Biomedical subjects

P Geavlete

Publications and source records attributed to P Geavlete.

12 recordsLinked to original sources

PubMed2001

Endoscopic classification and endourologic therapy in proximal incomplete ureteral duplication pathology.

OBJECTIVE: To assess whether patients with proximal incomplete ureteral duplication (PIUD) had functional or anatomical Y junction zone pathology. In such cases, stasis and infection, with or without associated renal scarring, are often found. The results after minimally invasive treatment (retrograde endoincision of ureteral stenosis, localized on one limb) can be evaluated. PATIENTS AND METHODS: In a retrospective analysis of 807 ureteroscopies, we found 29 cases with PIUD pathology dating from July 1996 to March 1999. The investigative protocol involved: intravenous pyelography (IVP) with delayed films, voiding cystourethrogram, and duplex Doppler renal ultrasonography (DDRU) for the resistive index. We used semirigid ureteroscopes (7.5 and 8.5 french) and the Storz cold knife/scissor. The mean follow-up period was 17 months (range 5-33 months). RESULTS: In 22 cases (76%) we found functional obstruction of the Y junction region and in 7 cases (24%) a ureteral stricture shorter than 1 cm of lower or upper limbs. We described four particular morphologies of the Y junction zone: double-barrelled (wide bifid limbs) with larger Y junction, lateral insertion, punctiform insertion and valvular insertion of one of the limbs. The first type is associated with functional obstruction and the others are characteristic of anatomic obstruction. After retrograde cold endoincision, normal PIUD was found in 85% of cases. CONCLUSIONS: Pathological aspects of PIUD may pose interesting problems in diagnosis and therapy. Endoscopic particularities of the Y junction zone could be correlated with IVP and DDRU. Retrograde endoureterotomy appears to be an effective minimally invasive procedure for treatment of anatomical obstruction where the ureteral stenosis of one limb is shorter than 1 cm.

Adult↗

PubMed2001

[Doppler ultrasonography in the function assessment of double J ureteral endoprosthesis in patients with extrinsic ureteral obstruction].

OBJECTIVES: The efficacy of internal urinary drainage by double J stent is relatively difficult to evaluate by classical methods. This prospective study evaluated variations of the resistance index (RI) in patients with unilateral extrinsic ureteric obstruction, requiring internal drainage by double J stent. MATERIAL AND METHODS: Variations of the resistance index (RI) and the correlations between RI and the results of other investigations were determined in a group of 48 patients with unilateral extrinsic ureteric obstruction, treated by ureteric stent. The presence of urine from the stented ureteric meatus was also assessed. RESULTS: The preoperative assessment demonstrated a sensitivity of 73% for RI (> 0.7) and 84.5% for DRI for the demonstration of obstruction. Following stenting, RI decreased by 11%, with a mean index of 0.66; the RI was less than 0.07 in 62.5% of cases. The mean index was 0.68 one month later and 0.71 three months later (an increase of 0.05 compared to the post-stent evaluation). CONCLUSIONS: The resistance index may represent a useful element in the assessment of the efficacy of internal drainage by double J stent, while the presence of urine in the ureteric orifice may not be helpful.

Adult↗

PubMed1991

Evolution of the urothelial bladder field after intravesical Bacille Calmette-Guérin therapy.

After transurethral resection (T.U.R) and open surgery of 178 patients with superficial bladder tumors (pTa, pT1) we applied intravesical Romanian (modified Pasteur strain) Bacille Calmette-Guérin therapy. An introduction phase consisting of 8 weekly instillations was followed by a maintenance phase of instillations monthly for 10 months and then 3 monthly for 2 years. Two cases with primary Carcinoma in situ (Cis) were treated with the same protocol. The random urothelial biopsies (4 quadrant) showed before immunotherapy 105 cases (58.33%) with simple (36 cases), medium (36 cases), severe (13 cases) dysplasia and Cis (20 cases) and after 3 years of treatment we found 37 cases (20.55%) with simple (14 cases), medium (14 cases), severe (9 cases) dysplasia and two cases with invasive stage after Cis. The response rate was 75, 55% at 3 years. The mean period of follow up was 50 months. The complications of this therapy were frequent but mild. These results demonstrated the dynamic evolution of the urothelial bladder field after "long-course treatment" with intravesical BCG.

