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P Grise

Publications and source records attributed to P Grise.

At least 19 recordsLinked to original sources
PubMed2006

[Three-year outcomes of the tension-free vaginal tape procedure for treatment of female stress urinary incontinence with low urethral closure pressure].

OBJECTIVE: The aim of this study was to assess, with long-term outcome, the effectiveness of TVT for stress urinary incontinence (SUI) with low maximum urethral closure pressure (MUCP) and to identify predicting factors for failure in this case. PATIENTS AND METHODS: This is a bicentric retrospective study including women who underwent a TVT procedure for grade 3-SUI according to the Ingelman-Sundberg's scale. All patients had a low MCUP defined by PCUM < 30 or by the formula 110-the age+/-20% cmH2O. Urethral hypermobility was defined on physical examination and urodynamic investigations. TVT was the only operation performed. Patients were assessed at three months then at longer term with an average follow-up of three years and ever less than one year. RESULTS: A total of 60 women 30 to 78 years old (mean age 55) were so operated. More than third of them (38%) had already been operated for incontinence. Thirty-eight percent had SUI without urethral hypermobility. Thirty percent presented bladder overactivity. The short-term evaluation found that, out of 58 patients, 70,6% cured, 10,3% improved and 18,9% classified as failure. The long-term evaluation, concerning 44 patients, found that 57% remained cured, 16% improved and 27% were classified as failure. Bladder overactivity was cured or improved in more than half of the cases (60%). Ten percent of de novo urgencies were noted, all of which persisted later on. For all that, as much as two thirds of these patients were satisfied with the TVT. Mean age of patients classified as failure, was higher (65 years). Previous SUI surgery did not modify the results. When the MUCP was < 20 cmH2O, success was present only one time out of two. The absence of urethral hypermobility decreased to a significant degree the probability of cure (38 vs. 82,6%, P < 0.01), and more still when bladder overactivity was associated (16,6 vs. 66,6%, P < 0.01). Postoperative voiding troubles constituted a pejorative factor for success of surgery. DISCUSSION AND CONCLUSION: Even if results of TVT with low MCUP are worse, they do not remain less appreciable. When we confront the benefits awaited with this technique compared to the usually described complications, TVT must represent the first treatment of this indication.

Adult↗
PubMed2005

Management of coralliform lithiasis on renal allograft with bricker-type ureterointestinal anastomosis.

PURPOSE: The authors report the management of a coralliform lithiasis that occurred in a renal allograft in association with a Bricker ureterointestinal anastomosis for urinary diversion. MATERIALS AND METHODS: A 58-year-old patient with a significant previous urological history, ie, surgery for childhood incomplete bladder extrophy, trans-ileal Bricker type ureterostomy, and in the end a renal allograft, presented with hematuria and septicemia. Complete radiological examination revealed an obstructive upper tract coralliform lithiasis in the transplanted kidney. A percutaneous nephrolithotomy also was performed for surgical treatment. RESULTS: On postoperative day 2, a urinary fistula was observed at the nephrostomy orifice. The Bricker ureterointestinal anastomosis was located at the same level as the nephrostomy orifice, which maintained upper urinary high pressures as well as the fistula. CONCLUSIONS: Possible preexistent lithiasis in a donor kidney should not be overlooked. In the management of kidney stones larger than 3 cm, percutaneous nephrolithotomy remains the "gold standard" procedure even in cases of external urinary diversion. We proposed an original management of the previously described postoperative complication using a hyperpression drainage tube device in association with a JJ stent.

Humans↗
PubMed2004

Surgical treatment of female stress urinary incontinence with a trans-obturator-tape (T.O.T.) Uratape: short term results of a prospective multicentric study.

