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Biomedical subjects

A Mhidia

Publications and source records attributed to A Mhidia.

11 recordsLinked to original sources
PubMed1999

[Bologna procedure in stress urinary incontinence with stage III cystocele (with or without vaginal hysterectomy)].

OBJECTIVES: The vaginal approach constitutes a solution for all types of urinary stress incontinence (USI). The type of surgery depends on the position of the bladder neck and urethra, the quality of the sphincter and the severity of genital prolapse. The objective of this study was to evaluate the efficacy of the Bologna procedure in the treatment of urinary stress incontinence (USI) with stage III cystocele. MATERIAL AND METHODS: This procedure can repair genital prolapse and USI via a 2 cm suprapubic incision, with vaginal hysterectomy, and intraoperative cystoscopy. The patient is placed in the lithotomy position and a Crossen T-shaped vaginal incision is made releasing the anterior wall and allowing the creation of 2 pedicled vaginal flaps posterior to the urethral meatus. The flaps, passed through the suprapubic pelvic fascia, support the bladder neck by means of 2 nonresorbable sutures to the rectus abdominis muscles. Fifty-four patients were treated by the Bologna procedure with or without vaginal hysterectomy from 1990 to 1996 and were reviewed with a mean follow-up of 30 months (16 to 46 months). All women (mean age: 63.4 years) underwent a preoperative clinical examination, renal ultrasound, cystoscopy and urodynamic assessment (37 cases). RESULTS: Twelve patients developed postoperative complications (9 local infections, 3 cases of deep vein thrombosis with one pulmonary embolism). All complications were treated by local drainage and/or removal of the suspension sutures. Continence was excellent in 45 women (83.3%), improved in 4 (7.4%), and unchanged in 5 (9.3%). The anatomical results were excellent with correction of prolapse in 48 patients (89%). Six patients subsequently developed prolapse of the vaginal dome and 5 complained of voiding discomfort. CONCLUSION: USI and genital prolapse must be treated simultaneously. The vaginal approach is minimally invasive and can treat both diseases during the same operation.

Aged↗
PubMed1998

[Ureteral reimplantation on psoas bladder: long-term results].

OBJECTIVE: To evaluate indications and long-term results of ureteral reimplantation with psoas hitch bladder. MATERIALS AND METHODS: Between January 1985 and December 1997, we performed psoas-hitch ureteral reimplantation in 18 patients (13 females and 5 males). Mean age was 48 years old. All ureteral injuries involved a pelvic portion of the ureter. The indication was: ureteral injury during gynecological procedures in 5 cases, stricture following open uretero-lithotomy in 3 cases, avulsion of the ureter during ureteroscopy in 1 case, stricture following prior ureteral reimplantation in 3 cases, prostate cancer involving the distal ureter in 1 case, megaureter in 1 case, radiation therapy in 1 case, pelvic and ureteral endometriosis in 3 cases. Treatment consisted to adequate mobilization of the bladder, fixation of the posterolateral corner of the bladder to psoas and ureteral reimplantation with anti-reflux system. In all cases, psoas-hitch ureteral reimplantation has been performed because of an inability to perform end-to-end uretero-ureterostomy or direct uretero-neocystostomy. RESULTS: No complications were observed. At follow-up of 7 months to 12 years (mean 5.7 years) we noticed 13 success (72.4%), 4 improvements (22.2%) and one patient (5.4%) was lost at follow-up. No nephrectomy was done. CONCLUSION: Psoas-hitch bladder ureteral reimplantation is simple, effective and a first-line procedure for the replacement of the long defects of the lower ureter.

Adult↗
PubMed1998

[Conservative treatment of stage III kidney injuries].

OBJECTIVE: The aim of this study is to evaluate the safety and effectiveness of conservative management in stage III renal trauma. MATERIAL AND METHODS: We reviewed the records of 150 patients who presented in our institution with renal trauma between 1986 and 1995. RESULTS: Minor injuries (stage I and II: 100 cases) were treated with expectant management. Only 3 patients required nephrectomy in this group. Stage III injuries were seen in 40 patients. The great majority (85%) were treated conservatively with renal sparing procedures such as endourologic techniques (14 cases), nephrorraphy or partial nephrectomy (20 cases). Total nephrectomy was performed in 15% of the cases and only for severely injured kidney or major associated intraabdominal injuries. In this group, none of the patients suffered from hypertension at follow-up. All patients (10 cases) with pedicle injury (stage IV) required total nephrectomy. CONCLUSION: Stage III renal trauma with urinary extravasation can safely be treated conservatively.

Adolescent↗
PubMed1998

[Outcome of renal function in 114 patients who underwent uninephrectomy for renal cancer].

