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Biomedical subjects

E Z Moriel

Publications and source records attributed to E Z Moriel.

17 recordsLinked to original sources
PubMed1999

Laser prostatectomy. Long-term follow-up of 303 patients.

OBJECTIVE: This retrospective study was undertaken to evaluate results and complications in 303 patients with symptomatic bladder outlet obstruction due to benign prostatic hyperplasia (BPH) who underwent laser prostatectomy focusing on the long-term follow-up, 57 patients had a follow-up of more than 3 years. MATERIALS AND METHODS: A total of 303 patients were treated with the neodymium:YAG laser system for 1993 to 1997, of whom 57 patients were followed up for at least 3 years. All of the patients have been evaluated after 3 months, 6 months and 2 years. 57 patients were evaluated after 3 years. Pre- and postoperative American Urological Association (AUA) symptom score, uroflowmetry (UF), and immediate and long-term complications were assessed. RESULTS: The mean AUA symptom scores of 303 patients decreased over the 24 months follow-up from 16.9 to 7.6. In 57 patients after 36 months the mean AUA symptom score was 7.1. The mean maximal UF increased over the 24 months from 9 to 14.1 cm3/s in 303 patients. In 57 patients at 3 years the mean UF was 13. 9 cm3/s. The overall complications of 303 patients included two perforations of the bladder wall and two perforations of the prostatic capsule. Six (1.9%) patients had postoperative febrile UTI and 28 (9.2%) patients had acute urinary retention after catheter removal. Early bleeding occurred in 3 (0.9%) patients, late bleeding in 8 (2.4%), 4 (1.2%) had urethral stricture, and 1 had stricture of the bladder neck. The overall reoperation rate for symptomatic residual tissue was 1.9% (6 patients). CONCLUSION: Neodymium:YAG laser ablation of prostate represents an efficacious surgical intervention for symptomatic bladder outlet obstruction due to BPH with minimal associated morbidity.

Aged↗
PubMed1994

Vein grafting of tunical incisions combined with contralateral plication in the treatment of penile curvature.

OBJECTIVE: To evaluate whether multiple incisions of Peyronie's plaque with placement of vein grafts to cover the tunical defects coupled with contralateral tunical plication is effective in straightening the penis while allowing preservation of normal erectile function. METHODS: Nine patients with Peyronie's disease and 2 patients with congenital curvature of the penis were surgically treated with a vein patch graft technique to correct their penile curvature. All patients underwent relaxing transverse incisions of their plaque with placement of a vein graft from the deep dorsal vein of the penis and/or the saphenous vein. Transverse relaxing incisions about 1 to 2 cm long were made on the tunica albuginea where a curvature was identified by an artificial erection. A corresponding size of the harvested vein was sewn into the defect created by the relaxing incisions. If there was evidence of a residual curvature after the vein grafts were sewn in, a plication of the contralateral surface of the tunica albuginea was performed. RESULTS: Of 10 patients who were potent preoperatively, 9 retained their potency post-operatively. Complete straightening of the erect penis occurred in 9 of 11 patients. Penile shortening occurred in three men. None of the patients permanently lost sensation in the shaft or glans of the penis. Two patients have anesthesia on part of the skin of the penile shaft. In all patients, the grafts were unable to straighten the penis 100 percent, thereby requiring at least one plication suture in the contralateral corpus. CONCLUSIONS: The use of vein grafts to cover multiple incisions of the tunica albuginea combined with contralateral corporeal plication is an easy alternative and an effective way to treat penile curvature while attempting to preserve erectile function.

Adult↗
PubMed1994

Evaluation and treatment of iatrogenic ureteral injuries during obstetric and gynecologic operations for nonmalignant conditions.