OBJECTIVE: The aim of the study was to assess the efficacy and safety of a new minimally invasive surgical procedure using the Trans-Obturator-Tape Uratape to treat female stress urinary incontinence. PATIENTS AND METHODS: 183 women with stress urinary incontinence (SUI) associated with urethral hypermobility, underwent the T.O.T. procedure (October 2001 to March 2003). 26 patients were previously operated for incontinence. 26 patients were operated at the same time for their genital prolapse. Mean age was 56 years (29-87). 50/183 patients were having mixed incontinence. A non-elastic, polypropylene tape (UraTape, Mentor-Porgès) with a silicon coated central part was placed under the mid-urethra. The surgical placement technique utilises a trans-obturator percutaneous approach. All patients underwent post-operative clinical examination, cough-stress test (full bladder), uroflowmetry, and post-voiding residual assessment. RESULTS: Mean follow-up was 7 months (1-21). At 1 year follow-up 80.5% of the patients were completely cured and 7.5% were improved. The overall peri-operative complication rate was 2.2% with no vascular, nerve or bowel injury. 6 patients (3.3%) had post-operative urinary retention. CONCLUSION: The present multicentric study confirms the results obtained by the instigator of the technique, E. Delorme, and allows us to consider T.O.T. as an effective and safe technique for the treatment of female stress urinary incontinence, alone or in combination with prolapse repair.

Adult↗
PubMed2004

Evaluation of the transurethral ethanol ablation of the prostate (TEAP) for symptomatic benign prostatic hyperplasia (BPH): a European multi-center evaluation.

OBJECTIVE: We prospectively conducted a European multi-center study to assess the safety and efficacy of injecting dehydrated ethanol using a specialized injection system for the treatment of BPH. METHODS: Patients with symptomatic BPH were enrolled and evaluated to undergo transurethral ethanol ablation of the prostate for their BPH condition. Procedures were performed using the ProstaJect device. Treatment dosages were based on prostate volume, prostatic urethral length and median lobe involvement. Follow-up evaluations were done at four days and one, three, six and 12 months. RESULTS: One-hundred fifteen symptomatic patients underwent the transurethral ethanol ablation procedure and ninety-four patients have been followed and evaluated for the entire 12-month post-treatment period. The average prostate volume was 45.9 g, and average ethanol injected was 14 ml. Post-operatively, 98% of patients voided spontaneously four days following treatment. Significant reduction in reported lower urinary tract symptoms was evidenced at the one-month follow-up visit and maintained through 12 months follow-up, with International Prostate Symptom (IPSS) and Quality of Life (QoL) scores decreased by more than 50%. Peak flow rates (Q(max)) improved by 35% by the three-month evaluation and these results were sustained through to 12-months follow-up. The average prostate volume reduction was 16%. Adverse events included discomfort or irritative voiding symptoms in 26% of patients, hematuria in 16%, with retrograde ejaculation, and erectile dysfunction reported in less than 3% of patients. The majority of these events required no intervention. Two patients experienced serious adverse events (bladder necrosis) and underwent open surgery that included a urinary diversion and a ureteral implantataion. During the one year follow- up, 7% of patients required a trans-urethral resection of prostate (TURP). CONCLUSIONS: This preliminary multi-center data, representing the largest reported cohort to date, suggests that TEAP may be considered an effective minimally invasive treatment option for lower urinary tract symptoms secondary to BPH. Analyses of safety lead to a procedure modification for needle placement more distal from the bladder neck. Objective reduction in symptoms was not correlated in prostate volume reduction suggesting a non-purely mechanical effect.

Aged↗
PubMed2001

Effect of sacral nerve stimulation in patients with fecal and urinary incontinence.

PURPOSE: Preliminary studies have shown improvement in fecal incontinence in several patients who received temporary or permanent stimulation. The purpose of this study was to report our experience in sacral nerve stimulation in the treatment of fecal incontinence and to target patients who would benefit most from stimulation. METHODS: Patients with fecal incontinence were studied clinically and manometrically before, during, and after temporary nerve stimulation. If temporary nerve stimulation was clinically successful, the patient was implanted and followed up for six months. RESULTS: Nine patients (6 female) with a mean age of 50.7 +/- 12.3 years underwent temporary nerve stimulation. Temporary nerve stimulation was successful in eight patients, six of whom were implanted. Of the patients who could be evaluated, three of five had improved at the six-month follow-up visit, particularly in relation to the number of urgency episodes and delay in postponing defecation. All implanted patients had urinary symptoms. Urinary urgency was also improved by stimulation. During temporary nerve stimulation, the maximal squeeze pressure amplitude increased. After implantation, only the duration of maximal squeeze pressure seemed to improve. CONCLUSION: Sacral nerve stimulation can be used in the management of fecal incontinence, particularly in cases of urge fecal incontinence associated with urinary urgency. This study seems to confirm the effect of sacral nerve stimulation on striated sphincter function.

