Biomedical subjects

Sami Arap

Publications and source records attributed to Sami Arap.

43 records · Page 3Linked to original sources

PubMedDate not supplied

Evaluation and treatment of the overactive bladder.

The overactive bladder is characterized by symptoms of frequency, urgency, and urge incontinence, substantially affecting the quality of life of millions of people throughout the world. The symptoms are associated with significant social, psychological, occupational, domestic, physical, and sexual problems. Despite the considerable impact of this condition on quality of life, sufferers are often unwilling to discuss their problem with family members or health care professionals. This situation is unfortunate, for much can be done to alleviate the symptoms of this distressing condition. It is therefore of utmost importance that medical education about symptoms of the overactive bladder and other related problems be improved to help health care professionals identify and treat patients who will benefit from therapy. This article reviews current thinking regarding definition, epidemiology, quality of life effects, evaluation, and management of the overactive bladder.

Humans↗

PubMedDate not supplied

Laparoscopic nephrectomy in live donor.

OBJECTIVE: To present the initial experience of videolaparoscopic nephrectomy in live renal donor. MATERIALS AND METHODS: In the period from April 2000 to August 2003, 50 left nephrectomies in live donor were performed by videolaparoscopy for transplantation. Twenty-eight patients were male (56%) and 22 female (44%). Mean age was 37.2 years, and the mean body mass index (BMI) was 27.1 kg/m2. RESULTS: Mean surgical time was 179.5 minutes, and warm ischemia time of the graft was 3.79 minutes. The mean estimated bleeding was 141 mL. There was no need of blood transfusion or conversion to open surgery. In 42 cases (84%), the vascular portion of the graft was considered good by the recipient's surgical team and in all cases, the ureter was considered of proper size, though in one of them (2%) its vascularization was considered improper. The transplanted kidneys produced urine still in the surgical room in 46 of the 50 transplantations considered. In only 2 cases opioid was required for analgesia. In average, 3.1 doses of dipyrone were used for each patient during hospital stay, and hospital discharge occurred, in average, after 3.2 days post-operatively. Two patients required re-operations and one of them evolved to death. CONCLUSIONS: The laparoscopic nephrectomy in live donor for renal transplantation is an alternative to conventional open surgery. In relation to the graft, no alteration, either anatomic or functional, was detected. Though there is already a large documentation in the international literature regarding this procedure, in our setting a prospective randomized study with the usual surgical study is still necessary in order to prove the advantages and disadvantages of the method.

Adult↗

PubMedDate not supplied

Surgical complications after renal transplantation in grafts with multiple arteries.

INTRODUCTION: Renal transplantation with multiple arteries appears, in literature, associated to a major index of surgical complications. This study compared the surgical complications and short-term outcome renal transplants with multiple arteries and single artery grafts. MATERIALS AND METHODS: The data of 64 renal transplants with multiple arteries performed between January 1995 and December 1999 were compared to the ones of 292 transplants with single renal artery. The aspects analyzed were number of arteries of the graft, donor type, vascular reconstruction technique, the occurrence of surgical complications, the incidence of delayed graft function, graft function 1 month after transplantation, graft loss and the patients' deaths. RESULTS: The incidence of surgical complications in grafts with multiple arteries and single renal artery was respectively: vascular--3.1% and 3.1%; urological--6.3% and 2.7% and other surgical complications--15.6% and 10.6%, respectively. The incidence of lymphoceles was 3.1% in grafts with a single artery and 12.5% in grafts with more than 1 artery (p = 0.0015). The incidence of delayed graft function in grafts with multiple arteries and with a single renal artery was respectively 35.1 and 29.1% (p = 0.295). Mean serum creatinine at the 30th postoperative day was 2.46 and 1.81 in grafts with multiple and with 1 artery, respectively (p = 0.271). CONCLUSIONS: Kidney transplantation using grafts with single and multiple arteries present similar indexes of surgical complications and short-term outcome; lymphoceles were more frequent among grafts with multiple arteries.

Adolescent↗

PubMedDate not supplied

Assessment of sexual function in patients undergoing vasectomy using the international index of erectile function.

INTRODUCTION: The present study aims to prospectively compare the sexual function in males before and after vasectomy surgery using the international index of erectile function (IIEF). MATERIALS AND METHODS: From October to December 2002, sixty-four patients who were candidates for male sterilization in the vasectomy program of the Urology Section at the General Hospital of the University of São Paulo were included. The same investigator applied the IIEF before and 90 days after the surgery. The mean scores obtained on pre and postoperative visits for all domains of sexual function were analyzed and compared with the Wilcoxon test. RESULTS: The mean patient age was 35 years (range from 25 to 48 years) and the mean number of children per man was 3. The total mean score of the IIEF was 64.06 before surgery and 65.64 after the procedure, with this difference considered statistically significant (p < 0.001). Sixty-seven per cent of the patients improved their scores, versus 17% and 16% who showed worsening or no change at all in IIEF scores following surgery, respectively. Of the 5 sexual function domains, desire and sexual satisfaction presented statistically significant improvement. CONCLUSION: This study showed that vasectomy caused a positive impact on sexual function, especially on desire and sexual satisfaction, in the majority of men undergoing surgery. There was no case of surgery-related erectile dysfunction.