BCG Vaccine↗

PubMedDate not supplied

[Retrograde cold knife endo-pyelotomy in ureteropelvic junction stenosis].

Between September 1998 and July 2000 we performed a new procedure of ureteropelvic junction (UPJ) stenosis treatment: retrograde endopyelotomy (REP). So, 17 patients (7 males and 10 females) between 23 and 56 years old with hydronephrosis (IInd grade--3 cases, IIIrd grade--12 cases and IVth grade--2 cases) were evaluated with an unitary protocol: gray-scale and duplex Doppler (resistive index--RI measurement), IVP, ureteropyelography and renal scintigraphy in selected cases. The hydronephrosis was primitive in 12 cases and secondary in 5 cases (after previous open surgery). We excluded from our series of patients cases with aberrant vessels (polar inferior), associated renal stones, important hydronephrosis and young patients. Video assisted endoincision was realized at 6 and 3 o'clock position on the left side and at 6 and 9 o'clock position on the right side with Wolf semirigid ureteroscopes, Storz special knife/scissor. Double J indwelling catheter (8 Fr.) was removed after 6 weeks. The evaluation has been made at 3.6, 9 and 12 months demonstrating normal pyelocaliceal system in 10 cases (58.8%), a significative reduction of hydronephrosis grade in 3 cases (17.6%), mean RI = 0.63, with the presence in 15 cases (88.2%) of RI under 0.70. Stable good results were found in 14 cases (82.3%). After the failure of this technique (stenosis in 2 cases) the REP was practiced again. We didn't find intraoperative complications. Our conclusions despite the relative short follow-up period are very much in favor of this modality of treatment, minimally invasive, being an efficient technique in the modern therapy of hydronephrosis.

Adult↗

PubMedDate not supplied

[Duplex Doppler ultrasound value in upper urinary tract obstruction ].

UNLABELLED: Our prospective study aimed to establish the duplex Doppler ultrasonography (DDU) value in patient's investigative protocol with acute or chronic ureteral obstruction. A. DDU IN ACUTE URETERAL STONE OBSTRUCTION: Between October 1988 and January 2001 we applied DDU evaluation for 177 cases with ureteral lithiasis in which we also studied gray scale echography, resistive index (RI), the difference between affected kidney and contralateral kidney (delta RI) and the characteristics features (amplitude, velocity and frequency) of the ureteral jets (intravesical evaluation in color Doppler mode). a. For 65 cases with RI < 0.70, delta RI < or = 0.06 we didn't find obstruction and 95.4% of the patients had spontaneous passage of the stones. b. For 109 cases with RI > 0.70, delta RI > or = 0.06 the spontaneous passage of the stone was found in 40 cases (36.7%). DDU associated with ureteral jet evaluation increased the predictive value of this method. So, the presence of the ureteral jet on the obstructed side of the upper urinary tract was associated with 63% of spontaneous passage of the stone while the absence of the jet was followed by 5% of spontaneous passage of the stone. The RI was sensitive in 74% and specific in 81% and delta RI was sensitive in 85% and specific in 91%. B. DDU IN CHRONIC URETERAL OBSTRUCTION: Between October 1988 and January 2001 we evaluated the DDU value in chronical ureteral obstruction on 78 cases with operated and/or irradiated genital neoplasm's and retroperitoneal involvement. Our results found RI sensitive in 63% and specific in 70% and delta RI was sensitive in 72% and specific in 78%. After double J stenting (indwelling) RI varied from 0.74 to 0.66 (0.08), with a significative decrease (over 10%) in 61.5% of the cases in which preoperator RI was greater than 0.70. After 1 month we found an increase of RI with 0.02 and after 3 months with 0.05. IN CONCLUSION: We consider DDU a functional imagistic method with an important place in the investigative protocol of the obstructive uropathy.

Algorithms↗

PubMedDate not supplied

[Topical immunotherapy with BCG in the adjuvant treatment of superficial bladder tumors--15-year-experience].

