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R de Petriconi

Publications and source records attributed to R de Petriconi.

At least 19 recordsLinked to original sources
PubMed1996

The ileal neobladder in women: 9 years of experience with 18 patients.

PURPOSE: We present our surgical and functional experience with orthotopic bladder replacement in women. MATERIALS AND METHODS: Since 1986, 18 women have undergone lower urinary tract reconstruction with an ileal neobladder. A nerve sparing cystectomy is done, and reservoirs are connected to the proximal urethra or urethrovesical junction. A total of 13 patients was available for complete followup as of March 1995. RESULTS: There were no perioperative deaths and few early complications. The only 2 failures were a neobladder vaginal fistula and these cases, which were converted to a conduit, are excluded from this study. Late complications requiring rehospitalization or reoperation in 2 patients included urethroileal stenosis that had to be dilated without further sequelae and bilateral ureteroileal stenosis that was treated endoscopically. At 3 months postoperatively excellent continence was achieved in 8 patients, while 2 had grade 1 stress incontinence and 3 were hypercontinent. As of March 1995 only 4 patients voided to completion while 9 required intermittent catheterization (continuously in 5 and twice daily for residual urine in 4). We were unable to demonstrate a functional difference of the various resection lines located at the proximal urethra or urethrovesical junction. CONCLUSIONS: Urethral support and nerve sparing cystectomy plus the ileal neobladder as a reservoir guarantee excellent continence in all patients. Despite our efforts, we have been unable to demonstrate any advantage of the nerve and urethral support sparing cystectomy technique as far as micturition is concerned. The development of hypercontinence in 70% of the patients with time demonstrates that our current understanding of the functional and anatomical basics of the voiding process is too limited to allow bladder replacement with a perfect functional result in all female patients. Our long-term experience, which is different from initial reports, justifies creation of an ileal neobladder in select female patients as long as they accept a 70% risk of clean intermittent catheterization in the long term. Overall patient satisfaction, including sexual life, is exceptional. However, disappointment is considerable when clean intermittent catheterization is required after periods of successful voiding per urethram.

Cystectomy↗
PubMed1995

Renal pelvis rupture after blunt abdominal trauma.

A 45-year-old male patient presented with rupture of the left renal pelvis after blunt abdominal trauma. The patient had preexisting bilateral megaureters with secondary obstruction of the pyeloureteral junction. The underlying disease was a persisting type III posterior urethral valve. Diagnosis of renal pelvis rupture and the underlying malformation was achieved sonographically and by abdominal CT scan. The left kidney was exposed at the time of admission and a pyeloplasty according to Anderson-Hynes was carried out. Secondarily the urethral valve was resected.

Abdominal Injuries↗
PubMed1995

[Nerve-sparing cystectomy technique in the woman].

With the advent of the nerve-sparing and urethral-support-sparing cystectomy technique, the urethral closure mechanism and the rhabdosphincter muscle of the lower urethra are left intact. The fibers of the interior hypogastric plexus supporting the urethra and the vagina remain intact. The autonomic nerve fibers are particularly at risk at two points: where they cross under the ureters between the uterine and vaginal arteries and in the bladder neck area. In both areas damage must bei avoided by careful dissection. The endopelvic fascia is incised immediately lateral to the posterior urethra at the urethrovesical junction. As much as possible of the urethropelvic ligament and the paraurethral vascular and nerve plexus must be saved. The urethrovesical junction is dissected off the anterior vaginal wall down to the posterior bladder wall. The cardinal ligaments are divided well anterior to avoid the pelvic plexus. The superior vesical artery and uterine vessels are cross-clamped, cut and tied. Once the uterine artery is transsected, the distal ureter comes into view and can be isolated, avoiding damage to the nerve fibers. The vaginal cavity is entered by a transverse incision, and the edges of the vaginal incision are held open with Ellis clamps. The distal stump of the ureter following its division is pulled medially to facilitate dissection of the lateral bladder wall. The perivesical vascular plexus and the inferior hypogastric plexus, which is located laterally to the vessels, are separated from the lateral wall of the bladder and vagina. (ABSTRACT TRUNCATED AT 250 WORDS)

Autonomic Nervous System↗
PubMed1995

Continuous in situ cold perfusion with histidine tryptophan ketoglutarate solution in nephron sparing surgery for renal tumors.

