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Biomedical subjects

P Dik

Publications and source records attributed to P Dik.

14 recordsLinked to original sources
PubMed2003

Detrusorectomy for neuropathic bladder in patients with spinal dysraphism.

PURPOSE: We assess the outcome of detrusorectomy in 35 patients with spina bifida who were incontinent due to poor bladder volume or poor compliance. MATERIALS AND METHODS: Of 51 patients requiring bladder augmentation 35 underwent detrusorectomy. In 3 patients ileocystoplasty was later performed as a secondary procedure because of failure of the detrusorectomy. RESULTS: A total of 35 patients (17 males, 18 females) underwent detrusorectomy. Mean patient age at operation was 9.9 years (range 0.4 to 17.8). Mean followup was 4.9 years (range 1 to 10.5). A continent catheterizable vesicostomy was constructed in 14 patients and ureteral reimplantation was performed in 8. Twenty-five patients also underwent sling and/or Burch cystourethropexy during detrusorectomy, of whom 19 are continent and 5 have some leakage between clean intermittent catheterizations. In 1 girl the sling procedure was not successful, and she was subsequently treated with bladder neck closure. Bladder compliance after operation was improved in 9 cases and unchanged in 10. Of the 16 patients in whom compliance was already acceptable before the operation and was unchanged after detrusorectomy 7 were able to stop antimuscarinic therapy. Compliance became poor in 4 cases, of which 3 required ileocystoplasty. Bladder volume (as a percentage of normal volume for age) was increased after detrusorectomy in 13 patients, unchanged in 11 and decreased in 11. Complications of detrusorectomy included bladder leakage in 2 cases. One patient needed a laparotomy because of urinary ascites shortly after the operation. CONCLUSIONS: Detrusorectomy may be combined with other procedures such as ureteral reimplantation, slingplasty and continent vesicostomy. Of 35 treated patients compliance improved in 16 (46%),volume improved in 13 (37%), 3 had no change in parameters, and 3 had a slight decrease in volume and compliance. Four patients had poor results, of whom 3 needed a secondary ileocystoplasty. Therefore, it may be concluded that detrusorectomy is a safe and probably useful procedure for improvement of bladder volume and compliance in patients with neurogenic bladder dysfunction, and may obviate the need for ileocystoplasty in a limited number of patients.

Adolescent↗
PubMed2001

Bladder-sphincter dysfunction in myelomeningocele.

Pediatric urodynamics taught us that detrusor-sphincter dyssynergia creates a bladder outlet obstruction in about 50% of any population of children with myelomeningocele. This functional obstruction causes renal damage due to obstructive uropathy, exactly the same way as a congenital anatomical urethral obstruction does. Pediatric urodynamics also taught us that in children with myelomeningocele pelvic floor activity and detrusor activity can be abnormal (hyperactive or inactive) completely independent from each other. These insights have changed the management of myelomeningocele. Children with overactivity of the pelvic floor can be singled out at infant age, and started on clean intermittent catherization, to prevent obstructive uropathy and preserve renal function. Children with detrusor overactivity can be singled out too at very early age, and treated with anticholinergics, to prevent irreversible structural damage to the detrusor and preserve normal bladder capacity and compliance.

Female↗
PubMed2001

The treatment of post-urethrotomy incontinence in pediatric and adolescent females.

