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Stéphane Droupy

Publications and source records attributed to Stéphane Droupy.

10 recordsLinked to original sources
PubMed2004

A prospective randomized trial comparing tension-free vaginal tape and transobturator suburethral tape for surgical treatment of stress urinary incontinence.

OBJECTIVE: The purpose of this study was to prospectively and randomly compare tension-free vaginal tape (TVT) with transobturator suburethral tape (T.O.T.) for the surgical treatment of stress urinary incontinence (SUI) in women. STUDY DESIGN: Sixty-one women with SUI were randomly assigned to either TVT (n=31) or T.O.T. (n=30). The preoperative evaluation included a quality-of-life questionnaire and a comprehensive urodynamic examination. The 1-year outcome included a detrusor pressure-uroflow study to compare bladder outlet obstruction. RESULTS: Patient characteristics, preoperative quality of life, and urodynamic evaluation were similar in the 2 groups. Mean operative time was significantly shorter in the T.O.T. group (15 min+/-4 vs 27 min+/-8, P<.001). No bladder injury occurred in the T.O.T. group versus 9.7% (n=3) in the TVT group (P>.05). The rate of postoperative urinary retention was 25.8% (n=8) in the TVT group versus 13.3% (n=4) in the T.O.T. group (P>.05). The rates of cure (83.9% vs 90%), improvement (9.7% vs 3.3%), and failure (6.5% vs 6.7%) were similar for the TVT and T.O.T. groups, respectively. The 1-year outcome data were collected in 29 women of the TVT group and 27 women of the T.O.T. group. No vaginal erosion occurred in either of the groups. In terms of bladder outlet obstruction, no differences were found after TVT and T.O.T. CONCLUSION: T.O.T. appears to be equally efficient as TVT for surgical treatment of stress urinary incontinence in women, with no reduction of bladder outlet obstruction at 1-year follow-up.

Adult↗
PubMed2004

Transobturator tape (Uratape): a new minimally-invasive procedure to treat female urinary incontinence.

OBJECTIVE: Assessment of one-year results of a new technique of transobturator suburethral tape in the treatment of female stress urinary incontinence. METHODS: UraTape, a non-woven, non-elastic polypropylene tape with a 15 mm long central (suburethral) silicone-coated section was inserted via the transobturator route. The tape is inserted tension-free in a horizontal plane underneath the middle of the urethra between the two obturator foramens. The ends of the tape are tunnelled percutaneously with a tunneller. As the retropubic space is preserved intact, cystoscopy is not required. From May 2000 to February 2002, 150 patients with stress urinary incontinence without associated prolapse were operated and a minimum of 1 year follow-up was available for 32 patients (mean follow-up 17 months; range 13-29). The mean age was 64 years (range 50-81). All patients were assessed before surgery by clinical and urodynamic examination: 5 patients presented sphincter incompetence (maximum closure pressure <20 cm H(2)O); 5 patients presented with recurrent urinary incontinence after Burch procedure or TVT; 18 patients presented with mixed incontinence, six of them with detrusor instability confirmed by cystometry. The results were evaluated by two independent investigators (clinical examination, uroflowmetry, cough test). Voiding disorders suggesting bladder outflow obstruction were defined as the presence of the following two criteria: Q(max)<15 ml/s, residual urine volume >20%. RESULTS: 29/32 patients (90.6%) were cured and 3/32 (9.4%) were improved. Mean operating time was 15minutes. No intra-operative complications were recorded. One patient had complete postoperative bladder retention which resolved after 4 weeks of self-catheterization. There were no problems with urethral erosion, residual pain or functional impairment related to the tape. 5/32 patients had voiding disorders suggesting bladder outflow obstruction. Two patients developed de novo urge incontinence. CONCLUSION: Uratape transobturator tape is a simple and effective procedure with follow-up of one year for the treatment of female stress urinary incontinence confirmed after 1 year of follow-up. The transobturator approach avoids the risk of bladder, bowel or vascular injuries. Evaluation of the results after a longer follow-up period is needed to validate this technique.

Aged↗
PubMed2003

[Andropause].

Explore the source record for details and available documents.

Adult↗
PubMed2003

Urodynamic testing predicts long-term urological complications following simultaneous pancreas-kidney transplantation.

