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F Haab

Publications and source records attributed to F Haab.

At least 19 recordsLinked to original sources
PubMed1999

[Contribution of pressure-flow relationship studies in the evaluation of benign hypertrophy of the prostate].

Pressure-flow studies consist of simultaneously measuring urine flow rate and the detrusor pressure required to achieve this flow rate. It is the reference test for the diagnosis of bladder neck obstruction, characterized by the combination of high detrusor pressure and low urine flow rate. Pressure-flow studies are essentially indicated in the presence of voiding disorders of undetermined aetiology, with a discordance between clinical history, clinical examination and uroflowmetry, or in the presence of neurological disease associated with benign prostatic hyperplasia (BPH), or when surgical treatment of BPH is associated with particular morbidity in order to document bladder neck obstruction.

Age Factors↗
PubMed1998

Aseptic avascular necrosis of the femoral condyles in renal transplant patients: clinical and radiological aspects on 69 knees.

The purpose of this study was to analyze clinical and radiological aspects of aseptic avascular necrosis (AVN) of the femoral condyles in renal transplant patients. Forty-five renal transplant patients were followed between 1971 and 1993, and 69 knees have been studied. The immunosuppressive protocol comprised in all cases corticosteroids, with aziathioprine and since 1983 cyclosporin in 80% of patients. Episodes of rejection were treated with bolus doses of methylprednisolone. In 53.3% of patients, both knees were involved. The necrosis was bicondylar in 60.8% of knees. In the case of an unicondylar lesion, the lateral condyle was involved in 24.7% of knees vs 14.5% for the medial condyle. Symptoms occurred on average 4.9 years after transplantation (range 3 months-10.5 years). This period appeared significantly shorter for patients who had suffered an episode of rejection. In only 24.4% of patients was the knee involvement isolated. Pain was the initial symptom for 83% of patients. Other symptoms included locked knee (20.7%), effusion (49.2%), instability (14.5%), and loss of motion (15.9%). The diagnosis was established by standard radiographs, and in 8 patients by magnetic resonance imaging. Aseptic AVN of the femoral condyles in renal transplant patients is not rare even if it is less frequent than femoral head necrosis. Medication with corticosteroids is the main risk factor.

Adolescent↗
PubMed1998

Urethral graciloplasty for treatment of female intrinsic sphincter deficiency: rationale for the transvaginal approach: an anatomical study.

PURPOSE: To compare the retropubic and transvaginal approaches in terms of the length of gracilis muscle available for female urethral graciloplasty. MATERIALS AND METHODS: Two groups of female cadavers were submitted to bilateral gracilis muscle dissection, followed by urethral graciloplasty using either the standard retropubic approach or the transvaginal approach. The two groups were studied in terms of various muscle characteristics, in particular the length of muscle that could effectively be wrapped around the bladder neck. RESULTS: Because muscle transfer to the perineum was more direct, the transvaginal approach provided a greater functional length of gracilis for effective periurethral wrapping than the retropubic approach (mean: 8.4 cm. versus 5.2 cm., p = 0.0022). CONCLUSION: The transvaginal approach allows a more "proximal" graciloplasty and should therefore be evaluated clinically to provide circumferential bladder neck support without tension.

Aged↗
PubMed1998

Proposed cutoff values to define bladder outlet obstruction in women.

