Biomedical subjects

Philippe E Spiess

Publications and source records attributed to Philippe E Spiess.

21 records · Page 2Linked to original sources

PubMed2002

Is an artificial sphincter the best choice for incontinent boys with Spina Bifida? Review of our long term experience with the AS-800 artificial sphincter.

OBJECTIVE: We describe our long-term experience in a uniform population of Spina Bifida boys all treated with the AS-800 model artificial urinary sphincter (AUS) and compare our results to other treatment modalities available to children with neurogenic incontinence. MATERIALS AND METHODS: The complete medical records of 30 patients with insertion of the AS-800 were reviewed. All were boys having Spina Bifida with only one having prior bladder neck reconstruction. The mean age at insertion was 12.6 years and the average follow up was 6.5 years. Anticholinergic agents and self-intermittent catheterization were used concomitantly to the AUS in 21 and 22 patients respectively. RESULTS: In our series, 19 (63%) patients were completely dry, 6 (20%) were slightly wet, 5 (17%) were incontinent. The mean lifetime of all artificial sphincters was 4.7 years with no statistically significant difference in survival of those inserted at the bladder neck and bulbar urethra (4.6 and 4.9 years respectively). However, a survival analysis revealed a sharp drop after 100 months with only 8.3% of the sphincters implanted lasting beyond this point. There were a total of 32 revisions performed in 17 patients constituting a 0.164 revision rate/patient-years. The other surgical treatment available to these children is bladder neck reconstruction with reported continence rates ranging from 61% to 76% at about 2 years follow up. CONCLUSIONS: In our experience, the AS-800 model artificial sphincter has a long term survival which rarely exceeds 8 to 9 years putting into question whether it or bladder neck reconstruction is the best long term solution for treating children with neurogenic incontinence. This question may be only answered by a randomized, controlled trial comparing these two modalities.

Adolescent↗

PubMedDate not supplied

Multilocular cystadenoma and cystadenocarcinoma of the prostate.

BACKGROUND: Multicystic prostatic tumors are rare, with only a few reported cases of prostatic cystadenoma and cystadenocarcinoma in the scientific literature. METHODS: A retrospective review of our tumor registry over the last 25 years identified 2 rare cystic tumors of the prostate: 1 multilocular cystadenoma and 1 multilocular cystadenocarcinoma. RESULTS: The first case illustrates the clinical and pathologic features of prostatic multilocular cystadenoma. A 42-year-old man presented with a 16-cm suprapubic mass causing displacement of adjacent visceral organs. Pathologic examination after prostatectomy confirmed it to be a multilocular cystadenoma of the prostate. The patient's postoperative course was uneventful, and his serum prostate-specific antigen level remained at < or =0.04 ng/ml throughout the course of his disease. In the second case, we present an 80-year-old male presenting with a 12-cm cystic mass of the prostate. His serum prostate-specific antigen level remained at > or =9.0 ng/ml throughout the course of his disease. The tumor had an aggressive local growth pattern, with invasion into perirectal adipose tissue. This patient underwent a pelvic exenteration, followed by adjuvant systemic chemotherapy and complete androgen blockade. Despite aggressive treatment, he had 3 recurrences over 4 months but remains alive with disease at 23-month follow-up. CONCLUSIONS: Cystadenocarcinoma of the prostate is locally aggressive and should be included in the differential diagnosis of cystic lesions of the prostate.

Adult↗

PubMedDate not supplied

Review of the M.D. Anderson experience in the treatment of bladder sarcoma.

OBJECTIVE: To assess the histologic subtypes, clinical presentations, treatment approaches, and treatment-related outcomes of patients with bladder sarcoma. METHODS: Between January 1985 and July 2004, 19 patients (12 men and 7 women) with primary bladder sarcoma were evaluated at the University of Texas M.D. Anderson Cancer Center. Median follow-up duration was 72 months (range 3-141). RESULTS: The median age of patients at presentation was 57 years (range 22-94). The histologic subtypes of bladder sarcoma were leiomyosarcoma (N = 14), angiosarcoma (N = 3), and unclassified sarcoma (N = 2). The clinical presentation consisted of gross, painless hematuria in 79% of patients, lower urinary tract symptoms in 16%, and microhematuria in 5%. The primary treatment modalities used were surgery in 16 (84%) patients, chemotherapy in 2 (11%), and palliation in 1 (5%). The rate of local and distal recurrence was 16% and 53%, respectively. The most common sites of distant metastases were the lungs, bone, brain, and liver. The 5-year disease-specific survival rate was 59%, with a median survival duration of 6 years. There was no statistically significant difference in disease-specific survival between patients with bladder leiomyosarcoma compared to other sarcoma subtypes (P = 0.149). Lymphovascular invasion (P = 0.03) and lymphatic metastasis (P = 0.03) were associated with disease-specific survival, and surgical margin status was associated with recurrence-free (P = 0.04), disease-specific (P = 0.03), and overall survival (P = 0.005). CONCLUSIONS: Bladder sarcoma is a highly aggressive malignancy, regardless of its histologic subtype. Surgical margin status is an important determinant of survival.

Adult↗