Twenty-one iatrogenic ureteral injuries (20 patients) as a result of obstetric and gynecologic operations are presented. All injuries occurred during operations for benign conditions, such as Cesarean section and transabdominal hysterectomy. Pelvic adhesions as a result of repeat Cesarean section, markedly enlarging the uterus at the time of abdominal hysterectomy, and massive hemorrhage during surgical treatment were the main causes of ureteral injury. Nine ureters were transected (eight patients) and 12 ureters had postoperative obstruction. Fistulas occurred between the affected ureter and the vagina (five patients), uterus (one patient) and skin (one patient). The existence and the site of such a fistula is clearly demonstrated roentgenographically using intravenous urograms while a urethral catheter filled with contrast media is inserted into the bladder. Only a few ureteric injuries (two patients) were diagnosed and managed during the initial gynecologic operation. The remainder underwent delayed repair procedures. In most patients, the upper urinary tract was protected by percutaneous nephrostomy. The preferred operation for definitive correction was ureteroneocystostomy using the psoas hitch procedure. Direct localization by difficult dissection of the injured ureteral site was unnecessary with ureteroneocystostomy because this procedure bypasses the site of the injury to the ureter. This procedure can be applied in most injuries to the ureter, distal or proximal, which occur during gynecologic and obstetric operations. Renal salvage was achieved in all instances, with no operative or postoperative complications.

Adult↗
PubMed1993

Experience with the immediate treatment of iatrogenic bladder injuries and the repair of complex vesico-vaginal fistulae by the transvesical approach.

We describe our experience in treating 16 established cases of vesicovaginal fistulae in non-irradiated bladders which followed obstetric and gynecological procedures. The fistulae, most of which were large and complex, were successfully repaired surgically after two to three months intervals, using the O'Connor transvesical technique. The advantages of late correction using the transvesical approach in such cases are discussed. Thirteen additional cases of accidental bladder injuries during obstetric and gynecological procedures are presented. These injuries were successfully treated by immediate primary sutures. Our experience shows that bladder injuries mainly occur in women who had previously had a Cesarean section.

Adult↗
PubMed1993

Levels of nitric oxide metabolites do not increase during penile erection.

Cavernosal smooth muscle relaxation, one of the primary events in penile erection, is initiated by the synthesis and release of nitric oxide (NO) from the neurons of the cavernosa. The present study was undertaken to determine whether or not serum levels of NO metabolites rise during an erection. Since NO is rapidly converted into nitrites and nitrates, we measured these serum levels in the peripheral and cavernosal blood of 15 potent adult male volunteers who were exposed to erotic stimuli in order to elicit a penile erection. Our data demonstrate that both nitrite and nitrate levels in the peripheral and cavernosal blood do not appreciably change during and immediately following an erection. This indicates that the determination of whether or not abnormalities in the synthesis and release of NO play any role in erectile dysfunction will require alternative testing methods.

Adult↗
PubMed1993

Cavernous artery obstruction following blunt trauma to the penis.

Erectile dysfunction following blunt trauma to the erect penis usually is associated with an injury to the tunica albuginea of the corpus cavernosum. We recently identified 2 patients with erectile dysfunction following bending of the penis during coitus whose only abnormality after a complete evaluation, including penile angiography, was a deep cavernous artery injury. We suggest that during examination of patients with erectile dysfunction following blunt injury to the erect penis a complete vascular evaluation, including penile angiography, may be necessary to detect an unrecognized injury to the deep cavernous arteries.

Adult↗
PubMed1993

Sodium bicarbonate alleviates penile pain induced by intracavernous injections for erectile dysfunction.

In an attempt to determine whether penile pain associated with intracorporeal injections could be due to the acidity of the medication, we performed a randomized study comparing the incidence of penile pain following intracorporeal injections with or without the addition of sodium bicarbonate to the intracorporeal medications. A total of 38 consecutive patients who presented to our clinic with impotence received 0.2 ml. of a combination of 3 drugs: 6 mg. papaverine, 100 micrograms. phentolamine and 10 micrograms. prostaglandin E1 with (pH 7.05) or without (pH 4.17) the addition of sodium bicarbonate (0.03 mEq.). Of the 19 patients without sodium bicarbonate added to the medication 11 (58%) complained of penile pain due to the medication, while only 1 of the 19 men (5%) who received sodium bicarbonate complained of penile pain. From these data we conclude that the penile pain following intracorporeal injections is most likely due to the acidity of the medication, which can be overcome by elevating the pH to a neutral level.

Adult↗
PubMed1993

Pulmonary migration of coils inserted for treatment of erectile dysfunction caused by venous leakage.

Embolization of penile veins by coils and/or detachable balloons has been reported as a possible effective form of treatment of venogenic erectile dysfunction. The major appeal for this avenue of therapy in these patients is the reported low morbidity and negligible rate of complications compared to an open operation. We describe a case of asymptomatic pulmonary migration of a coil placed for venous leakage in a patient in whom the procedure was conducted through the femoral vein rather than the deep dorsal vein. We conclude that patients undergoing coil embolization for venous leakage should be appraised of the potential for coil migration.

