124 results on '"Leach, G E"'
Search Results
2. Comparative studies on graminicide-resistant and susceptible biotypes of Eleusine indica
- Author
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MARSHALL, G., primary, KIRKWOOD, R. C., additional, and LEACH, G. E., additional
- Published
- 1994
- Full Text
- View/download PDF
3. Prospective evaluation of the incontan transrectal stimulator in women with urinary incontinence.
- Author
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Leach, G. E. and Bavendam, T. G.
- Published
- 1989
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- View/download PDF
4. Quality-of-life outcomes in men treated for localized prostate cancer.
- Author
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Litwin MS, Hays RD, Fink A, Ganz PA, Leake B, Leach GE, Brook RH, Litwin, M S, Hays, R D, Fink, A, Ganz, P A, Leake, B, Leach, G E, and Brook, R H
- Abstract
Objective: To assess health-related quality of life (HRQOL) in men treated for clinically localized prostate cancer.Design: A cross-sectional analysis of HRQOL after treatment with radical prostatectomy, pelvic irradiation, or observation alone for clinically localized prostatic adenocarcinoma, and in age-matched comparison patients.Setting: A large managed care population in California.Subjects: A total of 528 men, including 214 treated for clinically localized prostate cancer (41 with evidence of metastatic disease were excluded from this analysis) and 273 age-matched, ZIP code-matched comparison patients without prostate cancer. Cancer patients were analyzed in three treatment groups: radical prostatectomy (n = 98), primary pelvic irradiation (n = 56), and observation alone (n = 60).Main Outcome Measures: General HRQOL was measured with the RAND 36-Item Health Survey 1.0. Cancer-specific HRQOL was measured with the CAncer Rehabilitation Evaluation System-Short Form and the Functional Assessment of Cancer Therapy-General form. Disease-targeted quality of life was measured with a new instrument assessing function and bother in three organ systems: sexual, urinary, and bowel.Results: No differences among treatment groups were seen in comparisons of general HRQOL: Significant differences among treatment groups were seen in both function and bother in the prostate-targeted measures of sexual, urinary, and bowel domains. When cancer patients were compared with men of similar age without prostate cancer, differences were seen in the sexual, urinary, and bowel function and bother but not in general HRQOL measures. Although cancer-free men were found not to have full potency or continence, prostate cancer patients treated with surgery or radiation reported significantly worse sexual, urinary, and bowel function than men without cancer. Men who had undergone nerve-sparing prostatectomy did not differ from those who had undergone standard prostatectomy, but the power to detect a difference was low.Conclusions: Although no differences were seen in general HRQOL, three disease-targeted domains were found to differ significantly among the treatment groups and comparison patients. Even after controlling for the sexual and urinary dysfunction experienced by older men without cancer, those receiving therapeutic interventions for their prostate cancer were found to have poorer disease-targeted HRQOL: We conclude that in addition to general HRQOL, disease-targeted measures must be used to assess outcomes of care in men treated for localized prostate cancer. [ABSTRACT FROM AUTHOR]- Published
- 1995
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5. Role of the Four-Corner Bladder Neck Suspension to Correct Stress Incontinence with a Mild to Moderate Cystocele
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Dmochowski, R. R., Zimmern, P. E., Ganabathi, K., Sirls, L., and Leach, G. E.
- Published
- 1997
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6. Feasibility of Outpatient Percutaneous Bladder Neck Suspension Under Local Anesthesia
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Haab, F. and Leach, G. E.
- Published
- 1997
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- View/download PDF
7. Prospective Multicenter Prolase II Clinical Trial of Neodymium:Yttrium-Aluminum-Garnet Laser Prostatectomy
- Author
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Kabalin, J. N., Gill, H. S., Leach, G. E., Bowers, G. W., Nill, T., and Konowalchuk, T. W.
- Published
- 1997
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8. Undiagnosed urethral carcinoma: an unusual cause of female urinary retention
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Kobashi, K. C., Hong, T. H., and Leach, G. E.
- Published
- 2000
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9. Outpatient Visual Laser-Assisted Prostatectomy Under Local Anesthesia
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Leach, G. E., Sirls, L., Ganabathi, K., and Roskamp, D.