Between September 1984 and June 1999 we applied a long-term (3 years) protocol treatment (Pasteur strain produced by Cantacuzino Institute) in superficial bladder tumors (SBT) recurrence prophylaxis. In 1014 cases (pTa--11 cases, pT1G1--607 cases, pT1G2--149 cases, pT1G3--247 cases) our retrospective analysis used a personal protocol: 8 weekly intravesical instillations, then monthly instillations until 1 year, then 3 monthly instillations during the following 2 years. Pathologic bladder mucosa (simple, moderate and severe dysplasia, carcinoma in situ) was associated in over 80% of cases. Mean follow-up period was 118 months (range 174 to 6 months). Our results demonstrated the efficiency of this protocol (29.5% recurrences on 840 cases who had complete therapy). The importance of tumoral grading was clearly found: 13% recurrence rate for pT1G1, 39.5% for pT1G2 and 49% for pT1G3. Side-effects (local--78%, systemic--4%) and complications (3%) were treated by symptomatic or antituberculous drugs. Our significative study revealed that intravesical immunotherapy (with BCG vaccine) can be considered the first choice in the complementary treatment of SBT.

Adjuvants, Immunologic↗

PubMedDate not supplied

[New criteria for the diagnosis and endourological treatment of urethral strictures].

Between January 1994 and January 2000 we analyzed a series of 440 cases with urethral structures (US) in which we performed internal urethrotomy (IU). Bulbous site (76%), inflammatory etiology (84%) and primary disease (74%) were the characteristics of our series of patients. The diagnosis protocol was based on classical evaluation, urethral echography (7-10 MHz and endorectal Multiplan) and, in 37 cases, histopathological analysis of urethral callus. Based upon echographic description of the structural zone, the endo-incision was performed only at 12 o'clock position in 205 cases (46.8%), at 6 and 12 o'clock positions in 71 cases (16%), "star incision" in 141 cases (32%) and only at 6 o'clock position in 23 cases (5.2%). The recurrence rate was 15.7% (69 cases) after a follow-up period of 2 to 36 months. In 37 cases with urethral biopsy from structural zone, we described a high recurrence rate (62.5%) with "local active inflammation". Complementary treatment with anti-inflammatory drugs reduced this rate to 10% of cases. Our significative study revealed that echographic and histopathological evaluation of US could increase the efficiency of endourological treatment in this pathology; urethral ultrasound could be the first choice in the diagnostic of US and could establish the "perfect" site of endo-incision.

Adolescent↗

PubMedDate not supplied

Urothelial bladder biopsy--important evolution prognosis factor of superficial bladder cancer under intravesical Bacille Calmette-Guérin therapy.

During 11 years we investigated the value of multiple randomised biopsies (4 quadrant) and by in vivo staining with methylene blue (chromocystoscopy) of 231 cases with superficial bladder tumours under complementary intravesical Bacille Calmette-Guérin therapy (3 years of immunotherapic treatment after our protocol). We discovered the appearance of 20 cases with carcinoma insitu (Cis) and 105 cases with different degrees of dysplasia (simple, medium and severe). We demonstrated 69.44% pathological bladder biopsies on normal-looking mucosa. 75% of the recurrent tumours (44 cases-22.44%) had pathological bladder urothel al field modifications associated with bladder cancer. On this occasion, we point out the highest prognostic value of the complex protocol of superficial bladder tumour evaluation based on the study of the bladder biopsies as an essential parameter.

BCG Vaccine↗

PubMedDate not supplied

Evolution of carcinoma in situ under intravesical Romanian Bacille Calmette-Guérin therapy.

We analysed the evolution of 33 cases with carcinoma in situ (Cis) of the urinary bladder using the intravesical Bacille Calmette-Guérin (BCG) therapy (2 cases with primary Cis, 20 cases discovered at 4 quadrant biopsies within surgical treatment of superficial bladder tumours and 5 cases discovered at 3 monthly evaluation cystoscopy and chromocystoscopy). The mean period of follow-up was 40 months. Our protocol of immunotherapy was maintained for 3 years (8 weekly instillations with 100 mg Romanian--modified Pasteur BCG vaccine in 50 ml of saline, followed by monthly instillations for 10 months and then 3 monthly instillations for 2 years with the same doses). We described the great importance of this "long-course treatment": 12 cases with persistent Cis after 6 months and 2 cases with persistent Cis after 21 months. During September 1984-August 1990 we registered 6 invasive tumours (18.18%). These results showed the dynamic evolution of Cis under long-term intravesical immune BCG stimulation.