Adult↗
PubMed1990

Endoscopic correction of vesicoureteral reflux: our experience with 115 ureters.

Endoscopic subureteral injection of polytetrafluoroethylene was performed in 115 ureters to correct vesicoureteral reflux. We treated primary reflux in 84 single ureters, 16 duplex ureters and 4 megaureters (grade V), and secondary reflux in 11 ureters associated with neurogenic bladder, uncapped ureteroceles and failed ureteroneocystostomy. Followup evaluation consisted of a voiding cystourethrogram, which was done in the operating room immediately after the endoscopic procedure, ultrasound 1 month postoperatively, and a diethylenetriaminepentaacetic acid renal isotope scan and repeat voiding cystourethrogram 6 months after injection. Grades II to IV primary reflux involving single as well as duplex ureters resolved in 94% and 82%, respectively, of the cases after 1 injection and in 98% and 93% of the cases after 2 or more injections. The severely and chronically dilated ureters did not respond to the treatment.

Child, Preschool↗
PubMed1986

Surgical aspects of gastrointestinal persimmon phytobezoar treatment.

One hundred thirteen patients presented with gastrointestinal complications due to persimmon phytobezoars during a 3 year period. One hundred three patients had a history of persimmon ingestion. One hundred five patients had undergone previous gastric operation for duodenal ulcer, one patient underwent highly selective vagotomy, and seven patients had not undergone previous operation. An elevated temperature, leukocytosis, and decreased bowel sounds were typical early clinical manifestations of small bowel obstruction by persimmon phytobezoars. In 13 patients, gastric bezoars were found, in 20 patients, gastric and intestinal bezoars, and in 80 patients, intestinal bezoars. One hundred patients were treated surgically. In 14 of the 20 patients with concomitant gastric and intestinal phytobezoars, extraction of the bezoars was achieved by gastrotomy. Of the remaining six patients, it was achieved by intraoperative milking of the gastric bezoar into the small bowel in two patients and by conservative treatment in four patients. Of the 100 patients who presented with small bowel obstruction, 60 were treated by milking of the bezoar into the large bowel, 34 by enterotomy, and 6 by conservative therapy with intravenous fluids, gastric suction, and a water-soluble contrast meal. Small bowel resection of a gangrenous segment was necessary in two patients. Two patients died after operation because of sepsis and respiratory complications. Eleven of the 13 patients in whom postoperative wound infection developed underwent gastrotomy or enterotomy. We conclude that the treatment of choice of intestinal obstruction due to persimmon phytobezoars is milking of the bezoar into the large bowel without enterotomy. Preoperative or operative endoscopy should be performed in patients presenting with complications of gastrointestinal phytobezoars. Patients who have undergone gastric operation should be warned against the risk of persimmon ingestion.

Bezoars↗
PubMed1983

An unusually high incidence of gastrointestinal obstruction by persimmon bezoars in Israeli patients after ulcer surgery.

Seventy-seven patients presented with gastrointestinal obstruction due to phytobezoars during a 5-mo period. Most of the patients (88.3%) had a history of persimmon ingestion, and all had previous surgery for ulcer disease. Seventy-one patients were treated surgically; 67 because of intestinal obstruction and 4 for extraction of gastric phytobezoars. Five patients were reoperated once and 1 patient twice because of retained phytobezoars. Six patients were treated conservatively. Seventy-five patients recovered after surgical or conservative therapy, and 2 patients died. Patients who have undergone gastric surgery should be warned about the risk of persimmon ingestion.

Adolescent↗
PubMed1979

Detrusor hyperreflexia in multiple sclerosis. Alleviation by a combination of imipramine and propantheline, a clinico-laboratory study.

16 patients with multiple sclerosis, complaining of urgency, frequency and urge incontinence were studied urologically. They all suffered from detrusor hyperreflexia. We managed to improve this disturbance by lowering the parasympathetic tone and at the same time increasing the sympathetic tone of the urinary outlet, using a combination of imipramine and propantheline. The subjective clinical alleviation was also corroborated by cystomanometry and urethral pressure profile before and after treatment.

Adult↗