ABSTRACT
FROM PHYSIOPATHOLOGY TO TREATMENT: Urinary incontinence on effort in women is due to a default in sub-urethral anatomical structure, which leads to incontinence on effort (coughing, laughing, carrying heavy weights, physical activity). When re-education fails, surgical treatment using Burch's technique or the placing of sub-urethral TVT (Tension free Vaginal Tape) is generally proposed. BURCH'S TECHNIQUE: Burch's technique consists in an upper tract colposuspension via coelioscopy or laparotomy, under rachis or general anaesthesia. In the literature, the following rates of complete cure have been presented: 64 to 87%, 75 to 95% and 63 to 89% respectively in the short, median and long term together with the cure of certain complications (vesicular instability, dysuria, secondary prolapse, infections). THE TVT TECHNIQUE: Developed in the early nineties, the placing of TVT is a mini-invasive technique requiring the use of polypropylene tape inserted vaginally under the urethra under rachis or local anaesthesia. It is associated with over 80% median term clinical efficacy and rare complications (vesicular perforation, arterial wounds, perineal haematoma, dysuria, infections).
Subject(s)
Urinary Incontinence, Stress , Adult , Aged , Female , Follow-Up Studies , Humans , Middle Aged , Postoperative Complications , Recurrence , Time Factors , Urinary Incontinence, Stress/physiopathology , Urinary Incontinence, Stress/rehabilitation , Urinary Incontinence, Stress/surgeryABSTRACT
The TVT device (Tension-free Vaginal Tape) is used in our Hospital to treat stress urinary incontinence, resulting in an excess cost for the Pharmacy. The Burch technique, used previously, does not require any specific medical device, but is invasive and requires a longer hospital stay. The objective of this study was to compare the financial impact of these two techniques, by defining the discriminant costs. Seventeen isolated Burch procedures and twenty one TVT procedures were included. The costs analysed concerned medical devices, medicinal products, laboratory procedures, operating time, hospital stay and duration of postoperative follow-up. The Burch procedure cost FFR 26,322 and the TVT procedure cost FFR 10,958. The TVT technique reduces the cost of hospitalisation and represents an economy of operative equipment and nursing workload (reduction of operating time and postoperative stay).
Subject(s)
Urinary Incontinence, Stress/surgery , Urologic Surgical Procedures/economics , Urologic Surgical Procedures/methods , Adult , Aged , Aged, 80 and over , Costs and Cost Analysis , Female , Humans , Middle AgedABSTRACT
Stroke after coronary bypass grafting (CABG) is often disabling. The incidence of ischemic stroke may approach 3% to 5%. Several risk factors have been identified including previous history of stroke, prolonged cardiopulmonary bypass time, and postoperative atrial fibrillation. Retrospective study during the period 1992-1995 was undertaken to determine the incidence, risk factors of neurological deficit after open-heart surgery at King Khalid University Hospital, Riyadh, Saudi Arabia. There were 350 patients who were subjected to CABG, 10 patients (2.8%) were found to suffer from cerebrovascular accidents (CVA) following open-heart surgery. In 18 patients, the complaint lasted more than 24 hours (stroke), while 2 patients developed transient ischemic attacks (TIA). Five factors were found to be associated with increased risk of post cardiac surgery CVA. These factors are postoperative atrial fibrillation, carotid bruit, past history of heart failure, past history of CVA and smoking. The authors concluded that it is necessary to start a prospective study to verify the area of improvement with regards to technique, selection of patients and mode of perfusion during cardiopulmonary bypass (CPB).
Subject(s)
Anesthesia/adverse effects , Cardiac Surgical Procedures/adverse effects , Coronary Artery Bypass/adverse effects , Stroke/etiology , Adult , Aged , Atrial Fibrillation/complications , Diabetes Complications , Female , Heart Failure/complications , Heart Valves/surgery , Humans , Hypertension/complications , Male , Middle Aged , Retrospective Studies , Risk Factors , Stroke/epidemiologyABSTRACT
The authors report a case of Cockett's syndrome discovered by ilio--cava angiography at a patient who was operated on a bilateral retro-iliac ureter which occasioned an important renal insufficiency. After a review of the literature, it appears it is the first case published with such a pathologic association mentioned.