INTRODUCTION: Combined pancreas-kidney transplantation is the treatment of choice for patients with type I diabetes mellitus associated with chronic renal failure. The introduction of the bladder drainage technique constituted a marked improvement of the surgical technique with a reduction of life-threatening complications. However, drainage of pancreatic secretions via the urinary bladder causes urological complications leading, in some cases, to cystoenteric conversion. We retrospectively analysed whether pre-operative urodynamic findings may predict the subsequent development of urological complications and influence the choice of exocrine secretion drainage. PATIENTS AND METHODS: From 1987 to 1997, 39 bladder-drained simultaneous pancreas-kidney transplantations were performed in 16 men and 23 women with a mean age of 38.5 yr. All patients underwent a complete urological assessment prior to surgery, including medical history, physical examination, urethrocystography and urodynamic assessment. RESULTS: Twenty-eight patients are alive with a mean follow-up of 62 +/- 8 months. In 60% of cases, both kidney and pancreas remain functional. Seven patients experienced recurrent lower urinary tract infections. Six patients suffered from chemical urethritis (four men and two women) and six suffered from recurrent haematuria (blood transfusions were required in two patients). One patient had incrusted stones at the site of duodenal staples. Urological complications were mostly observed in the 22 patients (79%) with abnormal urodynamic characteristics (Relative risk: 5.1). Intravenous Somatostatin failed to definitively cure these complications in most cases. Seven patients (17%) (five with urethritis, two with haematuria) required cystoenteric conversion. Two patients developed post-operative ileal fistula, one cutaneous and one into the bladder. All urinary symptoms resolved in these seven patients. CONCLUSION: The frequency of specific urinary complications is high (28%) in bladder-drained simultaneous pancreas-kidney transplantation patients. These complications are statistically more frequent in the case of an abnormal pre-transplant urodynamic assessment.

Adult↗
PubMed2003

[Transobturator tape (Uratape). A new minimally invasive method in the treatment of urinary incontinence in women].

OBJECTIVE: To evaluate the one-year results of transobturator suburethral tape for the treatment of female stress urinary incontinence. MATERIAL AND METHODS: Suburethral tape was implanted via the transobturator technique. UraTape non-woven, non-elastic polypropylene tape with a 15 mm wide central (suburethral) silicone-coated zone was inserted without tension in a horizontal plane underneath the middle of the urethra from one obturator foramen to the other. The lateral ends of the tape were tunnelled percutaneously with a tunnelling device. The retropubic space was preserved and cystoscopy was not required. From May 2000 to February 2002, 32 patients with a mean age of 64 years (range: 50 to 81 years), suffering from stress urinary incontinence without associated prolapse, were operated by the same surgeon (ED). All patients were evaluated before the operation by clinical and urodynamic examination: 5 patients presented sphincter incompetence (maximum closing pressure < 20 cmH2O); five patients presented recurrent urinary incontinence after Burch or TVT; 18 patients presented mixed incontinence and detrusor instability was demonstrated on cystometry in 6 of them. The results were evaluated by two independent doctors (clinical examination, uroflowmetry, cough test). Voiding disorders suggestive of bladder outflow obstruction were defined by the presence of the following two criteria: Qmax < 15 ml/s, residual volume > 20%. RESULTS: The mean follow-up of the study was 17 months (range: 13 to 29 months). The mean operating time was 15 minutes. No intraoperative complication was observed. One patient presented complete postoperative bladder retention that resolved after 4 weeks of self-catheterization. 29/32 patients (90.6%) were cured and 3/32 (9.4%) were improved. No urethral erosions were observed. No residual pain and no functional impairment related to the tape was observed. 5/32 patients presented voiding disorders suggestive of bladder outflow obstruction. Two patients developed de novo urge incontinence. CONCLUSIONS: Transobturator Uratape is a simple and effective procedure with a follow-up of one year for the treatment of female stress urinary incontinence. The transobturator approach avoids the risks of bladder, intestinal and vascular injuries. Evaluation of the results with a longer follow-up is necessary to validate this technique.

Aged↗
PubMed2003

[Prospective study of harvest-to-transplant time: proposed organization].

INTRODUCTION: The cold ischaemia time of a kidney before transplantation has a negative impact on the risk of acute tubular necrosis and graft survival. This cold ischaemia time can be reduced by a different organization of harvesting, organ distribution and transplantation. MATERIAL AND METHODS: Seventy nine organ donor case files from the same hospital were reviewed from reception of the donor until transplantation. 135 renal transplantations, including 60 kidneys and 14 kidney-pancreas transplants were performed on site with organs harvested from these donors. The various phases of harvesting were studied: reception and resuscitation of the patient took 30 hours, and the diagnosis of brain death, information of the families and transfer of the donor to the operating room for harvesting took 11 hours. RESULTS: The mean cold ischaemia time was 6 hours when kidney-pancreas transplantation was performed and 22 hours 30 minutes for isolated local renal transplantation. The decisive factor is the time required to obtain HLA typing, which is only performed during organ harvesting for isolated renal transplantation. HLA typing and lymph node sampling in the intensive care unit would save 7 hours. CONCLUSION: The authors recommend that HLA typing and lymph node sampling for cross matches be performed in the intensive care unit in order to reduce the cold ischaemia time.

Adult↗
PubMed2002

Impact of different combined preservation modalities on warm ischemic kidneys: effect on oxidative stress, hydrostatic perfusion characteristics and tissue damage.

