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Biomedical subjects

P Hoebeke

Publications and source records attributed to P Hoebeke.

16 recordsLinked to original sources
PubMed1997

[Differences in the profile of nycthemeral diuresis].

Monosymptomatic enuresis in childhood can be divided in two subtypes by a nycthemeral diuresis profile, including urinary volume and osmolality. The first one is characterized by an abnormal circadian diuresis cycle, responsible for nocturnal polyuria and/or low urinary overnight osmolality, there is a good response to desmopressin; the other one is the so-called cognitive or idiopathic type, which provides a poor response to desmopressin.

Adolescent↗
PubMed1997

[Urination disorders revealing posterior urethral valve: clinical aspects].

One hundred sixty-four boys presenting with voiding dysfunction without any obvious uropathy or neuropathy were enrolled in a prospective study. Nine (5.5%) were suspected to have urethral valves after video-urodynamic assessment, later confirmed by cystoscopy. Those with proven posterior urethral valves were compared to a control group of boys without urethral obstruction. There was no difference in anamnesis nor clinical presentation between the two groups. Even on uroflowmetry the urethral valves were not suspected; only the urodynamic assessment could distinguish the obstructed from the non-obstructed boys. Although there remains controversy about the existence of posterior urethral valves in functional voiding disorders in boys, we could demonstrate that after a complete prospective screening such a rare combination occurs in around 5% of the cases.

Child↗
PubMed1996

Outpatient pelvic-floor therapy in girls with daytime incontinence and dysfunctional voiding.

OBJECTIVES: Analysis of an experience in treating girls with dysfunctional voiding with an outpatient pelvic-floor therapy consisting of voiding and drinking schedule, pelvic-floor relaxation biofeedback, instructions on toilet behavior, and uroflowmetry. METHODS: The files of 50 girls (between 6 and 13 years of age) with urodynamically proven dysfunctional voiding who participated in the training program were analyzed retrospectively. Thirty-five girls received anticholinergics during the entire course of the training. The long-term absence of diurnal incontinence was used as the criterion for the success of the therapy. The duration of treatment before reaching this success was used as a parameter to measure the intensity of therapy. For a portion of the study group, a comparison is made with the duration of the preceding therapies to demonstrate indirectly the cumulative effect of the pelvic-floor therapy. RESULTS: Forty-six girls (92%) normalized their flow and bladder capacity after therapy and saw their daytime incontinence disappearing. All of these girls achieved this result in a maximum of 18 sessions within a 6-month period. At the follow-up examination after 6 months, five of the girls had relapsed (10%), which brings the ultimate success after 6 months of follow-up to 82%. CONCLUSIONS: Pelvic-floor therapy seems to be a reasonable and meaningful component in the treatment of bladder dysfunction in which detrusor-sphincter dyscoordination plays a role.

Adolescent↗
PubMed1996

One hundred consecutive cystoscopic examinations in children: indications and results.

OBJECTIVE: To evaluate the place and value of cystoscopy in paediatric bladder dysfunction. METHODS: A retrospective analysis of files of 100 children who underwent cystoscopy. RESULTS: In 6 patients with neurogenic bladder dysfunction, cystoscopy was done for the diagnosis of secondary uropathy. In patients with uropathy, of the neonatal group of 6 patients 2 were seen for evaluation of disorders of sexual differentiation and 4 were seen for further diagnosis of neonatal hydronephrosis. In 21 children cystoscopy was part of the diagnostic and/or therapeutic workup for severe urinary-tract infection and in 5 patients for other uropathies. Sixty-two patients with non-neurogenic, non-uropathic bladder dysfunction were selected to undergo cystoscopy on the urodynamic findings. In boys, 36 had an obstruction and 12 had normal cystoscopy. In girls, 4 had an obstruction and 10 had a minimal meatal deformity. CONCLUSIONS: In children with neurogenic dysfunction, cystoscopy is only indicated in diagnosis and therapy of secondary uropathies. Cystoscopy is part of the diagnostic and therapeutic strategy in uropathy. In non-neurogenic, non-uropathic dysfunction urodynamic study allows the selection of patients who have minimal anatomic deformities that provoke the bladder dysfunction and for whom cystoscopy is indicated.

Adolescent↗
PubMed1996

The GAP (glans approximation procedure) for distal hypospadias. Technical aspects.

We present some technical aspects of the GAP procedure for distal hypospadias repair. About 20 GAP procedures have been performed to date. Although immediate postoperative results were very encouraging with only 2 fistulae and 1 meatal stenosis, follow-up is too short to conclude on the validity of the technique. In particular the cosmetic result of this technique based on our preliminary experience, makes it an extra tool for the surgeon interested in hypospadias repair. We therefore want to present some of the technical aspects.

Child↗
PubMed1996

The Arap modification of the MAGPI: experience in 72 patients.

Since july 1991 the Arap modification of the Meatal Advancement Glanduloplasty Incorporated (MAGPI) is used for repair of minor anterior hypospadias. Seventy-two boys have been treated by this technique since then. Follow-up is longer than 2 years in half of the patients. The functional and cosmetic result, as estimated by the surgeon and an urologist who did not perform the operation was excellent in 64 patients (89%). In 3 patients the functional result is good but the cosmetic result is poor. In 2 patients meatal stenosis developed of which 1 was treated by dilatation and 1 by meatotomy. In 3 patients there was complete loss of the suture lines resulting in hypospadias which was repaired by other techniques. Ten patients underwent praeputioplasty with the procedure. In 4 patients the sutureline lost partially necessitating circumcision. The Arap modification of the MAGPI is presented as a good technique for the repair of minor anterior hypopadias.

