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Biomedical subjects

W Oosterlinck

Publications and source records attributed to W Oosterlinck.

At least 37 records · Page 2Linked to original sources
PubMed2000

Endoscopic urethroplasty with a free graft on a biodegradable polyglycolic acid spiral stent. A new technique.

OBJECTIVES: Explore the possibility of an endoscopic urethroplasty with a free graft on a biodegradable, self-reinforced polyglycolic acid spiral stent. METHODS: Urethral strictures, failures of previous urethrotomies, which still can be incised endoscopically are selected. Strong fibrotic strictures which are bad indications for the use of a free graft are excluded. A free graft (skin on mucosa) is sutured around the stent and brought at the place of the endoscopically opened stricture where the graft is fixed with a suture through skin, bulbar muscles and spongiosum. A suprapubic diversion is left for 10 days. The stent keeps the graft in contact with surrounding well vascularized tissue where it can take. Other parts of the graft become necrotic. The stent hydrolyses in about 3 weeks. MATERIAL AND RESULTS: 10 patients with bulbar strictures from 2 to 4 cm in length and failed previous urethrotomies were treated successfully with this technique. The follow-up varies from 39 to 3 months (mean: 21 months). After 2 years 1 stricture recurred in a man who underwent regular endoscopies for recurrent bladder tumors. All other patients were successful until now. One stent got lost in the bladder during the procedure but could be brought at the right place. Other complications were 1 hematuria, 1 urosepsis, 1 perineal pain, 1 painful evacuation of a part of the stent 16 days after operation, and 1 difficult micturition. CONCLUSION: The preliminary experiences indicate that this technique is a possible treatment of short bulbar strictures after failure of endoscopic treatment.

Absorbable Implants↗
PubMed2000

Treatment of superficial bladder tumors: achievements and needs. The EORTC Genitourinary Group.

OBJECTIVE: The therapeutic objectives in the initial treatment of superficial tumors are to remove completely the tumor, to assess the need for further therapy and to plan the follow-up. METHODS/RESULTS: The EORTC Genitourinary Group assessed the percentage of patients with recurrence at 3 months (3RR) after complete resection of all visible lesions taking into account the institution, the number of tumors at presentation and the year of treatment. The 3RR was considered for 18 institutions. For single tumors, the 3RR varied from 0 to 36% and for multiple tumors from 7 to 75%. The 3RR by number of tumors was 8.7% for single tumors, 21% for 2-5 tumors and 32.2% for >5 tumors. The 3RR by year of entry for single tumors ranged from 21.0 to 43.8% during 1975-1978, from 6.3 to 12.7% during 1984-1986 and from 3 to 5.3% during 1987-1989. For multiple tumors it ranged from 50.0 to 61.5% during 1975-1978, from 20.2 to 27.3% during 1979-1983 and from 14.4 to 24.6% during 1984- 1986. The use of more refined instruments probably led to the decreasing percentage of the 3RR in more recent years, the large variation between institutions remains unexplained. The bladder's unique location renders its mucosa accessible to instillation of chemotherapeutic and immunotherapeutic agents. Cytostatics can be instilled into the bladder hours after surgery without severe complications. A single early instillation within 6 h after transurethral resection (TUR) in patients with a solitary bladder tumor category T(a)/T(1)G(1) to G(3) could reduce the recurrence rate per year by nearly 50%. The superiority of any of the commonly used intravesical drugs has never been demonstrated; the time to initiate therapy is important for treatment outcome. Optimal results can be achieved by initiating treatment early (within 24 h after TUR) and for a duration of 6 months, and maintenance (>6 months) for patients with a delayed first instillation (>7 days after TUR). Bacillus Calmette-Guérin (BCG) immunotherapy has been confirmed to be highly effective in the reduction of tumor recurrence, the treatment of residual papillary transitional cell carcinoma and the treatment of carcinoma in situ (CIS). The response rate in the treatment of the papillary disease averages 55%, and for CIS 73%. In the prevention of tumor recurrence the relative benefit of BCG is 45%. A direct prospective randomized comparison of BCG with intravesical chemotherapy has found it to be significantly superior to thiotepa, to doxorubicin and to mitomycin C when only patients with intermediate and high risk for recurrence were treated. In studies including patients with low recurrence risk, no advantage for BCG was found. Clinical trials showed no superiority of BCG immunotherapy to chemotherapy in preventing progression to > or =T(2). CONCLUSIONS: Investigation of the concept of chemoimmunotherapy up to now lacked evidence of advantages for this approach. Preventive regulatory measures directed to decrease tobacco smoking and some occupational exposures to aromatic amines may contribute to the reduction of bladder cancer. Bladder cancer is a multistep process making this tumor a candidate for chemoprevention. To date, retinoids are the best-studied chemopreventive agents achieving mixed clinical results in superficial bladder tumors. The potent apoptosis-inducing retinoid fenretinide is currently in the phase III trials. The follow-up of patients with all types of superficial tumors must be lifelong; unfortunately cystoscopy cannot be replaced yet by the control of any markers present or not in the urine. There is hope this may change in the near future.

