527 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
Urogenital dysfunction in male patients with Charcot-Marie-Tooth: a systematic review
Aims Purposes of this study were to describe lower urinary tract symptoms (LUTS) and related urodynamic patterns in patients with hereditary spastic paraplegia (HSP), and to characterize LUTS management and associated uronephrological complications. Methods We retrospectively reviewed medical files of HSP patients, consecutively followed in our Physical and Rehabilitation Medicine Department between 1999 and 2016. Clinical, urodynamic, and radiological data were collected and analyzed. Different treatments which have been prescribed and uronephrological complications were also recorded. Patients with other neurological or urological diseases were excluded. Results Thirty-three patients with HSP were included. Mean duration of follow-up was 8.1 ± 5 years, mean age 62 ± 14 years, and 70% were men. The most frequent LUTS was urgency and voiding dysfunction (both 69.7%). Incontinence and retention with a significant postvoid residue above 100 mL accounted for 66.7% and 57.6% of initial symptoms respectively. Neurogenic detrusor overactivity was diagnosed in 80.7% of patients. Two-thirds of our cohort were treated with anticholinergics and 9.1% required intradetrusor botulinum-toxin injections. Only 27.3% of patients performed clean intermittent self-catheterization. Febrile urinary tract infections (21.2%), urolithiasis (15,1%), hydronephrosis (6%), and chronic renal failure (9.1%) were found. Conclusion Given their high prevalence and the risk of uronephrological complications, LUTS should be systematically assessed in HSP patients. The systematic screening of urological dysfunction in this population would improve its management, decrease the incidence of uronephrological complications, and increase the quality of life
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
Systematic review exploring the relationship between sexual abuse and lower urinary tract symptoms
INTRODUCTION AND HYPOTHESIS: Patients presenting with lower urinary tract symptoms (LUTS) may report a history of sexual abuse (SA), and survivors of SA may report LUTS; however, the nature of the relationship is poorly understood. The aim of this review is to systematically evaluate studies that explore LUT dysfunction in survivors of SA. METHODS: A systematic literature search of six databases, Cochrane Database of Systematic Reviews, MEDLINE, EMBASE, CINAHL, AMED, and PsycINFO, was performed. The last search date was June 2021 (PROSPERO CRD42019122080). Studies reporting the prevalence and symptoms of LUTS in patients who have experienced SA were included. The literature was appraised according to the PRISMA statement. The quality of the studies was assessed. RESULTS: Out of 272 papers retrieved, 18 publications met the inclusion criteria: studies exploring LUTS in SA survivors (n=2), SA in patients attending clinics for their LUTs (n=8), and cross-sectional studies (n=8). SA prevalence ranged between 1.3% and 49.6%. A history of SA was associated with psychosocial stressors, depression, and anxiety. LUTS included urinary storage symptoms, voiding difficulties, voluntary holding of urine and urinary tract infections. Most studies were of moderate quality. Assessment of SA and LUTS lacked standardisation. CONCLUSIONS: The review highlights the need for a holistic assessment of patients presenting with LUTS. Although most of the studies were rated as being of 'moderate' quality, the evidence suggests the need to provide a "safe space" in clinic for patients to share sensitive information about trauma. Any such disclosure should be followed up with further assessment
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
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