Child↗
PubMed1996

[Trans-glandular urethral advancement for distal hypospadias. A 16-year experience].

Eighty six patients where operated by the urethral transglanular advancement technique. During this period, we modified the reconstruction of the meatus to prevent the uncosmetic appearance of the meatus, resulting from the initial technique. The results were excellent. In 40 patients (23 adults and 17 adolescents) we were able to judge the appearance and function of their adult penis with a follow-up of at least 7 to 16 years after the intervention. In conclusion, we think that the fear of ischaemia and retraction or even necrosis, with secondary late chordee, after extensive urethral mobilisation, is unjustified.

Adolescent↗
PubMed1996

[Modified Mathieu technic for hypospadias with moderate chordae].

A modified Mathieu technique for hypospadias with moderate chordee is presented. The modifications consist of a skin flap with a large pedicle derived from the dartos fascia, correction of the chordee by resection of the fibrous tissue and dorsal plication of the tunica albuginea and possible reconstruction of the prepuce. Defects of up to 2.5 cm long can be corrected with this modified technique. Seventy six children were operated according to this technique, with a follow-up of more than 24 months in 20 cases. The complications observed in these 20 patients were one fistula, two meatal strictures and one total loss of the skin flap due to infection.

Child, Preschool↗
PubMed1995

Experience with augmentation cystoplasty. A review.

Good experience with clam cystoplasty is reported for 28 patients (14 female), 89% of whom had a neuropathic bladder. Prolonged conservative treatment had failed in all cases. The efficacy of the operation in terms of continence, increased bladder compliance, and bladder capacity was confirmed. Complications were common and included inability to void (70%) requiring clean intermittent catheterisation (CIC), recurrent urinary tract infection (59%) and stone formation (22%). Due to these complications, further surgery was required for 44% of the patients. Although clam enterocystoplasty is an efficient way to reconstruct a functionally disturbed urinary tract, careful patient selection is essential. Lifetime follow-up and recognition of the most frequent complications is mandatory.

Adolescent↗
PubMed1995

Commercial television bladder dysfunction.

Bladderdysfunction seems to have an increasing frequency in infancy, and especially in children without obvious congenital organic or functional bladderdysfunction. The disorder seems is related with changes in our behaviour, that are stimulated by familial and social pseudo-reasons. Commercial interests and marketing play a major role. This leads to wrong dry-training, an exaggerated hygienic education, prudisheness, wrong toilet-posture, lack of time to void, post-poning, wrong drink- and void-pattern, wrong food-pattern and increasing constipation. Prevention is necessary by an adapted reeducation of parents ans society.

Adolescent↗
PubMed1995

Bladder function and non-neurogenic dysfunction in children: classification and terminology.

Urological function and dysfunction in children are different from function and dysfunction in adults. The dynamics of the urinary tract in children are more complex as development from simple reflex controlled infant bladder to mature bladder function takes place during the first five years of live. The most crucial event in this development is the maturation of the inhibition that takes place in the growing urinary tract. Apart from gaining neurological control over de lower urinary tract there is the physical growth of the bladder-sfincter unit. Otherwise in children there exist a large amount of structural organic congenital pathology of the lower urinary tract that can trouble the normal development. Finally there is the cognitive function that has no anatomical substrate in the lower urinary tract but which takes place in the central nervous system and which is influenced by training and which can play a major role in development of non structural functional dysfunction. In order to train a child adequately the anatomical structure needs to have undergone enough maturation. By training a child on a too early age one can help to develop non structural functional dysfunction. In a time where competition in dry-training is encouraged by commercial pressure and where parents have less time, so that they are urged to train their children dry, more and more non-structural functional dysfunction in children is seen. The most prominent symptom of maldevelopment of the urinary tract, be it structural or functional is urinary incontinence. It is the most common problem seen in the paediatric urology practice.(ABSTRACT TRUNCATED AT 250 WORDS)

Child↗
PubMed1994

Urethral advancement for distal hypospadias: 14 years' experience.

76 patients with distal hypospadias were operated on with this technique. The technique is first shortly described. A modification of the meatal reconstruction prevents the uncosmetic flattening of the glans. The overall results were excellent. In 40 cases (23 adults and 17 adolescents) we were able to judge the appearance and function of their adult penis in a follow-up of at least 5-14 years after the operation. We conclude that the fear of ischemia and retraction or even necrosis, with secondary late chordee, after extensive urethral mobilization is unjustified.

Adolescent↗
PubMed1993

Watertight sutures with fibrin glue: an experimental study.

A rat model was developed to test the watertightness of sutures and used to evaluate the value of fibrin glue (Tissucol, Immuno France, Tisseel, Immuno U.S., Inc.) in making conventional sutures watertight. Fibrin glue raised the mean hydrostatic pressure to which the skin suture resisted from 9.1 to 26.3 cm H2O, thus indicating that it enhances suture watertightness immediately after surgery. After 3 and 6 days, the pressure was increased, respectively, from 24.8 to 47.9 and from 56.5 to 73.3 cm H2O. For bladder sutures, the results are comparable.

Animals↗
PubMed1993

[Principles of wound healing as applied to urethra surgery].

The authors describe the physiology of wound-healing and the factors influencing wound-healing that may play a role in urethral surgery. They present the specific characteristics of wound-healing in each treatment for urethral strictures. This knowledge can help to choose the right treatment for each type of urethral stricture.

Humans↗