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Y Barthelemy

Publications and source records attributed to Y Barthelemy.

8 recordsLinked to original sources
PubMed1999

[Urinary continence after retropubic radical prostatectomy: retrospective study with self-administered questionnaire].

OBJECTIVES: To precisely evaluate the incidence of urinary incontinence after radical prostatectomy and its impact on quality of life. MATERIAL AND METHODS: A self-administered questionnaire was sent to 116 patients operated between 1987 and 1996. Preoperative and postoperative urinary continence, the time until urinary continence was achieved, the presence of urgent micturition, the degree of discomfort caused by urinary incontinence and associated voiding disorders were assessed. RESULTS: The questionnaire response rate was 96.6%. The urinary incontinence rate (continuous use of pads) was 13.4%. No predictive factor for postoperative urinary incontinence was identified. Urge incontinence was present in 31.3% of cases. 85% of patients claimed to be satisfied with the operation and 95.4% declared that they would be willing to undergo radical prostatectomy again. CONCLUSION: The incidence of urinary incontinence after radical prostatectomy is acceptable and the morbidity that it generates is well tolerated and has little impact on quality of life.

Aged↗
PubMed1997

Twenty-year experience with jejunal conduits.

OBJECTIVES: To assess the results of jejunal conduit urinary diversion, with particular attention to electrolyte imbalance and long-term renal function. METHODS: From 1976 to 1994, 50 patients underwent urinary diversion using a short jejunal loop (10 to 12 cm) placed transperitoneally. Of these patients, 18 received pelvic irradiation before diversion. Renal function and configuration of the upper urinary tract were assessed by creatinine clearance and excretory urography. RESULTS: Median follow-up was 26 months (3 to 204). Of 50 patients, 22 had a follow-up more than 5 years later (median 86 months). Eight patients (16%) underwent 10 revision procedures postoperatively. Late complications related to urinary diversion included renal calculi (12%), parastomal hernia (6%), pyelonephritis (4%), ureterojejunal obstruction (4%), and stomal prolapse (2%). Electrolyte imbalance occurred in 2 patients (4%) and was easily corrected by 4 g sodium bicarbonate. No significant decrease in creatinine clearance (P = 0.6) was found in 22 patients with a follow-up of more than 5 years; however, of these patients, 2 had a decrease in creatinine clearance of greater than 20%, due to ureterojejunal obstruction. Of 42 ureterorenal units, hydronephrosis occurred and increased in 1 and 2 cases, respectively, and renal scarring occurred and progressed in 2 and 2 cases, respectively. CONCLUSIONS: Urinary diversion using a short length of jejunum placed transperitoneally is a reliable procedure and gives good long-term renal function. Electrolyte imbalances are rare. Moreover, jejunal conduit can be used in almost all situations, especially after pelvic irradiation.

Adolescent↗
PubMed1997

Spontaneous rupture of orthotopic detubularized ileal bladder replacement: report of 5 cases.

PURPOSE: We defined the mechanisms responsible for rupture of orthotopic, detubularized ileal bladder replacement. MATERIALS AND METHODS: We reviewed retrospectively the records of 5 cases of ileal neobladder rupture treated at our center between 1985 and 1995. RESULTS: The interval to perforation varied from 3 to 60 months after surgery. The perforation site was typically the upper part of the right limb of the reservoir. We observed an acute episode of bladder over distension immediately before perforation in 2 cases and a chronic state of neobladder over distension in the 3 remaining cases. Bacterial infection was associated in 4 cases. Intraperitoneal adhesions were an associated mechanism for rupture in only 1 case. We found chronic ischemic changes weakening the bladder wall to be an additional factor for rupture in the 3 cases associated with chronic over distension. CONCLUSIONS: Acute or chronic over distension of the neobladder is the main factor for spontaneous rupture of orthotopic detubularized ileal bladder replacement. Chronic ischemic changes of the bladder wall, possibly facilitated by detubularization and the variability of the mesenteric circulation, are additional factors that lead to perforation.

Aged↗
PubMed1996

Retroperitoneoscopy: a laparoscopic approach for adrenal and renal surgery.