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- 1994
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10. Intravesical Oxybutynin Chloride: Experience with 42 Patients
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Weese, D. L., Roskamp, D. A., Leach, G. E., and Zimmern, P. E.
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- 1993
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11. Ectopically Draining Dysplastic Kidney Associated with Genuine Stress Urinary Incontinence: Unusual Combined Cause of Incontinence
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Barrows, B., Bavendam, T., and Leach, G. E.
- Published
- 1992
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12. Vaginal repair of large cystoceles.
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Kobashi KC and Leach GE
- Subjects
- Female, Humans, Severity of Illness Index, Urinary Bladder Diseases pathology, Urinary Bladder Diseases surgery, Vagina surgery
- Abstract
Repair of cystoceles requires a complete understanding of the pelvic anatomy. While smaller defects are relatively straightforward, greater degrees of prolapse can be among the most challenging surgeries in pelvic floor reconstruction. This article reviews current transvaginal techniques used for repair of large cystoceles.
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- 2001
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13. A new technique for cystocele repair and transvaginal sling: the cadaveric prolapse repair and sling (CAPS).
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Kobashi KC, Mee SL, and Leach GE
- Subjects
- Adult, Aged, Aged, 80 and over, Cadaver, Female, Follow-Up Studies, Humans, Length of Stay, Middle Aged, Reoperation, Retrospective Studies, Suture Techniques, Treatment Outcome, Urinary Bladder surgery, Urinary Bladder Diseases complications, Urinary Incontinence, Stress etiology, Urinary Incontinence, Stress surgery, Fascia Lata surgery, Urinary Bladder Diseases surgery
- Abstract
A new technique using cadaveric fascia lata for the simultaneous repair of a cystocele and placement of a pubovaginal sling by means of a transvaginal approach is described, and our early results are reported. We refer to this as the cadaveric prolapse repair with sling (CaPS). Fifty patients, ages 37 to 90 years, underwent a new technique for simultaneous cystocele repair and transvaginal pubovaginal sling using a single piece of cadaveric fascia. Maximum follow-up was 6 months (range 1 to 6). A 6 x 8 cm segment of cadaveric fascia lata is placed transvaginally to repair the defect through which the bladder herniates into the vagina and to provide sling support at the bladder neck/proximal urethra. The sling is anchored to the pubic bone with transvaginal bone anchors. The remainder of the fascia is then secured to the medial edge of the levator muscles/pubocervical fascia bilaterally and at the vaginal cuff or cervix with absorbable sutures to reduce the cystocele. Patients are being evaluated with preoperative and postoperative stress, emptying, anatomy, protection, instability (SEAPI) scores as well as with grading of the prolapse based on a 3-grade anatomic classification system. Presenting symptoms have included stress urinary incontinence (SUI) in 13 (26%), urge incontinence in 4 (8%), mixed incontinence in 6 (12%), and pelvic prolapse in 20 (40%). These symptoms are not mutually exclusive; some patients presented with a combination of symptoms. The mean SEAPI scores were 5.51 preoperatively and 0.63 postoperatively, representing a significant improvement (P <0.001). Of the 40 patients whose prolapse was quantified, 1 patient (2.5%) had a minimal cystocele, 16 (40.0%) had moderate cystoceles, and 23 (57.5%) had large cystoceles. After the CaPS, 36 (72%) were completely dry, 3 (6%) had persistent SUI, 1 (2%) had de novo urinary incontinence (UI), 3 (6%) had persistent UI, and 1 (2%) had mixed incontinence. No patient had permanent urinary retention. Transvaginal placement of cadaveric fascia for concomitant sling and cystocele repair provides material of excellent strength for the repair without relying on the inherently weak tissues in the patient with pelvic prolapse. Thus far, the early results with CaPS are extremely encouraging. Long-term follow-up is underway to evaluate the efficacy of this procedure.
- Published
- 2000
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14. Pelvic prolapse.
