453 research outputs found
Prevention of urinary tract infection in spinal cord-injured patients: safety and efficacy of a weekly oral cyclic antibiotic (WOCA) programme with a 2 year follow-up--an observational prospective study.
POPULATION: Spinal cord injury (SCI) patients with neurogenic bladder have an increased risk for symptomatic urinary tract infection (UTI). Recurrent UTI requires multiple courses of antibiotic therapy, markedly increasing the incidence of multidrug-resistant (MDR) bacteria. METHODS: During an observational prospective study, we determined the safety and efficacy of a weekly oral cyclic antibiotic (WOCA) regimen to prevent UTI in SCI adult patients with neurogenic bladder undergoing clean intermittent catheterization. The WOCA regimen consisted of the alternate administration of an antibiotic once per week over a period of at least 2 years. The antibiotics chosen were efficient for UTI, well tolerated and with low selection pressure. RESULTS: There was a significant decrease in antimicrobial consumption linked to the dramatic decrease in the incidence of UTI. Before intervention, there were 9.4 symptomatic UTIs per patient-year, including 197 episodes of febrile UTI responsible for 45 hospitalizations. Under the WOCA regimen there were 1.8 symptomatic UTIs per patient-year, including 19 episodes of febrile UTI. No severe adverse events and no new cases of colonization with MDR bacteria were reported. CONCLUSIONS: In this prospective, observational pilot study a novel approach to the prevention and treatment of UTI in SCI was investigated. Our study shows the benefit of WOCA in preventing UTI in SCI patients
Aid to Percutaneous Renal Access by Virtual Projection of the Ultrasound Puncture Tract onto Fluoroscopic Images
Background and Purpose: Percutaneous renal access in the context of
percutaneous nephrolithotomy (PCNL) is a difficult technique, requiring rapid
and precise access to a particular calix. We present a computerized system
designed to improve percutaneous renal access by projecting the ultrasound
puncture tract onto fluoroscopic images. Materials and Methods: The system
consists of a computer and a localizer allowing spatial localization of the
position of the various instruments. Without any human intervention, the
ultrasound nephrostomy tract is superimposed in real time onto fluoroscopic
images acquired in various views. Results: We tested our approach by laboratory
experiments on a phantom. Also, after approval by our institution's Ethics
Committee, we validated this technique in the operating room during PCNL in one
patient. Conclusion: Our system is reliable, and the absence of
image-processing procedures makes it robust. We have initiated a prospective
study to validate this technique both for PCNL specialists and as a learning
tool
Medical image computing and computer-aided medical interventions applied to soft tissues. Work in progress in urology
Until recently, Computer-Aided Medical Interventions (CAMI) and Medical
Robotics have focused on rigid and non deformable anatomical structures.
Nowadays, special attention is paid to soft tissues, raising complex issues due
to their mobility and deformation. Mini-invasive digestive surgery was probably
one of the first fields where soft tissues were handled through the development
of simulators, tracking of anatomical structures and specific assistance
robots. However, other clinical domains, for instance urology, are concerned.
Indeed, laparoscopic surgery, new tumour destruction techniques (e.g. HIFU,
radiofrequency, or cryoablation), increasingly early detection of cancer, and
use of interventional and diagnostic imaging modalities, recently opened new
challenges to the urologist and scientists involved in CAMI. This resulted in
the last five years in a very significant increase of research and developments
of computer-aided urology systems. In this paper, we propose a description of
the main problems related to computer-aided diagnostic and therapy of soft
tissues and give a survey of the different types of assistance offered to the
urologist: robotization, image fusion, surgical navigation. Both research
projects and operational industrial systems are discussed
Mapping of transrectal ultrasonographic prostate biopsies: quality control and learning curve assessment by image processing
Objective: Mapping of transrectal ultrasonographic (TRUS) prostate biopsies
is of fundamental importance for either diagnostic purposes or the management
and treatment of prostate cancer, but the localization of the cores seems
inaccurate. Our objective was to evaluate the capacities of an operator to plan
transrectal prostate biopsies under 2-dimensional TRUS guidance using a
registration algorithm to represent the localization of biopsies in a reference
3-dimensional ultrasonographic volume.
Methods: Thirty-two patients underwent a series of 12 prostate biopsies under
local anesthesia performed by 1 operator using a TRUS probe combined with
specific third-party software to verify that the biopsies were indeed conducted
within the planned targets. RESULTS: The operator reached 71% of the planned
targets with substantial variability that depended on their localization (100%
success rate for targets in the middle and right parasagittal parts versus 53%
for targets in the left lateral base). Feedback from this system after each
series of biopsies enabled the operator to significantly improve his dexterity
over the course of time (first 16 patients: median score, 7 of 10 and cumulated
median biopsy length in targets of 90 mm; last 16 patients, median score, 9 of
10 and a cumulated median length of 121 mm; P = .046).
