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R J Opsomer

Publications and source records attributed to R J Opsomer.

At least 19 recordsLinked to original sources
PubMed2003

[Contribution of the preoperative urodynamic findings in the determination of risks factors of urinary incontinence after radical retropubic prostatectomy].

UNLABELLED: The aim of the study was to determine whether preoperative urodynamic evaluation helps the physiotherapist to adapt preoperative management of patients undergoing radical retropubic prostatectomy (RP) by identifying a group at risk of incontinence. MATERIAL AND METHODS: We compared the preoperative urodynamic evaluation of 229 men scheduled for RP with their continence status, evaluated by standardized pad-test and questionnaire, at 6 weeks and 4 months postoperatively. RESULTS: The primary urinary incontinence risk has been obtained for five patient's categories, namely normal, bladder instability, bladder outlet obstruction, hypocontractility, and mixed results. None of the patients diagnosed with detrusor instability and bladder outlet obstruction was continent at six weeks from surgery. At four months, although it improves, the continence status remains significantly poorer than observed in all other groups. CONCLUSION: Preoperative urodynamic evaluation of patients scheduled for RP allows identifying patients with a high risk of postoperative urinary incontinence.

Aged↗
PubMed2001

A dose-escalation study to assess the efficacy and safety of sildenafil citrate in men with erectile dysfunction.

OBJECTIVE: To assess the efficacy and safety of sildenafil citrate (Viagra, Pfizer Inc., USA) in a double-blind, placebo-controlled, dose-escalation study over a period of 26 weeks in men with erectile dysfunction of a broad spectrum of aetiology. PATIENTS AND METHODS: In all, 315 patients from five countries were randomized to receive treatment with placebo (156 men) or sildenafil (159 men). Significant concomitant medical conditions were hypertension (20%), a history of pelvic surgery (19%), diabetes mellitus (15%), and ischaemic heart disease (10%). Patients randomized to treatment received a starting dose of 25 mg of sildenafil or matching placebo, which could be increased to 50 mg and then to 100 mg of sildenafil, based on efficacy and tolerability. Assessments of efficacy comprised the 15-item International Index of Erectile Function (IIEF), including question three (ability to achieve an erection) and question four (ability to maintain an erection), a partner questionnaire, an overall efficacy question, and event-log data. RESULTS: After 12 weeks of treatment, 26%, 32% and 42% of patients were taking 25, 50 and 100 mg of sildenafil, respectively. A similar distribution of doses was reported after 26 weeks of treatment. Treatment with sildenafil significantly improved the patients' abilities to achieve and maintain an erection compared with treatment with placebo (P < 0.001). Scores for four of the five sexual function domains of the IIEF (erectile function, orgasmic function, intercourse satisfaction and overall satisfaction) also improved significantly (P < 0.001). There was a significant improvement in the mean score for the erectile function domain, regardless of the aetiology of erectile dysfunction (P < 0.001). After 12 weeks and 26 weeks of treatment, 82% and 79% of patients receiving sildenafil reported improved erections, compared with 24% and 23% of patients receiving placebo, respectively (P < 0.001). Treatment-related adverse events were mild to moderate and occurred in 27% of patients receiving sildenafil, compared with 8% of patients receiving placebo. CONCLUSION: Sildenafil is an effective and well-tolerated treatment for men with erectile dysfunction of a broad spectrum of aetiology.

Administration, Oral↗
PubMed1998

[Correction of severe median hypospadias. Review of 77 cases treated by the onlay island flap technic].

Seventy-seven hypospadias, selected from a series of 504 treated in our institution, were operated using the pediculated transverse "onlay" preputial graft. We try to demonstrate that this technique produces excellent functional and cosmetic results. Chordee can be corrected using extensive dissection of the urethral plate with association, if necessary, of a Nesbit type of dorsal plication. Complications rate, in our hands, is lower in comparison to the technique described by John Duckett, where the urethral plate is divided and a complete urethral tube is performed. We report 4 fistulas, one distal end breakdown of the repair and one postoperative hematoma that had to be revised. Because of this low complication rate, in many cases, the "onlay" pediculated graft replaces advantageously the Duckett type of repair.

Cutaneous Fistula↗
PubMed1998

Urodynamic and electrophysiological testing in pediatric neurourology.

In our institution, children with voiding disorders are submitted to a detailed evaluation comprising a careful clinical examination, laboratory tests, imaging (kidney ultrasonography and voiding cystourethrography) and urodynamic tests. Depending on the etiology of voiding dysfunction, children are subjected to a non invasive or an invasive urodynamic evaluation. Non invasive urodynamic testing comprises a free urinary flowmetry associated or not with an EMG recording of the pelvic floor. Invasive urodynamic testing consists of a pressure-flow study or a video-XR-urodynamic test. In rare instances, genitourinary electrophysiological investigations will be performed. Herein we describe these different urodynamic and electrophysiologic tests.

Child↗
PubMed1998

Is adrenalectomy part of radical nephrectomy?

