117 research outputs found
Morphological changes on the intestinal mucosa in orthotopic neobladder
No full textIntroduction: The intestinal mucosa undergoes significant atrophic changes when it is used to reconstruct the urinary tract. We analyzed the ultrastructural changes of intestinal mucosa in the orthotopic neobladder on the basis of our clinical experience. Patients and Methods: Fifteen male patients with an ileal neobladder underwent endoscopic biopsy at different postoperative intervals. Results: No significant changes were observed 3 months after surgery. After 6 and 12 months, the structure of the microvilli was modified significantly. No other substantial changes after 24 months were observed. Conclusions: Progressive modifications occur in the cytoplasmic structures involved in the absorptive process. They do not seem to begin before 3 months and are almost totally completed after 1 year. Copyright © 2012 S. Karger AG, Basel
Urinary levels of glycosaminoglycans in patients with idiopathic detrusor overactivity
No full textIntroduction and hypothesis We assessed whether urinary excretion of glycosaminoglycans (GAGs) may be affected by a condition of detrusor overactivity (DO). Materials and methods We evaluated 24-h urinary excretion of GAGs in 25 patients (mean age 63.81 years) with DO and in 14 healthy controls (mean age 65.75 years). No patients or controls had urinary tract infection. The excretion of GAGs was measured on the basis of total urine volume and normalized to creatinine concentration. Student's test was employed to check between the urinary excretion of GAGs in the two groups. Results The urinary content of GAGs discovered in control group was significantly higher than that in pathological group for the ratio GAGs/creatinine concentration. Conclusions The low content of GAGs might be due to relative ischemia of the bladder wall epithelial layer following a chronically increased contractile activity of the detrusor even if further studies are needed to confirm this finding
Porcine small intestinal submucosa implant in pubovaginal sling procedure on 48 consecutive patients: long-term results
No full textObjective: The long-term efficacy of pubovaginal sling (PVS) procedure with porcine small intestinal submucosa (SIS) implant was retrospectively assessed. Study design: Forty-eight patients with SUI underwent a pubovaginal sling with SIS. Patient evaluation included history, physical examination with stress test and prolapse assessment by Baden-Walker classification, routine laboratory tests, 24 h-pad test, and multichannel urodynamic measurement. Postoperatively the patients were classified as cured, improved and unchanged or failed. A King's Health Questionnaire (KHQ) was performed to verify post-operatively the quality of life of these patients. Results: At median follow-up of 76 months 33/48 (69%) were cured, 6/48 (12%) were improved while 9/. 48 (19%) were failed or unchanged. No urinary retention or dyspareunia was reported and no vaginal erosion or adverse tissue reaction was detected. The descriptive statistics of KHQ scores by dimensions was done in 32/48 patients (67%). Failed or unchanged patients showed worse scores than cured and improved patients in all KHQ dimensions showing an overall overlapping between objective and subjective results although these findings are weakened due to the lack of a preoperative evaluation of QoL. Conclusions: PVS procedure using SIS cannot offer a durable option for the treatment of SUI as reported by the current mininvasive techniques. (C) 2011 Elsevier Ireland Ltd. All rights reserved
Pubovaginal sling procedure with porcine small intestinal submucosa (SIS) implant: Intermediate-term follow-up
No full textTransvaginal bone-anchored sling procedure: 4 years of follow-up on more than 200 consecutive patients
No full textOBJECTIVES To report intermediate-term results with reference to quality of life (QoL) and complications in 232 consecutive patients with stress urinary incontinence (SUI) treated with a transvaginal pubic bone-anchored sling (BAS). METHODS We retrospectively reviewed 232 consecutive patients affected by SUI who underwent BAS using biologic and synthetic materials, with a mean follow-up of 50 months. Stress urinary incontinence was due to a defect of anatomic Support and to intrinsic sphincteric deficiency in 220 patients and 12 patients, respectively. In all cases QoL was evaluated by Korman questionnaire. RESULTS The questionnaire outcomes of 232 patients were evaluated. One hundred seventy-three patients (74.5%) reported being cured, 21 patients (9.0%) were unchanged, and 38 patients ( 16.5%) failed. One hundred seventy-Seven patients (76.2%) were satisfied with the BAS procedure, and 38 (16.3%) would perhaps still choose BAS implantation, whereas 17 patients (7.5%) would not repeat this choice again. Sixty patients (25.8%) reported pelvic pain that was occasional in 47 patients (20.2%) and recurrent in 13 patients (5.6%). Twenty-five patients (14.1%) reported dyspareunia that was occasional in 17 patients (10.7%) and recurrent in 8 patients (3.4%). CONCLUSIONS The BAS procedure shows an overall acceptable Subjective cure rate, even if in the presence of a high percentage of complications. In this setting the BAS procedure cannot be proposed for correction of SUI
An unusual use of AMS 800 artificial urinary sphincter cuff in the treatment ofsphincteric neurogenic incontinence: case report
