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Biomedical subjects

R M Scarpa

Publications and source records attributed to R M Scarpa.

At least 37 records · Page 2Linked to original sources
PubMed2000

Large benign prostatic hyperplasia means impossible ureteroscopy: myth or reality?

OBJECTIVE: We intended to ascertain the true role played by large-size prostatic glands with BPH in impeding ureteroscopy; since no such impediment was experienced by the authors, we then listed the most frequent obstacles to ureteroscopy, contrary to what is commonly reported in literature. MATERIALS AND METHODS: Endourological reports on a series of 2,147 diagnostic or therapeutic ureteroscopies were examined, together with the patients' clinical records. Male patients accounted for 1,288 cases. In 45 cases, the operators found the prostate so enlarged as to be worthy of note. In 9 of these cases, the procedure was performed bilaterally; thus, a total of 54 ureteroscopies was undertaken in patients with enlarged prostates or large median lobes. RESULTS: None of the surgical reports indicated that the ureteroscopic procedure was hindered by an enlarged prostate. On the other hand, the most frequent causes preventing ureteroscopy are, for both male and female patients, some types of tumor: uterine, ovarian, ureteral, bowel, bladder and prostate cancer, and inflammation. CONCLUSIONS: Benign prostatic hypertrophy (BPH) is not of itself an impediment to ureteroscopy when it is performed by an expert operator equipped with suitable instruments. On the other hand, tumours of the female reproductive system, as well as bladder and prostate tumours and serious inflammations and infections may make the procedure impossible or cause serious problems during its performance, at times requiring combined antegrade and retrograde maneuverings. At the root of this obstacle lies neoplastic or inflammatory infiltration and stiffening which attaches itself to the organs and hardens their connections. In the case of BPH, we do not find infiltration, but only a dislocation, which can be compensated by means of a few technical stratagems. Some interesting expedients in the incannulation of difficult meatuses were already suggested in 1914 by Heitz-Boyer and Marion.

Adult↗
PubMed2000

Human ejaculatory duct: parameters of smooth muscle motor activity and modulatory role of autonomic drugs.

The contractile behaviour and effects of several autonomic drugs on the motor activity of human isolated ejaculatory ducts were investigated. Ejaculatory ducts exhibited spontaneous contractions characterised by an amplitude of 2.35 +/- 0.28 mN, a duration of 62. 9 +/- 3.72 s and a frequency of 0.64 +/- 0.014 waves min-1. Acetylcholine (10-5-10-4 m) induced a slight increase in basal tone and in the frequency of the contraction waves. These effects were suppressed by atropine (10-4 m). Noradrenaline (norepinephrine) increased the basal tone and frequency of spontaneous contractions in a dose-dependent manner. These responses were competitively inhibited by HEAT, a selective a1-adrenoceptor antagonist. These preliminary functional findings, indicating the presence of spontaneous motor activity of human ejaculatory ducts and its possible control by adrenergic agonists, suggests a physiological role for human ejaculatory duct in the propulsion of semen from the seminal vesicle towards the urethra.

Acetylcholine↗
PubMed1999

Evaluation of morbidity of multi-channel pressure-flow studies.

This prospective study was carried out to evaluate the morbidity and complication rate of invasive urodynamics of the lower urinary tract after receiving oral antibiotic prophylactic treatment. A total of 105 patients, 55 men and 50 women, were included in the study and underwent pressure flow study (PFS) as part of the diagnostic assessment. Clinical diagnosis was prostatic obstruction from benign prostatic hyperplasia (BPH) in men and stress urinary incontinence or voiding dysfunction in women. Urine was screened for infection both before and after testing, and the incidence of urinary tract infections (UTI), dysuria, and other complications were assessed at 1-week follow-up to evaluate post-investigation morbidity. Dysuria of mild degree was experienced by 33% of patients, with no significant difference between male and female patients. Post-investigational UTI and fever were reported in 3.6% of men and 4% of women. Six patients had macroscopic hematuria of mild degree. No patient had urinary retention or severe complaints after the investigation and no patient required hospitalization. Post-void residual volume was higher in men with BPH obstruction compared to women; a significant difference between post-investigational UTI and residual volume could not be demonstrated (P = 0.8). We conclude that the objective morbidity rate of invasive urodynamic investigation is low. Mild dysuria is common, while severe complications, fever, and hematuria are seldom reported, and the risk of developing UTIs is low with antibiotic prophylaxis, with no significant difference between men and women. Neurourol. Urodynam. 18:647-652, 1999.

