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Biomedical subjects

H Claes

Publications and source records attributed to H Claes.

At least 19 recordsLinked to original sources
PubMed2002

A shared care approach to the management of erectile dysfunction in the community.

Erectile dysfunction (ED) affects men of all ages and results in considerable distress and impact on quality of life for those who suffer from it. As ED is associated with a wide variety of under-lying conditions and cardiovascular co-morbidities, there is a requirement for diversity of treatment options and several factors must be considered to customise and optimise therapy. In the ideal holistic approach to management of the ED patient, both primary care and specialist physicians have an important role to play. This article reports on a sequential approach for the diagnosis and treatment of ED, with an emphasis on 'shared care'. The deliberations are based on a pan-European inter-disciplinary group that met at the Lygon Arms, UK on 22 February 2002.

Erectile Dysfunction↗
PubMed1999

Tamsulosin 0.4 mg once daily: effect on sexual function in patients with lower urinary tract symptoms suggestive of benign prostatic obstruction.

OBJECTIVE: To evaluate the effect of tamsulosin, 0.4 mg once daily, on sexual function in comparison with placebo and alfuzosin, 2.5 mg three times daily, in patients with lower urinary tract symptoms (LUTS) suggestive of benign prostatic obstruction (BPO). METHODS: Data from 830 patients randomized into three European multicenter studies with similar protocols were analyzed. In two studies, patients were randomized to receive either tamsulosin, 0.4 mg once daily, or placebo, and in the third, patients were randomized to receive either a fixed dose of tamsulosin, 0.4 mg once daily, or alfuzosin, titrated to 2.5 mg three times daily. The studies employed a 2-week placebo run-in period, followed by a 12-week study period. Sexual function was assessed by related adverse events and by a sexual function score determined from a life-style questionnaire. RESULTS: Abnormal ejaculation occurred significantly more frequently in patients treated with tamsulosin than in those receiving placebo (p = 0.045); however, the incidence of abnormal ejaculation was similar in patients receiving tamsulosin or alfuzosin in the comparative study. Abnormal ejaculation was not perceived as a major problem by the patients since it resulted in few treatment discontinuations (n = 3). It was also reversible on drug withdrawal. There was no difference between tamsulosin and placebo or alfuzosin with regard to the occurrence of decreased libido or impotence. In addition, there was no significant difference in the change in sexual function score between patients treated with tamsulosin and those treated with alfuzosin. Compared with patients receiving placebo, there was, however, a significant improvement in total sexual function score in patients receiving tamsulosin (p = 0.042). CONCLUSIONS: Tamsulosin, 0.4 mg once daily, is well tolerated and has no overall negative impact on sexual function compared with placebo or alfuzosin. Compared with placebo, tamsulosin may even improve sexual function.

Adrenergic alpha-1 Receptor Antagonists↗
PubMed1997

Urinary incontinence in Belgium: a population-based epidemiological survey.

OBJECTIVE: To investigate the prevalence, typology, and experience of urinary incontinence, as well as the available therapeutic modalities and information sources among people living at home in Belgium. METHODS: A representative population sample of 5,269 adults completed a questionnaire in their own homes. There were 2,499 men and 2,770 women aged 30 years and over. RESULTS: 130 men (5.2%) and 442 women (16.30%) had urinary incontinence at the time of the survey. Of 1,426 women aged over 50 years, 300 (21.0%) had urinary incontinence. 17.4% of the incontinent people experience several episodes daily. In women, incontinence increases with parity. Stress incontinence is by far the most common form of the disease (42%); 53% of incontinent women (9.9% of the female population) experience this kind of disorder. Overall, 95% of stress incontinent people are women. The relative frequency of urge incontinence is similar in both sexes (males 45%; females 55%). Urinary incontinence is considered as bothersome by about 30% of the affected subjects; 7 of 10 subjects with daily incontinence episodes consider the disorder as more or less bothersome. 29.9% of affected people report that they discuss the problem with their general practitioner, 11.4% with a specialist, 25.3% with their spouse or partner, and 17.4% with a family member. Of course, people who consider the disease as bothersome score higher on these items. On the other hand, 32.1% do not reveal the problem. Although 72.5% of incontinent people are aware of protection systems, the main therapeutic modalities are not very well known (drugs 33.9%; surgery 24.7%). Most people with incontinence (70-75%) take no specific measures, 20% use pads, panty liners or nappies, and only 9% look for a curative measure. The preferred information source is the family physician for 50%, the specialist physician for 11%, and the pharmacist for 9%. The role of the mass media is equivalent to that of specialist physicians and pharmacists. CONCLUSIONS: Incontinence has a profound effect on daily life, and is still considered by many as 'taboo'. An appropriate information system, in which the general practitioner plays a key role, is obviously desirable.

