Biomedical subjects

P Conort

Publications and source records attributed to P Conort.

At least 19 recordsLinked to original sources

PubMed2001

Anatomic and functional results of transperitoneal-transvesical vesicovaginal fistula repair.

OBJECTIVES: To evaluate the anatomic and functional results of transperitoneal-transvesical repair of simple and complex vesicovaginal fistulas (VVFs). METHODS: Between 1978 and 1995, 30 VVFs in 28 patients (mean age 44.6 years, range 21 to 80) were treated by way of a transperitoneal-transvesical approach. VVFs were secondary to hysterectomy in 67.8% of cases; 46.7% of VVFs were considered complex fistulas. Fifty percent of the VVFs were retrotrigonal and 40% were trigonal. A flap was interposed in 70% of cases. The vaginal fistula orifice was left open in 66% of cases, and 33% of VVFs required ureteral reimplantation. The mean duration of bladder drainage was 15.8 days (range 6 to 42), and the mean follow-up was 30 months (range 23 days to 14.6 years). The anatomic and functional results were evaluated by physical examination, cystoscopy, and a self-assessment questionnaire. Success was defined as the disappearance of the fistula. RESULTS: The overall success rate was 85% (24 of 28). The success rate was 87.5% for simple VVFs, 71% for complex VVFs, 93% for retrotrigonal VVFs, 66% for cervicotrigonal VVFs, and 80% for fistulas requiring ureteral reimplantation. Postoperative voiding disorders were reported in 38% of patients. CONCLUSIONS: Transperitoneal-transvesical repair of simple and complex VVFs remains the reference treatment for a disease that has become rare in countries with a well-developed healthcare system, but that is disabling and poorly tolerated by patients after the treatment of another disease.

Adult↗

PubMed2001

Guidelines on urolithiasis.

OBJECTIVES: A project was initiated by the Health Care Office of the European Association of Urology in order to formulate common recommendations and guidelines for the treatment of patients with urolithiasis. The basic task for the working group therefore was to extract and evaluate evidence from the literature in order to reach a consensus on how these patients could best be managed. METHODS: Extensive reviews of the literature together with a thorough and detailed discussion of the various topics, by a working group including of experts from several European countries, provided the basis for a consensus overview of urolithiasis and its management. RESULTS AND CONCLUSIONS: Recommendations are given for the management of patients with acute stone colic and for active removal of stones from the ureter and kidney. Moreover, the principles for risk evaluation of patients with recurrent stone formation and appropriate recurrence preventive treatment are given.

Calcium↗

PubMed2000

[Male urinary incontinence and dynamic graciloplasty].

Only a few surgical treatments are available for male urinary stress incontinence and artificial urinary sphincter remains the reference treatment. It is associated with a certain morbidity and specific technical limitations and can therefore not always be used in a given patient. Stimulated graciloplasty could constitute a useful alternative treatment in exceptional situations. The objective of this study was to review the technique, the indications already defined apart from urinary incontinence and the results of stimulated graciloplasty in urology.

Electric Stimulation↗

PubMed2000

[High intensity focused ultrasound (HIFU) in urology].

INTRODUCTION: Focused ultrasound is now well known to urologists in the context of its validated application in extracorporeal lithotripsy. High Intensity Focused Ultrasound (HIFU) represents a potential therapeutic modality for tissue destruction due to its very high energy and its capacity to precisely reach a target with a very short emission time. The authors review the current state of art of HIFU in urology at a time when its indication in prostate cancer is being defined. MATERIAL AND METHOD: After a brief description of the main physical principles of ultrasound and the main data determining focussing of high energy ultrasound, the main machines available (research and clinical) are described. The published clinical literature concerning the tissue destructive action in urology is reviewed. RESULTS: HIFU has been used in urology to treat renal, vesical, prostatic (BPH and cancer), and external genital organ lesions. Purely extracorporeal machines are gradually being replaced by intracorporeal procedures, especially transrectal techniques for prostatic lesions. The quality of ultrasound detection of the target still limits the use of this minimally invasive modality. The intervening tissues are spared with a good therapeutic efficacy on the target tissues, provided optimal firing parameters are used. CONCLUSION: HIFU has a demonstrated potential in the treatment of prostate cancer and studies conducted by several teams have defined the technique and its efficacy. Other indications have been studied, but must be validated by further clinical trials. The future will probably see the design of machines adapted to a specific target tissue rather than a single multidisciplinary extracorporeal machine.