Adult↗
PubMed1999

Urodynamic analysis of voiding dysfunction in orthotopic ileal neobladder.

We examined the urodynamics, particularly voiding dysfunction, in patients with a neobladder. Free uroflowmetry, pressure-flow study, and voiding cystourethrography were performed in 22 patients (mean age 65 years) at a mean of 21 months after ileal neobladder substitution. The results of free uroflowmetry were used to divide patients into two groups: the good voiders and the poor. Daytime continence was achieved in all patients, while 10 (45%) had nighttime continence. To void 250 ml urine the good voiders strained 2 +/- 1.5 times, and the poor voiders 6 +/- 5 times. The neobladder neck was at the most caudal portion of the reservoir in good voiders, and there was wide funneling. In the group with poor emptying ability, the outlet was not located at the most dependent position. The principal factors for ensuring good voiding function in neobladder patients are the ability to perform effective straining and the location of the neobladder neck.

Adult↗
PubMed1999

Holmium:YAG laser ureterolithotripsy.

OBJECTIVE: To report on the experience obtained in the treatment of a series of 150 cases of ureteral stone disease by means of the holmium:yttrium-aluminum-garnet (Ho:YAG) laser. METHODS: One hundred and fifty consecutive cases treated by means of Ho:YAG laser ureterolithotripsy have been reviewed in order to assess the results. In 81 cases the stones were located in the lower third, in 47 in the medium third, and in 22 cases in the upper third of the ureter. The laser was set at a power of 8-10 W and at a frequency of between 6 and 10 Hz. Thin ureteroscopes were selected, such as the 7-Fr Gautier or the new ultrathin 4.8-Fr Wolf instrument. In some cases other ureteroscopes were chosen. RESULTS: Lasertripsy was effective in every kind of stone, allowing fragmentation into portions measuring at most 4 mm (largest diameter) or disintegration. The clearance rate of the stones was 92.6% during the 30-day follow-up period. Calcium dihydrate stones were of course more easily broken than monohydrate ones. No damage to the ureter was observed following the vaporization which is produced by this kind of laser, since particular attention was paid to avoid any contact between the laser beam and the ureteral mucosa. In some instances ureteroscopic maneuvering provoked some slight lacerations. In a few cases accidental contact of the laser beam with the ureteral mucosa produced extremely small coagulations of no immediate or postoperative relevance. CONCLUSIONS: The Ho:YAG laser constitutes an effective instrument for the fragmentation of any kind of ureteral stone; it allows the use of thin or ultrathin instruments and, if manipulated with care, does not damage the ureteral mucosa or the ureteral wall.

Humans↗
PubMed1999

[Temporary retrograde and anterograde ureteral catheterization].

This article examines the technical modalities or ureteral catheterization. The authors also discuss unconventional modalities which, if used without prejudice, can sometimes constitute brilliant and economic solutions to complex problems which are often impossible to resolve otherwise. After a summary of the history of ureteral catheterization, the authors present the main indications for temporary ureteral catheterization: radiographic and fluoroscopic examination of the ureter; separate cytological harvesting; separate bacteriological harvesting; confirmation of the side of unilateral haematuria; preliminary temporary dilatation of the ureter to prepare it for ureteroscopy; temporary drainage of the excretory tract after endourological investigation. The authors also present particular situations may be observed temporary catheterization, or even permanent stenting, for example in the case of procedures in children, pregnant women and renal transplant recipients.

Adult↗
PubMed1998

Transurethral electrovaporization of the prostate in benign prostatic hyperplasia. Evaluation of results using different urodynamic parameters.