Adult↗

PubMedDate not supplied

A cost-effective technique for pure laparoscopic live donor nephrectomy.

OBJECTIVE: Compare two different techniques for laparoscopic live donor nephrectomy (LDN), related to the operative costs and learning curve. MATERIALS AND METHODS: Between April/2000 and October/2003, 61 patients were submitted to LDN in 2 different reference centers in kidney transplantation. At center A (CA), 11 patients were operated by a pure transperitoneal approach, using Hem-O-Lok clips for the renal pedicle control and the specimens were retrieved manually, without using endobags. At center B (CB), 50 patients were also operated by a pure transperitoneal approach, but the renal pedicles were controlled with endo-GIA appliers and the specimens were retrieved using endobags. RESULTS: Operative time (231 +/- 39 min vs. 179 +/- 30 min; p < 0.000), warm ischemia time (5.85 +/- 2.85 min vs. 3.84 +/- 3.84 min; p = 0.002) and blood loss (214 +/- 98 mL vs. 141 +/- 82 mL; p = 0.02) were statistically better in CB, when compared to CA. Discharge time was similar in both centers. One major complication was observed in both centers, leading to an open conversion in CA (9.1%). One donor death occurred in CB (2%). Regarding the recipients, no statistical difference was observed in all parameters analyzed. There was an economy of US$1.440 in each procedure performed in CA, when compared to CB. CONCLUSIONS: Despite the learning curve, the technique adopted by CA, showed no deleterious results to the donors and recipients when compared with the CB. On the other hand, this technique was cheaper than the technique performed in the CB, representing an attractive alternative for LDN, mainly in developing centers.

Cost-Benefit Analysis↗

PubMedDate not supplied

[Extracorporeal lithotripsy for the treatment of urolithiasis in children].

OBJECTIVE: Urinary lithiasis affects between five and 10% of the human population during their lifetime, only 2-3% of whom are children. Therapy of urolithiasis in the pediatric age group with minimally invasive methodology represents an attractive alternative. This study presents results of extracorporeal shockwave lithotripsy, a minimally invasive methodology, for the treatment of urinary lithiasis in children. METHODS: In the period between September 1991 and September 2000, 87 children were submitted to extracorporeal shockwave lithotripsy; as six of them presented with two calculi 93 urinary calculi were treated over that period. The Dornier-Philips lithotriptor was used in the procedures. RESULTS: Pelvic, superior and medium caliceal calculi were fragmented and eliminated in 87.7% and 77.8% of cases, respectively. Inferior caliceal stones were eliminated in 64.7% of cases. Only one of the three patients with staghorn calculi became stone-free after therapy (33.3%). All patients with ureteral calculi were stone-free after therapy. Bladder stones were fragmented and eliminated in 60% of cases. CONCLUSIONS: Extracorporeal shockwave lithotripsy is a safe and effective treatment for pelvic, caliceal, ureteral and bladder urolithiasis in children. Staghorn calculi have not shown satisfactory results when treated by this method. Extracorporeal shockwave lithotripsy results were influenced in our experience by the position and size of the treated calculi.

English Abstract↗

PubMedDate not supplied

Endopyelotomy with the Acucise catheter.

OBJECTIVES: Determine the efficiency of the Acucise catheter in the treatment of ureteropelvic junction (UPJ) obstruction. MATERIALS AND METHODS: Between May 1997 and April 1999, 30 patients with primary or secondary ureteropelvic junction obstruction were treated using Acucise endopyelotomy catheter. The diagnosis was based on intravenous urography and diuretic renography. None of the patients underwent imaging studies for identification of blood vessels at the UPJ region. Twenty-one patients presented mild pyelocalyceal dilation and 9 had severe pyelocalyceal dilation. As for etiology, primary stricture was found in 24 patients and secondary stricture in 6. Three patients had UPJ obstruction associated with homolateral renal lithiasis. Retrograde Acucise endopyelotomy was performed in 27 patients; the antegrade access was used in 3 patients that had associated renal calculi. Incision of the stricture was performed laterally in all patients under fluoroscopic guidance. A 7F double-J catheter was placed immediately following the procedure, and removed after 6 weeks. Antegrade pyelotomy required a hospital stay of 3 days and retrograde pyelotomy required 1 day. RESULTS: Postoperative intravenous urography and diuretic renography demonstrated good results in 26 patients (86.6%). CONCLUSIONS: Acucise endopyelotomy represents a minimally invasive therapeutic option and can be used both in adults and in children 8 years old and above. Patients with UPJ obstruction and severe pyelocalyceal dilation had poorer results than those with mild pyelocalyceal dilation.

Journal Article↗