Standard radical nephrectomy entails en bloc removal of the kidney together with Gerota's fascia and the ipsilateral adrenal. Thanks to the refinement of imaging techniques (ultrasound, CT and MRI), smaller tumors are being diagnosed. In addition, direct extension to the adrenal gland or adrenal metastasis can be detected in most cases. This is why several authors reserve adrenalectomy for large and/or upper pole tumors or abnormal appearing glands on preoperative CT-scan. However, preoperative diagnosis is not always accurate. Furthermore, micrometastatic adrenal invasion at the time of nephrectomy and late recurrences in the persistent adrenal have been documented, so that partisans of adrenalectomy only spare the adrenal in exceptional cases. The authors have reviewed several series in the litterature as well as there own, and conclude that ipsilateral adrenalectomy can be omitted for small middle- or lower pole tumors when the adrenal appears normal on CT and during the surgical intervention.

Adrenal Gland Neoplasms↗
PubMed1998

Testicular torsion after previous orchidopexy for undescended testis.

We report one case of acute testicular torsion following orchidopexy for an undescended testis. A review of the literature reveals only ten similar cases. History of a previous testicular surgery should not preclude the possibility of a torsion in that testicle. We conclude that at orchidopexy for an undescended testis, eversion of the tunica vaginalis is an essential step to avoid any future torsion.

Acute Disease↗
PubMed1997

[Recurrence following radical surgery for prostatic cancer. Analysis of clinical, biological and anatomo-pathological prognostic factors].

To better characterize risk factors of progression (or recurrence) of prostate cancer after radical surgery, we analysed clinical and biological preoperative characteristics and post-operative pathology results in a series of 179 patients who underwent radical prostatectomy between January 1, 1993 and December 31, 1994. The mean follow-up in the series is 36 months (24-36). 39 patients treated before radical prostatectomy by hormonotherapy or surgery (TURP, TULIP) were excluded from analysis. 28 patients treated with immediate adjuvant therapy were also excluded from the study on risk factors of recurrence. Clinical understaging is 37% (50/134 patients with stage T1-T2 have extracapsular extension or invasion of seminal vesicles). Preoperative PSA value is related to the pathologic stage. Extracapsular disease was found in 17% and 46% when PSA was < 4 ng/ml or > 10 ng/ml respectively, thereby confirming the poor staging value of preoperative PSA alone. Analysis of the surgical margins demonstrates a statistically significant difference (p = 0.018) between patients with a preoperative PSA < 10 ng/ml (22% of positive margins) and those with a PSA > 10 ng/ml (42% of positive margins). Predictive factors of recurrence were analyzed in the 112 patients who have not received pre- or postoperative treatment. The respective impact of clinical stage, preoperative PSA value, Gleason score, invasion of prostatic apex, capsular perforation, surgical margins, invasion of seminal vesicles or of pelvic lymph nodes, and invasion of intraprostatic, intracapsular or extraprostatic nerves were evaluated. In T3 cases, we observe 50% recurrence (but only 4 patients fall into this group) versus 14% in clinically localized tumors (T1c-T2c). No recurrence is detected when preoperative PSA is < 4 ng/ml; on the contrary 21% of patients with a PSA > 10 ng/ml recurred. Infiltration of the apex does not influence prognosis. In our experience, capsular perforation is a worse prognostic factor than positive surgical margins, the respective rate of failure being 25% and 17% respectively. Invasion of extraprostatic nerves increases the risk of failure compared to capsular perforation alone (31% vs 18%). Seminal vesicles invasion significantly worsens prognosis (50% vs 13% recurrence respectively; p = 0.024). All patients with positive lymph nodes recurred (p = 0.001).

Adenocarcinoma↗
PubMed1997

Megaureter in childhood: conservative or surgical management?

Antenatal and incidentally diagnosed megaureters can be safely treated conservatively after careful work up by combined imaging technics. Serial and repeated imaging are non the less usually necessary to confirm the diagnosis. This aspect could be fastidious and expensive. In case of symptoms, breakthrough infections or loss of kidney function, surgical treatment should be considered and good results can be expected. Refluxing megaureter has to be considered as high grade reflux and surgical approach is more often suggested. The authors have reviewed the experience of 139 patients with megaureters treated in the last decade to illustrate those facts.

Child↗
PubMed1997

The external vacuum device in the management of erectile dysfunction.

The effectiveness of a vacuum erection device was evaluated in a 3-year prospective trial involving 110 men with erectile disorders. The patients ranged from 36 to 75 years of age (average: 61). Fifty-seven had chosen the vacuum device as a first treatment attempt; 27 were on intracavernous self-injections with a vasoactive agent but wanted another treatment; and several treatment modalities had failed in the remaining 26 patients. At the 3-month follow-up, the patients were mailed a questionnaire to evaluate the quality of sexual intercourse with the vacuum constriction device. Partner satisfaction was evaluated in parallel. Improvement in sexual parameters as well as difficulties and side effects induced by the device were investigated. Our results confirm the efficacy of the vacuum constriction device in the treatment of erectile dysfunction in selected patients.