Adult↗
PubMed2001

A study of the anatomic features of the duct of the urachus.

The urachus is an embryonic remnant resulting from involution of the allantoic duct and the ventral cloaca. Attaching the bladder dome to the umbilicus, this duct becomes progressively obliterated during fetal life. It may subsequently persist as different variants after birth, some regarded as normal, others as pathologic, due to incomplete closure. Six pediatric cases are reported here, and the literature on the embryology and anatomic basis of the duct is discussed. The urachus is present in nearly 100% of children at birth, with several possible shapes: tubular, fusiform or funnel. It gradually regresses and is found in only a third of adults. Its length varies from 1 to 15 cm. In our series 6 patients showed defective closure of the duct, including 3 with complete patency, 1 cyst, 1 diverticulum and 1 external sinus. Although rare, congenital pathology of the urachus requires a sound knowledge of the anatomy and embryology to distinguish normal forms from those subject to complications. It should be suspected with any lesion in the umbilical region and the appropriate treatment instituted.

Adolescent↗
PubMed2001

[Treatment of idiopathic retroperitoneal fibrosis].

Idiopathic retroperitoneal fibrosis is a rare disease and a delay in diagnosis may cause renal failure. Medical treatment i.e. corticotherapy or more recently, tamoxifene has been used successfully. This approach is recommended in patients either with moderate obstruction of the upper urinary, risk of major surgery or in cases of recurrence after surgical treatment. Ureterolysis using conventional surgery or laparoscopy remains the treatment of choice. This procedure should be considered in patients with neoplasic fibrosis, corticoresistant fibrosis or in cases of peri-aneurysm fibrosis.

Humans↗
PubMed2001

[Biphasic sarcomatoid carcinoma of the prostate].

Sarcomatoid carcinoma of the prostate is a rare aggressive tumor, characterized by an intimate admixture of two malignant epithelial and sarcomatoid components. We report the case of a prostate tumour reputed to have a poor outcome, in a 59-year-old man. The radical prostatectomy specimen was completely involved. There were no signs of recurrence or metastasis after 15 months of follow up. The serum PSA values before and after chirurgical treatment were normal. The definition of this tumour as its histogenesis and prognosis is discussed.

Biomarkers, Tumor↗
PubMed2001

[Consultation skills in urology: a model for teaching and evaluation].

OBJECTIVE: Consultation activity is an important aspect of urological practice, but the specific teaching of this activity is underdeveloped. The objective of this study was to establish a list of consultancy skills as a basis for a planned and structured approach to teaching and evaluation of consultancy skills in urology. MATERIAL AND METHOD: Two-step qualitative protocol: 1) Establishment of an initial list of skills based on data of the literature; 2) Submission of this list to a series of "focus groups" (urologists, interns, referring physicians) in order to validate and progressively refine the model. RESULTS: The items identified were classified into 3 distinct lists: 1) theoretical knowledge; 2) technical skills specific to urology, predominantly performed in the consulting setting, 3) interpersonal skills exclusively concerning the consultant-referring physician relationship. CONCLUSIONS: The consensual specification of these skills can be used to objectively define teaching and evaluation strategies for urology consultancy skills.

Referral and Consultation↗
PubMed2001

[Claude-Nicolas Le Cat (1700-1768), a famous surgeon and urologist of the 18th century].

