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Biomedical subjects

M Radej

Publications and source records attributed to M Radej.

18 recordsLinked to original sources
PubMed1998

Comparative analysis of bladder neck suspension using Raz, Burch and transvaginal Burch procedures. A 3-year randomized prospective study.

PURPOSE: Ever since Pereyra described needle suspension of the bladder neck for the treatment of stress urinary incontinence in women, numerous modifications have been presented. There were variations in the success reported by different authors. We report 3-year follow-up results in 146 women operated on for stress urinary incontinence using Raz, Burch and our own new procedures. MATERIALS AND METHODS: During a 5-year period, 146 women were operated on for genuine stress urinary incontinence. Using the method of Raz, and transvaginal Burch as well as the Burch retropubic urethropexy, a modified bladder neck suspension was performed in 46 (32%), 44 (30%) and 56 (38%) patients, respectively. In all patients a prior gynecological or urological operation for urinary incontinence and a clear neuropathic condition had been excluded before surgery. The routine diagnostic procedure consisted of multichannel cystometry, voiding cystourethrography, infusion urography and cystoscopy. A pressure-flow electromyography study was done in patients with a residual volume greater than 50 ml following voiding. The operations were performed by the same surgeon (I.G.). Initial follow-up was done after 12 months and then every year. RESULTS: Urodynamic testing did not reveal significant differences between Burch and Raz (p = 0.2652), Raz and transvaginal Burch (p = 0.5745) as well as between Burch and transvaginal Burch procedures (p = 0.7602; Fisher's exact test). Three years after surgery, 50 of 56 (89.3%; Burch procedure), 37 of 46 (80.4%; Raz modification) and 38 of 44 patients (86.4%; transvaginal Burch) were continent. CONCLUSIONS: There is no reason (except patient condition) to prefer any of the numerous modifications of bladder neck suspension. We believe that the success of the operation lies in adequate mobilization of the bladder neck and urethra as well as in a surgeon's familiarity with the procedure.

Adult↗
PubMed1997

[Urinary bladder incontinence after prostatectomy. Urodynamic evaluation and results of therapy].

Forty-seven males referred due to postprostatectomy urinary incontinence (34 after transurethral resection of prostatic adenoma and 13 after open suprapubic adenomectomy) were retrospectively studied. Urodynamic evaluation identified 19 (40.4%) men with incontinence due solely to sphincter incompetence, and 19 (40.4%) men, in addition to sphincter incompetence, had urinary bladder dysfunction (unstable detrusor and/or reduced bladder compliance). Seven (14.8%) men had pure bladder dysfunction as the only cause of urinary incontinence. Two patients had normal urodynamic findings (N = 2; 4.2%). Men with urinary incontinence due only to sphincter incompetence were treated by insertion of artificial sphincter devices or condom catheter drainage (lack of artificial sphincters), while others were treated pharmacologically (imipramine, propantheline, oxybutynin or their combinations ... N = 25), or by augmentation cystoplasty using ileum after unsuccessful pharmacological treatment (N = 3). Out of 25 patients with pharmacological treatment, 21 were available for the final assessment of the treatment efficacy. Eleven (52.3%) patients were "socially continent" after the treatment. It is concluded that in the assessment of the cause of postprostatectomy urinary incontinence urodynamic evaluation is mandatory, and that the treatment should be based on the results of such studies. The role of bladder dysfunction as a cause of postsurgical urinary incontinence is again strongly emphasized.

Aged↗
PubMed1996

The sigmoidorectal pouch (Mainz pouch II).

A sigmoidorectal pouch was constructed in 20 patients (18 with invasive bladder cancer, 2 with complete urethral destruction with multiple vesicovaginal fistulas). The rectal-dynamic studies showed that by detubularization and reconfiguration of the sigmoid colon and rectum, we obtained a low-pressure reservoir, with the high-pressure contractions eliminated. Preoperatively, the basal rectum pressure was 21.4 cm H2O; rectum contractions reached a mean of 27.6 cm H2O (maximum 48 cm H2). Postoperatively (9-36 months) the mean basal pressure of the pouch was 19.3 cm H2O (p > 0.05; t test comparison with the preoperative value), with a mean contraction value of 19.1 cm H2O (p < 0.05). All the patients experienced continence day and night with a pouch emptying frequency of four times during the day and once at night, after 9 months. By fixing the pouch to the promontory or psoas muscle, without compromising the blood supply to the pouch, the risk of ureteral kinking and upper urinary tract dilatation were considerably decreased. The price to be paid for almost perfect continence was hyperchloremic acidosis in most patients.

Acidosis↗
PubMed1995

A modified Raz bladder neck suspension operation (transvaginal Burch)

A total of 36 female patients with genuine stress urinary incontinence underwent Raz needle suspension with fixation of suspension sutures to the iliopectineal ligament (transvaginal Burch procedure). By fixing suspension sutures to the iliopectineal ligament we expected to achieve a static suspension independent of everyday patient activities. Considering the small number of patients and limited followup, our results revealed continence in 80 to 85% of the patients after 3 years. We believe that fixation of suspension sutures to the iliopectineal ligament can favorably influence long-term results of needle suspension in the treatment of female stress urinary incontinence.

Adult↗
PubMed1995

Urodynamic and clinical characteristics of small intestine reservoir directly connected to urethral sphincter.

