Biomedical subjects
Publications and source records attributed to F Staerman.
The diagnosis of male infertility requires methodical approach which is primarily clinical, aimed at identifying all potential factors. Biological and radiological assessments allow diagnosis confirmation, and evaluation of both prognosis and therapeutic strategy.
OBJECTIVE: This study was carried out to evaluate the ultrasonographic findings on patients with voiding disorders after the tension-free vaginal tape procedure (TVT). PATIENTS AND METHOD: Fifty-four women had ultrasonographic evaluation 3 months after TVT procedure. The prolene tape position was evaluated with a complete sagittal view and the width of the tape and the distance between the bladder neck and the tape were measured. In the same time, patients completely cured by TVT (group 1), postoperative dysuria (group 2), de novo urge incontinence (group 3) and ineffective treatment were evaluated with a self-questionnaire and physical examination. Statistical analysis was performed using ANOVA test. RESULTS: The distance between the tape and the bladder neck shows a significant difference between group 1 and 2 (13.2 mm compared to 7.6 mm) and between group 1 and 3 (13.2 mm compared to 17.7 mm). The width of the tape is significantly different between group 1 and 2 (8.8 mm compared to 6.6 mm) and between group 1 and 3 (8.8 mm compared to 6.5 mm). The distance between the tape and the bladder neck in group 2, compared with group 3, is significantly shorter (7.6 mm compared to 17.7 mm). There is no difference between the width of the tape between groups 2 and 3 (6.6 mm compared to 6.5 mm). DISCUSSION AND CONCLUSION: These results show a correlation between voiding disorders after TVT procedure and transvaginal ultrasonographic measurement of the distance between the prolene tape and the bladder neck.
PURPOSE: In spite of classifications based on digital rectal examination, prostate specific antigen (PSA), transrectal echography and histological analysis, 20% to 40% of operated prostate adenocarcinomas are not yet organ confined. New diagnostic features to predict extracapsular invasion before treatment are needed to avoid surgical extraction within positive margins. MATERIALS AND METHODS: A retrospective study was performed for 74 prostate adenocarcinomas with Gleason 3+3. A total of 54 organ confined tumors (T1T2) at digital rectal examination were compared with 20 nonorgan confined tumors (T3T4). Image cytometric DNA analysis was performed on prostate initial biopsies. DNA ploidy results were compared in both groups for values of PSA greater than 15, less than 15 and less than 10 ng/ml. RESULTS: For a PSA rate less than 15 ng/ml, 83.8% of T1T2 were diploid vs 33% T3T4 (p = 0.042). For a PSA rate less than 10 ng/ml, 96% of T1T2 were diploid vs 33% T3T4 (p = 0.025). CONCLUSIONS: DNA ploidy appears to be an interesting feature at diagnosis. When in doubt about the localized character of a tumor, DNA ploidy it makes it possible to predict a nonorgan confined tumor. Gleason 3+3 prostate cancers that are organ confined at digital rectal examination are more often diploid than T3T4 tumors. The prognostic interest in DNA ploidy is more reserved because of its correlation with PSA level.
INTRODUCTION: Midodrine hydrochloride (Gutron) is proposed to induce ejaculation in spinal injury patients desiring paternity as an alternative to vibromassage, electrostimulated ejaculation and surgical collection of spermatozoa. The authors report their experience in 10 spinal injury patients. PATIENTS AND METHODS: 14 trials of pharmacologically-induced ejaculation were performed in a context of medically assisted reproduction (MAR) in 10 spinal injury patients (7 with paraplegia > T11; 1 with paraplegia < or = T11; 2 with quadriplegia) an average of 4.5 years after the injury. Patients had a mean age of 28.5 years (range: 18 to 36 years). Nine had persistent reflex erections. After IC injection of prostglandin E, 10 to 30 mg of Gutron was administered by slow i.v. infusion. Spermatozoa were collected during antegrade ejaculation and/or in previously alkalinised urine. RESULT: Ejaculation was obtained in 10 cases (71.4%), either antegrade (7 cases), or retrograde (3 cases). The 4 failures corresponded to ejaculation failure in 3 cases and adverse effects of Gutron (hypertension) in 1 case. However, storage of spermatozoa could be performed in only 4 cases (40%), as pyospermia or severe necrospermia were observed in 6 cases. CONCLUSIONS: Midodrine hydrochloride gives good results in terms of ejaculation in spinal injury patients. However, the quality of semen collected is often poor due to the long interval since the initial trauma. Midodrine hydrochloride, ideally used after antibiotic treatment, can nevertheless constitute an alternative to other techniques.