PURPOSE: In transplantation medicine the superiority of Bretschneider's histidine tryptophan ketoglutarate solution has been demonstrated in various animal investigations and in donor organs under clinical conditions. Because of the wide use of ultrasound scans and computerized tomography there has been a sharp increase in the number of small renal tumors detected. Therefore, efficient protection methods designed to conserve kidney tissues are attracting growing attention. MATERIALS AND METHODS: We report on 11 patients with space-occupying lesions involving a solitary kidney. All tumor resections were performed under continuous in situ perfusion with Bretschneider's solution. Even when dealing with extensive tumors involving the hilum, complete resection and reconstruction of the kidney in situ proved feasible. RESULTS: The mean cold ischemia time was 62.1 minutes (range 18 to 88) and mean Bretschneider's perfusion volume was 2,875 cc. The kidneys resumed excretion within an average of 16.8 minutes (range 0 to 60) and no patient required dialysis. Apart from temporary elevation of serum creatinine levels, postoperative renal function was unimpaired. There were no changes in serum electrolyte levels and no disorders of cardiac conduction. One kidney was lost postoperatively due to renal artery embolism. CONCLUSIONS: Continuous in situ perfusion with Bretschneider's solution is a new and interesting method for patients undergoing partial nephrectomy. Particularly for locally extended tumors, this procedure is highly efficient for intrarenal surgery.

Aged↗
PubMed1994

[Venous tumor invasion by renal cell carcinoma. Surgical technique, complications and survival rate].

Renal cell carcinoma invades the vena cava in 4-10% of cases. Another 10% of patients present with invasion of the renal vein. The surgical approach, complications and long-term outcome of 95 patients were investigated. Intraoperative complications occurred in 1 of 73 patients with involvement of the renal vein and 5 of 22 patients with vena cava thrombus. One patient in each group died due to pulmonary emboli in the perioperative period. Minor renal insufficiency occurred in 39 (54.2%) and 11 (50%) of the patients respectively. The rates of minor complications such as wound infections, haematoma and pneumonia were similar in the two groups. The mean intra-operative blood loss of 780 ml in patients undergoing tumour nephrectomy was significantly lower than the blood loss of 1485 ml in patients with tumour thrombus extension into the vena cava. The 5-year survival rate of patients with V1 tumours (71%) is comparable to that of patients without venous involvement. Tumour extension into the vena cava (V2) influences the 5-year survival rate significantly, decreasing it to 56.7%. In conclusion, long-term survival can be achieved for patients with renal cell carcinoma and venous involvement, though for patients with lymph node metastases or distant metastases only short-term palliation can be achieved. However, the potential benefits should be carefully weighed against the possible complications, the surgical morbidity and the resources expended in vena cava resection.

Adult↗
PubMed1993

[The biofragmentable Valtrac ring--a reliable concept for enteral anastomosis?].

In a retrospective investigation, 54 patients with 55 enteric anastomoses performed with the new biofragmentable Valtrac ring were examined. In 45 patients with disease of the colon partial resection of the large bowel had been performed. In 9 patients undergoing urinary diversion an end-to-end ileostomy was performed. The most important advantage of this device is that its use is achieved by way of a safe and quick technique which is easy to learn. Bowel stenosis, bleeding and other complications independent of anastomotic technique, such as wound infection, were no more frequent than after conventional suture anastomosis. In 3 patients an anastomotic leakage appeared. In 1 of these cases conservative management for a colocutaneous fistula was successful, but the other 2 patients had to undergo a second operation. In our opinion, the Valtrac system offers a convincing and reproducible alternative to conventional anastomotic techniques and it is easy to learn how to apply it.

Adult↗
PubMed1992

[Kidney carcinoma in Bourneville-Pringle disease].

We report a case of renal cell carcinoma in a 28-year-old woman with Bourneville-Pringle's disease. A review of the literature revealed 16 cases of renal cell carcinoma associated with tuberous sclerosis. The incidence of angiomyolipoma among patients with Bourneville-Pringle's disease is cited in the literature as 40-80%, but this is based solely on two early publications, while other publications suggest a considerably higher incidence of renal cell carcinoma in Bourneville-Pringle's disease, as in other phacomatoses (Hippel-Lindau's disease). We therefore recommend screening for renal cell carcinoma in patients with Bourneville-Pringle's disease.

Adult↗
PubMed1991

The ileal neobladder. Operative technique and results.

Bladder substitution by continent bowel reservoirs has been one of the real advancements in modern urology. Short-term experience with and patients' acceptance of the ileal neobladder have been excellent. As do others, we consider this technique to date the procedure of choice in male patients requiring radical cystectomy.

Adult↗
PubMed1988

[Low-pressure ileal neobladder formed by antimesentery section of circular smooth muscle fibers].