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Kobashi KC and Leach GE
- Subjects
- Diagnosis, Differential, Female, Hernia diagnosis, Herniorrhaphy, Humans, Uterus pathology, Vagina pathology, Rectocele diagnosis, Rectocele surgery, Urinary Bladder Diseases diagnosis, Urinary Bladder Diseases surgery, Uterine Prolapse diagnosis, Uterine Prolapse pathology, Uterine Prolapse surgery
- Abstract
Purpose: Pelvic prolapse is a common problem affecting women of all ages. We reviewed the pathophysiology, presentation, evaluation and treatment of pelvic prolapse., Materials and Methods: We comprehensively reviewed the literature using MEDLINE, resources cited in those peer reviewed articles and abstracts from recent international meetings., Results: Pelvic prolapse involves the herniation of various portions of the vaginal wall. Symptoms vary according to the area of the vagina affected. Proper evaluation is imperative for providing proper treatment. Various surgical approaches to repair have been developed and techniques continue to evolve., Conclusions: With the increasing involvement of urologists in the treatment of pelvic prolapse it is essential for us to become familiar with the anatomy, and the evaluation and management options available. We provide an overview of the care of patients with pelvic prolapse.
- Published
- 2000
15. Erosion of woven polyester pubovaginal sling.
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Kobashi KC, Dmochowski R, Mee SL, Mostwin J, Nitti VW, Zimmern PE, and Leach GE
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- Female, Humans, Retrospective Studies, Polyesters adverse effects, Urinary Incontinence, Stress therapy
- Abstract
Purpose: Various materials have been used for pubovaginal slings to correct female stress urinary incontinence. Use of synthetic materials provides a theoretical advantage in that no graft harvesting is necessary. Major risks of synthetic material use are erosion and infection of the sling. We report on erosion of woven polyester slings treated with pressure injected bovine collagen (ProteGen) which required removal., Materials and Methods: Office records of patients who had ProteGen slings removed at 5 centers during the last 24 months were retrospectively reviewed. Presenting symptoms, interval between sling placement and removal, subsequent procedures and continence status following sling removal were evaluated., Results: A total of 34 women required removal of the polyester sling secondary to erosion, infection or pain. The most common presenting complaints were delayed vaginal discharge in 21 patients (62%), vaginal pain or pressure in 21 (62%), suprapubic pain in 11 (32%) and recurrent urinary tract infection in 5 (15%) at a mean of 7.95 months (range 1 to 22) after sling placement. Of the patients 17 (50%) had vaginal erosion only, 7 (20%) isolated urethral erosion and 6 (17%) urethrovaginal fistulas. In 4 patients no erosion was obvious but slings were removed secondary to vaginal pain. Before sling removal 16 patients (47%) were totally dry, 13 (38%) had some degree of urinary incontinence and 3 (8%) had retention. Following sling removal 7 patients (20%) remained dry, 25 (74%) had mild to severe stress urinary incontinence with or without urgency and urge incontinence, and 2 (6%) are pending followup., Conclusions: Woven polyester slings treated with pressure injected bovine collagen are prone to erosion. Although the ProteGen sling was recalled in January 1999, patients who have had the sling placed must be followed closely.
- Published
- 1999
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16. Stress urinary incontinence.
- Author
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Kobashi KC and Leach GE
- Subjects
- Female, Humans, Laparoscopy, Quality of Life, Urinary Incontinence, Stress classification, Urinary Incontinence, Stress surgery, Urinary Incontinence, Stress therapy
- Abstract
New techniques for the treatment of female stress urinary incontinence are constantly being developed. In assessing treatment modalities, one must consider many variables including patient satisfaction and quality of life, cure or improvement rate, patient selection, and long-term durability of results. In 1998, many papers comparing and examining the outcomes of various new and old techniques were published.
- Published
- 1999
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17. [Criteria of Rigiscan normalcy in aged men].