Subject(s)
Iliac Vein , Ureter/abnormalities , Ureteral Diseases/complications , Vascular Diseases/complications , Acute Kidney Injury/etiology , Aged , Angiography , Constriction, Pathologic/complications , Constriction, Pathologic/diagnosis , Female , Humans , Syndrome , Ureteral Diseases/surgery , Urinary Tract Infections/complications , Vascular Diseases/diagnosisABSTRACT
Severe dysuria, due to insufficiency of the perineal floor associated during micturition with a posterior tilting of the prostate-bladder block in lower or in associated upper and lower motor neuron lesions, can be treated surgically by a prostato cytso pexy. Since 1971, eight patients with post-traumatic conus and/or cauda equina lesions have been treated by this intervention. On the follow-up the satisfactory results appear to remain stable. An alternative surgical technique using the abdominal pyramidalis muscle is described so as to fix the prostate, associated with a bladder-pexy. The recurrence of dysuria, after the intervention, has always been caused by an additional lower urinary tract pathology. The comfort of the patients has been greatly improved.
Subject(s)
Cauda Equina/injuries , Spinal Cord Injuries/surgery , Urinary Bladder, Neurogenic/surgery , Urination Disorders/surgery , Abdominal Muscles/surgery , Adolescent , Adult , Humans , Male , Middle Aged , Prostate/surgery , Spinal Cord Injuries/complications , Urinary Bladder/surgery , Urinary Bladder, Neurogenic/etiology , Urination Disorders/etiologyABSTRACT
The advantage of using JJ ureteral stent during pregnancy in case of ureteral obstruction is shown two clinical observations. We use ultrasonography to control the site of this catheter during the operation and for the follow-up of the patients.
Subject(s)
Drainage/instrumentation , Pregnancy Complications/therapy , Ureteral Obstruction/therapy , Urinary Catheterization/instrumentation , Adult , Female , Humans , PregnancyABSTRACT
Some prostatic cancers (T4) spread out along the ureters to the kidneys. Patients, usually arrive with terminal renal failure and bladder retention and have often fast-advancing cancer with massive nodes invading. T.U.R., reimplantation of the ureters into the bladder dome or into a psoïc bladder and the specific treatment of the cancer, have often permitted these patients to survive for some years without any dialysis. In these cases we often find very important lower limbs oedema. With lymphatic nodes radiotherapy and subcutaneous injections of heparin, these oedema may regress completely.
Subject(s)
Prostate/surgery , Prostatic Neoplasms/surgery , Ureter/surgery , Urinary Bladder/surgery , Aged , Humans , Male , ReplantationSubject(s)
Pessaries , Urinary Bladder Diseases/complications , Urination Disorders/etiology , Aged , Female , Humans , Hydronephrosis/etiology , Pessaries/adverse effects , Prolapse/complications , Radiography , Ureteral Diseases/etiology , Urinary Bladder Diseases/diagnostic imaging , Urinary Incontinence/etiology , Urination Disorders/therapyABSTRACT
The authors report a case of bilateral retro-iliac ureter with renal failure. The transvascular segments of the ureters were eliminated, and the two ureters were reanastomosed in front of the iliac vessels.
Subject(s)
Anuria/etiology , Ureter/abnormalities , Ureteral Obstruction/complications , Aged , Female , Humans , Hydronephrosis/etiology , Iliac Artery , Ureter/surgery , Ureteral Obstruction/etiology , Ureteral Obstruction/surgeryABSTRACT
Vesico-ureteric reflux in adult patients with normal and dilated ureters (88 ureters) was treated surgically by Fielding's procedure. The authors describe this technique with their own modifications, and discuss the results.