Humans↗

PubMed2000

[Assessment of hemorrhage risk of transvesical prostatectomy with bladder neck cerclage].

OBJECTIVE: Evaluation of blood loss and predictive factors of haemorrhagic complications of transvesical prostatectomy. MATERIAL AND METHODS: From January 1994 to December 1998, 202 patients with a mean age of 70.5 +/- 7.4 years (range: 46.6-89.3 years) were operated for benign prostatic hyperplasia with a mean prostate weight of 86 +/- 33 g. Transvesical prostatectomy was performed with bladder neck cerclage and suction drainage of the prostatectomy site for 48 hours. 107 patients donated blood preoperatively (mean: 2.8 +/- 0.7 units) to allow possible autotransfusion. Blood losses were evaluated by determining haematocrit during hospitalisation, the quantity of blood collected intraoperatively and the presence of postoperative bleeding possibly requiring surgical revision. RESULTS: The calculated overall blood loss was 435 +/- 306 ml of RBC, i.e. 1783 ml for an haematocrit of 30%. A high ASA score was significantly related with higher blood loss and preoperative anticoagulant treatment. No predictive factor for intraoperative bleeding (mean: 519 +/- 327 ml) was identified. Absence of the median lobe and a high ASA score were also predictive factors of postoperative bleeding. Age, operating time, prostate weight, recent urinary tract infection, preoperative drainage, preoperative haematocrit, and preoperative blood donation (autotransfusion) did not significantly influence the volume of blood loss. CONCLUSION: Apart from the ASA score, no predictive factor for the severity of bleeding associated with transvesical prostatectomy was defined in order to identify a group of patients at higher risk of severe bleeding.

Aged↗

PubMed2000

[Materials used in treatment of stress urinary incontinence with suburethral sling].

Suburethral sling is a classical method of surgical repair of female stress urinary incontinence (SUI). Initially reserved for SUI due to sphincter incompetence, this method now appears to be indicated for other types of SUI. A large number of organic and synthetic materials have been used in published series. The long-term functional results reported in the literature vary between 65 and 98%, regardless of the materials used. Some of the complications observed are specific to the type of material. Synthetic slings appear to be associated with a higher complication rate. It is too early, based on data of the literature, to determine the real role of Prolene tape (TVT).

Biocompatible Materials↗

PubMed1999

Comparison of the BTA stat test with voided urine cytology and bladder wash cytology in the diagnosis and monitoring of bladder cancer.

OBJECTIVE: To compare the BTA stat test (BTA stat), a new one-step immunochromatographic assay that can be performed in the urologist's office or in the laboratory, to voided urine cytology and bladder wash cytology (cytology) in the diagnosis and monitoring of cancer of the bladder (BC). METHODS: BTA stat and cytology were performed in a double-blinded, prospective, clinical study on specimens from 240 subjects (68 females; mean age of subjects: 64 years) suspected of having BC. RESULTS: In 107 subjects with final diagnoses of BC confirmed by cystoscopy or cystoscopy and biopsy, the overall sensitivities of BTA stat and cytology were 65 and 33%, respectively. For tumor grades I, II, and III, the sensitivities of BTA stat were 39, 67 and 83%, respectively. Those of cytology were 4, 20 and 69%. Nine subjects had a diagnosis of 'suspicious for bladder cancer'. The specificities of BTA stat and cytology in the 124 subjects without BC were 64 and 99%, respectively. In the subjects with a history of BC (n = 74), the specificities of BTA stat and cytology were 72 and 99%, respectively. The specificity of BTA stat was lower in subjects with benign or malignant genitourinary disease other than BC (46%) than in subjects without genitourinary disease (71%). CONCLUSIONS: The BTA stat test is considerably more sensitive than cytology in the detection of BC and can replace cytology as an adjunct to cystoscopy in the diagnosis and follow-up of patients with BC. However, due to low specificity, BTA stat should not be used without first ruling out potential interferences such as infections, renal disease and cancer, or genitourinary trauma.

Adult↗

PubMed1999

Multicenter trial of the quantitative BTA TRAK assay in the detection of bladder cancer.