We studied the obstruction-relieving capabilities of transurethral electrovaporization of the prostate (TVP) in 32 symptomatic patients with benign prostatic hyperplasia (BPH). Urodynamic studies with pressure-flow analysis were performed before and 6 months after treatment. All 32 patients showed significant improvement of both subjective and objective obstruction parameters. There were few postoperative irritative symptoms and one patient required recatheterization. In conclusion, TVP is a promising modification of performing transurethral resection of the prostate, and it is indeed capable of relieving bladder outflow obstruction.

Aged↗
PubMed1998

Ureteroscopic approach to early postoperative ureteral obstruction in the renal transplant patient.

The ureteroscopic treatment of acute postoperative ureteral obstruction in a kidney transplant patient is presented. This approach was made possible by the use of thin instruments, which do not require predilation, and was chosen in place of antegrade nephrostomy or open surgical access. The concept that the ureteroscope must be adapted to the ureter and its characteristics and not vice versa is stressed. The increasingly widespread availability and use of thin and ultrathin ureteroscopes will ensure that this approach is likely to become the rule rather than the exception in the future.

Acute Disease↗
PubMed1998

Urinary symptoms in women with gynecological disorders: the role of symptom evaluation and home uroflowmetry.

OBJECTIVE: The aim of our study was to analyze the effect of gynecological dysfunction on voiding symptoms in women. METHODS: A modified AUA symptom index questionnaire was self-administered and an ambulatory home uroflowmetry was performed, using a specially designed home uroflowmetry apparatus for multiple flow measurements. Urinary symptoms and home uroflowmetry (Home Urodata TM System) were evaluated in 68 women: 34 patients with gynecological dysfunction, and 34 normal controls. A total of 156 urination episodes was recorded, with a mean of 5.4 measurements per patient. RESULTS: Symptom index showed lower values in the group of normal controls than in the group with gynecological dysfunction. Voided volume, peak flow rate and average flow rate were all significantly better in the group of normal controls than in the group with gynecological disorders; the most remarkable changes were observed in patients with genital prolapse and with large uterine fibroma. In both groups the total urine volume was lower between midnight and 8 a.m. (2460 ml), if compared with the total urine volume between 8 a.m. and 4 p.m. (3360 ml) and the total urine volume between 4 p.m. and midnight (3072 ml) (p < 0.05). CONCLUSIONS: Noninvasive home uroflowmetry combines the information of a typical flowchart with uroflow parameters and supplies the physician with multiple consecutive voiding episodes, minimizing the environmental artifacts of the study. In our experience it was found to be useful to evaluate urinary symptoms reported by 18/34 patients (52.9%) with gynecological dysfunction. It can help to select which patients require further urodynamic investigation to improve the diagnostic accuracy and choose the correct treatment.

Adult↗
PubMed1997

Urolume double prosthesis in the treatment of complex urethral strictures: a 5-year follow-up case report.

The 5-year follow-up of the implantation of a UroLume double urethral stent in 2 patients with recurrent, post-traumatic urethral strictures is presented. The double implantation for each patient was done by the long extension of the urethral lesion. Only 1 patient presented a single phosphatic concretion in the implantation area during the extended follow-up. Urinary flow rates remained absolutely normal. Sexual life was unaffected. This simple modification of the UroLume implantation may offer effective treatment for extended and recurrent posterior urethral strictures in young sexually active men, for almost 5 years without early or delayed complications of clinical relevance.

Adult↗
PubMed1997

Urinary tract dysfunction in multiple sclerosis: is there a relation with disease-related parameters?

