Biomedical subjects

Sébastien Beley

Publications and source records attributed to Sébastien Beley.

6 recordsLinked to original sources

PubMed2006

Endoscopic lithotripsy and the FREDDY laser: initial experience.

BACKGROUND AND PURPOSE: The frequency-doubled double-pulse neodymium:YAG (FREDDY) laser has been developed for endoscopic lithotripsy and combines the characteristics of solid and dye lasers with a thin flexible optical fiber enabling it to be used with flexible ureterorenoscopy. Furthermore, it is less expensive and easier to maintain than other lasers. Our goal was to evaluate its efficacy and role in the ureteroscopic treatment of urinary stones. PATIENTS AND METHODS: We used a FREDDY laser in 26 patients (29 stones). For 4 stone cases, this was the first line of treatment; for the remaining cases, this was the second line of treatment, following SWL in 23 cases and nephrolithotomy in 2 cases. The mean stone size was 9 mm, with a range of 6 to 15 mm. There were 13 renal and 16 ureteral stones. The absence of residual fragments at 3-month postoperative radiography was considered to reflect successful treatment. RESULTS: Twenty-six stones were treated with satisfactory results. Within 3 months, 18 patients were stone free (69%), and 72.4% of the stones (21/29) had been treated completely. Fragments of 8 stones still remained in 8 patients. Of these stones, 5 were >10 mm and persisted at 3 months. Fragmentation was ineffective for 2 cystine stones and poor for 1 calcium oxalate monohydrate stone. Hospitalization, on average, was 1.5 days with a range of 1 to 3 days. A ureteral perforation was observed in the case of an impacted ureteral stone. CONCLUSIONS: Because of the wavelengths used, endoscopic FREDDY laser lithotripsy is an effective and harmless method. This laser can be used as a therapeutic tool because of its moderate cost and ability to be used with flexible ureterorenoscopy. However, it is important to be aware of the FREDDY laser's limited fragmentation capabilities for cystine stones and its inability to treat tissue lesions such as urinary-tract stenosis and tumors.

Adult↗

PubMed2006

[How to anticipate specialization at the Examen National Classant (National Entrance Examination) to encourage interns to choose urology].

OBJECTIVES: To analyse the value of an introduction to urology session to recruit interns following the Examen National Classant (ENC) (National Entrance Examination). MATERIALS AND METHODS: Over a 2-year period, interns appointed to surgery in Paris participated in a one-day introduction to urology session before starting work as surgical interns. A questionnaire at the beginning of internship recorded: age, gender, teaching hospital, student attachment in urology and desired specialization as a function of the surgical training programmes proposed by the ENC. Items concerning the desired specialization were resubmitted to the interns at the end of the session. RESULTS: Population. 166 interns, 98 females (59%) and 68 males (41%) with a mean age of 24.8 +/- 5 years (range: 22-31) participated in this study. 110 interns had trained at a Parisian teaching hospital (66.2%) and 56 (33.8%) had trained at a provincial teaching hospital. 31 interns (18.7%) had completed at least one urology attachment during their medical training. Desired specialization: Orthopaedics was the discipline most frequently cited (n=48; 28.9%). Urology was selected by 19 interns (11.4%), 17 of whom had completed an urology attachment during their medical training. At the end of the introduction to urology session, another 15 interns initially oriented towards other specializations were interested in urology training. CONCLUSION: Specialization of certain surgical disciplines during internship could become inevitable in the medium term. In this case, the organization of national introduction to urology sessions in each ENC allocation region would be a solution to encourage motivated interns to immediately choose urology as their surgical speciality by preference rather than by default.

Adult↗

PubMed2005

[Management of priapism in patients with sickle-cell anaemia].

Sickle-cell anaemia is an autosomal recessive hereditary haemoglobinopathy. Patients with sickle-cell anaemia present a high risk of priapism. At least 40% of sickle-cell patients report episodes of priapism. Priapism in patients with sickle-cell tend to start during childhood and rapidly threaten the erectile prognosis. Apart from specific treatment of sickle-cell anaemia, the urologist must be able to recognize forms of intermittent priapism and promote medical prevention. The urologist must also be able to distinguish low-flow priapism from the rarer high-flow priapism, as the treatments differ. Treatment strategies are increasingly well defined, with an increasingly limited place for surgery.

Anemia, Sickle Cell↗

PubMed2005

[Improvement of the recruitment of surgery interns derived from the Epreuves Nationales Classantes (National-Ranking Exam): practical solution applied to urology].

