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1.
Prog Urol ; 27(12): 603-608, 2017 Oct.
Article in French | MEDLINE | ID: mdl-28869171

ABSTRACT

INTRODUCTION: The etiology of the uretero-hydronephrosis in pregnancy is just hypothesis: hormonal or mechanical hypothesis, only investigated by echographic studies. MRI permits to visualize the entirety of the urinary tract, which can be helpful to find out a mechanical cause. METHODOLOGY: We have analysed the MRI of 100 asymptomatic pregnant women. We have determined the number and locations of the uretero-hydronephroses and researched whether there is any relationship between the uretero-hydronephrosis and certain abdominal structures. We focused on the psoas muscle and measured its depth, width and calculated its surface by a reproducible method. RESULTS: The analysis revealed that the uretero-hydronephrosis was predominantly at the right side (63%) and in the majority of the cases limited to the kidney (42%) and/or the proximal third of the ureter (42%). We were able to rule out some proposed etiologies: a compression of the ureter between the uterus and the iliac or ovarian vessels; a protective effect of the left intestinal structures. A link was observed between the psoas muscle and the physiological uretero-hydronephrosis: the ipsilateral psoas muscle seemed smaller in pregnant women presenting a uretero-hydronephrosis. CONCLUSION: We have highlighted a link between a physiological uretero-hydronephrosis during pregnancy and a lesser developped psoas muscle. The hypothesis proposed is that a smaller psoas muscle would have a less protective effect of the ureter due to a lesser development. This study offers a practical conclusion: a left sided uretero-hydronephrosis during pregnancy and/or including the entirety of the ureter is more probably a pathological hydronephrosis. LEVEL OF EVIDENCE: 4.


Subject(s)
Hydronephrosis/diagnostic imaging , Hydronephrosis/etiology , Magnetic Resonance Imaging , Pregnancy Complications/diagnostic imaging , Pregnancy Complications/etiology , Female , Humans , Hydronephrosis/epidemiology , Pregnancy , Pregnancy Complications/epidemiology , Retrospective Studies , Ureter
2.
Acta Chir Belg ; 114(5): 355-7, 2014.
Article in English | MEDLINE | ID: mdl-26021543

ABSTRACT

We report the case of a 72 year old male with penoscrotal extramammary Paget's disease (EMPD). The patient presented with an eczematous lesion on the scrotum extending on to the base of the penis. Given the persistent and progressive nature of the lesion a biopsy was taken which revealed a malignant lesion suggestive of extramammary Paget's disease. After performing a CAT-scan of the lower abdomen and inguinal region, which was negative, a primary surgical approach with curative intentions was taken. One year after surgery the patient is doing well and shows no sign of local recurrence.


Subject(s)
Paget Disease, Extramammary/diagnosis , Penile Neoplasms/secondary , Plastic Surgery Procedures/methods , Scrotum , Urologic Surgical Procedures, Male/methods , Aged , Humans , Male , Neoplasms, Unknown Primary , Paget Disease, Extramammary/surgery , Penile Neoplasms/diagnosis , Penile Neoplasms/surgery , Penis/pathology , Penis/surgery , Tomography, X-Ray Computed
3.
Acta Chir Belg ; 110(3): 313-6, 2010.
Article in English | MEDLINE | ID: mdl-20690513

ABSTRACT

PURPOSES: To compare the peri-operative biochemical data, the postoperative need for help with hygiene and mobility, and the duration of bladder catheterization, hospitalization and ICU stay of patients undergoing radical retropubic prostatectomy (RRP) versus robotic-assisted laparoscopic prostatectomy (RALP) performed by an experienced open, yet inexperienced laparoscopic, surgical team, in a peripheral low-volume urological centre. METHODS: Over a 4-year period (2004-2008), 22 men underwent radical prostatectomy without lymphadenectomy at the study institution. The mean age of the patients was 63.9 years and the mean PSA value at the time of diagnosis was 9.2 ng/mL. RESULTS: Patients in the robotic-assisted laparoscopic prostatectomy group presented a significantly lower decrease in haemoglobin, haematocrit and total plasmatic protein and a significantly smaller need for help with hygiene and mobility and a shorter duration of bladder catheterization, hospitalization and ICU stay. CONCLUSIONS: The results of this study have shown that robotic-assisted laparoscopic prostatectomy is associated with lower peri-operative morbidity and a shorter hospital stay than radical retropubic prostatectomy, even when only considering the first performed robotic-assisted laparoscopic prostatectomies by a yet inexperienced robotic team in a peripheral low-volume urological centre.