OBJECTIVES: There is no accepted urodynamic definition of outlet obstruction in women. Currently, the diagnosis is made on the basis of history and radiographic and endoscopic findings. The goal of this study is to design a pressure-flow nomogram (PdetQmax/Qmax) and define cut-off values for obstruction. METHODS: Two groups were studied prospectively in an open study: 124 control and 35 clinically obstructed patients. All had a complete history, physical examination, normal neurologic evaluation, cystoscopy, voiding cystography, and urodynamics-with-pressure-flow study. Pressure-flow plot and receiver operator characteristic curves (ROCs) were constructed to determine optimal cut-off values to predict obstruction for peak flow rate (Qmax) and detrusor pressure at maximal flow (PdetQmax). RESULTS: The etiology of obstruction was previous anti-incontinence surgery (n = 13), large cystocele (n = 11), urethral stricture (n = 6), and other (n = 5). On the basis of ROC curves, using cut-off values of Qmax of 15 mL/s or less and 12 mL/s or less, sensitivity was 85.7% and 71.4%, and specificity 78.2% and 90.3%, respectively. Using cut-off values of PdetQmax of more than 25 and more than 30 cm H2O, sensitivity was 74.3% and 71.4%, and specificity 79.8% and 88.7%, respectively. Using a combined cut-off value of Qmax of 1 5 mL/s or less and PdetQmax of more than 20 cm H2O, sensitivity was 74.3% and specificity was 91.1%. CONCLUSIONS: Based on this prospective, controlled study, preliminary cut-off values were obtained for refining the definition of outlet obstruction in women.

Female↗
PubMed1997

Results of pubovaginal sling for the treatment of intrinsic sphincteric deficiency determined by questionnaire analysis.

PURPOSE: We evaluated by questionnaire analysis the success rate and overall patient satisfaction after pubovaginal sling surgery. MATERIALS AND METHODS: A total of 40 women (mean age 65.7 years, range 45 to 79) underwent pubovaginal sling surgery for stress urinary incontinence due to intrinsic sphincteric deficiency. Patients completed a detailed questionnaire to assess voiding symptoms, urinary control and satisfaction. Of 40 patients 37 (92.5%) returned the questionnaire, with a mean postoperative followup of 48.2 months (range 24 to 60). RESULTS: Patients with preoperative stress urinary incontinence alone were more likely to be dry than were patients with preoperative mixed incontinence (67% versus 36%, p < 0.001). Ten patients (27%) reported stress urinary incontinence recurrence. Of the patients 23 (62.2%) reported urgency symptoms at followup, with de novo urgency occurring in 4 patients. Permanent retention was noted in 3 patients, including 2 with sacral arc denervation. Overall patients reported 86% postoperative improvement in urinary continence, and 81% would recommend the operation. CONCLUSIONS: At mean 4-year followup after pubovaginal sling surgery, this outcome study using a self administered questionnaire confirms high patient satisfaction despite significant postoperative urgency symptoms.

Aged↗
PubMed1997

Feasibility of outpatient percutaneous bladder neck suspension under local anesthesia.

OBJECTIVES: To demonstrate the feasibility of outpatient percutaneous bladder neck suspension (BNS) under local anesthesia to treat stress urinary incontinence (SUI) in females. METHODS: Since October 1994, 40 women with SUI (mean age 59.6+/-12.0 years) underwent outpatient percutaneous BNS with "Z" suture anchoring of the anterior vaginal wall and pubocervical fascia. The suspension sutures were secured to percutaneously placed bone anchors. The procedure was performed under local anesthesia. Pain during surgery was evaluated with an analogue scale graded from 0 (no pain) to 5 (severe pain). RESULTS: In 98% of the BNS, the procedure was successfully performed with the patient under local anesthesia. Conversion to general anesthesia was necessary for only 1 patient due to knee pain in the lithotomy position. No major complications were observed. Patients rated their perioperative pain as 1.0+/-0.6 (that is, minimal pain). Patients required pain medications for a mean of 2.4+/-1.3 days postoperatively. Mean duration of recovery (defined by a return to normal activities) was 2.2+/-1.0 weeks; 92% of the patients were continent postoperatively, and no recurrence of urethral hypermobility was observed. CONCLUSIONS: Our results demonstrate the feasibility of outpatient percutaneous BNS performed in patients under local anesthesia without significant morbidity. Continued follow-up will be necessary to determine the long-term efficacy of this procedure.

Aged↗
PubMed1997

[The Martius flap in vaginal surgery: technic and indications].