PURPOSE: Until 1986 many urologists performed currently outdated, redundant internal urethrotomy as standard therapy for recurrent urinary tract infection in girls. We describe the results of therapy in patients who became incontinent due to previous internal urethrotomy. MATERIALS AND METHODS: Between 1986 and 1995, 21 female patients with post-Otis urethrotomy incontinence have presented at our department with combined dysfunctional voiding, recurrent urinary tract infection and various types of urinary incontinence partially based on bladder instability and often provoked by abdominal straining. All cases were diagnosed by repeat video urodynamics and ultrasound of the open bladder neck. Endoscopy provided proof of scarring in the bladder neck and urethra. All patients except 1 underwent conservative treatment for at least 2 years, consisting of pharmacological therapy, physical therapy and biofeedback training. Surgical therapy to cure incontinence was performed in 14 cases, including a conventional Burch-type colposuspension in 5, modified needle colposuspension in 4 and complete endoscopic excision of the urethral scars followed by open reconstruction of the bladder neck and urethra in an abdominoperineal procedure in 5. RESULTS: Conservative treatment has been completely successful in 7 patients. Primary open or needle colposuspension was unsuccessful in 6 of 9 cases, including several requiring further surgery to achieve dryness. The results of excising urethral scars with bladder neck and urethral reconstruction were good in 4 of 5 patients at a followup of at least 4 years. CONCLUSIONS: When previous internal urethrotomy appears to be an important factor in the evaluation of incontinence, conservative therapy is the treatment of choice. Conservative therapy should consist of biofeedback reeducation of the voiding pattern and physical therapy. When surgery is needed, excision of the urethral scars with reconstruction of the bladder neck and urethra plus colposuspension is superior to colposuspension only.

Adolescent↗
PubMed2001

Results of preputial reconstruction in 77 boys with distal hypospadias.

PURPOSE: There is growing interest in preputial reconstruction combined with hypospadias repair. We retrospectively analyzed its results for future developments and patient information. MATERIALS AND METHODS: We evaluated 77 boys who underwent distal hypospadias repair combined with preputial reconstruction to determine complications, risks and failures. RESULTS: At a mean followup of 2.5 years 52 patients had an anatomically normal penis with a normal retractable foreskin, while 25 (33%) presented with a complication. The most common complications were partial dehiscence, and fistula of the prepuce and urethra. There was a complication of the reconstructed foreskin only in 16 cases (21%), a combined problem with the reconstructed foreskin and reconstructed urethra in 7 (9%), and a problem with the reconstructed urethra in 2 (3%). Of the 25 patients with complications 19 underwent reoperation with closure of the fistula or dehiscence and 5 were circumcised, while in 1 the parents accepted the minor cosmetic problem and refused reoperation. CONCLUSIONS: Preputial repair combined with hypospadias repair may lead to anatomically correct reconstruction of the penis at the cost of a 33% complication rate. Parents are informed about this risk and to date in 15% of all boys with distal hypospadias the parents have elected preputial reconstruction.

Child↗
PubMed2000

Female epispadias repair: a new 1-stage technique.

PURPOSE: Female epispadias is a rare anomaly. According to the literature it is usually treated with staged procedures, including bladder neck reconstruction, to achieve continence. We developed a 1-stage surgical technique that offers the possibility of achieving continence and a cosmetically normal appearance of the vulva. MATERIALS AND METHODS: We treated 4 patients 4 months to 8 years old. The main point of the technique is to free completely the urethral plate and bladder neck from surrounding tissue. After tubularizing the urethral plate into a urethra modified needle suspension brings the bladder neck and proximal urethra into the intra-abdominal position. The pelvic floor is then reconstructed between the anterior vaginal wall and urethra. Thus, continence may be attained by intra-abdominal positioning of the bladder neck and proximal urethra as well as by pelvic floor reconstruction. RESULTS: Of our 4 consecutive cases of primary untreated epispadias the technique proved successful in 3, while followup is too short in 1. One patient is completely dry and voids without a further procedure. Postoperatively 2 patients with 5 years or more of followup required injection of a bulking agent at the bladder neck level to achieve continence, including 1 who is damp during the day without the need to change clothes and 1 on clean intermittent catheterization twice daily because post-void residual urine volume causes recurrent urinary tract infection. CONCLUSIONS: The described technique is promising for treating this disabling anomaly.

Child↗
PubMed2000

Ectopic ureterocele: results of open surgical therapy in 40 patients.