Subject(s)
Laparoscopy , Prostatectomy/methods , Robotics , Aged , Blood Proteins/analysis , Blood Transfusion/statistics & numerical data , Hematocrit , Hemoglobins/analysis , Humans , Hygiene , Intensive Care Units/statistics & numerical data , Length of Stay/statistics & numerical data , Male , Middle Aged , Urinary Catheterization/statistics & numerical data
4.
Eur Urol ; 33(5): 441-6, 1998.
Article in English | MEDLINE | ID: mdl-9643662

ABSTRACT

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.


Subject(s)
Impotence, Vasculogenic/diagnosis , Impotence, Vasculogenic/physiopathology , Muscle, Smooth/physiopathology , Penis/blood supply , Adult , Aged , Blood Flow Velocity , Diagnosis, Differential , Gravitation , Humans , Impotence, Vasculogenic/etiology , Male , Manometry , Middle Aged , Muscle Relaxation/physiology , Regional Blood Flow , Regression Analysis , Sensitivity and Specificity
5.
J Urol ; 160(1): 63-6, 1998 Jul.
Article in English | MEDLINE | ID: mdl-9628606

ABSTRACT

PURPOSE: We define the precise meaning and diagnostic significance of the resistance index generated by duplex scanning. MATERIALS AND METHODS: In 80 patients penile rigidity was clinically evaluated and a penile duplex scan was performed after intracavernous injection of 10 microg. prostaglandin E1. The intracavernous equilibrium pressure was measured in 34 of these patients. RESULTS: We found a statistically highly significant linear relationship among cavernous pressure, resistance index and penile rigidity (p <0.001). CONCLUSIONS: The resistance index and clinical degree of penile rigidity are 2 expressions of intracavernous pressure. Clinical observation of erection is equivalent to the resistance index in screening for cavernous leakage.


Subject(s)
Erectile Dysfunction/physiopathology , Penis/physiopathology , Adult , Aged , Humans , Male , Middle Aged , Pressure , Prospective Studies , Ultrasonography, Doppler, Duplex
6.
Eur Urol ; 33(3): 293-6; discussion 296-7, 1998.
Article in English | MEDLINE | ID: mdl-9555555

ABSTRACT

PURPOSE: To study the effect of re-dosing of vasodilators on cavernous smooth muscle relaxation. METHODS: The intracavernosal pressure (ICP) was measured in 48 patients undergoing an intracavernosal injection test followed by gravity cavernosometry before and after administration of 1 or 2 booster injections with 20 micrograms prostaglandin E1 after an initial injection of a trimix of vasodilators. When submitted to Duplex scanning on another occasion, the injection of the trimix was followed by squeeze of the corpora. The occurrence of clinical full erection during the examinations was registered. RESULTS: The mean values of the ICP changed little, albeit statistically significant, after the first booster injection (+3.47 mm Hg) but not after the second one. With cavernosometry, a false diagnosis of cavernous leakage was made in at least 14 patients. During Duplex scanning, after the corpora were squeezed, 12 patients developed a clinical full erection, but none did during the intracavernosal injection test, even after re-dosing. A minimal drop in blood pressure was observed in 15 subjects after a booster injection. CONCLUSIONS: Administration of booster injections of 20 micrograms prostaglandin E1 after an initial injection of trimix did not induce sufficient cavernous smooth muscle relaxation. Squeezing of the corpora after injection of trimix was more successful.


Subject(s)
Erectile Dysfunction/drug therapy , Penile Erection/drug effects , Vasodilator Agents/administration & dosage , Adult , Aged , Alprostadil/administration & dosage , Blood Flow Velocity/drug effects , Blood Pressure/drug effects , Drug Therapy, Combination , Erectile Dysfunction/diagnostic imaging , Erectile Dysfunction/physiopathology , Humans , Injections , Male , Middle Aged , Muscle, Smooth/drug effects , Papaverine/administration & dosage , Penis/blood supply , Penis/diagnostic imaging , Phentolamine/administration & dosage , Retreatment , Ultrasonography, Doppler
7.
J Urol ; 158(2): 440-3, 1997 Aug.
Article in English | MEDLINE | ID: mdl-9224319

ABSTRACT

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.


