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J de Leval

Publications and source records attributed to J de Leval.

At least 37 records · Page 2Linked to original sources
PubMed1997

[Recurrent urethral stenosis treated with a Urolome Plus stent implantation: intermediate multicenter follow-up].

We present the medium-term results of 33 patients treated with Urolume Plus urethral stent between August 1990 and June 1996 in 9 Belgian and Luxembourg centers. They all had previous treatments for bulbo-membranous urethral stricture, but without sustained benefit (dilatation, internal urethrotomy, or/and urethroplasty). The mean age of the stricture was 5.4 years (+/- 4). The stent was inserted easily during a short hospitalisation. Median time of follow-up is two years (6 months to 4 years). Maximum flow rate at last follow-up was 20.7 ml/sec (+/- 7), and 83.3% of the patients were satisfied with the stent. In 70% of the cases, the stent achieved its purpose of maintaining a good urethral lumen. In 5 patients (15.15%), stricture recurred inside the stent and in 2 patients (6.06%) a new stricture appeared on another site. Among these 7 patients, 5 were satisfactorily treated by endoluminal resection (4 cases) or dilatation (1 case). There were 2 real failures (= 6%): one patient who has refused any complementary endoscopic treatment and the other one who is still undergoing repeated urethral dilatations. Having respected the right indications for this device, we are satisfied of the results. It is a good alternative after failure of other treatments for bulbar-membranous stricture.

Anesthesia↗
PubMed1995

[Preliminary results of extracorporeal lithotripsy under local anesthesia using a multimodal generator (Tri-gen Compact Direx C)].

From April till October 1994, 64 patients were treated with the new generation of Direx lithotriptors, the Trigen Compact. The treatment was given in one-day clinic. The preparation is made of an intravenous hydratation, Dipidolor intra-muscular, Voltaren intra-rectal and Emla on the skin in the area of the shocks. Only 38 patients are estimated at three months. The first results are encouraging, with globally 78% of good results (stone free or residual fragments inferior to 5 mm) and 22% of failure. The best results (90%) are obtained with the ureteral stones. The results of the treatments of caliceal and pyelo-lithiasis are a little bit less good, with respectively 78 and 71% of good results. These data should become better when all the patients will be estimated at 3 months.

Anesthesia, Local↗
PubMed1995

[Penile prosthesis in case of impotence: 12 years of clinical experience].

Among 95 patients who have received a penile prosthesis between 1982 and 1993 (mean follow up of 46 months), 21 (22%) presented complications requiring one or more reintervention(s). Only for two patients the problem was mechanical, in the majority, they were non mechanical. Five of those subjects (5.5%) presented such complications that definitive explanation of the device was necessary. The problems presented by the 9 remaining patients were fully satisfactorily managed. Presently 94.5 per cent of the patients are using the device. Follow-up study of our interdisciplinary group demonstrates the efficacity of the prosthesis for revitalisation of the couples. The definitive parameters of implantation acceptance are essentially the partner influence and the treatment cost. This clinical study shows that the implantation of a penile prosthesis is an effective therapy in the treatment of impotence in a selected population. Presently, the mechanical reliability of different device has been good to date.

Adult↗
PubMed1995

[Examination of the non-palpable cryptorchid testis].

Cryptorchidism affects approximately 1 in 150 boys. Non-palpable testes represent nearly 20% of all cases. If present, they are situated between the inferior renal pole and the external inguinal ring. Often at surgical exploration, however, a "nubbin" of testicular tissue is found at the end of blind ending spermatic vessels without demonstration of a recognizable testis; this finding is referred to as an absent testis. In other patients, no vascular or ductular (epididymis-vas deferens) or even testicular structure can be observed. This situation defines true testicular agenesis. Non-palpable testes have an increased risk of malignant transformation, infertility, associated inguinal hernia and congenital ductular abnormalities. Surgical treatment is often more complex and unsuccessful. Many imaging diagnostic methods to investigate patients with non-palpable testes (pneumoperitoneography, angiography, ultrasonography, CT scan and RMN) have been used so far but none of these has been uniformly accepted as the ideal investigative technique because they are unreliable and/or they involve a fair risk. Since Cortesi and associates first described in 1976 a case of abdominal testes identified by laparoscopy, this technique has gained increased acceptance by pediatric urologists and surgeons. Today, celioscopy plays a central role in the exploration of non-palpable cryptorchid testes. The authors try to establish an algorithm methodology for investigating non-palpable testes under the light of recently reported anatomical, pathological and surgical data.

Algorithms↗
PubMed1994

The experience of the CHU Liège with conservative surgery in the management of upper urinary tract tumors.

A review of 20 cases of conservative surgery for urothelial tumors of the upper tract is presented. The morbidity is limited; the recurrence rate is around 15% in the ipsilateral urinary tract with a mean follow up of 41 months. Conservative surgery does not seem to carry a higher fatal risk as compared to more radical surgery. It has indications in some cases which are defined.