Adult↗
PubMed1996

The hemodynamic influence of the ischiocavernosus muscles on erectile function.

PURPOSE: Special attention has been focused on the contribution of the ischiocavernosus muscles to intracorporeal pressure during erection. MATERIALS AND METHODS: Length of the ischiocavernosus muscles and corpora cavernosa was studied in 30 cadavers. RESULTS: A biomechanical model for calculating interference of the ischiocavernosus muscles in rigidity during the initial phase of penile erection is proposed. CONCLUSIONS: We found that, among other things, intracorporeal pressure can be influenced by the ischiocavernosus muscles during erection.

Cadaver↗
PubMed1995

Corporeal plication for surgical correction in Peyronie's disease improves rigidity.

A prospective study was done on 76 patients who underwent surgical correction by corporeal plication of the penile deformity secondary to Peyronie's disease. Nocturnal penile tumescence and rigidity were recorded by RigiScan during three consecutive nights, before and after the operation. A significant number of patients developed erections of better quality especially at the tip, after this significantly enhance the quality of erectile episodes, by increasing penile rigidity, during rapid eye movement sleep.

Adolescent↗
PubMed1994

[5-alpha-reductase inhibitors].

A reflection is made, on the one hand, on the lack of correlation between the intensity of micturition problems and the volume of the prostate and, on the other hand, on the different therapeutic approaches of irritative or obstructive voiding problems, and finally on the insufficiently convincing activity of Finasteride.

5-alpha Reductase Inhibitors↗
PubMed1994

Nocturnal penile tumescence evaluation before and after corporeal plication for Peyronie's disease.

A prospective study was done on 76 patients who underwent surgical correction by corporeal plication of the penile deformity secondary to Peyronie's disease. Nocturnal penile tumescence and rigidity were recorded by RigiScan during three consecutive nights, before and after the operation. A significant number of patients developed erections of better quality especially at the tip, after this corporeal plication procedure. These data indicate that corporeal plication does significantly enhance the quality of erectile episodes, by increasing penile rigidity.

Adolescent↗
PubMed1994

A histopathological study of deep dorsal penile vein in venogenic impotence.

We have studied the histopathology of 87 dorsal penile veins, obtained from patients who underwent a resection of the deep dorsal penile vein because of proven venous leakage. The amount of muscle tissue and of collagenous connective tissue has been numerically quantified. Special attention has been focused on the muscular/collagenization ratio. We show that this ratio is not correlated to age neither with the outcome of the operation and that no differences exist between veins in venous leakage patients and in potent patients. This study confirms that the reduction of venous outflow-the so called corporeal veno-occlusive mechanism-is probably a secondary passive phenomenon, due to smooth muscular relaxation, and mainly located within the corpora cavernosa, between the expanding sinusoidal wall and the noncompliant tunica albuginea. Our findings also strongly refute the hypothesis that polsters or other venous wall characteristics contribute to the normal physiology of the deep dorsal penile vein.

Adult↗
PubMed1993

Pelvic floor exercise versus surgery in the treatment of impotence.

A group of 150 consecutive male patients with erectile dysfunction and proven venous leakage were randomised either to surgery or to a pelvic floor training programme. The operative procedure consisted of dissection and removal of the deep dorsal vein of the penis and its tributaries or large veins that drain into the internal or external pudendal system. The training programme was given 5 times, in weekly sessions, and the patients were supervised by trained physiotherapists. Surgery was not superior to the pelvic floor training programme either subjectively or objectively. Moreover, a significant improvement was found following the training programme; 42% were satisfied with the outcome and refused surgery. Pelvic floor exercise is a realistic alternative to surgery in patients with mild degrees of venous leakage.

Adult↗
PubMed1993

Pelvi-perineal rehabilitation for dysfunctioning erections. A clinical and anatomo-physiologic study.

We have studied penile structure in 24 cadaver specimens and 155 patients have been treated for organic impotence by physiotherapy. Special attention has been focused on the closure mechanism of the corpora cavernosa during erection. We have found that the leakage factor of the corpora cavernosa is, among other things, influenced by the ischiocavernous muscles. Based on the above, we propose a model for the anatomic and physiologic basis of interference of the ischiocavernous muscles in venous occlusion during penile erection. Moreover we suggest that patients with erectile dysfunction should undergo pelvi-perineal rehabilitation in order to strengthen and control ischiocavernous muscles.

Adult↗
PubMed1992

Usefulness of urodynamic investigations in female incontinence.