The goal of this presentation is to describe operative technique and first clinical results of a ileal neobladder for total bladder replacement. Creation of an ileal neobladder for total bladder replacement is described in 18 patients. To achieve a low pressure system, disruption of directional bowel peristalsis with a longitudinal incision at the antimesenteric border of a 70 cm ileal segment is performed. A spherical pouch, the neobladder, is fashioned and anastomosed to the urethra. The ureters are implanted according to Le Duc and Camey. Videourodynamic studies during various postoperative phases demonstrate this neobladder to be a urinary reservoir with a capacity approximating that of a normal bladder, good compliance during filling by maintaining pressures lower than 30 cm water and no reflux. Advantages of this procedure when compared with "Kock's pouch", "Mainz pouch", "Camey's ileal bladder" or "the Bag" are: non interference with terminal ileum and Bauhin's valve (vitamin B 12 absorption); simple, sure surgical technique giving constant results (absence of invagination, and of rotation on mesenteric axis as in Kock's pouch); sensitivity of new bladder with rhythmicity of micturition in 18 cases; lowest intracavitary pressures of all reconstructed reservoirs.

Humans↗
PubMed1986

[Spontaneous rupture of the kidney. Apropos of a case of Kussmaul-Meier panarteritis nodosa].

A patient with periarteritis nodosa presented with purely intra-abdominal visceral manifestations. This form of the affection, in the absence of subcutaneous granulomas allowing histologic examination, can be revealed only by celiac and renal angiography, results being pathognomonic. As a function of the organ involved the clinical picture can be dramatic, with rupture of parenchymatous organs affecting vital prognosis and requiring immediate surgery.

Adult↗
PubMed1984

[Intravesical explosion during endoscopic resection. Apropos of a case].

Intravesical explosion during endoscopic resection are rare but may be devastating in effect, as shown by the case reported. The formation of explosive gas, essentially an air-hydrogen mixture, results from carbonization of tissues (particularly with the coagulation current) and the introduction of air into the bladder during manipulation of the resector. The nature of the bladder infusion liquid does not appear to play an important role. Prevention implies the use of a coagulation current of moderate power, the avoidance of air entering the bladder accidentally, and the continuous or repeated evacuation of the air bubble under the bladder vault.

Cystoscopy↗
PubMed1984

[Diagnosis and emergency treatment of traumatic rupture of the male urethra in pelvic fractures. Apropos of 14 cases].

Fourteen of 400 cases of fractured pelvis had rupture of the urethra and, unfortunately, an exploratory catheter was introduced in nearly all these patients. Routine radiological investigations were not conducted, and true emergency surgical repair was performed in only 3 cases, all of these three patients obtaining good urethral permeability. Analysis of data on recently published cases and from the present series shows that opposing views are still held by those who support immediate, emergency (true or deferred) end-to-end suture of the urethra, and those who advocate simple suprapubic drainage of the bladder or "realignment" of the urethra over an indwelling catheter with or without a direct approach to the site of rupture. However, carefully executed immediate end-to-end suture gives better results than other methods, and also considerably reduces duration of hospital stay and incapacity for work.

Adult↗
PubMed1984

[Treatment of primary vesico-renal reflux in adults. Apropos of 41 cases].

Between October 1970 and March 1983, forty one adults (thirty six women and five men) were treated for vesico-ureteral reflux. Fifteen were treated medically and twenty six surgically. In the latter category, four total nephrectomies were performed, one nephrectomy of the upper pole of a duplicated kidney, and twenty one antireflux ureterovesical reimplantations, involving thirty four ureters. The procedures used were Cohen's (26 cases) and Leadbetter-Politano (7 cases). The procedure used in one case is not recorded. The reflux was eliminated in all the cases, except one, which was a reoperation for ureteral stricture in a patient previously treated for reflux in another hospital. Of the sixteen patients with urinary infections, five remained infected despite the elimination of the reflux. IVP and isotopic exploration of kidney function revealed no postoperative change in the majority of the patients. Two patients, suffering from renal insufficiency preoperatively, required dialysis two and four years, respectively, after the elimination of the reflux.

Adult↗
PubMed1984

[Bladder duplication. A case report].

Duplication of the bladder is uncommon and rarely occurs as an isolated anomaly. This anomaly is classified as complete duplication, incomplete duplication, complete sagittal septum and incomplete sagittal septum. We present the case of a 7 month old child which had recurring pyuria.

Diagnosis, Differential↗
PubMed1983

[Panarteritis nodosa--a urologic problem?].

A case of panarteritis nodosa with renal and intraabdominal symptoms is described. Diagnosis of this visceral form of this rare disease is extremely difficult, and in the absence of subcutaneous granulomata can only be made on angiography. Depending on the site affected, visceral disease can lead to life threatening internal haemorrhage which in most cases has to be treated surgically.

Adult↗