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V Delmas

Publications and source records attributed to V Delmas.

At least 73 records · Page 4Linked to original sources
PubMed1998

[W enterocystoplasty with resorbable staples: technic and functional results. Preliminary study].

INTRODUCTION: The use of absorbable staples for enterocystoplasty allows a marked reduction of the operating time. The long-term results on continence need to be evaluated at result term before adopting this technique. METHODS: Eight patients underwent "W" enterocystoplasty performed with absorbable staples according to the so-called "Detroit" technique, with direct uretero-ileal anastomosis. The continence of these patients was evaluated by clinical follow-up and urodynamic assessment (3 patients). Quality of life was studied by a questionnaire sent to the patient. RESULTS: The mean operating time was 5 hours 20 minutes, the plasty was performed in 25 to 35 minutes. The mean follow-up was 18.7 months, during which two uretero-ileal strictures were diagnosed. 7 of the 8 patients have a good diurnal continence (no leaks) and 1 patient has moderate continence (1 protection). Nocturnal continence was considered to be good in 3 cases, moderate in 2 cases and poor in 3 cases (> 1 protection). Four of the patients evaluated by questionnaire reported urinary disorders. CONCLUSION: The use of absorbable staples allows a definite reduction of the operating time, for a modes excess cost and satisfactory functional results.

Absorption↗
PubMed1998

[Complete perineal prostatectomy carries an increased risk of capsular incision in healthy and cancerous tissue].

OBJECTIVES: To compare positive resection margin rates in tumour tissue and healthy tissue according to whether total prostatectomy for cancer is performed via a retropubic or transperineal approach. PATIENTS AND METHODS: This retrospective, non-randomized study was based on 94 patients suffering from clinically localized cancer (T1-T2) of the prostate operated either via a retropubic (46: group 1) or perineal (48: group II) approach. All slides were reviewed by two pathologists not informed about the clinical course. The frequency of tumour margins associated with extracapsular invasion, capsular incision, without extracapsular extension of the tumour, and finally the incidence of capsular incisions exposing tumour tissue, were determined. RESULTS: While the number of positive resection margins was equivalent in the two groups (61% for group I versus 56% for group II), it was higher in the perineal group (43% versus 29%, p < 0.05) when the tumour was confined to the gland (pT2). A higher incidence of resection margins in healthy tissue was also observed in group II (90% versus 37%). CONCLUSION: Transperitoneal prostatectomy is associated with a higher incidence of resection margins in tumour tissue in patients with prostate-confined cancer. Analysis of the resection margins in healthy tissue suggests that the surgical incision is a predisposing factor to their creation.

Aged↗
PubMed1998

[Inverted Y partial ureteral duplication. Apropos of an unusual case].

Inverted Y partial ureteric duplication corresponds to the presence of a variable length of duplicated ureter before entering the bladder in an orthotopic or ectopic position. A case od inverted Y partial ureteric duplication with ureteric confluence in the hilum of the kidney associated with anastomosis of an ectopic ureter in the epididymis is reported. The description of this original case is compared with the data of the literature.

Adult↗
PubMed1998

Anatomy of spontaneous splenorenal and gastrorenal venous anastomoses. Review of the literature.

Portal hypertension is characterised by the development of a collateral portocaval circulation. Among these venous reroutings, some are situated posteriorly in the left subphrenic compartment. These are the spontaneous splenorenal and gastrorenal anastomoses. Their incidence is estimated at around 16%. On the one hand, there are the direct shunts, which anastomose the spelling v. to the left renal v., of an anecdotal nature, and on the other the spontaneous indirect splenorenal shunts, characterised by the presence of a complete neurovascular pedicle traversing the gastrophrenic ligament. This relates to the gastric collateral v., which is connected to the left renal v. via the inferior v. of the left crus of the diaphragm and the middle capsular v., hence the name "gastro-phreno-capsulo-renal shunt". At an advanced stage of portal hypertension these splenorenal shunts may acquire a major caliber and behave like actual surgical shunts.

Collateral Circulation↗
PubMed1998

Acute renal failure in a diabetic patient.

We report the case of a young insulin-dependent diabetic patient in whom acute renal failure led to detection of ureterohydronephrosis secondary to neurogenic bladder. The persistence of a high daily urine volume revealed diabetes insipidus, suggesting Wolfram syndrome, which was confirmed by the diagnosis of optic atrophy. The main features of Wolfram syndrome, particularly urologic ones, and their treatment are discussed in the light of our findings in this patient.