BACKGROUND: Human complement factor H-related protein (hCFHrp) is produced by several bladder cancer cell lines and may be useful as a cancer marker. The aim of this study was to compare urinary hCFHrp and cytology for the detection of bladder cancer found by cystoscopy in patients with suggestive signs, symptoms, or preliminary test results. METHODS: The BTA TRAK assay, a quantitative enzyme immunoassay for the bladder tumor-associated antigen in urine, was compared with exfoliative cytology in 220 patients (155 men, 65 women; mean age, 64.2 years) presenting with signs, symptoms, or preliminary diagnostic results suggestive of this disease. Cystoscopy was the standard of detection. RESULTS: In the 100 patients found to have bladder cancer, the overall sensitivities of the BTA TRAK assay (at a previously determined decision threshold of 14 kilounits/L) and cytology were 66% (66 of 100) and 33% (33 of 100), respectively (P <0.001). The BTA TRAK assay proved to be statistically more sensitive than cytology for tumor grades I and II and for stage Ta and T1 tumors. In contrast, the overall specificity of the BTA TRAK assay in the 120 patients without cystoscopically confirmed bladder cancer was 69% (83 of 120) and that of cytology was 99% (119 of 120; P <0.001). The specificity of the BTA TRAK assay was higher in patients without benign or malignant genitourinary disease other than bladder cancer (76%; n = 89) than in patients with these conditions. When the BTA TRAK assay and cytology were used together such that a positive result in either test was scored as positive and the results compared with those of the BTA TRAK assay alone, increases in overall sensitivity and equivalent specificity were observed. CONCLUSION: Because of its relatively high sensitivity, the BTA TRAK assay could complement cytology as an adjunct to cystoscopy in the diagnosis and follow-up of most patients with bladder cancer.

Adult↗

PubMed1999

[Treatment of complicated renal colic in patients treated with indinavir: value of double J stents].

OBJECTIVE: Evaluation of the treatment of complicated ureteric stones in patients treated with indinavir. PATIENTS AND METHODS: From March 1997 to May 1998, 10 patients (7 males, 3 females, aged 30 to 56 years), treated by triple combination therapy for HIV infection, were drained for stones attributed to indinavir (CRIXIVAN), which had become obstructive and complicated. The duration of treatment with indinavir ranged from 14 days to 2 years. No patient had a history of urological disease. One patient presented with bilateral stones. All patients presented complicated clinical features: fever in 3 cases; severe pain in 8 cases, with delayed excretion more than 4 hours on IVU in 6 cases. All stones were radiolucent except for one slightly radioopaque stone. The stone was situated in the lumbar ureter in 3 cases, iliac ureter in 1 case and pelvic ureter in 8 cases. RESULTS: In 10 out of 11 cases, a double J stent was inserted, preceded by drainage by simple ureteric catheter (infected urine) in 1 case and by percutaneous nephrostomy (PCN) with antegrade insertion of the stent (failure of the retrograde route) in 1 case. No complementary stone fragmentation or extraction treatment was necessary after this procedure. Stents were left in place for 3 to 7 weeks. In one case, a stone of the lumbar ureter required PCN followed by extracorporeal lithotripsy. CONCLUSION: In the case of complications requiring a urological procedure, insertion of a double J stent allows curative treatment of very friable indinavir stones, which are fragmented by passage of the stent.

Adult↗

PubMed1999

[How to plan the treatment of prostatic adenoma today?].