Conclusions: In addition to being a useful tool to improve the distribution
of prostate biopsies, the potential of this system is above all the preparation
of a detailed "map" of each patient showing biopsy zones without substantial
changes in routine clinical practices
Recommandations pour lâutilisation de la toxine botulinique de type A (BotoxÂź) dans lâhyperactivitĂ© vĂ©sicale rĂ©fractaire idiopathique
RĂ©sumĂ©ObjectifsDĂ©finir des recommandations pour lâutilisation pratique de la toxine botulinique de type A (BoNTA) dans lâhyperactivitĂ© vĂ©sicale rĂ©fractaire idiopathique (HAVRI).MĂ©thodeĂlaboration de recommandations de bonne pratique par consensus formalisĂ©, validĂ©es par un groupe de 13 experts puis par un groupe de lecture indĂ©pendant.RĂ©sultatsEn cas dâinfection urinaire celle-ci doit ĂȘtre traitĂ©e et lâinjection reportĂ©e. Avant lâinjection, il est recommandĂ© de sâassurer de la faisabilitĂ© et de lâacceptabilitĂ© de lâauto-sondage. Lâinjection peut ĂȘtre rĂ©alisĂ©e aprĂšs une anesthĂ©sie locale urĂ©tro-vĂ©sicale (lidocaĂŻne), Ă©ventuellement complĂ©tĂ©e par lâinhalation de protoxyde dâazote et parfois sous anesthĂ©sie gĂ©nĂ©rale. Lâinjection sera rĂ©alisĂ©e au bloc opĂ©ratoire ou en salle dâendoscopie. La vessie ne doit pas ĂȘtre trop remplie (risque de perforation). Le traitement doit ĂȘtre appliquĂ© en 10 à 20 injections de 0,5 à 1mL rĂ©parties de maniĂšre homogĂšne dans la vessie en restant Ă distance des mĂ©ats urĂ©tĂ©raux. Il nâest pas recommandĂ© de laisser en place une sonde vĂ©sicale sauf en cas dâhĂ©maturie importante. Le patient doit ĂȘtre surveillĂ© jusquâĂ la reprise mictionnelle. Une note dâinformation sur les effets indĂ©sirables Ă©ventuels doit lui ĂȘtre remise Ă sa sortie. Une consultation doit ĂȘtre prĂ©vue 3 mois aprĂšs la premiĂšre injection (calendrier mictionnel, dĂ©bitmĂ©trie, rĂ©sidu post-mictionnel et examen cytobactĂ©riologique des urines). Un rĂ©sidu >200mL et/ou symptomatique doit faire discuter des auto-sondages. Une nouvelle injection pourra ĂȘtre envisagĂ©e lorsque le bĂ©nĂ©fice clinique de la prĂ©cĂ©dente sâestompe (entre 6 et 9 mois).ConclusionsLe respect de ces recommandations devrait permettre une utilisation optimale de la BoNTA.Niveau de preuve3.SummaryObjectivesProvide guidelines for practical usage of botulinum toxin type A (BoNTA) for refractory idiopathic Overactive Bladder management.Patients and methodsGuidelines using formalized consensus guidelines method. These guidelines have been validated by a group of 13 experts quoting proposals, subsequently reviewed by an independent group of experts.ResultsIn the case of patients with urinary tract infection, it must be treated and injection postponed. Before proposing an injection, it is recommended to ensure the feasibility and acceptability of self-catheterisation by patient. The injection can be performed after local anesthesia of the bladder and urethra (lidocaine), supplemented where necessary by nitrous oxide inhalation and sometimes under general anesthesia. Injection is performed in the operating room or endoscopy suite. The bladder should not be too filled (increased risk of perforation). Treatment should be applied in 10 to 20 injections of 0.5 to 1mL homogeneously distributed in the bladder at a distance from the urethral orifices. It is not recommended to leave a urinary catheter in place except in cases of severe hematuria. The patient should be monitored until resumption of micturition. After the first injection, an appointment must be scheduled within 3 months (micturition diary, uroflowmetry, measurement of residual urine and urine culture). Performance of self-catheterisation should be questioned in the case of a symptomatic post-void residual and/or a residue>200mL. A new injection may be considered when the clinical benefit of the previous injection diminishes (between 6 and 9 months). A period of three months must elapse between each injection.ConclusionsImplementation of these guidelines may promote best practice usage of BoNTA with optimal risk/benefit ratio
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