Biomedical subjects
Publications and source records attributed to W De Sy.
The surgical treatment of hypospadias continues to inspire urologists to develop new techniques. Views on the physiopathology of hypospadias have changed a great deal over the last ten years. Treatment techniques have also changed over the last ten years. An analysis of current trends in the treatment of hypospadias therefore appears justified.
PURPOSE: As the oral bioavailability of testosterone is very low because of its high first pass effect, buccal administration might present a viable alternative. In this study a buccal bioadhesive tablet was used in order to sustain the delivery and bypass the liver. METHODS: Testosterone and testosterone acetate, propionate, enanthate and decanoate were investigated. The influence of the concentration of testosterone (10-50%) and testosterone esters (30%) on in vitro bioadhesion was investigated. The absolute (i.v.) and relative (oral) bioavailability of 60 mg testosterone or an equivalent amount of testosterone ester was determined in castrated male dogs. RESULTS: Both the in vitro detachment force and the work of adhesion decreased gradually with an increasing amount of testosterone and for an increasing chain length of the esters, except in the case of testosterone enanthate. The in vivo results revealed that the bioavailability of testosterone was significantly higher (p < 0.05) than that of the esters, which is probably due to the lower solubility of the esters. The mean absolute bioavailability of testosterone from the bioadhesive tablet was 14.1%, while the mean relative bioavailability was 1370%. The buccal administration of testosterone via the bioadhesive tablet allowed the maintenance of the plasma level at above 3 ng/ml for 15 to 24 h. CONCLUSIONS: Buccal absorption of testosterone was significantly higher than that of its esters.
We present some technical aspects of the GAP procedure for distal hypospadias repair. About 20 GAP procedures have been performed to date. Although immediate postoperative results were very encouraging with only 2 fistulae and 1 meatal stenosis, follow-up is too short to conclude on the validity of the technique. In particular the cosmetic result of this technique based on our preliminary experience, makes it an extra tool for the surgeon interested in hypospadias repair. We therefore want to present some of the technical aspects.
Since july 1991 the Arap modification of the Meatal Advancement Glanduloplasty Incorporated (MAGPI) is used for repair of minor anterior hypospadias. Seventy-two boys have been treated by this technique since then. Follow-up is longer than 2 years in half of the patients. The functional and cosmetic result, as estimated by the surgeon and an urologist who did not perform the operation was excellent in 64 patients (89%). In 3 patients the functional result is good but the cosmetic result is poor. In 2 patients meatal stenosis developed of which 1 was treated by dilatation and 1 by meatotomy. In 3 patients there was complete loss of the suture lines resulting in hypospadias which was repaired by other techniques. Ten patients underwent praeputioplasty with the procedure. In 4 patients the sutureline lost partially necessitating circumcision. The Arap modification of the MAGPI is presented as a good technique for the repair of minor anterior hypopadias.
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The effects of alfuzosin, a potent alpha 1-blocker, were assessed in patients with benign prostatic hyperplasia, in a double-blind, multicenter, placebo-controlled, cross-over study. Treatment duration was 4 weeks for both alfuzosin and placebo. A significant beneficial effect of alfuzosin (7.5 to 10 mg a day) on clinical subjective and objective criteria was observed as compared to placebo: total Boyarsky score decreased by 1.63 points, peak urinary flow improved by 2.03 ml/sec. Alfuzosin was well tolerated, the observed adverse events corresponded to the pharmacological properties of this compound, and resolved rapidly.
Water soluble ionic contrast media (CM) and glucose 5% were administered to Sprague-Dawley rats 36 hours after bilateral warm renal ischemia for 45 min. In all animals (n = 28) the renal ischemia caused a decrease of the absolute urinary creatinine output. Intra-arterial injection of glucose 5% or CM did not produce different patterns of absolute urinary creatinine output. The serum creatinine increased after 36 hours of reflow. When compared by means of a Mann-Whitney U-test to a normal median serum creatinine obtained in a separate group of 22 normal rats, the increase was statistically significant (p less than or equal to 0.01). The serum creatinine medians returned to a normal level after 24 hours. It seems therefore that 45 min of warm renal ischemia and 36 hours of reflow is an insufficient challenge to the rat kidney for the detection of the nephrotoxic properties of CM as opposed to when CM are injected during ischemia.
In this preliminary study, water soluble contrast media (CM) were administrated to normal laboratory rats (n = 11) and renal function was monitored before and followed after this challenge. A significant decrease (p less than or equal to 0.001) of the absolute urinary creatinine output, was noted during 3 days after the injection of the CM: the median (M) control value was 0.0313 mumol/min. 100 g body weight (BW) (interquartile range (IR): 0.0014) while the M values the first, the second and the third day were 0.0209 mumol/min. 100 g BW (IR: 0.0141), 0.0198 mumol/min. 100 g BW (IR: 0.0044) and 0.0265 mumol/min. 100 g BW (IR: 0.0054) respectively. The serum creatinine 24 hours after injection was 59,8 mumol/l (IR: 7.92) which is significantly higher (p less than or equal to 0.002) compared to the M serum creatinine of 51.9 mumol/l (IR: 15.0) evaluated in a group of normal unchallenged laboratory rats. These changes are in contrast with the low frequency of renal failure episodes encountered in clinical circumstances. Further experiments with inclusion of a control group receiving a sham injection seem necessary.