The lower urinary tract is affected by multiple sclerosis in many patients. We screened urologically and neurologically 120 patients with a confirmed diagnosis of multiple sclerosis. The mean age was 42 years (range 22 to 69 years). Urodynamic investigation as well as neuro-urophysiological investigations were performed in all patients. Renal ultrasound was used to study morphology, and excretory urogram (IVU) was used to assess renal function and the upper urinary tracts in 105 patients. Obstructive symptoms were found more commonly than irritative symptoms. The urinary symptoms were found to be related to disease duration and not to disability status. Urodynamic abnormalities were statistically significantly related to disease duration (X2 = 38.51; P = 0.0001), and to the disability status (X2 = 76.70; P = 0.0001). Few patients, only 3.3%, had upper urinary tract dilatation. With medical management, hydronephrosis disappeared in all of the patients and did not recur. A combination of oral pharmacological agents and clean intermittent catheterization was used in the majority of the patients. We conclude that lower urodynamic abnormalities can be present in every patient with multiple sclerosis, and appear to be related to disease duration and disability status, thus early treatment based upon urodynamic evaluation and close follow-up can reduce morbidity and improve the quality of life.

Adult↗
PubMed1997

Results of treatment of refractory interstitial cystitis with intravesical hyaluronic acid.

Interstitial cystitis is a chronic benign disease of the bladder that causes bothersome and debilitating symptoms and mainly affects women. Since interstitial cystitis (IC) might result from a defective glycosaminoglycan layer of the bladder epithelium, we conducted a trial of hyaluronic acid (HA), used intravesically, to test its activity in the treatment of this disease. A total of 10 patients with typical findings of IC were included. Following bladder catheterisation, the patients received a dose of 40 mg, weekly for 6 weeks, and then monthly. Response to therapy was evaluated by comparing the pre-treatment and post-treatment symptom scores and voiding diaries. There was a 30% positive response rate at week 6, which was maintained until week 24. No significant local or general side-effects were noted during the course of treatment. Although we recorded a low incidence of success in our group of patients, the results of our limited study were satisfactory in the group of responsive patients (30%), who had no relapses during the observation period of 6 months. The intravesical administration of HA was well tolerated in all cases.

Administration, Intravesical↗
PubMed1997

Severe recurrent ureteral stricture: the combined use of an anterograde and retrograde approach in the prone split-leg position without X-rays.

We report on a 50-year-old woman first treated by us in 1990 for uroseptic fever. Urography showed occlusion of the terminal tract of the lower third of the left ureter. The patient was submitted to successful left ureteroneocystostomy (UNCS). Three months later, she had a relapse of uroseptic fever, and urography showed right ingravescent dilation and excellent functional activity of the left urinary tract. Right UNCS was performed. A further relapse on the right side was again treated with UNCS and psoas-hitch bladder, but both the dilation and the occlusion persisted. Considering the state of the patient, and in order to remove the right nephrostomy that had been applied in the meantime, and to reduce the state of inflammation in view of further surgery, it was decided to treat the right ureteral total stenosis with ureteroscopic resection through the ureter facilitated by an other luminous flexible ureteroscope inserted upstream via nephrostomy. This technique is based on concepts searching for stenotic ureteral zones in transplanted kidneys, with the help of an adequate luminous catheter. An X-ray follow-up 9 months later evidenced that the maneuver was totally successful.

Anastomosis, Surgical↗
PubMed1996

Behçet's disease and the neuropathic bladder: urodynamic features: case report and a literature review.

We report on a 16-year old patient with a neuropathic bladder secondary to Behçet's disease, which is an uncommon vasculitis usually involving venules. The genitourinary manifestations of this disease are discussed, a neuropathic bladder being a rare complication of the involvement of the nervous system. Urodynamic assessment is important when voiding dysfunction is present; three patients previously reported revealed a bladder function changing from normal detrusor to overactivity. Our patient showed early and severe involvement of the nervous system, and detrusor areflexia two years after the onset of the disease. Spontaneous voiding was restored two months after urological management (intermittent catheterization) was started.

Adolescent↗
PubMed1996

Evaluation of bladder contractility in men undergoing transurethral resection of the prostate.

OBJECTIVE AND METHODS: We analyzed preoperative and postoperative urodynamic parameters in 26 patients who underwent transurethral prostatic resection with the aid of a computer program. The parameters URA, W and Wmax were evaluated: URA affords a monitoring of the removal of obstruction, while Wmax and W function monitor changes in detrusor contractility, which appear significant after prostatic resection in obstructed patients. RESULTS: Many patients had a fading contraction, that is detrusor contractility decreased during micturition: in most of them the removal of obstruction restored this pattern to normal. CONCLUSION: Evaluation of these parameters is recommended for preoperative assessment and postoperative follow-up.