Hemodynamic disorders in brain dead organ donors induce hypoxia, warm ischemia and finally tissue damage. A cold preservation period also induces tissue and cellular lesions. The two major modes of preservation are cold storage (CS) and hypothermic pulsatile perfusion (HPP). We aimed to compare the influence of each mode of preservation and their combination on oxidative stress, perfusion characteristics and tissue damage, after a period of warm ischemia. Rat kidneys which had undergone ischemia (0, 30, 60 min) were preserved either by CS (12, 24 h), or by HPP (12 h), or by a combination of both (HPP+CS, CS+HPP), in University of Wisconsin cold storage solution (UWCSS) at + 4 degrees C. During HPP, renal vascular pressure decreased then increased to reach 90 mmHg after perfusion for 7 h. If HPP followed CS, the mean pressure reached 200 mmHg, showing successive high amplitude peaks. HPP had a deleterious effects on tissue structure with tubular necrosis, and induced an increase in catalase (Cat) and a decrease in manganese superoxide dismutase (Mn SOD) and gluthatione peroxidase (GPx) activity. Copper zinc superoxide dismutase (Cu/Zn SOD) activity was not reduced except with CS+HPP. During CS, we observed an increase in GPx, Cu/Zn SOD and Cat activity, a decrease in Mn SOD activity and no histological alterations in the kidney. CS induces a slight oxidative stress which is not important enough to induce major tissue damage. HPP with UWCSS induces a stronger stress, which overpowers the antioxidant defences, inducing tissue damage. The reperfusion of HPP with UWCSS emphasises the stress initiated by CS. In addition an increase in damage occurred in the CS + HPP group.

Adenosine↗
PubMed2002

Pro-erectile effect of systemic apomorphine: existence of a spinal site of action.

PURPOSE: Apomorphine exerts pro-erectile effects by acting on neurons in the paraventricular nucleus of the hypothalamus. In spinal cord injured rats we assessed whether apomorphine also directly activates the spinal autonomic and somatic neurons controlling penile erection MATERIALS AND METHODS: Intracavernous and blood pressure was monitored in groups of 10 anesthetized rats to quantify intracavernous pressure increases elicited after intravenous apomorphine. We determined the number and duration of increases, percent of maximum intracavernous pressure/mean diastolic blood pressure using the formula, maximum intracavernous pressure/diastolic blood pressure x 100, area under the intracavernous pressure curve/diastolic blood pressure and sum of the area under the curve/diastolic blood pressure. RESULTS: Of 2, 10, 50 and 250 microg./kg. intravenous apomorphine 50 microg./kg. induced significant pro-erectile effects and was subsequently used. In spinal cord injured rats 50 microg./kg. intravenous apomorphine significantly increased median maximum intracavernous pressure/diastolic blood pressure x 100 compared with vehicle injection (56 versus 27 seconds, p <0.001), area under the curve/diastolic blood pressure (21 versus 12 seconds, p = 0.07) and the sum of area under the curve/diastolic blood pressure (132 versus 32 seconds, p = 0.01). These pro-erectile effects of apomorphine were prevented by 50 mg./kg. hexamethonium intravenously or bilateral transection of the pelvic nerves. They were not affected by 3 mg./kg. of the peripheral D1/D2 antagonist domperidone intraperitoneally. In spinal cord injured rats subcutaneous pretreatment with 0.2 mg./kg. of the D1 antagonist SCH23390 significantly enhanced apomorphine induced erections, as indicated by an area under the curve/diastolic blood pressure of 23 to 30 seconds (p = 0.003), whereas they were not changed by 25 mg./kg. of the D2 antagonist sulpiride intraperitoneally. Under the same conditions 1 mg./kg. of the central D1/D2 antagonist haloperidol intraperitoneally only reduced the number of responding rats to 5 versus 10 of 10. CONCLUSIONS: In spinal cord injured rats systemic apomorphine elicits erection by acting at the spinal cord level. This finding suggests that systemic apomorphine elicits penile erections via spinal and supraspinal targets.

Animals↗
PubMed2002

[What are the arguments in favour of local allocation of kidneys harvested for transplantation?].

UNLABELLED: The rules of organ allocation allow one of the two kidneys harvested to be transplanted locally while the other is exchanged. This rule of local priority does not exist in all countries. The purpose of this article is to determine whether this rule provides a benefit for the patient. 804 locally harvested kidneys were compared to 1196 exchanged kidneys transplanted between 1970 and 2000 by the same renal transplantation team. RESULTS: The cold ischaemia time was shorter (-6 h), the number of cases of HLA identity was lower (-0.8), the rate of acute tubular necrosis was lower (-9), and the median graft survival of was 7 months longer for local kidneys. DISCUSSION: An article analysing the North American register reached similar conclusions: the local attribution rule reduces the cold ischaemia and the graft loss at one year. CONCLUSION: The local attribution rule has the advantage of increasing the organ harvesting rate from borderline donors, reducing the cold ischaemia, and improving the results: this rule should therefore be maintained.

Adult↗