Adult↗
PubMed1994

[Benign testicular and paratesticular tumors].

Five cases of benign testicular and paratesticular tumors are reported which have been treated by conservative methods. A literature review is presented about the most frequent benign testicular and paratesticular neoplasms. The preoperative diagnosis and the choice of treatment are discussed.

Adenomatoid Tumor↗
PubMed1994

[Diagnostic approach to candidates for radical prostatectomy: value of echographic staging].

The last 118 candidates to RPV in the urological department of the CHU Liège were retrospectively analyzed in regard of echographic patterns, anatomopathology and PSA levels. The local extension of the cancer was defined following its echographic patterns with reference to the TNM classification (UICC, 1992). The PSA density (PSAd) and the histological grade of the bioptic specimens were studied. There is a good correlation between the echographic stage, the mean level of PSAd and the anatomical extent of the cancer on the surgical specimen. In cancers classified as T2, 2 sub sub-groups may be identified with different prognosis: T2A and T2B in which a nodal extension or an extra-capsular growth is present in 1/3 of the cases and T2C in which such an extension is observed in one half of the cases. In biopsy grades IV or V, a microscopic involvement of the nodes is observed in 50% of the cases. In the remaining 50% with negative nodes, the surgical specimen shows an extra-capsular extension in 2 cases out of 3 (roughly, 80% of the grades IV-V are over the possibility of cure with surgery alone). The analysis of the specific echographic patterns identifies 3 morphological aspects which seem to carry a bad prognosis: posterior capsular deformity, junctional irregularity and heterogeneity of the lesion. The analysis of PSAd and of the tumoral volume measured by ultrasounds identifies 2 clear-cut values (PSAd > 1 and volume > 3 cm3) over which we now advocate a coelioscopic LAD (important risk of positive nodes).

Adenocarcinoma↗
PubMed1994

The experience of radical prostatectomy for locally confined prostate cancer in Liège.

The authors report their experience of 148 radical prostatectomies performed for adeno-carcinoma. They expose the reasons which have led them to adopt this kind of treatment and the reasons explaining a nearly exponential increase of the frequency of the operation during the last 5 years. They underline the importance of lymphadenectomy and the safety of frozen sections of the nodes. The surgical technique is briefly commented and the (low) morbidity of the operation is reviewed. They compare the results of RPV to those of external radiotherapy, watchful attitude or immediate hormonal treatment and they conclude in insisting on the benefit of the surgical approach as far as indications (which are defined) are strictly followed.

Adenocarcinoma↗
PubMed1993

Benign prostatic hyperplasia and normal prostate aging: differences in types I and II 5 alpha-reductase and steroid hormone receptor messenger ribonucleic acid (mRNA) levels, but not in insulin-like growth factor mRNA levels.

Benign prostatic hyperplasia (BPH) is so common in elderly men that the development of adenomatous nodules in this organ can be seen as a normal age-dependent process. In this work, we used Northern blotting to compare the levels of androgen, estrogen, and insulin-like growth factor-I (IGF-I) receptor in young (age range, 23-33; n = 3), old normal (age range, 52-80; n = 3), and BPH-affected subjects (age range, 66-87; n = 15). We have also investigated in these groups the expression of genes coding for the two 5 alpha-reductases (types I and II), aromatase, IGF-I, and IGF-II. Our results show significantly increased levels of IGF mRNA in old healthy and BPH-affected subjects; the respective rises for IGF-I, IGF-II, and IGF-I receptor mRNAs were 3.0-, 2.9-, and 1.5-fold (BPH) and 2.7-, 2.4-, and 1.8-fold (old normal controls). For estrogen receptor, androgen receptor, and type I and II 5 alpha-reductase mRNAs, a marked but opposite effect was observed in adenomatous tissues only; the respective levels were 2.2-, 1.8-, 3.9-, and 1.7-fold lower than those in young adult subjects, whereas no significant differences were recorded between the two normal groups. Morphometric analysis of each tissue specimen confirmed the significantly lower epithelium/stroma ratio in adenomas compared to young or old healthy tissues. Together, these observations suggest that prostatic adenomas may result from at least two conjugate processes: one characterized by a drop in the mRNA levels of steroid hormone receptors, which might be associated with a lower epithelium/stroma ratio, and another characterized by normal aging phenomena, of which the increased production of IGFs and IGF-I receptor transcripts could be biochemical markers.

Adult↗
PubMed1993

Testis tumor: the problem of the undescended testis.

The increased incidence of testicular cancer occurring in the undescended testis is well documented. Ten to 12% of cryptorchid testes are demonstrated in all series of testicular cancer which is in keeping with a 4 to 10 times increase of the risk. A lot of work is being carried out to elucidate the etiological factors that could explain this increase. A common etiological endocrine factor might be implicated. As it is well known that orchidopexy does not prevent subsequent malignancy, its effects on the histology of the testis and tumor pattern is studied with consideration of age at orchidopexy. Carcinoma in situ (Cis) first discovered in the infertile male population and seen many years before invasive cancer may provide a useful tool for follow-up of cryptorchid patients. According to the results of this work, management of cryptorchid testes is planned as either orchidopexy or orchidectomy, and time and place for biopsies is decided. Life-long follow-up is advocated.