PURPOSE: The treatment of ectopic ureterocele is controversial. In addition to debate on optimal therapy, discussion exists on whether there is further risk of deteriorating bladder function after extensive bladder surgery during the first year of life, which is a reason to postpone surgery. In a prospective nonrandomized trial we treated 40 patients regardless of age who had ectopic ureterocele with complete surgical reconstruction of the lower urinary tract and upper pole resection of poorly functioning upper pole moieties at referral. Excluded from study were 3 patients with only 1 affected renal moiety initially. MATERIALS AND METHODS: We treated 31 female and 9 male patients 0 to 8.8 years old (mean age 2.17) at surgery for ectopic ureterocele extending into the bladder neck and urethra, including 19 younger than 1 year. Primary ureterocele excision was performed in 37 cases with reconstruction of the urethra, bladder neck and trigone, and ureteral reimplantation. Because of small ureterocele size, the ureterocele was left in situ in 3 patients, leading to secondary ureterocele removal due to obstructive voiding and urinary incontinence in 1 each. A staged procedure in 5 neonates involved primary lower urinary tract reconstruction with upper pole cutaneous ureterostomies followed by upper pole resection or ureteral reimplantation a few months later. After bladder neck reconstruction in 16 cases colposuspension was also done to create a normal vesicourethral angle. All patients underwent clinical and urodynamic evaluation at least 1.25 years after surgery (mean followup 5.59). Patients who were too young for the clinical assessment of continence by January 1999 were excluded from study. RESULTS: All patients are continent. A secondary endoscopic procedure was required in 13 cases, including cystoscopy only in 2, scar incision near the ureteral orifice in 3, endoscopic reflux treatment in 4, ureterocele remnant resection in 2 and bladder neck incision for obstructive voiding in 2. Secondary open bladder reconstruction was performed in another case due to a diverticulum. Postoperatively only 1 or 2 uncomplicated episodes of urinary tract infection developed in 11 patients, while there were recurrent urinary tract infections in 4. In a patient with a preexisting loss of renal function a severe infection led to renal scarring. The voiding pattern was normal in 29 patients but 11 had dysfunctional voiding, including 5 with recurrent urinary tract infection. Urodynamic followup confirmed these clinical findings. Bladder capacity in these patients was relatively high at an average of 124% of expected capacity for age. We noted no statistically significant difference in followup parameters in patients who underwent surgery before and after age 1 year. Additional colposuspension in 16 patients did not result in any significant change in outcome compared with that in patients without this procedure. CONCLUSIONS: When compared with results in the literature, complete primary lower urinary tract reconstruction in patients with ectopic ureterocele appears to have better results than a staged approach with initial endoscopic treatment. Moreover, our study provides no proof that extensive reconstructive bladder surgery in neonates and infants leads to bladder function deterioration at a later age.

Child↗
PubMed1999

Urinary continence and erectile function after bladder neck sling suspension in male patients with spinal dysraphism.

OBJECTIVE: To assess the outcome of using sling suspensions combined with clean intermittent catheterization (CIC) in patients with spina bifida, of whom a third are incontinent through pelvic floor paralysis. PATIENTS AND METHODS: Between March 1992 and April 1997, 14 male patients (mean age at surgery 11.7 years, range 6.5-15.2) with spina bifida and neurogenic sphincter incontinence underwent a puboprostatic sling suspension as a primary treatment. The procedure, via an abdominoperineal approach, consists of suspending the bladder neck by placing a simple U-shaped rectus abdominus fascial sling. The perineal approach is used to develop the plane between the rectum and Denonvillier's fascia, and to prepare the passage of the sling alongside the prostate. Apart from the sling procedure, eight of the 14 patients underwent autoaugmentation of the bladder and two underwent ileocystoplasty during the same operation. All patients used CIC daily. Erectile function was assessed by reports from the patients and their parents, and continence by report and urodynamic studies. RESULTS: Of the 14 patients, 13 achieved urinary continence with no additional procedures; one required a subsequent submucosal injection at the suspension site with silicone particles in povidone (Macroplastique(R)) to become continent. Two patients reported slight leakage at night. Before surgery, all but one patient reported having spontaneous or mechanically manipulated erections; none had erections on psychological stimulation. After surgery, erectile function was preserved in 13 of the 14 patients; in one there were problems establishing the right dissection plane between the rectum and prostate, but spontaneous erections returned a year after surgery. CONCLUSION: In males, the abdominoperineal puboprostatic sling suspension using rectus abdominis fascia appears to be a successful treatment for sphincter incontinence in patients with spina bifida, and safely maintains erectile function.

