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R Kocvara

Publications and source records attributed to R Kocvara.

At least 19 recordsLinked to original sources
PubMed2005

[Comprehensive long-term analysis of hypospadias repair using vascularized flaps and tubularized incized plates--report on 588 cases].

BACKGROUND: The article presents a comprehensive long-term analysis of the modem hypospadias repair based on preservation and use of the urethral plate. METHODS AND RESULTS: In years 1987 to 2004, 476 patients (aged 8 months to 45 years) were operated using a praeputial (mostly) flap. 81% were indicated for reconstruction of a proximal form of hypospadias, mostly penile. In years 1986 to 1991, a tubularized flap was performed in 31 patients. Since 1992, an onlay island flap in 394 patients, inlay-onlay flap in 43 patients and onlay-tube-onlay flap in 8 patients have been used. In years 2000 to 2004, 112 patients (aged 13 months do 17 years) were operated using tubularized incised plate (TIP) repair, mostly because of distal form of hypospadias. To cover the neourethra, a dartos flap was used in 72 and spongioplasty in 37 patients. We achieved the primary healing in 89% and 91%, resp., of patients after onlay and onlay-inlay island flap repairs with an average follow-up of 6,7 and 5,7 years, respectively. The most frequent complications were fistula or dehiscence of the glans. After the TIP repair combined with a dartos flap, 89% of the first operated patients healed without complications with an average follow-up of 2.3 years. A higher complication rate (40%) was found after a spongioplasty with foreskin preservation. Secondary repairs were also associated with more complications. CONCLUSIONS: Using onlay and inlay-onlay one-stage repairs, or using TIP one-stage repair combined with a dartos flap, a successful primary hypospadias repair was achieved in 90% of patients. The definite repair should be completed during early childhood.

Adolescent↗
PubMed2005

[Effect of biofeedback in the treatment of voiding dysfunction].

BACKGROUND: Biofeedback represents a treatment option for children with voiding dysfunction characterised with poor pelvic floor relaxation. METHODS AND RESULTS: Thirty nine children with symptoms of voiding dysfunction were treated in BFB program. Average number of sessions to achieve good response was three. Follow up was 12 to 24 months. Very good clinical response was obtained in 55, 7% of patients, who were characterised by cessation or resolution of incontinence in 66, 7%, dyscoordination in 57, 6% and urinary tract infection in 41, 1% of children. CONCLUSIONS: Biofeedback therapy is an effective method for treating poor pelvic floor relaxation. It helps to improve coordination of the detrusor and external sphincter function and it accelerates voiding reflex maturation.

Adolescent↗
PubMed2002

The expression of PAX5, p53 immunohistochemistry and p53 mutation analysis in superficial bladder carcinoma tissue. Correlation with pathological findings and clinical outcome.

OBJECTIVES: The expression pattern of PAX5 in the tissue of superficial bladder transitional cell carcinoma (TCC), its prognostic value and its correlation with p53 immunohistochemistry and p53 mutation analysis were evaluated. METHODS: Study comprised 61 patients with histologically confirmed superficial bladder TCC. Expression level of PAX5 mRNA was investigated using reverse transcriptase-polymerase chain reaction (RT-PCR) and determined semiquantitatively. The presence of p53 mutations was determined by SSCP and confirmed by direct sequencing. The p53 immunohistochemistry was performed with DO1 antibody and semiquantitatively evaluated using HSCORE (HS) method. As the control group for the evaluation of the PAX5 expression served 8 men with benign prostatic hyperplasia. RESULTS: PAX5 expression was found in 50 patients with bladder TCC but in no patient from the control group. Its quantity however correlated neither with the stage nor with the grade of the tumor. P53 mutation was confirmed only in 1 patient with pTaG2 tumor in exon 5 (deletion of proline 128). On the contrary, positive immunohistochemical staining of p53 was detected in most patients. Using the cutoff value of HS 200, 56.9% of patients showed p53 overexpression. Quantity of p53 immunochistochemical positivity did not correlate with the quantity of PAX5 expression. Using the cutoff values of HS 200 for p53 and of 0.2 for PAX5, 7 of 8 patients with future progression had p53 and 4 had PAX5 overexpression respectively. CONCLUSION: The expression of gene PAX5 is a frequent event in superficial TCC of the bladder.

Aged↗
PubMed2000

[Metaphylaxis in the first occurrence of urolithiasis].