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We report a case of nested cell carcinoma, an uncommon transitional tumor. These tumors are composed of regular cuboidal transitional cells forming small nests with minimal cytologic atypia. Despite the benign course, this tumor resembling proliferation of Brunn's nests or inverted papilloma, must be considered as an aggressive transitional tumor. Thus, morphologic criteria are needed to make the diagnosis. Because of its aggressive behaviour, the surgical therapy depends on the tumor's infiltration.
PURPOSE: Endothelial P2y purinoceptor stimulation is known to induce vasodilatation mediated by NO release from endothelial cells. We examined the effect of a potent P2y agonist, adenosine-5'-O-(2-thiodiphosphate) (ADPbetaS), on human corporal cavernosal strips and its dependence on a functional endothelial lining. MATERIALS AND METHODS: The preparations mounted in isometric conditions were precontracted by noradrenaline (NA) at a concentration of 0.1 microM. Increasing concentrations of ADPbetaS from 1 microM to 100 microM were added in the presence and absence of a functional endothelium or in the presence and absence of an NO synthase inhibitor and a selective P2y antagonist. Acetylcholine (Ach)-induced relaxation was used in each experiment for control. RESULTS: In human precontracted corporal cavernosal strips with a functional endothelium (relaxed by acetylcholine) ADPbetaS induces a dose-dependent relaxation with maximal relaxation of 45.5+/-5.0% and an EC50 of 11.7 microM. The relaxant effect of ADPbetaS was reduced by 77.1+/-7.0% by reactive blue 2 (20 microM)(a P2y antagonist). L-NAME (L-Nitro Arginin Methyl Ester), an NO synthase inhibitor (100 microM), reduced Ach- and ADPbetaS- induced relaxations by 86.59+/-3.24% and 86.83+/-0.5% respectively. Ach- and ADPbetaS- induced relaxations were significantly inhibited after dislodging of the endothelial lining of the corporal cavernosal strips, 90.11+/-6.2% and 87.1+/-5% respectively. CONCLUSIONS: Human corporal cavernosal strips can be relaxed by stimulation of P2y purinoceptors via NO release. This relaxation is an endothelium-dependent mechanism. Purines may be implicated in physiological erection in man.
Propofol is an hypnotic drug used in anesthesia which was noted to induce marked vasodilation in vivo and in vitro, and to elicit intraoperative penile erections. The goal of this study was to assess the putative mechanistic basis for this later observation by confirming its action in vivo in a rat model of penile erection, as well as by studying its effects in vitro on cultured human corporal smooth muscle cells and isolated corporal tissue strips. In vivo experiments were conducted on Fisher 344 rats anesthetized with sodium pentobarbital or propofol. Intracavernosal pressure was recorded during current stimulation of cavernous nerves. A significant increase in the intracavernous pressure response was recorded at all levels neurostimulation, ranging from 1-10 mA. In vitro experiments were conducted utilizing digital imaging microscopy to assess the effects of propofol (3-12 micrograms/mL) on ET-1-induced (50 nM) intracellular Ca2+ transients [Ca2+]i in Fura-2-loaded cultured human corporal smooth muscle cells (passage 3-4) as well as to evaluate the effects of propofol on phenylephrine (PE)-induced contractile responses on isolated corporal tissue strips. With respect to the former, resting cytosolic calcium levels were not altered during preincubation with propofol alone at clinically effective concentrations (12 micrograms/mL). However, propofol produced a concentration-dependent decrease in the peak amplitude of the transient ET-1-induced (50 nM) [Ca2+]i response (P < 0.001). Preincubation of the cells with calcium free/EGTA (1 mM) buffer produced a reduction in the peak amplitude of the ET-1-induced [Ca2+]i transient (55.5 +/- 6% (n = 10 cells, P < 0.01)) which was indistinguishable from that produced by 8 micrograms/mL of propofol (53.4 +/- 5.6% (n = 12 cells, P < 0.01)). However, propofol had no effect on the histamine-induced [Ca2+]i response. Lastly, preincubation of isolated human corporal tissue strips with propofol (100-200 microM; 30 min) caused a significant diminution in the peak amplitude of the PE-induced contractile response. Taken together, these data indicate that the mechanistic basis for intraoperative penile erections observed with propofol may be related, at least in part, to altered transmembrane calcium flux through voltage-dependent calcium channels, and thus, decreased corporal smooth muscle tone.