Adjuvants, Immunologic↗
PubMed2000

[Surgical treatment of urethral stricture. Personal view].

The author expressed his personal views on the indications, advantages and disadvantages of current techniques for the treatment of urethral stricture in men, such as: endoscopic urethrotomy, end-to-end anastomosis, prepuce or oral mucosa free grafts, penile or scrotal pedicled flaps, expansible metal stents and two-stage urethroplasties. Apart from his own personal experience, he bases his discussion on the pathophysiology of healing and, often old data of the literature concerning surgery of the urethra. He critically reviews recent developments: the posterior approach to urethral stricture and temporary stents. Finally, he presents two personal techniques: endoscopic urethroplasty with free graft around a biodegradable stent and the use of a pudendal fasciocutaneous flap to correct large perineal defects.

Cicatrix↗
PubMed1999

Urinary excretion of tubular proteins and the technetium-99m dimercaptosuccinic acid (DMSA) absolute renal uptake in partial ureteral obstruction in rats: a functional evaluation of hydronephrotic kidneys.

The aim of this longitudinal study was to evaluate tubular proteinuria in rats with unilateral (UPO) and bilateral (BPO) partial ureteral obstruction with the dimercaptosuccinic acid (DMSA) scan as the gold standard for measuring renal tubular damage. We studied 70 female Wistar rats: 28 animals with UPO, 28 animals with BPO, 7 sham-operated animals, and 7 controls. All animals with obstructed ureters showed renal dilatation on the diethylenetriaminepentaacetic acid DTPA images 1 and 5 weeks postoperatively. One week following UPO and BPO, tubular proteinuria and urinary N-acetyl-beta-D-glucosaminidase (NAG) activity increased (P < 0.01) and the absolute DMSA uptake decreased (P < 0.01). Persistently (week 6) high tubular proteinuria was found in 29% of the animals and was related to severe damage on the DMSA scan (P < 0.01) and to albuminuria (P < 0.05). Renal tubular damage was demonstrated by measuring renal enzymes, tubular proteins, and DMSA uptake after UPO and BPO. Persistent elevated tubular proteinuria was related to severely damaged kidneys.

Acetylglucosaminidase↗
PubMed1999

Significance of bladder biopsies in Ta,T1 bladder tumors: a report from the EORTC Genito-Urinary Tract Cancer Cooperative Group. EORTC-GU Group Superficial Bladder Committee.