Adolescent↗
PubMed1996

Transurethral marsupialization of a medial prostatic cyst in patients with prostatitis-like symptoms.

PURPOSE: The results of transurethral marsupialization as treatment for medial prostatic cysts were assessed. MATERIALS AND METHODS: Between June 1992 and August 1994 we performed transrectal ultrasound on 704 patients with symptoms of bladder outlet obstruction or lower urinary tract symptoms and a medical prostatic cyst was found in 34 (5%). Transurethral marsupialization of the cyst via incision of the prostatic floor under transrectal ultrasound guidance was performed in 18 patients. Followup was 12 to 25 months (mean 18). RESULTS: Patients with a medial prostatic cyst complained of prostatitis-like symptoms (77%), scrotal pain (62%), impaired micturition (32%), small volume ejaculation (35%), painful ejaculation (24%), hemospermia (24%) and infertility (12%). After marsupialization of the cyst, symptoms resolved completely in 14 patients (78%), improved in 17 (94%) and did not improve in only 1 (6%). No complications of this procedure were noted. The 16 patients who did not undergo surgery still complain of prostatitis-like symptoms without evidence of bacterial prostatitis. CONCLUSIONS: We believe that a medial prostatic cyst can cause prostatitis-like symptoms and that marsupialization of the cyst can provide symptom relief in the majority of patients.

Adult↗
PubMed1992

Mitomycin C and aminoglutethimide in the treatment of metastatic prostatic cancer: a phase II study.

In a phase II study, 24 patients with metastatic prostatic cancer were treated with mitomycin C 15 mg/m2 i.v. every 6 weeks, combined with aminoglutethimide 250 mg twice a day. A low dose of 37.5 mg cortisone acetate was supplied daily to compensate for adrenal cortical suppression. A partial response was demonstrated in 4 of 24 evaluable patients with bi-dimensionally measurable metastases. Stable disease occurred in 8 patients over a period of more than 6 months. Within the maximum cumulative dose limit of 2 mg/kg body weight mitomycin C, toxicity was observed in 21 cases, including 2 deaths due to treatment toxicity. The poor response rate and high toxicity suggest that the addition of aminoglutethimide does not enhance the effect of mitomycin C in these patients.

Aged↗
PubMed1989

[Experiences with extracorporeal shockwave lithotripsy in 61 children].

Between March 1985 and January 1987 2547 ESWL treatments were performed on 2064 patients, including 33 boys and 28 girls younger than 18 years. Almost identical results were obtained in children as in adults. All stones desintegrated and success was achieved in 97%; 79% was considered stone-free after 6 months and 18% had passable asymptomatic residual fragments (biggest fragments less than 3 mm) which did not grow larger during a mean follow-up of 17.8 months. One patient had a recurrent stone, after having been stone-free for 13 months. Post-ESWL complications and morbidity were minimal. Auxiliary measures were necessary in 5 patients before ESWL and in 6 patients after ESWL. Failure to render the kidney free of stones occurred in 2 patients with complex urolithiasis. Because of these results ESWL should be considered the treatment of choice in the paediatric age group for urolithiasis.

Adolescent↗
PubMed1989

Treatment of distal ureteral stones in the horse riding position.

From August 1986 through March 1987, 102 patients with 110 distal ureteral stones were treated in 110 sessions with the standard Dornier HM-3 lithotriptor in the so-called horse riding position. The majority of the patients (70 of 110, 63.7%) were treated for distal stones alone, whereas in a third (40 of 110, or 36.3%) treatment was performed for distal and upper stone localization during the same session. Additional treatment besides extracorporeal shock wave lithotripsy was necessary in 12.7% of the patients. Of the 110 patients 89.4% were without residual stones after a mean of 17.3 days. This modified position of the patient, which is specific to the Dornier HM-3 lithotriptor, makes possible treatment of distal ureteral stones with results comparable to those of endoscopic management but with less major complications (4.7%). A total of 7 patients had anal blood loss in the early postoperative period. Rectal bleeding ceased within 36 hours after treatment. The position also allows for treatment of stones at other, more proximal locations without great modifications to the position during the same session.

Adolescent↗