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.
BACKGROUND: Androgen deprivation is currently the standard treatment for patients with metastatic prostate carcinoma. Few reliable prognostic markers are able to select, at diagnosis, patients who will respond favorably and durably to hormone ablation. Circulating polyamines, markers of cell proliferation that are elevated in prostate carcinoma, have been evaluated as a prognostic tool. METHODS: Eighty-eight patients with untreated, M1 classified prostate carcinoma who received endocrine therapy between 1988 and 1993 were included in this study. Performance status, hemoglobin, alkaline phosphatases, prostate specific antigen, Gleason tumor grade, extent of disease by bone scan, and circulating erythrocyte spermidine and spermine were correlated with observed progression free and cause-specific survivals. Multiple correspondence analysis and ascending hierarchical classification were performed to determine significant pretreatment prognostic factors. RESULTS: Pretreatment performance status, alkaline phosphatase, hemoglobin, and erythrocyte spermine levels were correlated with progression, with hemoglobin and erythrocyte spermine level being the most significant independent variables (P < 0.00001 and P < 0.0001, respectively). With regard to cause specific survival, only hemoglobin and spermine erythrocyte levels were significant independent variables (P < 0.0001 and P < 0.0005, respectively). Patients with spermine levels of less than 9 nmol/8.10(9) had a statistically better outcome than patients with 9 nmol/8.10(9) or more erythrocytes. Erythrocyte spermine was the best sole determinant of progression. A test combining spermine with performance status or hemoglobin improved each variable's predictive values. CONCLUSIONS: Circulating erythrocyte spermine levels, extracted from a blood sample, can discriminate, at diagnosis, patients with hormone-refractory from those with hormone-responsive metastatic prostate carcinoma.
A questionnaire was set to 250 general practitioners in the Brittany region, to determine the impact of information campaigns concerning benign prostatic hyperplasia (BPH) and prostatic cancer on their everyday approach to disorders of micturition in men over the age of 50 years. 225 questionnaires were interpretable. 75% of general practitioners systematically investigated the presence of disorders of micturition. In the presence of such symptoms, 76% of general practitioners conducted further investigations to exclude prostatic cancer. 89% of general practitioners performed first-line digital rectal examination, and 34% of them systematically performed this examination once a year. The investigations most frequently performed after digital rectal examination concerned the state of urine (50%) but only 30% of general practitioners used reagent dip-sticks and 43% ordered urine cultures. Other investigations consisted of transrectal ultrasonography (31%) an PSA assay (26%). 3% of PSA assays were ordered before digital rectal examination. Renal and vesical ultrasonography occupied 5th place, although distension of the upper urinary apparatus was a source of concern for 51% of general practitioners. In the presence of symptomatic BPH, general practitioners readily prescribed medical treatment (96%). They assessed the results of this treatment on the course of disorders of micturition (95%), digital rectal examination (91%), and PSA (50%). General practitioners are familiar with disorders of micturition after the age of 50 years. However, 25% of them do not systematically question patients about these symptoms. Digital rectal examination is now performed more frequently, although systematic examination of the prostate is rare (34%). PSA assay is not the doctor's first priority (3rd place in the list of examinations). Two examinations are rarely used and should be developed: reagent dip-sticks (30%) and renal and vesical ultrasonography (5th place). Only 4% of general practitioners did not prescribe any treatment in the case of uncomplicated BPH, which is not in line with current recommendations. There is certainly a need for better information of general practitioners, but this information is only valid when a consensus has been reached among urologists.