OBJECTIVES: We investigated to what extent biopsies of normal-appearing urothelium taken from patients with Ta,T1 bladder cancer showed malignant disease: carcinoma in situ, or papillary tumor. We also investigated biopsies underlying the papillary tumor, adjacent to the tumor, and from suspicious-appearing mucosa. METHODS: In EORTC protocol 30863 (low-risk tumors), 393 patients underwent a biopsy of normal-appearing urothelium. In protocol 30911 (intermediate- and high-risk tumors), multiple biopsies were taken from normal- appearing urothelium in 602 patients. RESULTS: No abnormalities were found in the random biopsies of 376 (95.6%) patients with low-risk tumors and in 532 (88.4%) patients with intermediate- and high-risk tumors. Six (1.5%) patients with low-risk tumors and at least 21 (3.5%) patients with higher-risk tumors showed carcinoma in situ in their random biopsies. None of the patients in the low-risk group and 1 (0.2%) patient in higher-risk group had an invasive tumor (T2). CONCLUSIONS: This analysis indicates that biopsies of normal-appearing urothelium in Ta,T1 bladder cancer patients show no abnormalities in about 90% of the patients. Performing such biopsies does not contribute to the staging or to the choice of adjuvant therapy after transurethral resection.

Biopsy↗
PubMed1998

Elevated tubular proteinuria, albuminuria and decreased urinary N-acetyl-beta-D-glucosaminidase activity following unilateral total ureteral obstruction in rats.

UNLABELLED: Urinary tubular proteinuria and N-acetyl-beta-D-glucosaminidase (NAG) activity has not yet been studied after unilateral total ureteral obstruction (UTO). The aim of the study was (1) to evaluate in a longitudinal study (7 weeks) the behaviour and the potential clinical value of tubular proteinuria and urinary NAG activity after UTO; (2) to study the physiopathology of the non-obstructed contralateral kidney by using these two different markers of tubular damage. METHODS: in 28 female, adult Wistar rats (UTO: n = 16, sham: n = 12), tubular proteinuria and urinary NAG activity were measured before and 1 and 5 weeks after surgery. RESULTS: a significant (P < 0.01) increase in tubular proteinuria/creatinine ratio and urinary creatinine and a decrease in urinary NAG activity was found 1 week after UTO. All parameters normalized after 6 weeks. Albuminuria increased progressively (P < 0.01) during the study. CONCLUSION: tubular proteinuria increases during the first week following UTO in rats. The initial increase of low molecular weight proteins following UTO is not due to tubular damage as no parallel increase of urinary NAG was found. We suggest an initial tubular overperfusion with primary urine, due to an increased single nephron glomerular filtration and overruling the reabsorption capacity of the proximal tubules.

Acetylglucosaminidase↗
PubMed1998

Diagnosis and localization of a complicated urinary tract infection in neurogenic bladder disease by tubular proteinuria and serum prostate specific antigen.

INTRODUCTION: Urinary tract infection is the most frequent complication occurring in patients with spinal cord injuries and can cause renal failure and male infertility. We used the urinary alpha-1-microglobulin (alpha 1Mg) as a marker for pyelonephritis and the serum prostate specific antigen (PSA) as a marker for prostatitis with reference to the currently available methods. The aim of our study is (1) to differentiate between upper (pyelonephritis) and lower urinary tract infection (cystitis, prostatitis) in neurogenic bladder disease, (2) to determine if high (< or = 38.5 degrees C) fever in a neurogenic bladder disease patient was due to urological (prostatitis, pyelonephritis) causes or not. PATIENTS AND METHODS: We evaluated 147 patients of whom 27 had acute pyelonephritis, 16 had prostatitis with fever, 13 had chronic pyelonephritis, 68 had cystitis; 23 were control patients of whom nine had fever (< or = 38.5 degrees C) and 14 did not. The diagnoses and localizations were made on the basis of clinical evidence, with a CT scan, urography, bladder wash-out tests, and five glass-specimen tests. The urinary alpha 1Mg was determined using latex enhanced immunonephelometry and the serum PSA was measured using RIA. RESULTS: For the urinary alpha 1Mg, the sensitivity is 96% and the specificity 93% for the diagnosis of acute pyelonephritis. The serum PSA has a sensitivity of 69% and specificity of 96% in the diagnosis of prostatitis. The urinary alpha 1Mg has a sensitivity of 96% and a specificity of 56% and the serum PSA has a sensitivity of 68% and a specificity of 100% in the differential diagnosis of prostatitis and pyelonephritis. The best discriminative parameter between pyelonephritis and prostatitis was the urinary alpha 1Mg/serum PSA ratio with a sensitivity of 92% and specificity of 88%. CONCLUSION: Upper-tract infection with fever can be diagnosed in neurogenic bladder disease by determining the urinary alpha 1Mg. In male patients, the serum PSA should be determined to distinguish upper-tract infection from prostatitis. High fever does not significantly influence our parameters so that we can differentiate whether or not high fever is due to urological causes.