Surgical treatment, mainly transurethral resection of the prostate, still remains the reference treatment for benign prostatic hyperplasia (BPH). Two studies conducted in the Urology Department of the Pitié-Salpêtrière Hospital have tried to define certain characteristics of this surgery. The first study tried to evaluate the long-term outcome of patients operated for benign prostatic hyperplasia. Analysis of 881 replies to a questionnaire sent to 3,147 patients operated for BPH (between 1976 and 1989) assessed functional status (by Madsen's symptom score), quality of life (by Fowler's method), and sex life (by two specific questions), with a follow-up ranging from 5 to 14 years. At this follow-up, 90% of patients declared to be satisfied with their voiding status, 95% considered their quality of life to be excellent and about 50% had maintained a sex life. The second study was designed to evaluate the morbidity of this treatment in elderly patients. A group of 33 operated patients over the age of 80 was compared to a control group composed of 66 patients between the ages of 60 and 70 years, treated in a similar way, in the same centre and in the same year. Morbidity was higher in the first group, but age itself did not appear to constitute a poor prognostic factor for surgery; it only intervenes by allowing certain complications of benign prostatic hyperplasia (acute retention) to create emergency situations complicating the perioperative period. Following demonstration of the short-term and long-term efficacy of this conventional surgery, many new technologies were subsequently developed in order to reduce perioperative discomfort, anaesthetic requirements, duration of catheterization and hospital stay. Some of them constitute a new approach to endoscopic surgery, such as prostatic tissue vaporization techniques (electrovaporization, laser contact vaporization), which have a comparable efficacy to that of TURP, while reducing bleeding, catheterization time and hospital stay. However, the duration of postoperative irritative symptoms is much longer. Other techniques use a thermal effect to obtain coagulation necrosis of prostatic tissue, using various energy sources: microwaves (thermotherapy), laser (interstitial laser), radiofrequency waves (TUNA). These techniques are perfectly adapted to outpatient surgery with local or regional anaesthesia. They do not interfere with continence, sexual function, but may be followed by high dysuria or retention rates, with a variable cathererization time, sometimes several weeks. Finally, urethroprostatic stents are easy to insert, provide a solution in critical situations and have replaced old indwelling catheters. The current choice of treatment therefore comprises several approaches: more effective, but still purely symptomatic medical treatment, safe conventional surgery providing excellent long-term results, but generating a certain perioperative discomfort and a certain morbidity, or, on the contrary "minimally invasive" techniques, greatly simplifying the therapeutic procedure, but whose morbidity has not yet been determined and whose results are still uncertain.

Adenoma↗

PubMed1999

[Colonic tubular adenoma following ureterosigmoidostomy: CT features].

We report a case of benign colonic tubular adenoma arising in a 36-year-old female at the site of ureterosigmoidostomy performed 25 years before. The tumor was revealed by recurrent episodes of pyelonephritis; hydronephrosis was present. On colonic enema, the tumor appeared lobulated, 4 cm in diameter. CT scan showed a multiloculated mass, which enhanced after injection. Pathology revealed a tubular adenoma of the colon with cystic dilatation of glandular structures. The role of imaging studies in the follow-up of patients after ureterosigmoidostomy is discussed.

Adenoma↗

PubMed1999

[Empirical treatment of urinary infections in urologic surgery].

Emergency prescription of empirical antibiotic therapy is justified in a context of febrile urinary tract infection, or to shorten the preoperative period in a hospitalised infected patient. The severity of the infection, its origin (community or nosocomial), morphological characteristics of the bacteria on direct examination, and urinary dip-stick data must be taken into account to select the most appropriate antibiotic while waiting for the antibiotic susceptibility test results.

Antibiotic Prophylaxis↗

PubMed1998

[Review on the use of CO2 in laparoscopy surgery].

Laparoscopic surgery is one of the treatment modalities available to urologists, who must be familiar with the concepts of the physiology of CO2 and its clinical consequences. CO2 is absorbed during insufflation, leading to hypercapnia, reaching a steady-state from the 20th minute. The insufflation pressure must be between 10 and 14 mmHg. Intraoperative surveillance is based on oxygen saturation (pulse oximeter) and capnography, which measures the CO2 concentration of expired air. The causes of hypercapnia must be prevented: untimely recovery, retroperitoneal dissection, excessive intra-abdominal pressure. If hypercapnia occurs, the patient must be exsufflated and the operation should be resumed after a certain interval. The specific complications of laparoscopy (gas embolism, arrhythmias, pneumothorax) can be avoided by respecting the rules of security and by maintaining surveillance during recovery. The pain due to diaphragmatic peritoneal irritation can also be decreased by complete exsufflation.

Carbon Dioxide↗

PubMed1998

[Spontaneous intraperitoneal rupture of the ureter].

An unusual case of spontaneous intraperitoneal rupture of the ureter was observed in adult with acute renal pain. Diagnosis was best established with CT rather than intravenous urography. CT demonstrated ureteral leakage with the contrast medium extravasating into the peritoneal cavity. The patient was initially managed successfully by endourology. Secondary stenosis of the ureter required surgery for partial resection of the distal ureter.