Acute Kidney Injury↗
PubMed1998

[Why are auto-intracavernous injections abandon in the long-term?].

OBJECTIVES: Self-administered intracavernous injections are proposed in the treatment of impotence, but are frequently discontinued in the long-term. The objective of this study was to assess the reasons for discontinuation of treatment. MATERIALS AND METHODS: Between 1991 and 1996, 250 patients consulting for impotence, to whom self-administered injections were proposed, received a questionnaire at home concerning the frequency of use, duration of erections and acceptability of self-administered injections, as well as the reasons for discontinuation of treatment. The sensitivity of the study was increased by contacting the patient by telephone. The results were analysed according to the aetiology of impotence. RESULTS: 144 patients (57.6%) answered the questionnaire. Of the 106 patients who failed to answer the questionnaire, the telephone call revealed that 66 patients had changed address, 36 had not received the questionnaire and 4 did not wish to participate. Of the 144 patients answering the questionnaire, 35 did not continue treatment at home (group I, 24.3%) because they were dissatisfied (22% of answers), encountered technical problems (22%) or had regained spontaneous erections (15%). 57 of the remaining 109 patients (group II, 57/144 (39.5%)) subsequently discontinued treatment after a mean duration of 6.9 months, because of personal dissatisfaction (33%), financial problems (20%), and erections insufficient to allow penetration (19.4%). Fifty two patients continued treatment (group III, 52/144 (36.2%)). The discontinuation rate was equivalent regardless of the drug used. The three groups did not differ in terms of mean age. The distribution of the causes of impotence was essentially similar in the 3 groups with 35% of psychogenic causes, 40% of mixed causes and 25% of organic causes. CONCLUSION: Intracavernous injections appear to be a reliable and lasting solution for the treatment of erectile impotence requiring selection of motivated couples, regularly reviewed in the outpatients department and having totally integrated the concept of self-administered intracavernous injection.

Adult↗
PubMed1998

[Embryologic hypotheses of prostatic ectopy: apropos of a case].

Events implicated in the development and the differentiation of the prostate gland are determinant to understand the pathology. Mc Neal's zonal anatomy is essential, the basis of which are found in the differences of embryonic origins. We describe a case of prostate ectopia, localized on the lateral aspect of the rectum. Final pathology report showed prostate adenoma. Different types of prostate ectopia have been described in the literature. Histological results showed that we can distinguish two types of ectopia: one which develops from the uro-genital sinus and the other from the mesonephrotic structures.

Choristoma↗
PubMed1998

[Diagnostic value of 10 systematized and ultrasound-guided transrectal prostatic biopsies].

OBJECTIVE: To study the improvement of prostatic cancer detection provided by ten strictly systematized transrectal prostatic biopsies. MATERIAL AND METHODS: This prospective study was conducted in 162 patients submitted to a series of 10 ultrasound-guided transrectal prostatic biopsies due to the presence of elevated PSA and/or an abnormality on digital rectal examination. Five biopsies were taken from different sites in each lobe: 2 biopsies were inserted between the 3 biopsies usually performed in the standard protocol, while maintaining the angle of entry of the needle recommended in this protocol. RESULTS: The complication rate was 1.85% with the 10-biopsy technique. Prostatic cancer was detected in 40.1% of the 162 patients. The percentage diagnostic improvement provided by the 10-biopsy protocol in the overall patient population was +3.1% compared to the standard protocol. The highest percentage diagnostic improvement was observed in the group of patients with PSA < or = 10 ng/ml (+4.9%) and in the group of patients with an ultrasound prostatic volume < or = 40 cc (+4%). CONCLUSION: The most marked diagnostic improvement appears to be related more to sampling of prostatic zones presenting a statistically increased risk of cancer (peripheral zone) than to the increased number of prostatic biopsies performed.

Adenocarcinoma↗
PubMed1998

[Effects of a 6F urethral catheter on uroflowmetry in men with benign prostatic hypertrophy].

