Biomedical subjects

A Herard

Publications and source records attributed to A Herard.

9 recordsLinked to original sources

PubMed2000

[Treatment of female stress urinary incontinence with cystocele by Gore Tex colpofixation and Burch operation].

OBJECTIVE: We treat female urinary stress incontinence (USI) with cystocele with or without associated genital prolapse by a combination of sacral colpopexy and Burch anterior colposuspension. We evaluated the results of a consecutive series of 77 patients completing a telephone interview after a mean follow-up of 40.6 months (range: 15 to 74 months). MATERIAL AND METHODS: From January 1991 to December 1995, 77 patients (mean age: 56.7 years) underwent Gore-Tex sacral colpopexy and Burch colposuspension for USI. Levator ani myorrhaphy was also performed in 53 severe cases. Incontinence was severe in every case, and associated with stage > or = 2 cystocele in 93% of cases. Urodynamic assessment revealed detrusor instability (DI) in 17.3% of cases and sphincter insufficiency (SI) < or = 35 cm H2O in 11.9% of cases. The main complications were: 4 haemorrhages requiring transfusion of one unit, 2 wound abscesses, one wall haematoma, and one small bowel obstruction at the 4th month, treated surgically. RESULTS: Six patients were lost to follow-up (good early results) and 2 files could not be analysed with sufficient follow-up (patients died from other diseases). Good results were defined by at least two of the following criteria: patient satisfied, no incontinence and no need for protective pads. We obtained 59 successes (85.5%) and 10 failures (14.5%). The results remained stable over time with 88.8% of success after a follow-up of more than 60 months (20 patients). Nine of the 10 failures occurred during the first year. They were demonstrated by the survey, while the post-operative follow-up at one month had been satisfactory. No specific treatment was therefore proposed. The two main factors of failures were DI and severe SI. Three times more failures were observed when the preoperative closure pressure were less than 30 cm H2O. CONCLUSION: Sacral colpopexy combined with Burch operation is a reliable solution for repair of USI with marked cystocele. It ensures good initial results which persist at one year and in the long-term.

Adult↗

PubMed1999

Eight year improvement in pathological results after radical prostatectomy.

The purpose of this paper is to compare the pathological stage of prostate cancer specimens with preoperative characteristics according to the year of diagnosis. One hundred and seventy five patients underwent radical prostatectomy for localized disease between January 1989 and December 1996. In each year group, the mean preoperative PSA (Prostate Substance Antigen, Hybutech((R)) Assay Nl<urgr/ml), digital rectal findings, Gleason grade, pathological staging, and postoperative and follow-up PSA values were prospectively recorded and compared. The mean PSA value was the only preoperative parameter that significantly fell with time (from 52-12.2 ngr/ml between 1989 and 1996), and correlated with a higher percentage of organ-confined disease (40% vs 81.8%). Biological progression one year after radical surgery decreased from 60% in 1989 to 4.5% in 1996. Results of radical prostatectomy are improving with time, corresponding to lower preoperative PSA values. This might result from earlier diagnosis of prostate cancer based on PSA, though the number of insignificant cancers is not increasing.

Journal Article↗

PubMed1998

Massive gross hematuria in a sickle cell trait patient with renal papillary necrosis. Conservative approach using a balloon ureteral catheter to tamponade the papilla bleeding.

We report the case of a patient with heterozygous sickle cell trait presenting with massive gross hematuria. Ureteroscopy revealed bleeding from the tip of papilla of the inferior calica and allowed us to tamponade the bleeding with a balloon ureteral dilator set (Cook(R) Urology). We show the value of the endourological approach in the conservative management of these patients at high risk of recurrent hematuria.

Adult↗

PubMed1998

[Infection on foreign material: bacterial colonization of ureteral endoprostheses].

Infection on foreign body: bacterial colonization of ureteric stents. The most frequent cause of the early removal of ureteric endoprostheses (double J) is generally due to bacterial colonization. In order to prevent or to restrict the prosthesis colonization, it is necessary to understand the major steps and the factors influencing the colonization. This is the reason why we aimed to extract the most relevant parameters influencing the bacterial colonization from the observations made in vivo thanks to in vitro analyses. We have studied in vivo the relationship between the bacterial colonization of the endoprostheses, the urinary infections and the antibiotherapy. In vitro, we have defined the conditions promoting the primary adhesion of the most frequently isolated bacteria on endoprostheses. Surface properties of bacteria and materials have been compared to:--the bacterial count of infected double J samples with respect to bacterial species,--the bacterial count of the infected samples with respect to pH and Ca2+, Mg2+ concentration. The results show a great variability of the biomaterial surface properties which could be optimized, the fact that the urinary medium acidification could lower the bacterial adhesion and the ambiguous role of Ca2+ and Mg2+ ions which is discussed in this paper. In the case of in vivo analyses, the conflicting results between leukocyturia and bacteriuria lead to the detection of the bacterial colonization under antibiotic treatment. The characterized urinary infection must warn the risk of pyelonephritis.