OBJECTIVES: Retroperitoneoscopy has gained acceptance for urologic surgery. We assessed the safety and efficacy of this procedure for renal and adrenal surgery. METHODS: Since December 1994, 20 patients (18 to 75 years old) have undergone laparoscopic adrenalectomy and nephrectomy, including simple nephrectomy in 8, partial nephrectomy in 1, radical nephrectomy in 2, tumorectomy with cyst excision in 1, and adrenalectomy in 8. The retroperitoneal space was created by blunt dissection with the index finger, completed by insufflation, without balloon dissection. RESULTS: Average kidney size was 65 m (range 50 to 108), and average adrenal tumor size was 31 mm (range 20 to 40). The average operating time was 127 minutes (range 60 to 180) for nephrectomy and 84 minutes (range 45 to 140) for adrenalectomy. The average hospital stay was 3 days (range 1 to 7) for nephrectomy and 2.4 days (range 1 to 4) for adrenalectomy. Average blood loss was 65 mL for both nephrectomy and adrenalectomy. Conversion from the laparoscopic procedure to open surgery was never required. Peritoneal effraction and ureteral injury occurred in only 4 patients and 1 patient, respectively. CONCLUSIONS: The laparoscopic retroperitoneal approach is safe and effective for simple renal nephrectomy and for excision of small adrenal tumors. Perioperative morbidity and hospital stay are reduced.

Adolescent↗
PubMed1996

[Augmentation ileocystoplasty in neurologic bladder].

OBJECTIVE: The authors evaluated the results of augmentation ileocystoplasty in patients presenting with neurogenic urinary incontinence. MATERIALS AND METHODS: A prospective study was conducted in 36 patients (25 women, 11 men) 30 of whom simultaneously underwent a bladder neck continence procedure. The mean follow-up was 32.2 months. RESULTS: Daytime continence was obtained in 32 patients (88.8%). Thirty patients (83.3%) were continent a night. The upper urinary tract did not deteriorate. One patient developed bladder stones and 2 presented a vesical perforation. Urodynamic studies showed an increased functional bladder capacity and compliance (p < 0.001) and loss of uninhibited bladder contractions. CONCLUSION: Augmentation ileocystoplasty is an effective and reliable surgical procedure after failure of conservative management. However, long-term complications can occur and regular surveillance is necessary.

Adolescent↗
PubMed1996

[Prognostic value of a positive single ultrasound-guided prostatic biopsy regarding tumor volume and intracapsular nature of prostatic adenocarcinoma].

OBJECTIVE: Study of the value of a single positive prostatic biopsy in the staging of prostatic carcinoma and the significance of the tumour volume. METHOD: The clinical, laboratory and pathological parameters were studied in 27 prostatectomized patients with a single positive prostatic biopsy. RESULTS: The length of tumour invasion on the biopsy was 2.6 mm (evaluation on 25 biopsies). Six patients (23%) had an extracapsular tumour and 21 (78%) had a significant tumour volume. Among the 16 patients with a length of tumour invasion < or = 3 mm, 13 (81%) had a significant tumour volume. 25% of patients with less than 3 mm of invasion on the biopsy and a Gleason score < or = 6 and 12% of patients with less than 3 mm of invasion and a PSA < or = 10 ng/ml had a non-significant tumour volume. CONCLUSION: The presence of a single positive prostatic biopsy is not sufficient to determine the pathological stage of a prostatic carcinoma. In this retrospective study, the majority of patients with a single positive biopsy had a significant tumour volume > 0.5 cc. No preoperative predictive factor of tumour volume was demonstrated.

Adenocarcinoma↗
PubMed1994

[A review of 72 renal artery stenoses in a series of 715 kidney transplantations in children].

In a series of 715 renal transplantations performed between 1973 and 1989, 72 cases of renal artery stenosis (RAS) in 69 children (9.7%) were managed at Hôpital Necker Enfants Malades. Forty cases of RAS were treated exclusively by antihypertensive drugs. A good result was obtained in 82.5% of cases. Thirty three transluminal angioplasties (TLA) were performed in 23 children with 26 RAS. A good clinical result was obtained in 15 children with a total of 17 stenoses, corresponding to a success rate of 65%. Transluminal dilatation of anastomotic stenoses always failed. There were no cases of transplant thrombosis. Eleven RAS were operated, including 5 after failure of TLA. Eight patients (73%) obtained a clinical improvement. There were 2 postoperative thromboses. Antihypertensive treatment must be administered in every case. If medical treatment fails, and with the exception of anastomotic stenoses, TLA should be the first-line procedure, while surgery is reserved for failures of TLA and for anastomotic stenoses.

Adolescent↗