OBJECTIVE: To determine whether the presence of a 6F catheter in the urethra modifies uroflowmetric parameters in a population of men with benign prostatic hyperplasia. PATIENTS AND METHODS: 260 patients, 45 to 86 years old, presenting with benign prostatic hyperplasia, underwent two uroflowmetries, one with the urethra free, the other with a 6F urethral catheter. Patients with a history of neurological disease, diabetes mellitus, prostatic cancer, lower urinary tract surgery or taking drugs likely to affect micturition, were excluded from the study. Maximum flow rate (Qmax) and voided volume were then compared during the 2 recordings, using Wilcoxon's non parametric test. RESULTS: No significant difference was observed between voided volumes in the 2 groups (m: 207 ml versus m: 226 ml), but a very significant difference was observed for maximum flow rate measurements (m: 8.62 ml/s versus m: 6.97 ml/s p = 0.0001). CONCLUSION: The presence of an urethral catheter, even small calibre (6F), modifies the flow rate by more than 1.5 ml/s. This element must be taken into account when performing and interpreting measurements of the pressure-flow relationship in men.

Aged↗
PubMed1997

Value of the preoperative detection of prostate-specific-antigen-positive circulating cells by nested RT-PCR in patients submitted to radical prostatectomy.

OBJECTIVE: To assess the value of the detection of circulating prostate cells [prostate-specific antigen (PSA) positive] by reverse-transcriptase nested polymerase chain reaction (nested RT-PCR) to improve the staging of clinically localized prostate cancer. METHODS: Nested PCR was performed on blood samples of 29 patients submitted to radical prostatectomy for clinically localized (T1-T2) prostate cancer. Nine patients with various benign urologic diseases comprised the negative control group. Incubation was for 25 cycles for each PCR, using beta 2-microglobulin to test the integrity of RNA samples. Each sample was tested in quadruplicate and analyzed by agarose gel electrophoresis, blotted and hybridized with specific internal primers. Nested PCR results were compared with the pT stage of the prostate specimen, processed according to the Stanford method. RESULTS: In 6 out of 29 patients (20.7%) with clinically localized prostate cancer, circulating prostate cells were detected by nested PCR. There was no relationship between pathologic stage and RT-PCR results. Eleven out of 14 pT2 patients (78.6%) were PCR negative and only 3 out of 15 pT3 patients (20%) were PCR positive. All control samples were PCR negative. CONCLUSIONS: In selected patients with T1-T2 prostate cancer, there was no relationship between pathologic stage and the presence of circulating PSA-positive cells detected by nested PCR. However, in 20.7% of patients with clinically localized prostate cancer, circulating prostate cancer cells were detected. A further follow-up based on PSA is necessary to clarify the clinical relevance of this biologic anomaly.

Aged↗
PubMed1997

[Treatment of ureteral stenosis using high pressure dilatation catheters].

INTRODUCTION: High-pressure dilatation catheters have been proposed as an alternative to open surgery in the treatment of ureteric strictures because of the low morbidity and short hospital stay. The objective of this study was to evaluate the results of this technique in patients with inflammatory ureteric strictures or uretero-ileal strictures. METHODS: From April 1991 to September 1996, 25 strictures were treated by antegrade or retrograde dilatation with a high-pressure balloon catheter followed by stenting with a double J stent for an average of 2.1 months (1-5): 14 uretero-ileal strictures (tuberculosis, schistosomiasis, iatrogenic, radiotherapy). A good immediate result was defined as intraoperative rupture of the stricture under fluoroscopic control. A good long-term result was defined as absence of recurrence of the stricture, evaluated clinically and radiologically (IVU and/or ultrasonography). RESULTS: The good immediate result rate was 82% (19 out of 23 strictures, with 2 non-evaluable cases). One intraoperative complication was observed (double J stent advanced too for into the ureter). 22 strictures were evaluable after removal of the double J stent and the good long-term result rate was 64% with a mean follow-up of 8.5 months (0.3-24). 8 patients developed a recurrence: 4 after Bricker, 3 with inflammatory strictures after radiotherapy and J with peritoneal carcinomatosis. CONCLUSION: This study shows that high-pressure balloon catheter dilatation of non-neoplastic ureteric strictures provides good results and can be considered to be the first-line treatment for these lesions.

Adult↗
PubMed1997

[Anatomic study of the pubic-urethral ligaments in women: role of urethral suspension].