Adult↗
PubMed1998

Gravity cavernosometry and assessment of complete smooth muscle relaxation: helpful in the differential diagnosis of cavernous leakage?

OBJECTIVE: To establish whether the relationship between cavernosal pressures and gravitational pressures of infused liquid during gravity cavernosometry is linear when complete smooth muscle relaxation is achieved and whether the determination of this relationship could be helpful in the differential diagnosis between organic and functional cavernous leakage. METHODS: Gravity cavernosometry was performed in 50 impotent patients. The cavernosal pressure was measured at at least four different gravitational pressures of the infused liquid. RESULTS: A linear relationship was obtained in all patients with normal maximal cavernosal pressure at gravity cavernosometry. A flat or nonlinear relationship was found in those with abnormal maximal pressure, whatever the cause of cavernous leakage. CONCLUSIONS: A linear relationship between cavernosal and gravitational pressures characterizes complete smooth muscle relaxation during gravity cavernosometry. However, the usefulness of the determination of this relationship is not yet established.

Adult↗
PubMed1998

Urinary alpha 1-microglobulin detects uropathy. A prospective study in 483 urological patients.

PURPOSE: The aim of the study was to evaluate prospectively urinary alpha 1-microglobulin as a marker of proximal tubular damage following acute pyelonephritis and outflow disease of the upper urinary tract in a urological population with minimal exclusion criteria. We also measured the urinary gamma-glutamyltransferase activity, urinary albumin, urinary and serum creatinine, serum IgA and serum alpha 1-microglobulin. PATIENTS AND METHODS: We studied 483 urological patients (age: 1 to 92 years, 297 men, 186 women) excluding patients receiving nephrotoxic drugs, or suffering from type 1 diabetes or renal diseases. There were 141 patients with urinary tract infection but no fever, 36 patients with high fever of non-renal origin, 51 patients with acute pyelonephritis and 156 patients with outflow disease of the upper tract, and 99 patients were included in the reference population. RESULTS: For acute pyelonephritis, vesico-ureteral reflux, and ureteral obstruction, urinary alpha 1-microglobulin had a sensitivity of 94%, 90% and 63% respectively and a specificity of 67%, 77% and 76%. The area under the curve of the receiver operator characteristic curve was significantly (p < 0.001) higher for urinary alpha 1-microglobulin than for albumin or gamma-glutamyltransferase activity. Unexpected positive results were found in acute prostatitis. The urinary alpha 1-microglobulin was the only parameter which differentiated between acute prostatitis and pyelonephritis (p < 0.001). Creatinine clearance or age had little and gender had no influence on the urinary excretion of alpha 1-microglobulin. Urine production rate significantly increases the urinary alpha 1-microglobulin/creatinine ratio. CONCLUSION: Our results suggest that the urinary alpha 1-microglobulin/creatinine ratio is a diagnostically useful marker of tubular damage in acute pyelonephritis and vesico-ureteral reflux in the urological population. Following renal colic and chronic ureteral obstruction, a significant increase in urinary alpha 1-microglobulin excretion was observed.

Adolescent↗
PubMed1998

Controversies in management of urethral trauma after pelvic fracture in men.