BCG Vaccine↗

PubMedDate not supplied

[Preliminary data on our laparoscopy experience in urinary pathology].

We studied laparoscopic urological procedures in 14 cases between July 1995 and October 1996. We applied retroperitoneal lomboscopic technique for 2 cases with symptomatic renal cyst (over 500 ml) and laparoscopic retroperitoneal lymphadenectomy in 12 cases (adenocarcinoma of the prostate-5 cases, pT2-3bMo, Gleason score between 3-9, PSA between 11-46 ng/ml and invasive bladder tumors-7 cases, pT2-3bMoG2-3). For the renal cyst we used extraperitoneal approach and for the pelvic lymph nodes we used in 8 cases intraperitoneal approach and in 4 cases extraperitoneal approach (patients with multiple prior abdominal surgeries). Lymph node tissue was present in 11 cases. For the bladder tumors we did first iliac lymph nodes dissection and for the prostate adenocarcinoma we did first obturator lymph nodes dissection. We didn't describe complications. For our patients it was 3 days long hospitalization. So, we consider that laparoscopic lymphadenectomy is essential for evaluation of the patients with prostate adenocarcinoma having markedly elevated prostate specific antigen, high Gleason grade, large clinical burden of tumor. For the invasive bladder tumors, radical cystectomy and especially bladder replacement surgery need absolutely evaluation of regional lymph nodes. For the symptomatic renal cysts (over 500 ml) laparoscopic surgery is with very good results, minimally invasive.

Adenocarcinoma↗

PubMedDate not supplied

[A ureteral endoscopic approach--a minimally invasive method complementary to nephroureterectomy].

Nephroureterectomy with ureteral stump excision and perimeatal cystectomy is the "golden standard surgical approach" for urothelial upper urinary tract cancer. Nephroureterectomy is also necessary in renoureteral tuberculosis, with compromised renal unit. Since June 1995 we performed the endoscopic distal ureteral approach in 11 cases (9 cases with upper urinary tract cancer and 2 cases with renal tuberculosis and concomitant ureteral distal lesions). In 7 cases we performed ureteral stripping after nephrectomy and in 4 cases we performed endoscopic disconnection of the intramural ureter followed by nephroureterectomy (in one operative step). Ureteral stripping was realized in two ways: perimeatal resection of the ureter and 12 o'clock incision. There was only one intraoperative complication which consisted in the dislodgement of the ureteral catheter who needs conversion to open surgery. Mean follow-up period was 12 months (range 2 to 28). The evolution of the patients was satisfactory, with significant reduction of the hospitalization. According to our experience the endoscopic distal ureteral approach is a safer complementary proceeding to the one step nephroureterectomy, being performed faster and easier than open ureterectomy.

Aged↗

PubMedDate not supplied

[An endoscopic treatment alternative in vesico-ureteral reflux (VUR)].

Vesicoureteral reflux (VUR) represent an important pathology (surgical treatment was until recently the "gold standard" therapy) in urology. Between September 1995 and October 1997 we used endoscopic Romanian collagen injection in 21 cases with VUR (3 cases grade II, 14 cases grade III, 4 cases grade IV). The collagen solution (1/1 with distilled water) was injected at the 6 hour of the ureteral large ostium (15/35 ml). In some cases we obtained the perfect occlusion of the incompetent ureteral ostium by complementary injections at 3 and 9 hours. It was necessary to reinject collagen twice in 8 cases and three times in 3 cases. Success rate appeared in 66.66% cases. We did not confront ourselves with postoperative complications. Hospitalization period was 3.2 days. The mean follow-up period was 12 months (range 6 to 28). Our results prove that endoscopic collagen injection applied in VUR is a simple, efficient, without complications method, minimally invasive.

Adolescent↗