Eight patients in whom a small intestine reservoir with direct anastomosis to the urethral sphincter had to be performed after radical cystectomy for invasive carcinoma of the urinary bladder, were included in the study. The function of small intestine reservoir was clinically and urodynamically monitored during 24 months postoperatively. All patients urinated per urethram, with abdominal strain or with urethral sphincter relaxation without abdominal strain. After 21 months, diurnal continence was maintained in 87.5%, and circadian continence in 75% of the patients. Urodynamic tests showed it to be a low-pressure reservoir, where the basal reservoir pressure never exceeded 30 cm H2O during filling. The values of maximal cystometric capacity showed that a certain time of reservoir maturation had to elapse after the reservoir construction. After 3-6 months, the mean maximal cystometric capacity was 250 ml, and after 9 months it was 520 ml. The proportion of continent patients was observed to rise with the increase in the small intestine reservoir capacity. We believe that three substantial issues are ensured by the described surgical technique, i.e. the antireflux mechanism, appropriate capacity and acceptable continence.

Aged↗
PubMed1994

Retrograde ejaculation and loss of emission: possibilities of conservative treatment.

Twenty-five patients with retrograde ejaculation/loss of emission were treated with ephedrine sulfate or imipramine hydrochloride. Seventeen of them suffering from both diabetes and retrograde ejaculation were treated with ephedrine or, in case that ephedrine failed to convert retrograde ejaculation into anterograde ejaculation, with imipramine. Positive results were obtained in 5/17 (29.3%) patients, i.e. in 3 (17.6%) and 2 (11.7%) patients on ephedrine and imipramine, respectively. The daily dose of ephedrine was 50 mg and that of imipramine 75 mg, during a 4-week period. In the group with retroperitoneal lymphadenectomy, after treatment with ephedrine, only 1 (12.5%) had retrograde ejaculation while the remaining patients (n = 7) continued to lack semen emission. These 7 patients were treated with imipramine, and 3 of them (42.8%) achieved anterograde ejaculation. In one third of patients with retroperitoneal lymphadenectomy and diabetes, with retrograde ejaculation or loss of semen emission, conservative treatment can offer improvement or conversion to anterograde ejaculation.

Diabetes Mellitus, Type 1↗
PubMed1984

Conservative treatment of female stress incontinence with imipramine.

The results of a clinical study of conservative treatment of women with stress incontinence are presented. A daily dose of 75 mg. imipramine hydrochloride was given for 4 weeks. Special attention was paid to the effects of imipramine on the functional urethral length and maximum urethral closure pressure. A total of 21 women (71 per cent) stated that they were continent after treatment with imipramine, while 9 (29 per cent) did not improve and treatment was stopped. According to our results, imipramine extended the functional urethral length and made it independent of stress factors in women who were continent after treatment with imipramine. In patients with persistent incontinence the functional urethral length was extended significantly but was shortened with stress despite imipramine therapy. We believe that imipramine could be an alternative treatment in selected cases with stress incontinence.

Adult↗
PubMed1977

Prevention of venous thromboembolism with low doses of heparin in urologic patients.

The effectiveness of low doses of heparin was investigated for the prevention of clinically manifested thromboembolic disease. In the group of 125 patients, who received 5,000 units of subcutaneous heparin two hours before the operation, and postoperatively 15,000 units per day for seven to ten days, deep vein thrombosis was not observed, and in only 1 patient (0.8%) pulmonary embolism was suspected. Of 216 patients from the control group, pulmonary embolism was clinically diagnosed in 4 (1.9%), deep vein thrombosis in 7 (3.4%), and in 2 patients (0.9%) fatal pulmonary embolism was found at autopsy. The difference between total thromboembolic disease of the control group (6.2%) and heparinized group was highly significant (p less than 0.02). Postoperative bleeding was seen two times more often in the heparin group, but bleeding was not severe and was easily controlled.

Female↗
PubMed1977

[Air as an optic medium in diagnostic cystoscopy].

The authors display that the application of air as an optic medium in diagnostic cystoscopy has some determined technical advantages and medical justifications ahead of the use of water. The quality of air as the optic medium doesn't lat behing after water. The fear of air embolism is not justified, because in numerous applications of this method not any incident has been recorded.

Cystoscopy↗
PubMed1976

Functional and tonometrical investigation of bladder and urethra in patients with stress incontinence.

During 1974, 80 women with symptoms of relative stress incontinence underwent cystotonometric, sphincterometric and urethrometric examinations. The average basal bladder pressure, sphincter resistance, urethral length with the patient in the lying position and functional urethral length (difference between urethral length in the lying and the upright positions) were measured. We tried to separate objectively stress from urge incontinence (about one-fourth of the patients). After statistical analyses of the data we concluded that there is neither correlation between sphincter resistance and urethral length, nor between sphincter resistance and functional length of the urethra but there is a correlation between sphincter resistance and basal bladder pressure. The functional length is the best method to separate patients with stress incontinence from thoses with urge incontinence, while sphincter resistance is of less importance. The functional length is also the best indicator of the seriousness of incontinence. The objective sign of a successful operation is the extension of the urethral length and the fixation of the functional length to 0 mm. In such cases sphincter resistance is slightly increased and inversely related to the size of the correction of functional urethral length.

Female↗