal function.

Adolescent↗