BACKGROUND: Urolithiasis is a socially important disease with a high tendency to recurrences. By specific medicamentous metaphylaxis it is possible to achieve an as high as tenfold reduction of recurrences, however, regular check-ups focussed on possible side-effects are required. The objective of the project was to assess prospectively the effectiveness of non-medicamentous metaphylaxis in patients with the first kidney stone. In 113 patients, a fluid and specific dietary regimen were recommended based on a comprehensive diagnosis of metabolic disorders (Table 1) and the regimen was modified with regard to results of metabolic check-up examinations after 6, 18, and 36 months (group 1). Ninety-four patients were recommended a fluid and non-specific dietary regimen after a limited metabolic evaluation with a subsequent check-up after 36 months (group 2). The two groups were clinically comparable. A stone recurrence developed in 7 (6%) patients of the group 1 and in 18 (19%) of the group 2 (p < 0.01). The difference was even greater after including the growth of the concrement (7% and 23%). The patients with a recurrence or growth of a stone had more frequently weddellite in the concrement and had also more frequently a bilateral residual or conservatively managed urolithiasis (p < 0.0001). Half the recurrencies were asymptomatic. The development of metabolic disorders in the group 1 indicated a gradual decrease of uric acid in serum and urine (p < 0.01) although it was not yet significant after 6 months. There was also a significant increase of calciuria (p < 0.01), most probably in conjunction with a regular calcium intake. CONCLUSION: Specific non-medicamentous metaphylaxis with an adequate calcium intake leads to a lower incidence of stone recurrences than a non-specific fluid and dietary regimen. It is justified to introduce the specific metaphylaxis in all patients after the first diagnosis of a kidney stone. It ensures subsequent adjustment of the individual diet which the patient is more likely to adhere to than to general non-specific instructions.

Humans↗
PubMed1999

A prospective study of nonmedical prophylaxis after a first kidney stone.

OBJECTIVE: To assess, in a multicentre prospective randomized study, the effectiveness of specific nonmedical prophylaxis and nonspecific dietary prophylaxis in patients treated after experiencing their first idiopathic calcium-containing kidney stone. PATIENTS AND METHODS: From 1991 to 1994, 242 patients with idiopathic calcium urinary stones from three urological centres were randomly assigned into two groups. In group 1 (intervention, 113 patients), a specific dietary regimen was recommended and thereafter corrected according to a comprehensive metabolic evaluation. Group 2 (control, 94 patients) underwent only minimal metabolic screening and used general dietary measures, with no regular follow-up. An increased fluid intake was recommended in both groups. After 3 years, the effectiveness of the prophylactic and dietary regimens was evaluated in 207 patients. RESULTS: At entry, the clinical characteristics were comparable in the two groups, with only extracorporeal lithotripsy being more frequent in group 2. Almost 80% of patients reported a high intake of meat and a low intake of dairy products. In group 1 and 2, a recurrent stone was encountered in seven (6%) and 18 (19%) patients, respectively; recurrent and growing stones were found in eight (8%) and 22 (23%) patients, respectively (P<0. 01). There was a higher incidence of bilateral residual (or untreated) stones, and Weddellite stones (P<0.001) among patients with a recurrent or growing stone. An analysis of the dynamics of the metabolic variables indicated the significance of repeated dietary counselling. CONCLUSION: Specific dietary therapy, adjusted according to a metabolic evaluation, is more effective than nonspecific general dietary recommendations in preventing the formation of a second urinary stone.

Adolescent↗
PubMed1998

[Onlay island flap urethroplasty in the treatment of urethral strictures].

UNLABELLED: A skin island flap was used to create a neourethra in 65 patients aged 2 to 66 years with prolonged or multiple stricture of the anterior urethra. Before, all patients were treated repeatedly and unsuccessfully by open or endoscopic surgery. The principle of the used onlay technique was to supplement the missing lumen of the urethra by an island, usually preputial flap. In case of as missing segment of the urethra the original inlay-onlay technique was applied. After a mean follow-up period of 27 months 12 complications (18.4%) were recorded, six strictures of the proximal anastomosis, three fistulas and three dehiscences of the glans. CONCLUSION: The onlay island flap urethroplasty makes it possible to cure prolonged and multiple strictures of the urethra in one stage and with a relatively low complication rate.

Adolescent↗
PubMed1997

Inlay-onlay flap urethroplasty for hypospadias and urethral stricture repair.