Bacteria↗

PubMed1998

Symptomatic caliceal diverticula treated with extraperitoneal laparoscopic marsupialization fulguration and gelatin resorcinol formaldehyde glue obliteration.

PURPOSE: The treatment of symptomatic stone filled caliceal diverticula has evolved from open surgery to less invasive procedures, such as extracorporeal shock wave lithotripsy, percutaneous techniques, retrograde ureteroscopy and laparoscopy, but it remains controversial. We describe a laparoscopic technique for the management of symptomatic caliceal diverticula. MATERIALS AND METHODS: An extraperitoneal laparoscopic procedure was done in 3 women with symptomatic caliceal diverticula. Watertight obliteration of the diverticular cavity was achieved without suturing, using gelatin resorcinol formaldehyde glue. RESULTS: Average operating time was 80 minutes, including ureteral catheterization. All patients became stone-free, there were no complications and average hospital stay was 6.6 days. At 6-month followup the patients remained asymptomatic with no diverticula or stone recurrence. CONCLUSIONS: Retroperitoneoscopy allows safe access to caliceal diverticula regardless of location, and permits complete removal of stone and fulguration of the diverticular neck. Gelatin resorcinol formaldehyde glue minimizes the risk of urinoma formation, and provides a simple, quick and safe alternative for nephrotomy closure.

Adolescent↗

PubMed1998

[Improvement over time of oncological results after radical prostatectomy: what are the responsible factors?].

OBJECTIVES: The histological results after radical prostatectomy constitute one of the main prognostic factors. We studied the course of these results over time in order to assess their improvement and to identify the factors responsible. MATERIAL AND METHODS: 175 radical prostatectomies were performed between 1989 and 1996. The preoperative assessment for each patient comprised clinical examination, PSA assay, and histological examination of 6 ultrasound-guided transrectal biopsies. All radical prostatectomy specimens were analysed according to the Stanford technique by the same pathologist: the weight of the prostatectomy specimen, the Gleason score, existence of capsular effraction, seminal vesicle invasion, positive lymph node dissection and the presence of positive surgical margins were studied. The results were studied and compared year by year using Student's test and the Chi-square test. RESULTS: From 1989 to 1996, stages pT1-pT2 increased from 40 to 81.8%, while the positive resection margin rate decreased from 80 to 18.1%. No difference was observed over time for weight and Gleason score. Among the preoperative factors, no difference was observed for age of the patients, number of positive biopsies and Gleason score of these biopsies. Only the mean preoperative PSA level decreased from 52.2 to 12.2 ng/ml (t = 0.0001) and the number of stage T1c tumours increased from 13.3 to 59%. CONCLUSION: The preoperative PSA level is the main factor explaining improvement of the oncological results, especially as the tumours operated between 1988 and 1996 were identical in terms of aggressiveness (Gleason score). This improvement of the results reflects better patient selection, although this selection is performed case by case without exclusive factors.

Aged↗

PubMed1998

[Role of biofilm in urology].

The particular organization of bacteria as a biofilm on surfaces plays an essential role in urology because of the increasing use of prosthetic materials. Although the biocompatibility of the various materials used is now more effectively controlled, colonization of surfaces by microorganisms is frequent and the formation of a biofilm is responsible for difficulties encountered during treatment of prosthetic infections. The problems concerning the detection and eradication of biofilm led the authors to propose a brief review of the growing understanding of biofilm in urology over the last five years.

Anti-Bacterial Agents↗

PubMed1998

[Current role of coagulase-negative staphylococci in urology].

Coagulase-negative Staphylococci (CNS), considered for many years to be commensal bacteria of the skin are now recognized as major agents of nosocomial infection. Bacterial factors (increased resistance), host factors (immune status) and multiplication of the portals of entry (presence of foreign material) have contributed to the increased incidence of nosocomial infections. The importance of the role of NCS in urology is due to their great capacity to colonize catheters and most prostheses. The particular organization of these bacteria into a conglomerate called biofilm is responsible for prosthetic infections, which can impair renal function and can sometimes be life-threatening. The authors review the current increase of the number of CNS isolated in urology departments and describe the various therapeutic strategies that can be proposed to eradicate these bacteria.

Cross Infection↗

PubMed1997

[Hemospermia].

Haemospermia is a relatively frequent symptom in urology, especially in young subjects. It is often benign, but is important because of the anxiety it can cause to the patient. The predominant aetiology of haemospermia is prostatic and seminal vesicle disease. Iatrogenic aetiologies, generally without severity, are due to the development of instrumental diagnosis and treatment in urology. Recent progress in the field of medical imaging, particularly transrectal ultrasonography and magnetic resonance imaging, has greatly contributed to the diagnostic and therapeutic approach to haemospermia.

Blood↗