OBJECTIVE: To evaluate the medium-term and long-term impact of radical nephrectomy on renal function and to identify prognostic factors able to help predict deterioration of renal function in patients treated for renal cancer by radical nephrectomy, with a functionally and morphologically healthy remaining kidney. MATERIAL AND METHODS: Between January 1992 and June 1996, 114 patients (72 males, 42 females) with renal cancer were treated by radical nephrectomy. The contralateral kidney was healthy. The mean age of the patients was 64 years (31-85 years). Pre- and postoperative renal function was assessed by serum creatinine assay, in micromol/l. RESULTS: 105 patients were alive (16 with metastases) and 9 had died. The mean follow-up of the survivors was 19.6 months (3-53 months). A slight elevation of mean serum creatinine was observed in this group after nephrectomy compared to preoperative figures (117.9 micromol/l versus 95.6 micromol/l). 37 patients (35.2%) had a postoperative serum creatinine greater than or equal to 121 micromol/l, most of them were elderly, male (81%) and/or hypertensive (43%) and/or diabetic (11%). 6 (5.7%) of these 37 patients had a serum creatinine greater than or equal to 170 micromol/l and all were hypertensive and/or diabetic. CONCLUSION: This study shows that HT, diabetes, advanced age and male sex constitute risk factors for deterioration of renal function. The indication for conservative surgery for T1 T2 N0 M0 tumours should be discussed in the presence of these factors. In their absence and provided the remaining kidney is healthy, renal function remains relatively stable after radical nephrectomy for cancer.

Adult↗
PubMed1998

[Injuries of the renal pedicle: is renal revascularization justified?].

OBJECTIVE: Renal trauma with pedicle lesions may require emergency vascular repair, a surveillance in a surgical unit or immediate or secondary nephrectomy. The objective of this study was to evaluate these various treatment modalities. MATERIAL AND METHODS: 28 patients presenting with renal pedicle trauma, treated in two urological centres between 1985 and 1995 were reviewed. All cases of trauma were investigated by intravenous urography, CT and/or arteriography. 16 patients had associated intra-abdominal lesions. RESULTS: 7 patients underwent vascular repair after a mean interval of 4.8 hours. There were 5 nephrectomies and 2 functional kidneys, including 1 with hypertension. 13 patients underwent first-line nephrectomy: 4 performed as an emergency for haemodynamic instability, and 9 performed as a deferred emergency for silent kidney or secondary haemodynamic disorders. The mean time to diagnosis was 20 hours. No complication was observed in this group. Non-surgical management was decided in 8 patients. The mean time to diagnosis was 7.5 hours. One death was observed in this group, due to associated cerebral lesions. 3 patients subsequently underwent late nephrectomy for severe hypertension and 4 had a persistent silent kidney without sequelae. Overall: 21 nephrectomies, 2 functional kidneys (1 patient was hypertensive), 4 silent kidneys without hypertension and one death were observed. CONCLUSION: In cases of renal pedicle trauma seen after the 4th hour, the severity of ischaemic lesions and renal sequelae and the small number of kidneys saved despite revascularization surgery argue in favour of immediately elective nephrectomy.

Emergencies↗
PubMed1997

Autogenous skin graft in the treatment of large incisional lumbar hernias and bulges.

OBJECTIVE: Repair of large incisional lumbar hernias or muscular bulges is a challenge to the surgeon as reflected by the high recurrence rate. We evaluated a surgical procedure using a running strip of autogenous skin graft as a retention suture. METHODS: Eight patients with large incisional lumbar hernias (> or = 20 cm, n = 6) or muscular bulges (n = 2) underwent a parietal reconstruction with this procedure. Two patients had previously been treated with synthetic meshes without success, and one had a colocutaneous fistula. RESULTS: No recurrence was observed in 6 patients (75%) with a mean follow-up of 14 months. After significant weight gain, 2 repairs failed at 6 months and 1 year (partially in 1 case). No recurrence was noted for muscular bulges. CONCLUSION: The use of a running strip of autogenous skin graft is a simple and reliable procedure for the repair of large lumbar hernias or muscular bulges for patients with stable weight conditions.

Hernia↗
PubMed1996

[Pelviscopy: a good solution].

With the ongoing evaluation of laparoscopic techniques in urology, the transperitoneal access used initially has been progressively replaced by the much simpler retroperitoneal route. The applicability of these new techniques has now been proven though their application still requires a delicate procedure. A long training period is usually required to be able to perform safe operations of reasonable duration. We present a different technique using a modified vaginal speculum and a laparoscopic optic positioned between the valves of the speculum to give a good visualization and expose the operative field. Several retroperitoneal procedures can be performed with this technique using the video-assisted pelviscope, including nephrectomy, pyeloplasty, lymphadenectomy in the pelvis... This video-assisted surgical technique is an interesting compromise between classical surgery and laparoscopic surgery. It is both simple and safe causing little tissue damage and has the advantage of a short postoperative recovery period.

Endoscopy↗
PubMed1993

[Cloacal exstrophy: what therapeutic approach for what result?].

The authors report 11 cases of cloacal exstrophy and analyse the anatomical features and the results of surgery. The outcome of three patients aged 20, 18 and 9 years is related. Advances in prenatal assessment of malformations is likely an explanation for the lack of new cases in the recent years. However the surgical procedure now available provides a better quality of life to patients with such a disabling malformation.

Adolescent↗