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P Zimmern

Publications and source records attributed to P Zimmern.

At least 19 recordsLinked to original sources
PubMed2000

Medical treatment modalities for lower urinary tract symptoms: what are the relevant differences in randomised controlled trials?

OBJECTIVES: Relevant differences in efficacy and tolerability will be reviewed among medical treatment modalities for lower urinary tract symptoms (LUTS) suggestive of benign prostatic obstruction (BPO). Available data on the long-term effectiveness of these treatments will be also discussed. METHODS: Information reviewed here comes mainly from published scientific articles and abstracts describing direct comparative trials among alpha1-adrenoceptor antagonists, finasteride, and/or phytotherapy. RESULTS: Direct comparative trials demonstrated alpha1-adrenoceptor antagonists to be more effective than finasteride in improving symptoms and increasing urinary flow. Moreover, finasteride did not perform better than placebo in those studies that included a placebo arm. While finasteride treatment appears more beneficial in patients with an enlarged prostate volume (>50 ml), the efficacy of alpha1-adrenoceptor antagonists is not related to prostate size. To study the efficacy of plant extracts, adequately performed placebo-controlled and direct comparative trials are needed. Medical treatment modalities generally have a low incidence of adverse events. Regarding long-term effectiveness of medical treatment, the few available data show that finasteride can reduce the risk of acute urinary retention (AUR) and surgery. Short-term, direct comparative studies suggest that, like finasteride, alpha1-adrenoceptor antagonists have a comparable positive effect on disease progression. CONCLUSION: More comparative information is needed on the long-term efficacy, tolerability, and effectiveness of medical treatments for LUTS. Information on disease progression (i.e., long-term complications related to BPO) and treatment outcomes (i.e., switch to other therapy or surgery) is necessary because such information directly effects a treatment's cost-effectiveness.

Finasteride↗
PubMed1999

[Criteria of Rigiscan normalcy in aged men].

PURPOSE: To define the changes in penile tumescence and rigidity in normally potent older men before a nerve-sparing radical retropubic prostatectomy (NS-RRP) and to establish a base-line for investigating erectile dysfunction in that age group. MATERIAL AND METHODS: 75 patients used the Rigiscan for 2-3 nights before undergoing a NS-RRP procedure. Rigiscan data were analyzed visually using Kaneko & Bradley criteria, and by computerized analysis. The computerized data were compared to the patient self-evaluation of potency (questionnaire), patient's age (above and below 60 years old), peak cavernosal artery velocity measured by Duplex Doppler scanning, and to the visual analysis of the Rigiscan data. RESULTS: 55 of 75 men (73%) completed three sessions. 42 men had at least 2 normal sessions, and when compared to the 33 with abnormal visual tracings, only age was significantly characteristic (p < 0.05). Tip event rigidity (%) in < 60 year-old men was greater than in older men (p < 0.01). Nearly all men had erections lasting more than 2 minutes, while only 29 of 74 had 10 minutes erections with rigidity > 70%. The best correlation between visual and computerized analyses was noted in the group of 54 men who experienced > 70% rigidity for more than 2 minutes. CONCLUSION: This large prospective series of potent older men studied by Rigiscan and other subjective and objective parameters helps establishing normative data in the diagnosis of erectile dysfunction. An important observation is clearly the lack of correlation between the patient's questionnaire or the Doppler findings and the Rigiscan data.

Adult↗
PubMed1997

[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↗
PubMed1997

[Transvaginal closure of the bladder neck in women with a neurogenic bladder and destroyed urethra].

Complete destruction of the urethra is one of the long-term complications of continuous bladder catheterization in women with advanced neurogenic bladder, resulting in a continuous urine leak around the catheter. This type of incontinence can be treated by closure of the bladder neck associated with suprapubic bladder drainage. Several approaches hve been proposed: abdominal, vaginal and mixed abdominal-vaginal. Each of these techniques is described, together with their results. Closure of the bladder neck decreases the nursing care, reduces the risk of perineal infectious and cutaneous complications and improves the patient's quality of life. Ileal urinary diversion is not always possible in these patients who often have a poor general status. Transvaginal closure of the bladder neck therefore constitutes one of the treatment options.

Female↗
PubMed1997

[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↗
PubMed1997

[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↗
PubMed1995

Incontinence.

Explore the source record for details and available documents.

Female↗
PubMed1995

[Interstitial cystitis: new concepts on etiology and diagnosis].

Interstitial cystitis is a common disease with non objective diagnostic criteria. In 1989 the National Institute of Health (NIH) defined symptoms and cystocopic findings in order to select patients to include in research programs on pathophysiology of interstitial cystitis. While there is no lack of theories, the etiology of interstitial cystitis remains obscure. Today, the general opinion is that the etiology is multifactorial and that we may be dealing with a syndrome rather than with a specific disease.

Biomarkers↗