OBJECTIVE: In 1963, the studies by Zacharin emphasized the importance of the suspensory apparatus of the female urethra, consisting of two non-extensible fibrous bands composed of 3 distinct ligaments. The objectives of this study were to evaluate the role of these ligaments in support of the urethra and to define the value of their preservation in cystectomy with bladder replacement in women. MATERIAL AND METHODS: Five fresh female cadavres with a mean age 78 years (range: 75-82) were used for dissection of the suspensory apparatus of the urethra via a suprapubic then sagittal approach by section of the pelvis 2 cm from the midline. Histological studies of the urethra were then performed. RESULTS: The suspensory apparatus of the urethra was found to be a paired, symmetrical system composed of 2 paired and symmetrical fibrous bands. Dissection of these bands revealed three anterior, intermediate and posterior pubourethral ligaments. The posterior pubourethral ligament was inserted on the anterior and lateral surfaces of the urethra and vagina (underneath the bladder neck) on anatomical studies, but also on histological sections. Section of the posterior pubourethral ligament allowed great mobility of half of the urethra. Section of these ligaments totally released the urethra from the pubis. CONCLUSION: Our study confirmed the importance of this ligamentous system in suspension of the urethra and demonstrated the value of preservation of these structures in cystectomy with bladder replacement in women.

Aged↗
PubMed1996

[Detection of prostatic cancer in symptomatic patients with serum levels of prostate-specific antigen between 4 and 10 ng/ml].

OBJECTIVES: Determine the incidence of prostate cancer in patients consulting for common miction disorders and serum prostatic specific antigen (PSA) between 4 and 10 ng/ml. METHODS: A total of 153 patients consulted for miction disorders. In 107 of them, the digital examination was abnormal and PSA was between 4 and 10 ng/ml. Transrectal sonography and prostatic biopsies were performed in these 107 patients. We determined the number of cancers detected and assessed the contribution of PSA density (PSAD) to diagnosis. In patients undergoing radical prostatectomy, invasion of the capsule (C+) and positive exeresis section (M+) were recorded. RESULTS: Cancer of the prostate was diagnosed in 29.4% of the patients on the basis of at least 1 of the 6 biopsies. This rate was 47.8% in patients with an abnormal and 21.5% with a normal digital examination. Radical prostatectomy was performed in 32 patients: 50% of them were C+ and 33% M+. CONCLUSION: Biopsy of the prostate is indicated in patients with an abnormal prostate at digital examination when PSA is between 4 and 10 ng/ml. When the prostate appears to be normal, PSAD may be helpful in determining when to perform a biopsy. Intermediary serum PSA levels do not guarantee favorable pathological characteristics.

Adenocarcinoma↗
PubMed1996

Ventral tethering of the vagina and its role in the kinetics of urethra and bladder-neck straining.

Based on the principle that the urethra forms an integral part of the ventral wall of the vagina, the aim of this study was to determine the elements of fixation of this wall and their role in the maintenance of urethral statics during strain exertion. Eight dissections of the female pelvis were performed by a simultaneous high and low approach. The anatomic data were compared with a study of the kinetics of the urethra by dynamic MRI. The lower part of the ventral vaginal wall is tethered to the pubis and the ischiopubic rami by a complex mixed system containing elements of both suspension and support. These elements simultaneously allow a complex and asymmetric movement around the inferior border of the pubic symphysis and maintain urinary continence during straining.

Aged↗
PubMed1996

Anatomic basis of mesenteric elongation for ileo-anal anastomosis with J-shaped reservoir: comparison of two techniques of vascular section.

Total proctocolectomy followed by ileo-anal anastomosis with a reservoir is the operation of choice for the treatment of familial adenomatous polyposis and of certain forms of hemorrhagic proctocolitis. Vascular section is sometimes necessary to enable the extremity of the reservoir to reach the anal sphincter without traction. The aim of this study was to compare the gain in length obtained by two different techniques of vascular section and to assess in terms of the vascular anatomy of the last small intestinal loop which technique best preserved the vascularisation of the reservoir as a whole. Twenty-two fresh cadavers had an ileal J-shaped reservoir of 18 cm fashioned from the last loop of small intestinal loop after section of the root of the mesentery. The gains in length so obtained were measured after section of the ileocolic a. at its origin (group A) or section between the two vascular arches of the last small intestinal loop (group B); the superior mesenteric vessels were then injected with colored resin. The gain in length obtained by these two methods was identical (2.3 +/- 1.1 cm for group A as against 2.18 +/- 0.9 cm for group B), but only if the section of the ileocolic a. was accompanied by section of the mesenteric peritoneum up to the vascular arch formed by the anastomosis between the terminal branch of the superior mesenteric a. and the ileocolic a. The constancy of this anastomosis always allowed section of the ileocolic a. while preserving good vascular distribution to the entirety of the reservoir. Section between the two arches was difficult when the distance separating them was small.