Follow-Up Studies↗
PubMed1996

Diagnosis and treatment of ureteral calculi during pregnancy with rigid ureteroscopes.

PURPOSE: There is still excessive debate as to the preferred diagnostic and therapeutic approach to urolithiasis in pregnancy. We report our experience with 15 pregnant patients with renoureteral colic marked by pain not responsive to analgesia, dilatation and fever. We focused on the usefulness of ureteroscopy with thin instruments and ultrasound in the diagnosis and treatment of ureteral stone and ureteral colic during pregnancy. MATERIALS AND METHODS: Between 1990 and 1993 we performed ureteroscopy and ureterolithotripsy on 15 pregnant patients 16 to 30 years old. Gestation time ranged from 20 to 34 weeks. All patients underwent ureteroscopy with thin rigid 7.0F or 9.5F ureteroscopes without dilation of the ureteral meatus. The use of ionizing radiation was avoided before, during and after the procedures. A stone was extracted from the lower third of the ureter in 2 cases, displaced into the kidney from the middle third of the ureter in 3, and fragmented with the pulsed dye laser in 3, the holmium:YAG laser in 3 and the ballistic lithotriptor in 2. Finally absence of ureteral calculi was confirmed in 2 cases. A double pigtail ureteral catheter was placed via echographic guidance in 14 cases to monitor curling of the pigtail in the renal pelvis, while in 1 a cylindrical ureteral catheter was used. In 5 cases no anesthesia was necessary, while 10 required neuroleptic analgesia. RESULTS: There were no complications after the procedure. All pregnancies were full term. CONCLUSIONS: Rigid ureteroscopy may be performed on the entire urinary tract even during advanced pregnancy. Stones may be fragmented, extracted or displaced and double pigtail ureteral catheters may be applied with only sonographic guidance, at times without use of anesthesia. The use of small instruments, such as the Gautier ureteroscope, that do not require dilation or any particular manipulation of the ureteral meatus seems to be essential together with an accurate ureteroscopic technique. In this manner it is possible to diagnose and treat ureteral calculi during pregnancy without resorting to ionizing radiation but using only ultrasound monitoring and ureteroscopy.

Adolescent↗
PubMed1995

Ureterolithotripsy in children.

OBJECTIVES: The pediatric application of ureteroscopy was initially hindered by the size of the instruments and the fear of damaging the urethra and ureterovesical junction during endoscopic maneuvers. This review of our experience is focused on the usefulness of thin and ultrathin ureteroscopes such as the 7 F Gautier rigid ureteroscope with rod lens optics (Wolf) or the new, ultrathin 4.8 F Wolf ureteroscope, semirigid, fiberoptic, in conjunction with atraumatic sources of energy such as pulsed dye laser or ballistic lithotripter, for the treatment of ureteral stones in children. METHODS: Between 1989 and 1994, we performed ureteroscopy and ureterolithotripsy on 7 children less than 10 years old. There were 6 male patients and 1 female patient, with a mean age of 6 years (range, 3.5 to 10). We used the pulsed dye laser Pulsolith and the ballistic lithotripter Lithoclast, the Gautier (Wolf) rigid, rod lens ureteroscope (7 F), without the sheath or the blunt needle 4.8 F semirigid (Wolf), fiberoptic ureteroscope. In all cases a double pigtail ureteral catheter was left in situ. RESULTS: In all 7 cases, the treatment was successful without early or delayed complications. In particular, no case of vesicoureteral reflux was observed in any of the children during subsequent follow-ups. CONCLUSIONS: This article demonstrates the feasibility of ureteroscopy and ureterolithotripsy in children less than 10 years old with ureteral stones. We believe that because of the fragility of the ureter in the pediatric age group, ureteroscopic maneuvers should be performed and handled by experienced endourologists in well-equipped centers.

Child↗