Subject(s)
Erectile Dysfunction/physiopathology , Penis/blood supply , Adult , Aged , Arteries/physiology , Blood Pressure , Gravitation , Humans , Male , Middle Aged , Regional Blood Flow
8.
J Urol ; 157(3): 830-2, 1997 Mar.
Article in English | MEDLINE | ID: mdl-9072579

ABSTRACT

PURPOSE: We compare the results of the resistance index generated by duplex scanning and the corporeal pressure generated by the intracavernous injection test followed by gravity cavernosometry. MATERIALS AND METHODS: We examined 40 impotent subjects with duplex scanning and gravity cavernosometry. RESULTS: For the entire group a significant correlation (r = 0.77, p < 0.001) was found between the resistance index and intracavernous injection test, and between the resistance index and the gravity cavernosometry (r = 0.62, p < 0.01). Excluding the results of patients who had a full erection during scanning, the correlation between the resistance index and intracavernous injection test remained but the correlation between the resistance index and gravity cavernosometry disappeared (r = -0.02, p > 0.05). CONCLUSIONS: There was no relationship between the value of the resistance index and the cavernous wall resistance, except in patients capable of developing a full erection after vasodilator injection.


Subject(s)
Impotence, Vasculogenic/physiopathology , Penis/physiopathology , Ultrasonography, Doppler, Duplex , Adult , Aged , Humans , Male , Middle Aged , Pressure
9.
Urology ; 49(2): 248-52, 1997 Feb.
Article in English | MEDLINE | ID: mdl-9037289

ABSTRACT

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.


Subject(s)
Erectile Dysfunction/drug therapy , Penile Erection/drug effects , Vasodilator Agents/administration & dosage , Aged , Humans , Injections/methods , Male , Middle Aged , Penis , Vasodilator Agents/pharmacokinetics
10.
Eur Urol ; 32(2): 184-9, 1997.
Article in English | MEDLINE | ID: mdl-9286651

ABSTRACT

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.


Subject(s)
Digoxin/administration & dosage , Digoxin/pharmacokinetics , Penis , Vasodilator Agents/administration & dosage , Vasodilator Agents/pharmacokinetics , Aged , Humans , Impotence, Vasculogenic/diagnosis , Impotence, Vasculogenic/metabolism , Impotence, Vasculogenic/physiopathology , Injections , Male , Middle Aged , Norepinephrine/administration & dosage , Norepinephrine/pharmacokinetics , Penile Erection , Penis/physiology
14.
Paraplegia ; 24(5): 271-5, 1986 Oct.
Article in English | MEDLINE | ID: mdl-3774363

ABSTRACT

We report on our results with the intracavernous injection and self-injection of papaverine-phentolamine in a group of spinal cord injury patients with erectile impotence. This technique offers the possibility of achieving a full erection which continues for a few hours and disappears afterwards. In our limited experience no major complications have occurred. If our findings are confirmed, in future, the self-injection technique may become a valuable alternative to implanting a prosthesis in impotent paraplegics and tetraplegics.


Subject(s)
Erectile Dysfunction/drug therapy , Papaverine/administration & dosage , Phentolamine/administration & dosage , Drug Combinations , Erectile Dysfunction/etiology , Humans , Injections , Male , Papaverine/adverse effects , Papaverine/therapeutic use , Penis , Phentolamine/adverse effects , Phentolamine/therapeutic use , Priapism/chemically induced , Self Administration , Spinal Cord Injuries/complications
16.
Eur Urol ; 12(3): 169-70, 1986.
Article in English | MEDLINE | ID: mdl-3709585

ABSTRACT

Injection of a small dose of noradrenaline in one corpus cavernosum caused quick detumescence in 10 children and 7 adults with disturbing peroperative erections. The mode of administration is simple, and complications have not appeared. As this therapy has always been effective and avoids the need for deeper anesthesia, we dare to recommend it as first choice treatment for peroperative erections.


Subject(s)
Norepinephrine/administration & dosage , Penile Erection/drug effects , Urethra/surgery , Adult , Child , Child, Preschool , Humans , Intraoperative Period , Male , Norepinephrine/pharmacology
17.
Eur Urol ; 12(6): 395-7, 1986.
Article in English | MEDLINE | ID: mdl-3816893

ABSTRACT

The long-term results after antireflux operation in 47 adults are presented. Reflux was eliminated in all but 3 cases. Preoperatively most patients complained of urinary tract infection with or without fever, but sometimes investigation for hypertension or urolithiasis also led to the diagnosis. Postoperatively 70% of the patients are free of symptoms and infection. Renal scarring in pyelonephritic patients seems to stop after intervention. In all patients with a normal preoperative creatinine level, this level stays normal after the intervention. However, in 6 of 7 patients with a creatinine level of greater than 1.5 mg% before operation, the intervention could not stop the evolution toward terminal renal failure.


Subject(s)
Vesico-Ureteral Reflux/surgery , Adolescent , Adult , Female , Follow-Up Studies , Humans , Male , Middle Aged , Radiography , Urinary Tract Infections/etiology , Vesico-Ureteral Reflux/complications , Vesico-Ureteral Reflux/diagnostic imaging
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