Whenever trauma of the urethra is suspected a "test" catheterisation is potentially bad and useless. Retrograde urethrography should be performed before use of any catheter. Doctors in urgency department should be trained to do this. Suprapubic diversion under imaging guidance is the best solution when trauma is diagnosed. In complete rupture without extreme displacement of both ends of the urethra, reconstruction is foreseen at day 7 to 10 after trauma. Bleeding is stopped at that moment and elasticity of the tissues is still sufficient. A second urethrogram the day before intervention is advocated for better judgement of the lesions. Endoscopy with a flexible endoscope from above is performed as the first step of the operation. Minor distances or incomplete lesions of the urethra can be coped with endoscopic realignment. Distances of more than 1 cm are treated by open perineal route only leaving the pelvic hematoma closed. This technique should be restricted to referee centers in view of the small numbers of cases.

Animals↗
PubMed1997

Influence of the method of intracavernous injection on penile rigidity: a possible pharmacokinetic explanation.

OBJECTIVES: To study whether the method of intracavernous injection of vasodilators has an effect on the clinical outcome and to explain the mechanism of possible influence. METHODS: In an open clinical study, penile rigidity after bolus injection was compared with rigidity after slow injection in 52 self-injecting, impotent patients. In 35 volunteers, venous plasma levels of intracavernosally injected drugs were followed under different injection conditions: slow injection of undiluted drug, slow injection of diluted drug, bolus injection, use of a tourniquet, or slow injection followed by squeeze of the corpora. RESULTS: Of the 52 patients, 28 reported better penile rigidity after a bolus injection than after slow injection of vasodilators. The other 24 reported no difference in rigidity. Systemic side effects did not occur, but 4 patients reported local pain after bolus injection. In the 35 volunteers, the lowest plasma levels were observed when a tourniquet was used or when a bolus injection was performed; the quickest transfer was observed after a slow injection of a low volume of the drug. CONCLUSIONS: Better rigidity was observed after bolus injection in a majority of the patients using the same dose of vasodilators. This could be due to the pharmacokinetic phenomenon of a slower drug transfer to the systemic circulatory system after a bolus than after a slow injection.

Aged↗
PubMed1997

The urodynamic evaluation of neuromodulation in patients with voiding dysfunction.

OBJECTIVES: To determine which patients with voiding dysfunction might be suitable for treatment with neuromodulation, using urodynamics to obtain an objective measure of improvement and to illustrate the effect of neuromodulation on voiding dysfunction. PATIENTS AND METHODS: Patients were selected for implantation of a neuroprosthesis using a urodynamic evaluation before and during subchronic stimulation; 27 such patients (four men and 23 women, mean age 33 years, SD 15) were evaluated. RESULTS: Of the 27 patients, the 17 who responded well to neuromodulation all had hypocontractile detrusors and sphincter hypertonicity; sphincter relaxation during micturition was impaired. The urodynamic evaluation showed that these patients were not obstructed. Of 10 patients with spastic pelvic floor syndrome, nine responded well to the treatment. Those not responding to neuromodulation had mainly acontractile detrusors. CONCLUSION: The ideal candidates for neuromodulation are those patients with a spastic pelvic floor syndrome or with a hypocontractile detrusor, in combination with sphincter instability, and impaired sphincter relaxation. An increase of bladder contractility, enhancement of sphincter relaxation and decrease in bladder capacity and residual urine are the most important features of the response.

Adult↗
PubMed1997

The evaluation of arterial inflow by gravity cavernosometry.

PURPOSE: We determined whether the comparison between equilibrium pressure after intracavernous injection of vasodilators and maximal corporeal pressure at gravity cavernosometry could provide information about the relative contribution of arterial inflow and cavernous wall resistance to the erection process. MATERIALS AND METHODS: The results of gravity cavernosometry performed in 68 impotent patients were compared to those of duplex scanning in 53 and penile angiography in 10. RESULTS: A highly statistically significant (p < 0.01) but nonlinear correlation was observed between the equilibrium pressure after injection and maximal corporeal pressure, which indicates a paramount role of the corporeal veno-occlusive mechanism in the development of penile rigidity. However, in most patients with a pressure increase of more than 30 mm. Hg from the equilibrium pressure after injection to the maximal corporeal pressure, arterial insufficiency was diagnosed by duplex scanning and/or arteriography, and seemed to be the main limiting factor in the development of penile rigidity. CONCLUSIONS: Gravity cavernosometry provides functional information about the corporeal veno-occlusive mechanism and arterial inflow and, therefore, about the relative roles of these mechanisms in the development of penile rigidity.

