Obturator infected hematoma and urethral erosion following transobturator tape implantation.
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Abscess↗
Biomedical subjects
Bernard Malavaud
Publications and source records attributed to Bernard Malavaud.
[Laparoscopic cystoprostatectomy, initial experience: 13 patients].
From July 2003 to February 2004, 13 laparoscopic radical cysto-prostatectomies have been achieved in our department. The technique is describe, the ablation of the bladder and prostate is done through a pure laparoscopic approach when the reconstruction is done trough a small incision under the umbilicus. The uretro-neobladder anastomoses are performed under laparoscopy after re-integration of the bladder. All procedures have been successfully achieved; the mean operative time is 400 minutes, 320 for the cutaneous diversions and 450 for the Camey 2 procedures. Blood loss were 390 ml, blood transfusion was d for only one patient. No major complication was observed, the mean hospital stay was 14.2 days (+3.5). In our experience laparoscopic radical cystectomy is a safe option, associated with shorter hospital stays and gentler postoperative recovery.
Aged↗
Diagnosis and treatment of prostate cancers in renal-transplant recipients.
BACKGROUND: There is no consensus regarding prostate cancer in renal-transplant recipients (RTR). A questionnaire evaluating prostate cancer screening after transplantation and assessing the number, diagnostic modalities, treatment, and outcome of prostate cancer cases was mailed to 22 French renal-transplant centers. RESULTS: Among 1,680 RTR in 1998, 11 (0.65%) cases of prostate cancer were diagnosed, and among the 2,338 recipients followed up, 28 (1%) cases of prostate cancer have been diagnosed and treated. Median ages at diagnosis and at transplantation were 63 and 58, respectively. Clinical stages were T1 50% and T2 25%. Eighteen patients had a Gleason score under 7. At 18 months of mean follow-up, 2 men had died from prostate cancer, and in the curative treatment group, 16 of 17 men were alive with no evidence of disease. CONCLUSIONS: The incidence of prostate cancer in RTR appeared to be higher than expected. Prostate specific antigen (PSA) testing should be performed routinely each year in renal transplantation centers.
Adult↗
Ureteral stenosis as the sole manifestation of Wegener's granulomatosis.
In Wegener's granulomatosis, necrotizing lesions are typically located in the upper and lower respiratory tract and kidneys, and ureteral involvement is uncommon. We report 2 cases in which intrinsic ureteral stenosis was the sole manifestation of this small-vessel vasculitis. Excisional surgery evidenced characteristic granulomatous inflammation that allowed adjuvant elective medical treatment. Urologists, nephrologists, and internists should be aware of this atypical presentation of Wegener's granulomatosis. Thorough clinical and biologic assessments are warranted in the initial workup of isolated intrinsic ureteral stenosis.
Adult↗
Early experience with sildenafil for the treatment of erectile dysfunction in renal transplant recipients.
BACKGROUND: Erectile dysfunction (ED) is common in men with renal failure, but is not always alleviated following kidney transplant. The objective of the present study was to assess the feasibility in renal transplant patients of sildenafil citrate treatment, an agent with proven efficacy in the management of ED. METHODS: This was a phase IV, open, multicentre, 3 month, dose-escalation study. All patients meeting the inclusion criteria were prescribed a dose of 50 mg sildenafil at the first visit. Thereafter the dose could be increased to 100 mg or reduced to 25 mg based on efficacy or tolerability. The primary efficacy parameter assessed the ability of patients to achieve erections sufficient for intercourse and to maintain erections after penetration. Secondary endpoints assessed patient satisfaction with sildenafil and the effect of sildenafil on their quality of life. Patients were carefully monitored throughout the study for adverse events, interactions with immunosuppressive therapy and effect on graft function. RESULTS: The study included 50 patients in the intent-to-treat population. Sildenafil significantly improved patient's erection ability and the frequency of their erection maintenance. Analysis of the secondary efficacy parameters revealed that 66% of patients believed treatment had improved their erections. Patients reported improvements in their sexual life and partner relationships and a high level of satisfaction with treatment. There were no interactions between sildenafil and the immunosuppressive drugs and there was no significant adverse effect of sildenafil on graft function. CONCLUSIONS: Sildenafil is an effective and well-tolerated agent for the treatment of ED in renal transplant recipients.
Dose-Response Relationship, Drug↗
[Retroperitoneal laparoscopic nephrectomy fo polycystic kidney: preliminary results].
OBJECTIVES: To evaluate the morbidity and mortality of retroperitoneal laparoscopic nephrectomy for polycystic kidney. MATERIAL AND METHODS: Between June 2000 and March 2002, seven retroperitoneal laparoscopic nephrectomies for polycystic kidney were performed in six patients (three men, three women) with a mean age of 52.8 years. All patients presented end-stage renal failure treated by haemodialysis in five cases and by renal transplantation in one case. The ASA score was 2 in four cases and 3 in two cases. The indication for surgery was preparation for renal transplantation, episodes of macroscopic haematuria and pain in three cases, hypertension poorly controlled by medical treatment in two cases, preparation for renal transplantation in one case and pain associated with restrictive respiratory syndrome due to compression in one case. RESULTS: The mean operating time was 4 hours 35 minutes, and the mean blood loss was 400 ml. There were no intraoperative or perioperative deaths. An early postoperative complication occurred in two cases. The mean hospital stay was 11 days, with a mean stay of 2.4 days in the postoperative intensive care unit. No late complications were observed with a mean follow-up of 14 months. Preoperative pain, episodes of haematuria, hypertension and signs of compression resolved in each case. CONCLUSION: Laparoscopic nephrectomy for polycystic kidney is a technique that can be performed via a retroperitoneal approach without manual assistance and with low morbidity.
Female↗
[Symptomatic vesicoureteral reflux in kidney transplantation: results of endoscopic injections of teflon and predictive factors for success].
OBJECTIVES: Evaluation of the results of endoscopic Teflon injections for the treatment of symptomatic vesicoureteric reflux in renal transplant recipients and identification of prognostic factors. POPULATION AND METHODS: Between June 1997 and January 2002, out of a series of 408 renal transplant recipients, 15 patients (8 males, 7 females) with a mean age of 41.9 years were treated for symptomatic vesicoureteric reflux on the transplanted kidney by endoscopic Teflon injection. This treatment was indicated due to the presence of febrile or afebrile infections, possibly associated with deterioration of renal function. Reflux was demonstrated by retrograde cystography. The results of endoscopic treatment were evaluated by cystography at 3 months, and by clinical and laboratory examinations thereafter. RESULTS: The mean interval between renal transplantation and endoscopic treatment was 64.2 +/- 64.7 months. With a mean follow-up of 25 +/- 16.7 months, we observed a 53.3% success rate (8 patients), 13.3% of patients (2 patients) were improved and 33.3% of procedures were considered to be failures (5 patients). A lower number of preoperative infections, reflux < or = grade III and the absence of impaired renal function are predictive factors for the success of endoscopic treatment. The only complication was one case of renal colic due to meatal stenosis at 3 months, which responded favourably to endoscopic treatment alone. CONCLUSION: Endoscopic treatment of symptomatic vesicoureteric reflux on a transplanted kidney by Teflon injection is effective in two-thirds of cases. Due to the low morbidity of this minimally invasive procedure, this treatment should be proposed as first-line management for all cases of symptomatic vesicoureteric reflux on a transplanted kidney.
Adult↗