Adult↗

PubMed1997

[Isolated Burch type indirect colposuspension of the bladder neck in the treatment of stress urinary incontinence in women. Long-term results].

OBJECTIVES: Burch indirect colposuspension remains the reference surgical operation in the treatment of female urinary stress incontinence. The stability of the results is highly controversial and the causes of failure remain hypothetical. The objective of this study was to analyse the long-term results of this technique. METHODS: 100 women suffering from pure urinary stress incontinence, in whom a Burch indirect colposuspension was performed, were included in this study. These patients were reviewed with a mean follow-up of 5.2 years and a questionnaire designed to assess the results was sent to their homes. RESULTS: 64% of patients no longer suffered from incontinence. Deterioration of the results was observed up to 5 years after the operation, but subsequently remained stable. The results were operator-independent. Low sphincter pressure (< 30 cm H2O), preoperative detrusor instability, insufficient hormonal impregnation and a history of pelvic surgery were the main factors predictive of failure of this technique. CONCLUSION: This study confirms the benefit provided by this technique in almost two-thirds of patients and indicates the risk factors of failure which must be taken into account before proposing Burch indirect colposuspension to a woman suffering from urinary stress incontinence.

Adult↗

PubMed1996

[Problems raised by representation of activities in urology. Cooperative study by the urology services of the AP - HP (Public Services - Paris Hospitals)].

Paris public hospital urology departments conducted a study which had three objectives: - to test the indicators of activity to determine whether they were well adapted to measurement of the surgical activity performed, - to determine the contribution of the PMSI to the measurement of this activity, - to propose actions designed to improve the representation of the surgical activity actually performed by urology departments. The results of this study show that one half of the operations performed do not correspond to the field of PMSI (day-only admissions, outpatients department). The indicators currently used for budget allocation or interdepartment comparisons of activity are inadequate and, most importantly, induce deformities, variable from one department to another, which severely affect the image of the activity produced by these indicators. Two main reasons can explain these deformities: - the use of the NGAP and the score to measure activity: there is a marked variation of the score for the same operation, from one department to another. - the very poor census of activity performed in outpatient surgery. These two reasons are not related to the medical activity. Definition of a unique nomenclature for surgical procedures would constitute a great progress, provided that this nomenclature allows us to accurately describe our activity and can be modified according to our needs. Although the PMSI is a marked improvement of the information system, its application, in its current state, will not radically change the situation. The PMSI must be enlarged in one way or another, to outpatient activity including procedures performed in the outpatients department. For these measuring tools of activity, which determine the calculation of our budgets, to be adapted to our practice, we must be able to analyse their relevance and introduce changes. We need to develop this field of medico-economic research in urology.

Paris↗

PubMed1996

[Secondary management of urethral injuries].

In 80 to 90% of the cases of partial or complete rupture of the membranous urethra, early en-to-end urethroplasy is successful in re-establishing the urethra. Secondary or delayed treatment of urethral injuries is required in unsuccessful cases or when a surgical procedure cannot be performed within the first 10 days following injury as often occurs in polytrauma patients with fractured pelvis, pulmonary or cerebral contusions, or spinal fractures. Over the last 5 years, at the urology unit at the Pitié Hospital we have treated an equal number of patients immediately after injury and in procedures delayed for 4 to 6 weeks.

Humans↗

PubMed1996

[A case of lithiasis caused by 2,8 dihydroxyadenine. Evolutive characteristics. Therapeutic problems].

We report a case of bilateral 2,8 dihydroxyadenine urolithiasis in a 25-year-old woman, born from an incestuous union between a brother and sister, who developed the first manifestations at the age of 9 years. This condition results from APRTase deficiency and an autosomal recessive inherited disorder. Diagnosis requires physical analysis of the stones and measurement of APRT activity in red cells. Treatment by lithotripsy with piezo-electric shock waves was ineffective on the left leading to eventual nephrectomy. The right lithiasis was destroyed by lithotripsy. This result would suggest variable solidity of 2,8 dihydroxyadenine stones. In this patient, an indwelling endoprosthesis was left in place for 14 months for extra-medical reasons and led to staphylococcal urinary infections, struvite lithiasis and incrustations of the catheter within the bladder. Ureteroscopy and percutaneous nephrostomy were required to remove this secondary radio-opaque stone.

Adenine↗