Anal Canal↗
PubMed1996

Early detection of prostate cancer in men with prostatism and intermediate prostate-specific antigen levels.

OBJECTIVES: To determine the prevalence of prostate cancer and the diagnostic ability of prostate-specific antigen density (PSAD) in men with lower urinary tract symptoms and intermediate prostate-specific antigen (PSA) levels of 4 to 10 ng/mL (Hybritech assay) and to assess the clinical significance of prostate cancers in men who subsequently underwent radical prostatectomy. METHODS: Six systematic transrectal ultrasonography (TRUS)-guided biopsies were performed in 153 symptomatic men (mean age, 66 years) with PSA levels between 4 and 10 ng/mL, irrespective of digital rectal examination (DRE) findings. Prostate volume was also determined by TRUS and PSAD was calculated (serum PSA divided by volume of entire prostate). The rate of positive biopsies was compared with PSAD (more than 0.2 versus less than 0.2), DRE (positive versus negative), and patient's age (more than 70 years versus 61 to 70 versus 60 or less). Eligible patients with cancer underwent radical prostatectomy, and specimens were analyzed with regard to clinical significance of tumors. RESULTS: The overall cancer detection rate was 29.4%. PSAD and DRE, but not age, were both statistically significant in differentiating negative from positive biopsies. Independent of DRE findings, mean PSAD was significantly lower in biopsy-negative cases (0.29 +/- 0.17 and 0.25 +/- 0.16) than it was in positive cases (0.34 +/- 0.17 and 0.35 +/- 0.15). Half of the patients who underwent radical prostatectomy had pathologically nonorgan-confined disease (more than pT3), 34% had positive margins, and 47% had a Gleason score of 8 to 10. PSAD, DRE, and age could not predict outcome, probably owing to the small number of patients. However, the number of positive biopsies (1 or 2 versus 3 to 6) was able to predict pathologic stage. CONCLUSIONS: In men with lower urinary tract symptoms and intermediate PSA levels of 4 to 10 ng/mL, PSAD may be useful in the selection of patients for prostate biopsy. Carcinomas found using these criteria are of clinical importance.

Adult↗
PubMed1996

A single positive prostate biopsy in six does not predict a low-volume prostate tumour.

OBJECTIVE: To evaluate whether a single positive prostate biopsy in six systematic transrectal ultrasonography (TRUS)-guided biopsies is predictive of a small tumour volume in a subsequent radical prostatectomy (RP) specimen. PATIENTS AND METHODS: Of 158 patients submitted to RP for T1-T2 prostate cancer, 15.2% had one positive biopsy. The rate of positive margins (M+) and extra-capsular involvement (C+) were assessed on the RP specimen in those with one positive biopsy (group I) and in those diagnosed by more than one positive biopsy (group II). The percentage of those with postoperative biological progression (P+), having a prostate-specific antigen (PSA) level > 0.1 ng/mL, was evaluated in both groups. The Gleason scores in biopsies and specimens were also compared. Fifteen patients diagnosed by a single positive biopsy were management conservatively. RESULTS: The percentage of patients who were categorized C+, M+ and P+ was 29.2, 16.7 and 26% in group I and 70, 46.5 and 49.5%, respectively, in group II. All patients with < 10% of the biopsy core length invaded by cancer had intracapsular (P2) disease, whereas if all the core length was invaded by tumour, all patients had extracapsular (P3) disease. The Gleason scores for biopsy cores and whole specimens were identical in 38.7% of the cases; the Gleason score was underestimated on biopsy in 48.4% of cases. In the group treated conservatively, nine of 15 patients were in biological progression, with a mean follow-up of 22 months. CONCLUSION: A single positive needle-biopsy in six systematic TRUS-guided prostate biopsies is not predictive of low-volume prostate cancer on an individual basis and does not guarantee a favourable outcome after RP.

Aged↗