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Biomedical subjects

P De Kuyper

Publications and source records attributed to P De Kuyper.

4 recordsLinked to original sources
PubMed2003

Self-referred patients in an aging male clinic: much more than androgen deficiency alone.

Following an information campaign through the media on the subject of 'andropause', 81 consecutive self-referred patients were evaluated. At presentation these patients had complaints possibly related to partial androgen deficiency in the aging male. Hormonal parameters were measured and specific aging male questionnaires, such as Androgen Deficiency in Aging Male (ADAM) and Aging Males' Symptoms (AMS) scale questionnaires were completed. The median age was 59 (range 53-66) and mean body mass index (BMI) was 26.4 +/- 3.3 kg/m2. Mean testosterone was 479.8 +/- 149.0 ng/dl and mean free testosterone was 10.0 +/- 3.0 ng/dl. Only 7.1% of all patients were diagnosed with 'idiopathic' ADAM. The majority of patients presented with erectile dysfunction. A wide variety of conditions were diagnosed, including hemochromatosis, micro- and macroprolactinoma, hypothyroidism, benign prostate hypertrophism and prostate carcinoma. The scores of AMS psychological, somatovegetative and sexual subscales were 12, 16 and 13, according to AMS classification corresponding to severe, moderate and severe complaints, respectively. There was no correlation between AMS (total and subscales) and testosterone levels. A positive correlation between the somatovegetative subscale of the AMS and both BMI and insulin was found. In conclusion, we observed that in a group of self-referred men andropause is not a frequent diagnosis, and other pathology needs to be addressed requiring a multi-disciplinary approach.

Aged↗
PubMed2002

'Batman excision' of ventral skin in hypospadias repair, clue to aesthetic repair (point of technique).

OBJECTIVE: In the hypospadiac penis the ventral skin is poorly developed, while dorsal skin is redundant. The classical Byars' flaps are a way to use the excess dorsal skin to cover the penile shaft. The appearance after Byars' flaps however is not natural. We use a more natural looking skin allocation with superior aesthetic results. METHOD: The clue in this reconstruction is an inverted triangle shaped excision of ventral skin expanding over the edges of the hooded prepuce (which makes it look like Batman). After excision of the ventral skin it is possible to close the penile skin in the midline, thus mimicking the natural raphe. In case of preputial reconstruction the excised ventral skin makes the prepuce look more natural. CONCLUSION: The trend of further refining aesthetic appearance of the hypospadiac penis often neglects the penile skin reconstruction. A technique is presented by which the total penile appearances after surgery ameliorates due to better skin reconstruction.

Humans↗
PubMed2000

Bladder neck closure for treating pediatric incontinence.

AIMS OF STUDY: In order to evaluate the effects of bladder neck closure (BNC) for treatment of pediatric incontinence, on the quality of life of those children, we reviewed the files of 17 children who underwent this procedure during the last 5 years. Information on previous surgery before BNC, continence and complications after BNC and patient satisfaction are gathered. MATERIAL AND METHODS: During the study period, 17 children (9 male, 8 female) underwent BNC with continent diversion. Ten children (5 male, 5 female) suffered neurogenic incontinence in meningomyelocele, 5 children (4 male, 1 female) had bladder exstrophy, 1 girl suffered iatrogenic incontinence after treatment of an ectopic ureterocele and 1 girl suffered structural incontinence after pelvic fracture. Previous surgery for incontinence was done in 12 children with 36 procedures. Primary BNC was done in 5 children. For continent diversion the appendix was used in 13, the ureter in 2, a Monti procedure in 1, and an ileal valve in 1. In 9 children, ileal bladder augmentation was performed at the time of BNC. Four children were augmented before. Mean age at time of operation was 13.5 years. Mean follow-up is 35 months. RESULTS: After BNC, all patients were completely dry. One girl suffered some stomal incontinence during the night. This disappeared after recent bladder augmentation. Patient satisfaction is extremely high after surgery. All patients feel happy with their stoma and do not regret the choice they made. As for complications, urinary tract infections were seen in 9 patients. Stomal complications were seen in 8 patients. Three patients had some difficulty with catheterization, which could be solved with dilatation. Appendiceal polyps, which could be removed under local anesthesia, were seen in 3 and stomal stenosis which needed re-intervention in 2. In 1 patient, three revisions of the stoma were done, in the other patient, two surgical corrections. Out of 8 patients showing stomal complications, only 2 needed revision under anesthesia. All complications are seen in the first 6 months after the continent diversion. CONCLUSIONS: We present a series of patients who underwent BNC for treatment of incontinence. BNC is the ultimate bladder neck reconstruction. However, regarding the high success rate, the low complication rate and the high patient satisfaction, we must consider BNC as an important procedure for the reconstructive surgeon. If reconstruction fails, closure must be considered. Compared to most other procedures for bladder neck reconstruction, BNC gives the highest continence rate. Good patient compliance and strict medical follow-up of the upper tract is mandatory in these patients.

Adolescent↗