Adult↗
PubMed1996

Sympathetic skin responses from the limbs and the genitalia: normative study and contribution to the evaluation of neurourological disorders.

The autonomic innervation of the limbs and the genitalia was studied by means of electrical stimulation of the median nerve at the wrist and the dorsal nerve of the penis/clitoris and recording of sympathetic skin responses from the hand, the foot, and the perineum. In males, the response was also recorded from the penile shaft following median nerve stimulation. Normative data were obtained from 40 healthy volunteers (20 men and 20 women). The clinical contribution of these tests was investigated in a series of 42 patients referred to our laboratory for urinary and/or sexual disorders. Sympathetic skin responses are helpful in the evaluation of sexual impotence and of disorders affecting the pelvic floor as well as of well-known neuropathies.

Adolescent↗
PubMed1996

Transurethral ultrasound-guided laser-induced prostatectomy: a critical evaluation.

We evaluated 38 patients with a follow-up of 30 months after transurethral ultrasound-guided laser-induced prostatectomy (TULIP) for benign prostatic hyperplasia. The mean symptom score decreased by 54%, and peak urinary flow increased by 112%. For the entire series, 43.6% of the patients had an improved symptom score and 41% better urinary flow, but only 28.2% had improvement in both. Six patients (16%) required reoperation, two underwent a radical prostatectomy, and one patient presented total urinary incontinence. Also, 19% presented postoperative impotence, and 47% presented retrograde ejaculation. Although one third of the patients are improved with the TULIP procedure, the rate of complications is significantly higher than for TURP, which remains the most effective treatment of obstructive BPH.

Aged↗
PubMed1996

[Treatment of hypospadias: 15-year experience].

Numerous hypospadias correction techniques were described in the literature. The technique varies according to the position of the meatus and the importance of the chordee. These new techniques and the care taken in the manipulation of the tissues tend to decrease complications like stenoses and fistulas, frequent in the long urethroplasty. The correction of hypospadias should conform to aesthetic and plastic surgery. More than 300 corrections were carried out in our service. Surgical technique varied in the long run. Currently, we choose as often as possible a correction in one time: release of the chordae and urethroplasty. Straightening of the penis is obtained on one hand by release of the cutaneous chordae and wide dissection of the hypoplastic urethral plate and one or more dorsal plications according to Nesbit are carried out if it proves necessary. In the distal, glandular and coronal forms, the correction is of type M.A.G.P.I. (meatal advancement, glanduloplasty). The complication rate is extremely low. The aesthetic and functional result is very satisfactory. In the proximal forms, Duckett technique is used only in the obligatory cases given the large number of complications. It is generally replaced by Onlay technique. The urethral plate is left in continuity and serves as support to the pedicled and vascularized flap. In the intermediate situations with a middle shaft hypospadias, Mathieu technique is again of application. The aesthetic and functional result of this type of surgery requires good knowledge and careful application of the technique adapted to each case.

Adolescent↗
PubMed1996

[Complications of intravesical mitomycin chemotherapy, apropos of 2 clinical case reports].

Administration of intravesical chemotherapy by mitomycin C (MMC) is an adjuvant treatment of the recurrent superficial bladder cancer. Since use of MMC in 1967, many different toxicities were reported. Those are local toxicities. Systemic toxicity is rare. At the hand of 2 cases reports and recent literature, we discuss the possible complications of intravesical therapy with MMC.

Administration, Intravesical↗
PubMed1995

[Percutaneous treatment of tumors of the upper urinary tract].

In our Institution, 23 patients were selected for percutaneous resection of tumors of the upper urinary tract. Two patients underwent a second procedure: the first for ipsilateral recur and the second for an heterolateral tumor. Among these 23 patients, 11 presented a benign tumor, 9 were treated for a transitional carcinoma of whom 2 invasive state. Both underwent a nephro-ureterectomy. For the 7 superficial transitional carcinomas, the mean follow-up period is 30.4 months. The ipsilateral local recurrencee is 14.3% (1/7), and concern a poorly differentiated tumor (G III). The advantage of the endoscopic techniques to explore and treat the upper urinary tract tumors is double. With these techniques, we can diagnose and treat adequately benign tumors which don't justify radical surgery. In the case of transitional tumors, the percutaneous way is an acceptable method of management when it appears better to avoid a radical treatment (solitary kidney, bilateral synchronous tumors, impairment of total renal function, general injuries). However, it must be performed only in selected cases, and patients should be carefully selected.

Aged↗
PubMed1995

Female urinary incontinence: imaging by or for the urologist.

The author reviews the imaging techniques useful in the evaluation of female urinary incontinence: voiding cystourethrography and videoradiourodynamics. Voiding cystourethrography allows to disclose two forms of bladder base suspension defects: anterior and posterior suspension defects. It will be performed before surgery. Videoradiourodynamics will be limited to patients with recurrent urinary incontinence following unsuccessful surgery.

Female↗