Adult↗
PubMed1993

[Techniques of urodynamic diagnosis. Measurement--pressure--flow].

The urodynamic techniques useful for the diagnostic assessment of vesicosphincteric disorders are uroflowmetry, measurement of abdominal, urethral and vesical pressure and electromyography. Uroflowmetry is a very widely used screening examination, as it is atraumatic. Other techniques are more invasive, but provide more pathophysiological information. The methodology is recalled for each of these examinations. The parameters to be analysed are described in detail. The value and limitations of these modalities are emphasised. Combined examinations allow a better understanding of vesicosphincteric equilibria and disequilibria and reveal the concepts of compliance, detrusor pressure, isometric detrusor contractions, hyper and hypoactivity, and pressure transmission.

Compliance↗
PubMed1993

[Infravesical obstruction].

Infravesical obstruction presents clinically in the form of dysuria. Urodynamic studies play an important role to distinguish between a disorder of detrusor contractility and a functional or organic obstruction. The value of uroflowmetry, static and voiding urethral pressure profiles, cystometry and electromyography is discussed. The instantaneous voiding profile appears to be the most useful test: it allows calculation of urethral resistance, which is the ratio between bladder voiding pressure and the square of flow. Bladder neck obstruction is present in more than 80% of cases with a value greater than 0.5. Obstacles are more easily identified clinically in women, but the same tests can be applied with a poorer reliability for urethral resistance.

Electromyography↗
PubMed1993

[Treatment of male incontinence].

Male urinary incontinence may be due to a variety of pathophysiological mechanisms: detrusor hyper- or hypoactivity, lower obstruction and, most frequently, sphincter incompetence, generally secondary to surgery. As far as possible, treatment should be aetiopathogenic, with the use of drugs for detrusor dysfunction. The treatment of sphincter incompetence primarily consists of prophylaxis and education of urologists. When a lesion does not resolve with time, i.e. after more than one year of physiotherapy or drugs, the artificial sphincter may be indicated with good results in more than 90% of cases.

Exercise Therapy↗
PubMed1992

Growth hormone and prolactin stimulate androgen receptor, insulin-like growth factor-I (IGF-I) and IGF-I receptor levels in the prostate of immature rats.

In this study we investigated the involvement of several different pituitary hormones on rat prostate development. 22-day-old Wistar rats, hypophysectomized (hypox) at 19 days of age were supplemented with highly purified human prolactin (hPRL), human luteinizing hormone (hLH), porcine follicle-stimulating hormone (pFSH), and bovine growth hormone (bGH) or with saline. Quantitative analysis of RNAs shows that treatment with either PRL or GH increases significantly steady-state mRNAs levels of the following genes in the prostate: androgen receptor (AR) (respectively 3.5- and 4.8-fold above hypox controls), IGF-I (5- and 2.7-fold), and IGF-I receptor (2.9- and 2.3-fold). LH and FSH, by contrast, have negative effects on these parameters. To test whether the enhancing effect of PRL and GH on AR-mRNA abundance was followed by increased content in the protein itself, binding assays were performed with the androgen agonist [3H]R1881 (131 and 153 fmol/mg protein while hypox controls contained 110 fmol/mg protein). In addition to the well-documented presence of prolactin receptors in prostatic tissues, we have further demonstrated, by means of nuclease S1 protection assays plus dot- and Northern-blot analyses, that a GH receptor mRNA is produced in the immature rat prostate. Moreover, we observed not only strong lactogenic but also purely somatogenic binding to be occurring in the immature prostates. Finally, we have studied IGF-I mRNA content in separated epithelial/stromal cell fractions and have concluded that IGF-I expression is principally located in the prostatic stroma. Taken together, these results suggest that PRL and GH are involved in regulating AR synthesis, at least partially by direct action on the organ. In this context IGF-I appears as a paracrine factor playing a role in epithelium/stroma interactions during prostatic development.

Age Factors↗
PubMed1992

Original lithotomy positioning for transperineal extracorporeal shockwave lithotripsy for distal ureteric calculi with Tripter X1.

Extracorporeal shockwave lithotripsy (ESWL) has been initially designed for stones located in the kidney and the upper ureter. Our lithotripter is no exception. Its components (the table and the orientation of the semi-ellipsoid reflector) are adapted for the treatment of kidney or lumbar ureter stones. However, the elements forming the unit of treatment (the table, the C-arm and the Tripter) can be modified in such a way that focalization of stones of the lower ureter becomes possible through a perineal exposure. The aim is to avoid the pelvic bone shield while a good focalization of the stone is realized. From June 1989 to March 1991, 35 patients were treated for distal ureteric stones by ESWL in this original positioning.

Adolescent↗