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Biomedical subjects

R Carone

Publications and source records attributed to R Carone.

At least 19 recordsLinked to original sources
PubMed2001

Neuromodulation for fecal incontinence: outcome in 16 patients with definitive implant. The initial Italian Sacral Neurostimulation Group (GINS) experience.

PURPOSE: Sacral nerve modulation appears to offer a valid treatment option for some patients with fecal incontinence and functional defects of the internal anal sphincter or of the striated muscle. METHODS: Sixteen patients with fecal incontinence (4 males; mean age, 51.4 (range, 27-79) years) with intact or surgically repaired (n = 1) anal sphincter underwent permanent sacral nerve stimulation implant. Cause was traumatic in two patients, and associated disorders included scleroderma (2 patients) and spastic paraparesis (1 patient); eight (50 percent) of the patients also had urinary incontinence, and two (12.5 percent) had nonobstructive urinary retention. All patients were selected on the basis of positive findings from at least one peripheral nerve evaluation. The stimulating electrode was positioned in the S2 (1 patient), S3 (14 patients), or S4 (1 patient) sacral foramen. RESULTS: Mean follow-up was 15.5 (range, 3-45) months. Mean preimplant Williams score decreased from 4.1 +/- 0.9 (range, 2-5) to 1.25 +/- 0.5 (range, 1-2) (P = 0.01, Wilcoxon test), and the number of incontinence accidents for liquid or solid stool in 14 days decreased from 11.5 +/- 4.8 (range, 2-20) before implant to 0.6 +/- 0.9 (range, 0-2) at the last follow-up. Important manometric data were an increase in mean maximal pressure at rest of 37.7 +/- 14.9 mmHg (implantable pulse generator 49.1 +/- 18.7, P = 0.04) and in mean maximal pressure during squeeze (prestimulation 67.3 +/- 21.1 mmHg, implantable pulse generator 82.6 +/- 21.0, P = 0.09). CONCLUSIONS: Neuromodulation can be considered an option for fecal incontinence. However, an accurate clinical and instrumental evaluation and careful patient selection are required to optimize outcome.

Adult↗
PubMed2001

Chronic sacral neuromodulation in patients with lower urinary tract symptoms: results from a national register.

PURPOSE: The Italian Register was created in February 1997 to collect the national results of sacral neuromodulation. All Italian centers at which sacral neuromodulation is performed were invited to participate in our study. We present the results from retrospective and prospective registers. MATERIALS AND METHODS: A total of 196 patients underwent permanent implantation of sacral neuromodulation and were enrolled in the Italian register. There were 18 males and 75 females in the retrospective, and 28 males and 75 females in the prospective studies. Student's t test was used to compare paired values, and the Wilcoxon rank sum and nonparametric tests were used when necessary. RESULTS: Mean incontinent episodes daily plus or minus standard deviation for patients with detrusor instability went from 5.4 +/- 3.9 to 1.1 +/- 1.6 (median 5 and 0, respectively) at 12-month followup (p <0.001). For idiopathic retention average residual volume decreased from 277 to 108 cc (median 287 and 80, respectively), and 50% of patients stopped catheterization and another 13% catheterized once daily at 1-year after implantation. With neurogenic voiding disturbances, the results fluctuated with time from a minimum of 33% to a maximum 66% of patients who did not catheterize at 6-month followup and 12 months after implantation, respectively. At 12-month followup, 50% of patients with hyperreflexia had less than 1 incontinent episode daily. The problem was completely solved in 66% of patients in the retention group. Of patients in the urge incontinent population 39% were completely dry and 23% had less than 1 incontinent episode daily. CONCLUSIONS: Sacral neuromodulation is effective therapy for treating lower urinary tract symptoms resistant to less invasive therapy.

Adolescent↗
PubMed1995

Mutual influence between vesicourethral and anorectal function in spinal cord injury patients.

There is clinical evidence of a relationship between urethrovesical and anorectal dysfunction in spinal cord injured patients. This study was performed to assess how rectal distension could influence the results of urodynamic investigations. Ten patients with spinal cord injury were submitted to repeated urodynamic evaluations under different rectal conditions after performing complete anorectal testing. Distension of the rectal ampulla may interfere with vesicourethral function in spinal cord injured patients: in those with complete spinal cord lesions rectal distension causes a reduction in bladder compliance, earlier and higher amplitude of the first hyperreflexic contraction, and an increase in detrusor-external urethral sphincter dyssynergia. We suggest that urodynamic evaluation of spinal cord injured patients should not normally be performed if the patient has a full rectum.

Anal Canal↗
PubMed1994

[Neurological evaluation of erectile impotence].

The diagnostic approach to neurologic evaluation of erectile impotence in neurologic subjects differs from non neurologic subjects; in particular in this last group of patients the aim of diagnosis may drive to point out or exclude an hidden or underestimated neurologic lesion. Authors report the different diagnostic approach.

Erectile Dysfunction↗
PubMed1993

Effects of cisapride on anorectal and vesicourethral function in spinal cord injured patients.

The effect of cisapride on constipation in para and tetraplegia is well known. We have investigated the effects of this prokinetic drug on anorectal activity and on the function of the lower urinary tract. One result of the anorectal study showed a significant increase in activity and a reduction in compliance of the ampulla. The urodynamic study demonstrated earlier and higher amplitude reflex contractions in hyperactive bladders; hypoactive bladders significantly reduced their compliance. No functional alterations of striated urethral sphincter were observed.

Anal Canal↗
PubMed1989

Low dosage treatment with propiono-hydroxamic acid in paraplegic patients.

Severe urinary tract infections due to urease-producing bacteria are frequently associated with neurourologic pathologies and complicated by infected nephrolithiasis. Hydroxamic acids, acting as urease inhibitors, can effectively reduce lithiasic risk, normalizing the urinary environment, as well as enhancing the action of antibiotic treatments. A low dosage propiono-hydroxamic acid (PHA) treatment, 60 mg twice a day for 7 days and then 60 mg/day, was used in 15 patients affected with neurourologic pathologies for 3 months. Nine patients were stone-free and 6 stone-bearers. Urinary pH and ammonium decreased in both groups. Halving the PHA dose did not cause any variation in urinary pH or ammonium trends. In the stone-bearing group an increase in these parameters was correlated with urinary infection recurrences. Complete sterilization was achieved in 11 of 14 patients who completed the trial. In the stone-free group no patient had an infectious recurrence after the first month. Two patients in the stone-bearing group had repeated recurrences. One patient dropped out after 45 days due to a decrease in platelets. The efficacy of such low dose treatment makes even long-term or repeated therapies possible, as is often needed by neurourologic patients.

Adult↗
PubMed1983

Andrological and hormonal findings in subjects with ductus deferens agenesia.

The aim of our study has been the complete andrological and endocrinological evaluation of seven cases of bilateral ductus deferens agenesia. In all cases testicular biopsy demonstrated a normal spermatogenesis. Urographic examination showed, in four cases, the existence of congenital anomalies of the urinary tract. The presence of spermioagglutinating and spermimmobilizing antibodies in blood and in seminal plasma was excluded in all cases. Basal and stimulated levels of FSH, LH, PRL and testosterone were within normal limits. Surgical exploration of seminal tracts and bilateral collection of sperm at the caudal portion of the epididymis appear to be mandatory in order to select the cases for surgical therapeutic approach.

Adult↗