PURPOSE: The absence of a segment of the urethral plate renders the onlay urethroplasty procedure impossible. The plate may be too short (in hypospadias), or scarred after previous repair or due to a dense urethral stricture. A modified approach with restoration of urethral plate continuity is proposed instead of the tubularized island flap associated with higher complication rates. MATERIAL AND METHODS: In 12 of 20 patients with a partially deficient urethral plate the inlay-onlay preputial island flap was used. The wider part of the flap is inlaid in place of the missing plate and anastomosed to the residual plate. Formation of the urethra is then completed with standard onlay overlapping of the flap. In another 8 patients the combined (partially tubularized in advance) tube-onlay flap was used. RESULTS: The inlay-onlay flap technique was used in 3 new hypospadias patients, in 4 with a scarred, hair-bearing plate after previous operations and in 5 with virtually no urethral plate because of a dense urethral stricture. No urethral complications were encountered. Of the 8 patients undergoing the combined tube-onlay repair 3 had complications, including meatal stenosis (2) and partial dehiscence (1). CONCLUSIONS: Inlay-onlay flap urethroplasty allows correction of complex cases of hypospadias or urethral stricture with a partially deficient urethral plate in 1 stage with a low complication rate.

Adolescent↗
PubMed1997

[An artificial urinary bladder sphincter for men].

Urinary incontinence is a condition with involuntary escape of urine and causes not only medical but also social and hygienic problems. One of the causes of incontinence is insufficiency of the urethral closure mechanism which in men is usually caused by previous prostatectomy or neurogenic dysfunction of the lower urinary pathways. The method of choice is the application of an artificial sphincter (model AMS 800) to the bulbar urethra or cervix. The authors applied an artificial sphincter in 1993-1996 to one boy and 14 men aged 11-72 years. The basic components of the artificial sphincter of the urethra-AMS 800 is a cuff, balloon and pump. The whole system is filled with isotonic solution Omnipaque 300, the cuff which is 45-80 mm long is placed either round the bulbar urethra from a perineal approach or round the cervix by a retropubic approach. The pump is placed beneath the skin of the scrotum and the balloon is in a perivesical position. All parts of the AMS are connected by tubes. Because of infectious complications the authors had to explant the sphincter in two patients. In one patient it was necessary to add another cuff. The perineal approach is simpler, but is associated with a higher risk of erosion of the urethra. Patients with a neurogenic bladder had more complications than those after prostatectomy. Despite the fact that the method and aid is expensive, the treatment is very effective and makes the patients independent on other aids for incontinent patients.

Adolescent↗
PubMed1995

[The vermiform appendix and its use in urology].

There are presented new possibilities of using the appendix vermiformis in urology: Mitrofanoff's procedure (continent appendicovesicostomy), continent appendix stoma performed with the MAINZ pouch technique and continent appendicocolostomy. There was operated on 12 pts. for the neuropathic bladder using the Mitrofanoff's procedure. An ischemic occlusion of the appendicostomy was found out postoperatively in one case. All pts. but one practise clean intermittent catheterization through the appendicostomy (four to six times a day) and eight of them (67%) are continent by day and night.

Appendix↗
PubMed1995

[Surgical correction of hypospadias using a vascularized onlay flap].

The principle of the onlay technique is to create a neourethra from the preserved urethral plate to which the vascularized flap of the prepuce is applied. Thus 51 patients were operated 10 months to 27 years old, half of them were under 5 years. By this method hypospadias was treated from coronary to perineal ones. In 16 patients chordectomy was performed, in 6 plications of the cavernous bodies because of their disproportion of the ventral and dorsal side. In three instances it was necessary to transsection the urethral plate and supplement the onlay flap by tubulization of the neourethra. The method was also used in secondary strictures of the urethra after urethroplasty and in occlusions of a fistula. Complications of the neourethra were recorded in 4 (7.8%) patients. Another four patients had a partial necrosis of the skin cover. The onlay method is becoming universal for resolving the proximal variant of hypospadias, it is associated with a considerably smaller number of complications than tubulized plastic operations and makes possible a definite one-stage solution already at an early age.

Adolescent↗
PubMed1994

Development of metaphylaxis in calcium urolithiasis: a restriction of conventional drug therapy.

Between 1978 and 1992 (mean 9.2 years), metaphylaxis was introduced to 110 patients originally hospitalized for recurrent urinary calcium stones (mostly bilateral or multiple). Patients with hyperparathyroidism or with sponge kidney were excluded from the study. Until 1984, the condition had been treated mostly using conventional drug metaphylaxis (thiazides and allopurinol in 75% and 57%, respectively). After that year, there was a gradual decrease in the number of patients treated with thiazides (to 15%) and allopurinol (to 10%). This was associated with a steep rise in the proportion of patients treated with inhibitors (magnesium to 36% and citrates to 30%), or exclusively with non-medicamentous therapy (to 31%). These fundamental changes in approach have not reduced the effectiveness of metaphylaxis, and recurrence rates in individual years have not changed significantly either. Metaphylaxis was successful in 105 patients (95%) and the rate of recurrence has declined from 0.9 to 0.08 stones per year. The restriction of conventional drug metaphylaxis has entailed a marked decrease in the incidence of side effects of therapy and, consequently, a reduced need for follow-up tests and outpatient follow-up.