The Martius pedicle adipose flap can be used as an interposition flap during complex vaginal operations. It is a simple, rapid technique allowing raising of a well vascularized adipose flap with a mean length of 8 to 12 cm. It can be used in certain forms of vaginal repair, such as high supratrigonal vesicovaginal fistula, after bladder perforation, for obstructed urethra after colposuspension, after urethral destruction following prolonged bladder catheterization in a neurological patient, during repair of a complex urethral diverticulum or during transvaginal insertion of an artificial sphincter. After describing the flap raising operative technique, the various operative indications are presented.

Adipose Tissue↗
PubMed1997

Urinary stress incontinence due to intrinsic sphincteric deficiency: experience with fat and collagen periurethral injections.

PURPOSE: We prospectively compared the efficacy of 2 bulking agents to treat incontinence related to intrinsic sphincter deficiency. MATERIALS AND METHODS: A total of 67 women underwent periurethral injection for intrinsic sphincter deficiency at the same institution performed by 1 surgeon. Patients were divided into 45 who received fat (group 1) and 22 who received collagen (group 2) injections. Both groups were comparable for age, parity, number of previously failed procedures and number of pads used daily. Preoperative urodynamic evaluation revealed a low Valsalva leak point pressure in both groups (mean plus or minus standard deviation 23.82 +/- 12.41 versus 29.35 +/- 11.32, not significant). Patients rated the subjective degree of postoperative improvement as 0 to 100%. RESULTS: At a mean followup of 7 months after the last injection only 13% of the fat group and 24% of the collagen group were cured. The mean percentage of subjective improvement was significantly greater in the collagen than in the fat group (70.9 +/- 28 versus 31.2 +/- 41.7%, respectively, p < 0.001). The failure rate was significantly greater in the fat group compared to the collagen group (p < 0.001). CONCLUSIONS: Based on results of a prospective comparison of fat and collagen injection, collagen is more effective than fat for treatment of intrinsic sphincter deficiency.

Adipose Tissue↗
PubMed1997

Quality of life and continence assessment of the artificial urinary sphincter in men with minimum 3.5 years of followup.

PURPOSE: We determined the long-term efficacy and quality of life impact of the artificial urinary sphincter. MATERIALS AND METHODS: We reviewed the medical records of 68 men who underwent artificial urinary sphincter placement for post-prostatectomy incontinence (64) or neurogenic disease (4) between March 1980 and March 1992 (mean followup 7.2 years). Quality of life was assessed in 52 patients who completed the incontinence impact questionnaire and the urogenital distress inventory. RESULTS: At followup 54 men were socially continent (0 or 1 pad per day). Overall, pad score decreased significantly from 2.75 before to 0.97 after artificial urinary sphincter implantation (p < 0.001). The artificial urinary sphincter was permanently removed in 4 patients. Revisions for mechanical failure or urethral atrophy were required in 25% of the patients (mean 1.35 procedures per patient). The mechanical failure rate decreased significantly after 1987 due to device improvements (12.4 versus 44.4%, p < 0.01). Subjective improvement and overall satisfaction were rated as 4.1 and 3.9, respectively (scale 0 to 5). At followup the mean values of the incontinence impact questionnaire and urogenital distress inventory demonstrated the positive impact of the artificial urinary sphincter on quality of life. CONCLUSIONS: This long-term study documents the positive impact of the artificial urinary sphincter on patient quality of life with few mechanical failures since 1987.

Aged↗
PubMed1997

[The variability of the leakage pressure threshold due to exertion "the Valsalva Leak Point Pressure" as a function of the filling volume of the bladder].

OBJECTIVE: To determine the influence of the bladder filling volume on the Valsalva Leak Point Pressure (VLPP) in patients investigated for urinary stress incontinence. PATIENTS AND METHODS: 50 patients investigated for urinary stress incontinence were included in this prospective study. Evaluation consisted of clinical examination, urodynamic examination with simultaneous fluoroscopic assessment and cystoscopy. VLPP was measured while standing every 100 cc during filling until the cystomanometric bladder capacity. RESULTS: We observed a significant reduction of VLPP as a function of bladder filling volume. The VLPP measured at 200 cc constituted the reference value in view of its sensitivity and specificity for the diagnosis of type III urinary stress incontinence (Blaivas' classification). CONCLUSION: Measurement of VLPP must be standardized and interpreted as a function of bladder filling volume.