No full textStudy design: Case report of an unusual use of AMS 800 (American Medical Systems, Inc., Minnetonka, Minnesota) artificial urinary sphincter cuff in a female patient affected by neurogenic urinary incontinence. Objective: To describe this rare surgical solution. Setting: Department of Urology in Italy. Methods: A 43-year-old woman affected by flaccid paraplegia, acontractile bladder and incompetent bladder neck, underwent an implantation of an artificial urinary sphincter AMS 800. After 7 years, a mechanical failure of the device occurred and pubovaginal sling (PVS) utilizing the cuff of the sphincter was employed due to the poor quality of rectus fascia and the development of previous allergy for some heterologous materials. Results: At 17 months follow-up, the patient is contnent and able to empty the bladder by clean intermittent self-catheterization (CIC). Conclusion: The risk of developing an allergy reaction due to the employment of heterologous materials and the impossibility to use the rectus fascia obliged us to adopt the pre-existent cuff of the artificial urinary sphincter AMS 800.Study design: Case report of an unusual use of AMS 800 (American Medical Systems, Inc., Minnetonka, Minnesota) artificial urinary sphincter cuff in a female patient affected by neurogenic urinary incontinence. Objective: To describe this rare surgical solution. Setting: Department of Urology in Italy. Methods: A 43-year-old woman affected by flaccid paraplegia, acontractile bladder and incompetent bladder neck, underwent an implantation of an artificial urinary sphincter AMS 800. After 7 years, a mechanical failure of the device occurred and pubovaginal sling (PVS) utilizing the cuff of the sphincter was employed due to the poor quality of rectus fascia and the development of previous allergy for some heterologous materials. Results: At 17 months follow-up, the patient is contnent and able to empty the bladder by clean intermittent self-catheterization (CIC). Conclusion: The risk of developing an allergy reaction due to the employment of heterologous materials and the impossibility to use the rectus fascia obliged us to adopt the pre-existent cuff of the artificial urinary sphincter AMS 800
Clinical Considerations on the Perspectives in Renal Tumour Molecular Pathology
No full textObjectives: At present, clinical staging alone is not entirely accurate for predicting prognosis and selecting patients at risk for recurrence and metastasis, both of which have an impact on planning and providing additional adjuvant therapy. Many tumour markers have been studied, but no effective markers are currently available for the diagnosis and prognostication of renal cell carcinoma (RCC). Methods: We review the most recent molecular markers based on an online PubMed search. Terms for the search included renal cell carcinoma, molecular pathology, molecular analysis, molecular markers, and molecular mechanism. Results: The three major fields in the research on RCC are early diagnosis, prognostication, and therapy. Different methods for early diagnosis have been proposed, such as microsatellite analysis, methylation-specific polymerase chain reaction, and surface-enhanced laser desorption/ionisation mass spectrometry (SELDI-MS). Several markers have been suggested for prognostication, but they have not yet been evaluated sufficiently to recommend their inclusion in a clinical assay. New therapeutic approaches have been proposed to improve the treatment of patients resistant to immunotherapy. Conclusions: Many articles have been published on RCC. Most of them are devoted to the recognition of new tumour markers for therapy selection, diagnosis, and prognostication. Despite this vast effort, tumour markers for RCC still have not been validated clinically in prospective studies. © 2006 European Association of Urology
The current role of contrast-enhanced ultrasound (CEUS) imaging in the evaluation of renal pathology
No full textBy using a microbubble contrast agent and contrast-specific imaging software, the contrast-enhanced ultrasound (CEUS) is able to depict the micro and macrocirculation of the target organ. METHODS: A review of the peer reviewed literature was done regarding the current role of ultrasound CEUS imaging in the evaluation of renal pathology with reference to the diagnosis of renal ischaemia, in the characterization of complex cystic lesions and in those with equivocal enhancement at CT. RESULTS: CEUS provides information on tissue perfusion and may play a role in kidney mass characterization similar to the role of contrast-enhanced CT and MRI. In this context, the characterization of cystic lesions is probably the most consolidated field of application of contrast agents on kidney ultrasound imaging. Finally, CEUS provides a good alternative to CT, especially in patients with contraindications to iodinated contrast agents. CONCLUSIONS: The usefulness of CEUS in these applications is confir
Catheters and Infections
No full textCatheters are used for effective drainage of the bladder, either temporally or permanently,
in the presence of physiological and anatomical defects or obstruction of the lower urinary
tract. Catheters are used for a variety of reasons, as follows, to maintain bladder drainage
during and following surgery or epidurals anesthesia for minimizing and prevention of the
risk of distension injuries; investigations, for accurate urine output measurement, and
measurement of post-micturition residuals; treatments, to relieve urinary retention or for
chemotherapy instillation; intractable incontinence, as the final option for containment
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