Allopurinol↗
PubMed1992

[A single-stage reconstruction in hypospadias using a vascularized preputial flap].

The authors submit an account of their experience with a modern method of reconstruction of hypospadias connected with the chorda. In 31 boys (10 months to 15 years) they used for reconstruction of the urethra a flap from the prepuce with a preserved vascular stalk, as described by Duckett. In the majority they transferred a double flap ("double face") where the outer sheath of the prepuce was used to cover the ventral side of the penis. In three boys the authors performed their own modification of this plastic operation. Complications developed in 12 boys (38.7%): stricture of the proximal anastomosis of the urethra (6), stricture of the meatus (1), necrosis of the skin cover (4), dehiscence (1). An open operation had to be made in the last five patients (16.1%). In all children excellent functional and aesthetic results were achieved. The above plastic operation is indicated in penile and penoscrotal hypospadias with chorda. It is a single stage operation. Due to the use of vascularized tissue and the microsurgical technique it is possible to perform a definite reconstruction of the external genitalia already by the age of one year.

Adolescent↗
PubMed1989

[Detection of metabolic disorders as a cause of urolithiasis in clinical practice].

Metabolic disorders are the most frequent risk factor for the development of urolithiasis. They are manigenic substances or deficiency of inhibitors of crystalgenic substances or deficiency of inhibitors of crystallization and aggregation. The authors use for their diagnosis a modification of Pak's procedure. It involves examination of 24-hour urine with the patient on a low-calcium diet, supplemented by urine examination on fasting and after a 1000 mg calcium load. The procedure includes also examination of serum and bacteriological examination of urine. A total of 93% of patients with calcium lithiasis had a metabolic disorder, 42% suffered from idiopathic hypercalciuria, 32% from hyperuricosuria, 19% from hyperoxaluria, 15% from magnesium deficiency and 38% from hypocitraturia. On the other hand, patients with uric acid lithiasis had a detectable metabolic disorder only in 62%. Active detection of metabolic disorders is essential for the introduction of effective, specific metaphylaxis of urolithiasis.

Female↗
PubMed1989

[Adverse effects of drug metaphylaxis of urolithiasis].

The authors examined 133 patients with urolithiasis, treated with hydrochlorothiazide and 81 patients treated with allopurinol. In those treated with hydrochlorothiazide the calciuria and Ca/creat. index declined, and uricaemia rose. After treatment uricosuria increased significantly in 41% patients. The detection of diabetes did not exceed the prevalence in the population. In patients treated with allopurinol the uricaemia and uricosuria declined, a hepatic disorder with supraliminal rise of ALT was recorded in 23% of the patients and led to discontinuation of treatment in 15% of the patients.

Allopurinol↗
PubMed1989

[Metaphylaxis of urolithiasis, methods and results].

Urolithiasis is a frequent disease greatly susceptible to recurrence. The concrements are most frequently caused by metabolical disorders. Metaphylaxis is a comprehensive and long-term regimen which should reduce the rate of recurrence. Non-specific metaphylaxis comprises a general liquid-taking and dietary regimen, specific metaphylaxis is based on the results of metabolical examination and concrement analysis. The authors present the results of comprehensive metaphylaxis in 124 patients (104 with calcium lithiasis and 22 with uric acid lithiasis). The concrement formation decreased from 1.13 of concrement per year prior to treatment, to 0.11 of concrement p. a. during treatment. After almost 5-years of follow-up and treatment, 77% patients had no recurrence, while in 94% it was substantially reduced. Metaphylaxis had no effect in 7 patients (6%). The uric-acid group showed better results than the calcium lithiasis group. The findings are comparable with literary data.

Calcium↗
PubMed1989

[Acceleration of the chemolysis of kidney stones using ultrasound. Experimental study in vitro].

The dissolution of infectious renal concrements by means of percutaneous nephrostomy or ureteral catheter often requires lavage lasting several weeks. Using an experiment in vitro, the authors tried to reduce this interval by means of ultrasound. By combination of the physical effect of ultrasound with that of chemolytic dissolution of the infectious concrement was significantly accelerated. Thus, simultaneous intermittent ultrasound application to the body's surface during dissolution could considerably reduce the time needed for the concrement to dissolve in vivo.

Calcium Carbonate↗