Urinary incontinence in females has been evaluated in a prospective series of 408 patients by comparing the clinical diagnosis and the subsequent urodynamic findings. The presenting symptoms or combination of symptoms were shown to have only a limited diagnostic predictive value as measured by urodynamic diagnostic criteria. The symptom of stress incontinence was a sensitive detector of genuine stress incontinence (94% sensitivity) but was not very specific (65%). The symptoms of urgency and urge incontinence were found to have limited sensitivity (62%) and specificity (47%) in the detection of detrusor instability. Even patients with isolated complaints of stress incontinence have an incidence of detrusor instability of 52%, whereas 76% of those with a history of isolated urgency and urge incontinence had detrusor instability. An urodynamic evaluation should be performed on most female patients suffering from urinary incontinence and is essential for patients who are being considered for surgery of stress incontinence.

Adolescent↗
PubMed1991

Is there a place for conservative surgery in the treatment of renal carcinoma?

Since 1981, 31 patients have undergone conservative surgery for malignant renal tumours and have been followed up for at least 2 years. The techniques included enucleation or resection (wedge resection or partial nephrectomy). In 10 patients the indications for kidney-sparing surgery were absolute, while in the remainder the conservative surgical approach was a deliberate choice. The tumours varied in diameter from 1.3 to 12 cm and no metastases were detected on pre-operative screening. One patient died post-operatively from myocardial infarction. In the remaining 30 there were no local recurrences. Two patients died from skeletal metastases (1 with bilateral malignancy) and 2 underwent surgery in the post-operative period for haemorrhagic complications. The efficacy of conservative surgery in the local control of renal cancer is an argument in favour of its wider use.

Adenocarcinoma↗
PubMed1990

A retroperitoneal approach for transureteroureterostomy: a neglected and forgotten procedure.

Transureteroureterostomy in 17 consecutive cases is reviewed. Our technique of the operation (with retroperitoneal approach) is described. Stenosis of the recipient ureter or other complications did not develop in any of our cases. Based on our experience we continue to regard this procedure as an excellent means of urinary diversion for patients with unilateral lower ureteral lesions.

Adult↗
PubMed1989

Pulmonary migration following periurethral polytetrafluoroethylene injection for urinary incontinence.

We report a case of clinically significant migration of polytetrafluoroethylene (Teflon) paste particles to the lungs after periurethral injection. These particles were identified by standard and polarized light microscopy. Since the long-term effects in humans are not sufficiently known, we strongly warn against the use of polytetrafluoroethylene paste in children or young adults with a normal life expectancy.

Adult↗
PubMed1989

Amoxycillin/clavulanate prophylaxis for extracorporeal shock wave lithotripsy--a comparative study.

The incidence of urinary tract infection was examined in 181 patients with sterile urine who underwent extracorporeal shock wave lithotripsy (ESWL) as outpatients. The incidence of post operative infection was compared in a prospective randomized trial between patients who received a single prophylactic dose of amoxycillin/clavulanate iv and controls who received no antibiotic. Clinical signs of urinary infection, leucocyturia, positive urine cultures and abnormal ESR and peripheral leucocyte count were found much more frequently in the control than in the prophylactic group. This study has confirmed that even patients free of infection risk factors benefit from antibiotic prophylaxis before ESWL.

Adult↗
PubMed1989

Second-generation lithotripsy: a safe, noninvasive, ambulatory procedure.

A total of 600 patients underwent 696 treatments of extracorporeal shockwave lithotripsy (ESWL) during the period between June and November 1987. Our progressively increasing experience with the second-generation device shows that this new unit is as effective as the conventional one, and reveals several advantages. The focusing of the stone is easier; therapy time is shorter; general or regional anesthesia is no longer necessary; distal ureteral stones can be disintegrated, and adjuvant procedures are easily performed during the ESWL session. Of the last 400 patients of our series, 76% were treated on an outpatient basis without any major complications.

Ambulatory Care↗
PubMed1989

Transcutaneous nitroglycerin therapy in the treatment of impotence.

In order to avoid the side effects and drawbacks of intravenous injection of vasoactive drugs, we evaluated the use of transcutaneous nitroglycerin, a powerful smooth muscle relaxant, in enhancing the quality of erection. In this study, 26 impotent patients were treated with (nitroglycerin or placebo) patches applied to the skin of the penile shaft. A positive response was reported by 21 patients and 17 men out of the 21 were able to distinguish a marked difference between the nitroglycerin and placebo patches. These results indicate that nitroglycerin patches have to be tried, especially in patients with moderate erection disturbances.

Administration, Cutaneous↗