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Zimmern P, Leach GE, Yao J, and Wolde-Tsadik G
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- Adult, Age Factors, Aged, Data Interpretation, Statistical, Humans, Male, Middle Aged, Penis blood supply, Penis diagnostic imaging, Prospective Studies, Prostatectomy, Reference Values, Surveys and Questionnaires, Time Factors, Ultrasonography, Doppler, Duplex, Erectile Dysfunction diagnosis, Monitoring, Physiologic instrumentation, Penile Erection physiology
- Abstract
Purpose: To define the changes in penile tumescence and rigidity in normally potent older men before a nerve-sparing radical retropubic prostatectomy (NS-RRP) and to establish a base-line for investigating erectile dysfunction in that age group., Material and Methods: 75 patients used the Rigiscan for 2-3 nights before undergoing a NS-RRP procedure. Rigiscan data were analyzed visually using Kaneko & Bradley criteria, and by computerized analysis. The computerized data were compared to the patient self-evaluation of potency (questionnaire), patient's age (above and below 60 years old), peak cavernosal artery velocity measured by Duplex Doppler scanning, and to the visual analysis of the Rigiscan data., Results: 55 of 75 men (73%) completed three sessions. 42 men had at least 2 normal sessions, and when compared to the 33 with abnormal visual tracings, only age was significantly characteristic (p < 0.05). Tip event rigidity (%) in < 60 year-old men was greater than in older men (p < 0.01). Nearly all men had erections lasting more than 2 minutes, while only 29 of 74 had 10 minutes erections with rigidity > 70%. The best correlation between visual and computerized analyses was noted in the group of 54 men who experienced > 70% rigidity for more than 2 minutes., Conclusion: This large prospective series of potent older men studied by Rigiscan and other subjective and objective parameters helps establishing normative data in the diagnosis of erectile dysfunction. An important observation is clearly the lack of correlation between the patient's questionnaire or the Doppler findings and the Rigiscan data.
- Published
- 1999
18. Stress urinary incontinence in women: guidelines for surgical treatment.
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Leach GE
- Subjects
- Female, Humans, Practice Guidelines as Topic, Urinary Incontinence, Stress surgery, Urology standards
- Published
- 1998
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19. Re: modified Nesbit procedure for the treatment of Peyronie's disease: a comparative outcome analysis.
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Leach GE
- Subjects
- Humans, Male, Polytetrafluoroethylene therapeutic use, Surgical Procedures, Operative methods, Treatment Outcome, Urology methods, Penile Induration surgery
- Published
- 1998
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- View/download PDF
20. Evaluation of urinary IL-1alpha and IL-1beta in gravid females and patients with bacterial cystitis and microscopic hematuria.
- Author
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Candela JV, Park E, Gerspach JM, Davidoff R, Stout L, Levy SM, Leach GE, Bellman GC, and Lad PM
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- Bacterial Infections urine, Case-Control Studies, Cystitis urine, Female, Hematuria urine, Humans, Immunoenzyme Techniques statistics & numerical data, Pregnancy urine, Pyuria immunology, Pyuria urine, Reproducibility of Results, Sensitivity and Specificity, Bacterial Infections immunology, Cystitis immunology, Hematuria immunology, Interleukin-1 urine, Pregnancy immunology
- Abstract
Objectives: to determine IL-1alpha and IL-1beta levels in patients with bacterial cystitis, microscopic hematuria, and gravid females relative to a control group of normal subjects., Methods: enzyme immunoassays were used to measure concomitantly urinary IL-1alpha and IL-1beta in clean catch urine samples from normal subjects (n = 31) and study patients (n = 46). All normal subjects and patients underwent urinalysis, urine culture, and urine creatinine level determination. Since the IL-1alpha assay was developed for serum, the utility of the assay for urine specimens was unknown. The key parameters of urine collection, processing and sample storage for IL-1alpha were evaluated in detail., Results: mean values +/- SEM (pg/mg) for IL-1alpha/ Cr and IL-1beta/Cr were control group (0.25 +/- 0.10 and 0.17 +/- 0.06), bacterial cystitis (9.97 +/- 1.15 and 42.45 +/- 1.86), and microscopic hematuria (2.81 +/- 0.65 and 2.82 +/- 0.70). Differences in cytokine levels between the control group and patients with either bacterial cystitis or microscopic hematuria were statistically significant for both IL-1alpha/Cr (P < 0.026; P < 0.007, respectively) and IL-1beta /Cr (P < 0.0004; P < 0.014, respectively). IL-1beta/Cr correlates better with pyuria than IL-1alpha/ Cr (P = 0.02 vs P = 0.44). In gravid females, only IL-1alpha was significantly elevated relative to non-pregnant females (IL-1beta elevation approached statistical significance). Gravid females with positive urine cultures could not be distinguished from those with negative cultures based on either interleukin (P > 0.05)., Conclusions: Significant elevations of IL-1alpha and IL-1beta occur in patients with bacterial cystitis and microscopic hematuria. Correlation between pyuria and cytokine elevation was stronger for IL-1beta than for IL-1alpha. Changes in IL-1alpha may reflect changes in the bladder epithelium rather than in the inflammatory leukocytes. The ability of IL-1alpha and IL-1beta to serve as markers for bacterial cystitis in gravid females is diminished due to high basal levels during pregnancy.
