[Valsalva leak point pressure in the study of urinary incontinence in women].
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Female↗
Biomedical subjects
F Haab
Publications and source records attributed to F Haab.
[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↗
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↗
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↗
Re: Insertion of double pigtail ureteral stent for the prevention of urological complications in renal transplantation: a prospective randomized study.
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Humans↗
[Peri-ureteral injections for stress urinary incontinence].
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Adipose Tissue↗
[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↗
[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↗
[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↗
[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↗
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↗
Primary bladder neck obstruction: urodynamic findings and treatment results in 36 men.
PURPOSE: We reviewed the urodynamic findings and treatment outcomes of a large series of men with primary bladder neck obstruction. MATERIALS AND METHODS: A retrospective review was done of the presenting symptoms and urodynamic findings of 36 men with primary bladder neck obstruction. Outcomes after treatment with alpha-blockers, transurethral incision of the bladder neck and prostate, or no long-term therapy were determined by chart review and patient survey in the majority of cases. RESULTS: Mean age of the men was 41 years. Patients had significant lower urinary tract symptoms, decreased peak urinary flow rates, elevated post-void residual, markedly elevated peak voiding pressures and poor funneling of the bladder neck during voiding. Although most patients initially chose alpha-blocker therapy, only 30% of those beginning alpha-blockers continued them long term, usually due to inadequate symptomatic improvement. A total of 18 men underwent transurethral incision, which resulted in significant improvements in symptom scores, peak urinary flow rates, post-void residual and peak voiding pressures. Patients reported a mean 87% overall improvement in symptoms after transurethral incision. CONCLUSIONS: Video urodynamics facilitate diagnosis of primary bladder neck obstruction. Transurethral incision is the most effective therapy for primary bladder neck obstruction.
Adrenergic alpha-Antagonists↗
Post-prostatectomy incontinence: urodynamic findings and treatment outcomes.
PURPOSE: We examined urodynamic findings and treatment outcomes in a large population of men with post-prostatectomy incontinence. MATERIALS AND METHODS: A total of 215 men was referred for evaluation and treatment of significant post-prostatectomy incontinence. Urodynamic evaluation consisted of provocation multichannel medium fill cystometry with vigorous attempts to demonstrate incontinence. Treatment was directed by the results of the urodynamic study. A pad scoring system was used to gauge the severity of incontinence before and after treatment. RESULTS: Based on the results of urodynamic studies 40% of the men had genuine stress incontinence alone and approximately 60% had a major component of bladder dysfunction contributing to incontinence. Treatment results of 135 men demonstrated a significant decrease in pad score (p<0.001) for those treated with anticholinergics, those undergoing artificial sphincter insertion and those treated pharmacologically before sphincter placement. CONCLUSIONS: In our large series most men with prostatectomy incontinence did not have genuine stress incontinence alone. Thus, urodynamic studies are critical, not only to define cause of incontinence but to direct effective therapy.
Aged↗
Postprostatectomy incontinence.
Post-prostatectomy incontinence is a devastating complication that is frustrating for the patient and the surgeon. Bladder dysfunction with or without sphincteric incompetence is the main cause for post-prostatectomy incontinence. Treatment based on the urodynamic evaluation is effective in restoring continence and improving the patient's quality of life.
Humans↗
Testicular neoplasm presenting as a major pulmonary embolism.
OBJECTIVE: To report an unusual and life-threatening presentation of a nonseminomatous germ cell tumor of the testis. METHODS: A 35-year-old male presented with pulmonary embolism secondary to a neoplastic thrombus from a nonseminomatous germ cell tumor. Prompt management involved surgical thrombectomy with cardiopulmonary bypass and deep hypothermic circulatory arrest, followed by orchiectomy and adjuvant chemotherapy. RESULTS: Three years later, the patient remains disease free according to physical examination, radiographic workup and serum markers. CONCLUSION: The excellent long-term outcome of this patient supports an aggressive multidisciplinary management of nonseminomatous germ cell tumors in young adults.
Adult↗
Improvement of postischemic renal function by limitation of initial reperfusion pressure.
PURPOSE: This study was designed to determine whether lowering the initial reperfusion pressure can improve renal function after ischemia. MATERIALS AND DESIGN: Sixty minutes of warm renal ischemia was induced in 2 groups of 8 minipigs by clamping the left renal artery. Right kidneys were kept in situ as controls. In the standard reperfusion group, ischemic kidneys were immediately reperfused at systemic pressure. In the controlled reperfusion group, the renal artery reperfusion pressure was maintained at 60 mm. Hg for the initial 20 minutes of reperfusion by use of a regulating pump and then at systemic pressure for the next 100 minutes. RESULTS: On the basis of the postischemic anuria rate, glomerular filtration rate and renal histology, renal tolerance to ischemia was significantly improved in the controlled reperfusion group. CONCLUSION: These findings of improved renal function recovery after warm ischemia by controlled low reperfusion pressure may have clinical relevance to the reperfusion technique used after renal transplantation in humans.
Animals↗
Female stress urinary incontinence due to intrinsic sphincteric deficiency: recognition and management.
PURPOSE: The recent literature on intrinsic sphincteric deficiency is reviewed. MATERIALS AND METHODS: We performed an extensive literature search related to the diagnosis, management and treatment of intrinsic sphincteric deficiency. RESULTS: Stress urinary incontinence results from insufficient urethral resistance and/or support during increases in intra-abdominal pressure. Since treatment of stress urinary incontinence is closely related to the mechanism of urinary leakage, recognition of intrinsic sphincteric deficiency is of the utmost importance in its evaluation. Furthermore, to date there is no consensus on the treatment of intrinsic sphincteric deficiency and various procedures may be considered. CONCLUSIONS: The pathophysiology of urinary incontinence in female patients is still controversial. Intrinsic sphincteric deficiency is best recognized by history and clinical examination in conjunction with documentation of severe stress urinary incontinence, a fixed urethra and a low Valsalva leak point pressure. The pubo-vaginal sling procedure still represents the most widely accepted treatment to correct intrinsic sphincteric deficiency.
Female↗
[Prostate specific antigen. Clinical applications of ultrasensitive assay].
Recent progress in the techniques used to assay prostate specific antigen (PSA) have made this diagnostic tool even more useful in the management of patients with cancer of the prostate. However, although "ultrasensitive" methods can now detect minute levels, there still is no widely accepted definition of the detection threshold making it difficult to compare results reported with the different techniques. Ultrasensitive assay is particularly interesting in patients who have had radical prostatectomy, offering complementary information to the pathology examination of the surgical specimen. Used as a tool for following disease course after surgery, ultrasensitive PSA is currently the most sensitive measure of disease recurrence. Ultrasensitive assay can also give an evaluation of the effect of post-surgery complementary radiotherapy. Inversely, it adds no further information compared with regular assay before surgery. Thus, ultrasensitive assay is not indicated for differential diagnosis or screening programmes but is a valuable tool for evaluating the effectiveness of curative surgery or exclusive curative radiotherapy.
Humans↗