OBJECTIVES: To analyse the value of an urology initiation session proposed to young interns to improve recruitment of the discipline since the introduction of the new National-Ranking Exam (NRE). MATERIALS AND METHODS: In October 2004, the 77 interns appointed to surgery in Paris on the basis of the ENC participated in a one-day urology initiation session organized by the AFUF, at the AP-HP School of Surgery. All interns were given a questionnaire at the beginning of the session to record the following data: age, gender, teaching hospital, a student attachment in urology and desired specialization as a function of the surgical training programmes proposed by the ENC. Items concerning the desired specialization were resubmitted to the interns at the end of the session. RESULTS: Population. 77 interns, 48 females (62.3%) and 29 males (37.7%) with a mean age of 25.2 +/- 5 years (range: 23-31). 55 interns had trained at a Parisian teaching hospital (67%) and 22 (28.6%) had trained at a provincial teaching hospital. 16 interns (20.8%) had completed at least one urology attachment during their medical training. Desired specialization. Orthopaedics was the discipline most frequently cited (n = 20; 26%). Urology was chosen by 8 interns (10.40%), who had all completed an urology attachment during their medical training. At the end of the urology initiation session, another 8 interns expressed the desire to specialize in urology. Of the 16 potential urology interns, 9 (56.2%) confirmed that their decision was final. CONCLUSION: Urology occupies a special place and remains a popular surgical speciality among students. Organization of practical sessions constitutes a solution to inform, create an emulation and motivate surgery interns to choose urology.

Adult↗

PubMed2005

[Comparative study of two latest generation flexible ureterorenoscopes].

INTRODUCTION AND OBJECTIVES: Miniaturization and development of flexible instruments have led to the development of flexible ureterorenoscopy. The objective of this study was to compare the capacities of active deflection of two latest generation flexible ureterorenoscopes and to evaluate alteration of deflection and flow of irrigating fluid in the presence of instruments in the operating channel. MATERIAL AND METHODS: Two ureterorenoscopes were evaluated in this study. The Karl STORZ Flex-X and the ACMI DUR-8 Elite. Comparison of deflection movements was performed ex situ by super-imposing all active movements of the two ureterorenoscopes. Alteration of deflection was performed by alternately placing an extraction or fragmentation instrument of variable dimensions in the operating channel. Alteration of flow was also assessed in the presence of the same instruments. RESULTS: The ex situ deflection capacities of the DUR-8 Elite flexible ureterorenoscope were more extensive than those of the Flex-X, but it was more complicated to manipulate. Alterations of deflection and flow of irrigation fluid were comparable for the two ureterorenoscopes. CONCLUSION: On the basis of these data, we can confirm that the two latest generation ureterorenoscopes present comparable capacities, but different functioning modalities. We therefore recommend that each operator test the two ureterorenoscopes to become familiar with their manipulation. Other studies are necessary to evaluate the optical properties, ease of use in clinical practice and fragility of these new ureterorenoscopes.

Equipment Design↗

PubMed2005

[Endoscopic lithotripsy and FREDDY laser technology. Initial experience].

INTRODUCTION AND PURPOSE: FREDDY laser technology was developed for endocorporeal lithotripsy. The purpose of this study was to evaluate, based on our initial experience, the efficacy and place of this technology in the treatment of urinary calculi by ureterorenoscopy. (World of Medicine) to treat 26 patients (29 stones) by ureterorenoscopy. This was the second procedure for 25 stones: after ESWL (23 cases) or percutaneous nephrolithotomy (2 cases) and the first procedure for 4 stones. The mean stone diameter was 9 mm (range: 6-15 mm). Thirteen stones were situated in the kidney and 16 were in the ureter. Success of treatment was defined by the absence of residual fragments immediately after the operation or at one month on plain abdominal x-ray. RESULTS: Twenty-six stones were satisfactorily fragmented. At three months, 21 out of 26 (80.7%) patients were stone-free corresponding to 21 out of 29 (72.4%) stones). Failures concerned 8 stones (5 patients). For five stones, measuring more than 10 mm, residual fragments persisted at three months. For three other stones, two cystine stones and one calcium oxalate monohydrate stone, fragmentation was insufficient or even nonexistent for the cystine stones. The mean length of hospital stay was 1.5 days (range: 1-3 days). A ureteric perforation due to a stone impacted in the ureteric wall was observed. CONCLUSIONS: FREDDY laser endoscopic lithotripsy is a safe and effective method due to the wavelength used. This laser could constitute an alternative treatment option in view of its moderate cost and the fact that it is adapted to flexible ureterorenoscopy. However, it presents certain limitations in terms of fragmentation, particularly in the case of cystine stones, and cannot be used to treat solid lesions (urinary tract strictures and tumours).

Adult↗