- Published
- 1998
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21. Results of pubovaginal sling for the treatment of intrinsic sphincteric deficiency determined by questionnaire analysis.
- Author
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Haab F, Trockman BA, Zimmern PE, and Leach GE
- Subjects
- Aged, Female, Follow-Up Studies, Humans, Middle Aged, Muscle, Smooth physiopathology, Patient Satisfaction, Remission Induction, Retrospective Studies, Urinary Bladder physiopathology, Surveys and Questionnaires, Urinary Incontinence, Stress therapy
- Abstract
Purpose: We evaluated by questionnaire analysis the success rate and overall patient satisfaction after pubovaginal sling surgery., Materials and Methods: A total of 40 women (mean age 65.7 years, range 45 to 79) underwent pubovaginal sling surgery for stress urinary incontinence due to intrinsic sphincteric deficiency. Patients completed a detailed questionnaire to assess voiding symptoms, urinary control and satisfaction. Of 40 patients 37 (92.5%) returned the questionnaire, with a mean postoperative followup of 48.2 months (range 24 to 60)., Results: Patients with preoperative stress urinary incontinence alone were more likely to be dry than were patients with preoperative mixed incontinence (67% versus 36%, p < 0.001). Ten patients (27%) reported stress urinary incontinence recurrence. Of the patients 23 (62.2%) reported urgency symptoms at followup, with de novo urgency occurring in 4 patients. Permanent retention was noted in 3 patients, including 2 with sacral arc denervation. Overall patients reported 86% postoperative improvement in urinary continence, and 81% would recommend the operation., Conclusions: At mean 4-year followup after pubovaginal sling surgery, this outcome study using a self administered questionnaire confirms high patient satisfaction despite significant postoperative urgency symptoms.
- Published
- 1997
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22. Female Stress Urinary Incontinence Clinical Guidelines Panel summary report on surgical management of female stress urinary incontinence. The American Urological Association.
- Author
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Leach GE, Dmochowski RR, Appell RA, Blaivas JG, Hadley HR, Luber KM, Mostwin JL, O'Donnell PD, and Roehrborn CG
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- Clinical Trials as Topic, Female, Humans, Urinary Incontinence, Stress surgery
- Abstract
Purpose: The American Urological Association convened the Female Stress Urinary Incontinence Clinical Guidelines Panel to analyze the literature regarding surgical procedures for treating stress urinary incontinence in the otherwise healthy female subject and to make practice recommendations based on the treatment outcomes data., Materials and Methods: The panel searched the MEDLINE data base for all articles through 1993 on surgical treatment of female stress urinary incontinence. Outcomes data were extracted from articles accepted after panel review. The data were then meta-analyzed to produce outcome estimates for alternative surgical procedures., Results: The data indicate that after 48 months retropubic suspensions and slings appear to be more efficacious than transvaginal suspensions, and also more efficacious than anterior repairs. The literature suggests higher complication rates when synthetic materials are used for slings., Conclusions: The panel found sufficient acceptable long-term outcomes data (longer than 48 months) to conclude that surgical treatment of female stress urinary incontinence is effective, offering a long-term cure in a significant percentage of women. The evidence supports surgery as initial therapy and as a secondary form of therapy after failure of other treatments for stress urinary incontinence. Retropubic suspensions and slings are the most efficacious procedures for long-term success (based on cure/dry rates). However, in the panel's opinion retropubic suspensions and sling procedures are associated with slightly higher complication rates, including longer convalescence and postoperative voiding dysfunction.
- Published
- 1997
- Full Text
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23. Quality of life and continence assessment of the artificial urinary sphincter in men with minimum 3.5 years of followup.