A multi-center study was performed in 110 patients with superficial transitional cell carcinoma of the bladder. Adriamycin (50 mg/50 ml) was administered intravesically within 24 hours after transurethral resection of TA-T1 (0-A) bladder tumours. Instillation was repeated twice during the first week, then weekly during the first month and then monthly for 1 year. The tolerance was evaluated in these 110 patients and 29 patients presented with local side effects. In 24 of these patients the chemical cystitis was severe enough to drop them out of the study. No systemic side effect was observed. Recurrence was studied on 82 evaluable patients at 1 year of follow up and on 72 patients followed for 2-3 years (mean: 32 months). Of these 82 patients, 23 were primary cases and 59 recurrent. On all 82 patients, 50 did not show any recurrence after 1 year (61%) while 32 presented with one or more recurrences (39%). Of these recurrences, 27 were T1 tumor while 5 progressed to more invasive lesions. In patients that were free of recurrence during the first year, 80% remained tumour free during the 2-3 years follow up period. In patients developing one or more recurrences during the first year, only half of them presented further recurrences once the instillations were stopped. The beneficial effect of Adriamycin appears obvious and might be related to the drug itself, the early and repeated instillations after TUR or both factors.
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A multicenter study was performed in 110 patients with superficial transitional cell carcinoma of the bladder. Adriamycin (50 mg/50 ml) was administered intravesically within 24 h after transurethral resection of TA-T1 (O-A) bladder tumors. Instillation was repeated twice during the first week, then weekly during the first month and afterwards monthly for 1 year. The tolerance was evaluated in these 110 patients, and 29 patients presented with local side-effects. In 24 of these patients chemical cystitis was severe enough for them to drop out of the study. No systemic side-effects were observed. Recurrence was studied in 82 evaluable patients after 1 year of follow-up and in 72 patients followed for 2-3 years (mean 32 months). Of the 82 patients studied after 1 year, 23 had primary and 59 recurrent disease. Of the 82 evaluable patients, 50 did not show any recurrence after 1 year (61%), while 32 presented with one or more recurrences (39%). Of these recurrences, 27 were T1 tumors while five progressed to more highly invasive lesions. In patients that were free of recurrence during the first year, 80% remained tumor-free during the 2- to 3-year follow-up period. Of the patients developing one or more recurrences during the first year, only 50% presented with further recurrence once the instillations were stopped. The beneficial effect of Adriamycin appears obvious and might be related to the drug itself, the early and repeated instillations after TUR, or both.
Bifid and double blind ureters are two rare congenital anomalies of the upper urinary tract. Usually they are incidental findings. Occasionally, they are associated with urinary tract infection, but the symptoms are not specific. The key to diagnosis is a careful urethral cystoscopy and retrograde pyelogram. Asymptomatic patients without urinary tract infection require no treatment. When symptoms or infection are present, excision of the blind branch is required with antireflux reimplantation of the normal ureter if needed.
In this study evolution of plasma androgen levels in patients with advanced prostatic carcinoma, treated by either subtotal bilateral orchiectomy or estrogens, was studied in order to determine whether subcapsular orchiectomy results in complete elimination of testicular testosterone secretion and whether in subsequent months there occurs any reactivation of eventually remaining Leydig or increased adrenal androgen secretion. This study, performed on 40 patients having undergone bilateral subcapsular orchiectomy for prostatic carcinoma, shows that this intervention results in testosterone levels in the female range and that during the year following subcapsular orchiectomy there is no evidence for reactivation of Leydig cells or for increased adrenal androgen secretion as evaluated from plasma testosterone, androstenedione, and dehydroepiandrosterone sulphate levels. In patients treated with estrogens we found no evidence for stimulation of adrenal androgen secretion, whereas in neither group of patients with prostatic carcinoma we found evidence for increased androgen levels at the time of recurrence of the carcinoma.
There is a wide application of diagnostic ultrasound in urology. Hitherto the transrectal and transurethral approach for evaluation of the pelvic organs has been used much more often. However, since the development of high resolution real-time sector-scanners, the transabdominal suprapubic approach through the full bladder has become more promising. Using this technique which, as a screening procedure, is most acceptable for the patient, detailed normal anatomy can be seen such as the ureteric orifices, the base plate, the proximal part of the urethra, the seminal vesicles and the ampullae, the ejaculatory ducts and the zonal anatomy of the prostate. In this report, the sonographic appearance of these various structures is correlated with anatomical data and the advantages of the transabdominal approach are discussed.
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Six methods for prevention of renal arterial vasospasms, due to extensive surgical trauma are compared in an experimental study in rats. The 'proximal transit time' was chosen as a measure for renal arterial flow 1, 5, 10 and 15 min after a standard surgical trauma. Xylocaine infiltration around the renal pedicle was least effective. Hydration of the rat, preoperative mannitol perfusion, and preoperative phenoxybenzamine treatment gave comparable effects and were significantly better than no treatment. The topical application of papaverine (1 mg/kg) around the renal pedicle did significantly better than the above-mentioned methods. The most effective treatment, however, was the combination of hydration, mannitol perfusion and papaverine application around the renal pedicle.