Adult↗
PubMed1997

[Urethrolysis after surgical cure of stress urinary incontinence using colpopexy: surgical technics].

OBJECTIVE: Infravesical obstruction can occur after surgical cure for urinary stress incontinence (USI). Apart from palliative treatments with limited effects, this iatrogenic complication can be corrected by complete urethrolysis. The various indications and techniques of this surgery are presented. METHOD: Urethrolysis is designed to release the urethra and bladder neck and can be performed via a transvaginal or retropubic approach. Some authors then recommend resuspension of the bladder neck, while others use a Martius or omentum flap to reduce the risk of restenosis. RESULTS: The success of urethrolysis is measured by the return of normal micturition with complete disappearance of the irritating and/or obstructive symptoms. The success rate for the transvaginal procedure varies from 65% to 92% according to different teams, while the success rate via an abdominal incision was 93% in one series. CONCLUSION: Urethrolysis is a difficult surgical technique, whose long-term results have not yet been precisely determined. The transvaginal route is associated with a low morbidity and remains our personal preference to release the obstructed urethra after operation for USI.

Abdomen↗
PubMed1997

[Feasibility of "Valsalva Leak Point Pressure". Prospective study].

OBJECTIVE: To prospectively evaluate the feasibility of determination of the Valsalva Leak Point Pressure (VLPP). PATIENTS AND METHODS: From 1st January to 31st July 1996, 155 consecutive patients investigated for urinary incontinence with no pelvis static disorder performed Valsalva manoeuvres during cystomanometry in order to determine the VLPP. The examination was performed in the standing position at a filling volume of 200 cc with then without a vesical pressure transducer. The mean age of the patients was 54 +/- 16 years (range: 16-84 years). RESULTS: The mean maximal intensity of abdominal straining pressure measured by the intravesical transducer was 72 +/- 28 cm of water. The VLPP could not be determined in 50.4% of cases, as the abdominal straining pressure during the Valsalva manoeuvre was less than 60 cm of water. No correlation was observed between abdominal straining pressure and patient age (r = 0.13; p > 0.1). CONCLUSION: Leak Point Pressure cannot always be determined by the Valsalva method. Other techniques of progressive increase of intravesical pressure must be investigated.

Adolescent↗
PubMed1997

[Cowper's gland: anatomic, physiological and pathological aspects].

Cowper's glands are small appendages of the male genital tract, that are sometimes observed on intravenous urography voiding films. They are involved in the immune defence of the genitourinary tract, play a role in fertility, and secrete many glycoproteins, including PSA. They can be visualized in the form of a duct image parallel to the urethra, sometimes associated with opacification of the gland on IVU. This image can be differentiated from a fistula, extravasation of contrast agent, urethral duplication, or an artefactual image, by the course parallel to the urethra, the upper limit not exceeding the urogenital diaphragm, and the position of the orifice. These glands can be affected by neoplastic, infectious, stone and especially cystic disease: syringocele. The physician should think of these glands in patients with unusual genitourinary symptoms in order not to miss disease of these organs, and to prescribe appropriate treatment.

Bulbourethral Glands↗
PubMed1997

Latex thimble for needle suspension procedures.

OBJECTIVE: To present a latex finger tip protector designed to reduce the risk of finger tip injury during needle suspensions for correction of stress urinary incontinence. MATERIAL AND METHODS: The latex finger tip protector is placed over the gloved tip of the index finger. The suture carrier is kept in contact with the protected finger tip during passages through the abdominal fascia and retropubic space. RESULTS: We have been using the finger tip protector for 2 years and in more than 50 modified Peyrera bladder neck suspensions. We did not experience any finger injury and the procedure was found to be more comfortable for the surgeon. CONCLUSION: The latex finger tip protector is useful whenever the finger is used to control the passage of the ligature carrier through the retropubic space.

Finger Injuries↗