Le Cat was a famous surgeon in France in the 18th Century, at a time when surgery was recognised as a separate specialty and the search for clinicopathological correlations was being developed. Le Cat was born in Picardy and studied anatomy and surgery in Paris. He was appointed surgeon to the Archbishop of Rouen in 1726, then head surgeon at Hôtel-Dieu hospital in Rouen. He performed two major operations: lithotomy for bladder stones and cataract surgery. He developed an instrument for lithotomy, the Gorgeret cystotome. His reputation in France and Europe is reflected by his numerous academy prizes, publications, and surgical notoriety.

France↗
PubMed2001

[Role of helical tomodensitometry in the early diagnosis of renal infarction].

INTRODUCTION: Renal infarction is a rare and often difficult diagnosis. The objective of this study was to demonstrate that contrast-enhanced spiral CT in patients presenting features of renal colic, can establish the diagnosis by confirming the presence of infarction of the renal parenchyma. MATERIAL AND METHODS: Over a 10-month period, the authors proposed the following decision flow-chart for all patients admitted with clinical features of renal colic: plain abdominal x-ray and first-line renal ultrasound, which, in the absence of a diagnosis (stones or dilatation of cavities), were completed by unenhanced spiral CT scan. When these examinations were normal, contrast-enhanced spiral CT scan was then performed. RESULTS: 300 patients were included in this study, and CT was performed in 40 cases. This management allowed the diagnosis of infarction of the renal parenchyma in three patients, who are described here. When unenhanced CT sections do not reveal any abnormality, contrast-enhanced sections are essential to visualize the infarcted zone, seen as a triangular low density lesion with clearly defined margins and a vascular topography. CONCLUSION: Contrast-enhanced spiral CT should now be considered to be the reference examination for the assessment of non-documented renal colic. This recent imaging modality should allow the diagnosis of a greater number of infarctions of the renal parenchyma, which formerly remained undiagnosed.

Humans↗
PubMed2001

[Role of complementary tests in the management of colo-vesical fistulae].

OBJECTIVE: Colo-vesical fistulas (CVF) are a complication of inflammatory or neoplastic diseases of the lesser pelvis. Although the clinical diagnosis is obvious in the presence of pneumaturia or faecaluria, a number of patients require complementary diagnostic and/or pretreatment investigations. The objective of this study was to analyse the management of these patients in order to define the place and cost-effectiveness of complementary investigations. MATERIAL AND METHODS: This retrospective study was based on 37 patients with a colo-vesical fistula, secondary to sigmoid diverticulitis in 60% of cases. RESULTS: Cystoscopy was the most cost-effective examination for the diagnosis of CVF with a sensitivity of 94%. The preoperative assessment of CVF and the underlying disease was optimally performed by a combination of cystoscopy, opaque enema and CT. CONCLUSIONS: Our study defined the place of the various examinations in the assessment of colo-vesical fistula, but the value of magnetic resonance imaging, not performed in this series, remains to be defined.

Adult↗
PubMed2001

[Evaluation of clinical reasoning in urology: contribution of the Script Concordance Test].

OBJECTIVE: The Script Concordance test is designed to measure knowledge organization, to allow interpretation of data in clinical decision making. The objective of this study was to assess the value of this new written evaluation instrument to evaluate clinical reasoning in urology. MATERIAL AND METHOD: An 80-item examination was completed by a group of medical students (n = 15), a group of urology interns (n = 11), a group of registrars-assistants (n = 7), and a group of experienced urologists (n = 10). The scores obtained were compared by analysis of variance. The reliability of the test was studied by calculating Cronbach's coefficient alpha. RESULTS: The mean score was 46.95 +/- 6.80 for students, 56.18 +/- 1.73 for interns, 66.27 +/- 4.92 for registrars and 63.38 +/- 2.19 for urologists. The differences observed between the scores for students, interns and urologists were significant. The reliability coefficient was 0.79 for the entire examination. CONCLUSIONS: This test is able to discriminate various levels of experience in urology. It proposes a simple and direct approach to evaluation of knowledge organization. Further studies are necessary to confirm the contribution of this test to the strategy of evaluation of the clinical skills in urology.

Clinical Competence↗