The recording of tumescence and rigidity during nocturnal erections is considered to be the reference examination to differentiate between the organic or psychogenic origin of erectile dysfunction. However, its diagnostic value is more doubtful in the absence of normal rigidity values. 170 consecutive patients were submitted to this type of recording (RigiScan, Dacomed, USA). With the exception of patients suffering from multiple sclerosis, all patients with erectile dysfunction considered to be psychogenic obtained a rigidity > or = 60%. 59% of these patients were detected by this method (sensitivity: 59%, specificity: 87%). In contrast, no conclusion can be drawn from a pathological nocturnal recording (32% of psychogenic patients) and finally, in view of the aetiologies of this series, this examination was considered to be useful in 29% of patients.
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.
The etiology of impotence in patients with multiple sclerosis (MS) is difficult to assess due to the possibility of normal nocturnal penile tumescence and rigidity (NPTR) recording despite neurologic involvement. Sixteen patients with MS and impotence were studied with Rigiscan, cavernous artery doppler, neurophysiological tests and intracavernous injection of PGE1. When more restrictive criteria of normality than usual are used for Rigiscan (rigidity > or = 80% and/or duration > 30 minutes), an inverse relationship between NPTR recording and sexuality score or PGE1 dose is reported. No significant difference is noted for neurophysiological tests. With such criteria, Rigiscan alone or combined with intracavernous PGE1 is a valuable means to differentiate neurogenic from psychogenic impotence in MS patients. Neurophysiological tests are of limited clinical value.
Due to the increased use of modern imaging systems during the last few years, kidney tumors are often diagnosed at an earlier and less advanced stage. This fact implies a reevaluation of the operative technique of radical nephrectomy that was recommended 30 years ago. The ipsilateral adrenal involvement during radical nephrectomy for renal cell carcinoma is assessed and the necessity of its extirpation is discussed. Between September 1987 and September 1993, we performed 299 radical nephrectomies for renal cell carcinoma and removed 285 ipsilateral adrenal glands. Eleven adrenal glands (3.8%) were involved with the kidney tumor and 274 (96.2%) were free of disease. In 7 of the adrenal gland involved cases (63.6%) the tumor invaded the gland by direct extension from the superior pole of the kidney. In the other 4 cases the ipsilateral adrenal gland was affected by a metastatic lesion. In all 11 adrenal gland involved cases the tumors were at an advanced stage (the lowest was stage pT3N1). Our results led us to recommend adrenalectomy during radical nephrectomy only when direct extension of the kidney tumor into the gland is suspected (upper pole or large tumors) or when the adrenal is the site of a single metastasis. Macroscopically normal adrenal glands at radical nephrectomy should not be routinely extirpated. Metastatic renal cell carcinoma (not by contiguity) in the ipsilateral adrenal gland should be regarded as a stage M+ (distant metastasis) tumor.
A total of 23 patients who had an intraoperative penile erection during endoscopic or penile surgery underwent intracavernous injection of 200 micrograms phenylephrine. Detumescence occurred rapidly in all patients with a single injection. Hemodynamic changes consisted of a transient increase in systolic and diastolic blood pressures (+9%, p < 0.05) without significant change in pulse rate (-5%, p > 0.05). No marked side effect was reported even in elderly patients. Intraoperative penile erection, which seems to be more frequent in patients younger than 50 years, during general anesthesia with propofol or epidural anesthesia, can be treated safely with intracavernous injection of phenylephrine.
Testicular microlithiasis corresponds to calcifications in the lumen of seminiferous tubules. This rare condition, primarily diagnosed histologically, is usually discovered on scrotal ultrasonography. The characteristic appearance combines multiple microscopic hyperechoic areas disseminated bilaterally throughout the testicular parenchyma. The coexistence of microlithiasis and testicular neoplasms has been described and raises the problem of the therapeutic approach following incidental discovery on scrotal ultrasonography performed for other reasons. The authors report a case of testicular microlithiasis discovered on ultrasonography performed after testicular trauma.
Female stress incontinence can always be treated by a transvaginal approach. It is often associated with genital prolapse which must be treated at the same time as the incontinence. Patients can be classified into 4 groups according to the position of the bladder neck, the degree of sphincter function and the associated genital prolapse. Operative techniques designed to simultaneously control incontinence and genital prolapse are indicated for each of these groups. Urologists should be just as familiar with the transvaginal treatment of female stress incontinence and disorders of pelvic tone as gynaecologists now are with urodynamics and cystoscopy.