Adult↗
PubMed1997

Pharmacodynamics of intracavernously injected drugs and cavernous wall resistance.

OBJECTIVE: It was our aim to investigate whether drug transfer from the cavernous bodies to the systemic circulation after intracavernous (i.c.) injection is influenced by the resistance of the cavernous wall. METHODS: i.c. injection of 62.5 micrograms digoxin as a tracer. (1) In 32 volunteers; in 5 together with the vasocontractor norepinephrine, in 20 together with a 'trimix' of vasodilators, in 7 alone without vasoactive drug. Plasma digoxin levels were measured after 5, 10 and 15 min. (2) Together with a trimix of vasodilators, in 30 men presenting a normal cavernosometry and in 30 men presenting an abnormal one. Plasma digoxin levels were measured after 2, 3, 5, 6, 10 and 15 min. RESULTS: (1) One minute after i.c. injection, the plasma peak of digoxin was 40 times higher (p < 0.01) after injection with norepinephrine than after injection with vasodilators. (2) There was a statistically significantly (p < 0.01) higher plasma digoxin level 5, 6, 10 and 15 min after injection in the 30 patients presenting an abnormal cavernosometry than in the 30 patients presenting a normal one. CONCLUSIONS: Drug transfer from the cavernous bodies to the systemic circulation is highly influenced by the resistance of the cavernous wall. It seems possible to diagnose cavernous leakage by means of a peripheral dosage of a routinely dosable drug, injected i.c. together with vasodilators.

Aged↗
PubMed1997

New data on diagnosis and medical treatment of retroperitoneal fibrosis.

A review of the literature of the last 5 years on retroperitoneal fibrosis is given. MRT seems to add to the exact extend of the disease and galliumscintigraphy can give new information on the activity of the process and the usefulness of medical therapy. The use of corticosteroid or other immunosuppressive drugs such a azathioprine, again is confirmed. Other drugs mentioned in the medical therapy are methotrexate, cyclophosfamide and penicillamine. A few cases responded well to tamoxifen, a drug which was already used in therapy of desmoid tumours. Medical treatment is anyhow superior to surgery alone.

Anti-Inflammatory Agents↗
PubMed1997

Membrano-bulbo-urethral junction stenosis. Posterior urethra obstruction due to extreme caliber disproportion in the male urethra.

OBJECTIVE: Based on 4 cases of infravesical obstruction due to extreme caliber disproportion between the posterior urethra and the penile urethra, a pathophysiological mechanism for this dynamic obstruction is given and endoscopic treatment is described. SUBJECTS: Four cases of membrano-bulbo-urethral junction (MBUJ) stenosis, seen between September 1995 and April 1996, are described. Two boys had previous successful valve resection but still showed extreme ballooning of the posterior urethra. The other 2 boys showed bladder instability on urodynamics and the male variant of the spinning top urethra on voiding cystourethrography (VCUG). RESULTS: All cases were successfully treated by endoscopic incision at the 12 o'clock position of the kink between the posterior and the penile urethra which is seen when the full bladder is expressed. Disproportion in the posterior urethra, seen on VCUG, together with bad urinary flow measured on uroflowmetry raise the suspicion of MBUJ stenosis. CONCLUSION: Although rarely seen, extreme caliber disproportion in the male urethra can cause obstruction. Ballooning of the posterior urethra, caused by urethral valves, bladder instability resisted by voluntary sphincter contraction or congenital posterior urethral dilatation, creates an obstructive kink in the urethra comparable to some obstructions in ureteropelvic junction stenosis. If suspicion of such a form of obstruction arises, cystoscopy during pressure on the full bladder is mandatory in order to see the obstruction, descending as a membrane from the vault of the urethra.

Adolescent↗