- Author
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Haab F, Trockman BA, Zimmern PE, and Leach GE
- Subjects
- Aged, Aged, 80 and over, Follow-Up Studies, Humans, Male, Middle Aged, Prostatectomy adverse effects, Surveys and Questionnaires, Time Factors, Urinary Incontinence etiology, Quality of Life, Urinary Incontinence surgery, Urinary Sphincter, Artificial
- Abstract
Purpose: We determined the long-term efficacy and quality of life impact of the artificial urinary sphincter., Materials and Methods: We reviewed the medical records of 68 men who underwent artificial urinary sphincter placement for post-prostatectomy incontinence (64) or neurogenic disease (4) between March 1980 and March 1992 (mean followup 7.2 years). Quality of life was assessed in 52 patients who completed the incontinence impact questionnaire and the urogenital distress inventory., Results: At followup 54 men were socially continent (0 or 1 pad per day). Overall, pad score decreased significantly from 2.75 before to 0.97 after artificial urinary sphincter implantation (p < 0.001). The artificial urinary sphincter was permanently removed in 4 patients. Revisions for mechanical failure or urethral atrophy were required in 25% of the patients (mean 1.35 procedures per patient). The mechanical failure rate decreased significantly after 1987 due to device improvements (12.4 versus 44.4%, p < 0.01). Subjective improvement and overall satisfaction were rated as 4.1 and 3.9, respectively (scale 0 to 5). At followup the mean values of the incontinence impact questionnaire and urogenital distress inventory demonstrated the positive impact of the artificial urinary sphincter on quality of life., Conclusions: This long-term study documents the positive impact of the artificial urinary sphincter on patient quality of life with few mechanical failures since 1987.
- Published
- 1997
24. [The variability of the leakage pressure threshold due to exertion "the Valsalva Leak Point Pressure" as a function of the filling volume of the bladder].
- Author
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Haab F, Dmochowski R, Zimmern P, and Leach GE
- Subjects
- Adult, Aged, Aged, 80 and over, Cystoscopy, Female, Fluoroscopy, Humans, Manometry, Middle Aged, Pressure, Prospective Studies, Reference Values, Sensitivity and Specificity, Urinary Incontinence, Stress classification, Urinary Incontinence, Stress diagnosis, Urine, Urodynamics, Valsalva Maneuver, Urinary Bladder physiopathology, Urinary Incontinence, Stress physiopathology
- Abstract
Objective: To determine the influence of the bladder filling volume on the Valsalva Leak Point Pressure (VLPP) in patients investigated for urinary stress incontinence., Patients and Methods: 50 patients investigated for urinary stress incontinence were included in this prospective study. Evaluation consisted of clinical examination, urodynamic examination with simultaneous fluoroscopic assessment and cystoscopy. VLPP was measured while standing every 100 cc during filling until the cystomanometric bladder capacity., Results: We observed a significant reduction of VLPP as a function of bladder filling volume. The VLPP measured at 200 cc constituted the reference value in view of its sensitivity and specificity for the diagnosis of type III urinary stress incontinence (Blaivas' classification)., Conclusion: Measurement of VLPP must be standardized and interpreted as a function of bladder filling volume.
- Published
- 1997
25. Multiple urinary cytokine levels of bacterial cystitis.
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Davidoff R, Yamaguchi R, Leach GE, Park E, and Lad PM
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- Colony Count, Microbial, Hematuria urine, Humans, Sensitivity and Specificity, Cystitis microbiology, Cystitis urine, Cytokines urine
- Abstract
Purpose: We have examined urinary cytokine levels to define the inflammatory response in patients with bacterial cystitis or microhematuria relative to normal subjects. Cytokines examined include interleukin-1beta (IL-1beta), IL-1alpha, tumor necrosis factor (TNF alpha), IL-6 and IL-4. Unique features of this study include a) a simultaneous study of several relevant cytokines b) a study of the inflammatory response at both low and high counts of bacterial infection and c) an assessment of whether microhematuria without bacterial cystitis or pyuria is associated with cytokine elevation compared to normals., Materials and Methods: Enzyme immunoassays were utilized for each cytokine. Patients studied include those with bacterial cystitis (n = 49), patients with microhematuria (n = 11), and normal subjects (n = 36). Cytokine levels were also determined for patients with low count bacterial cystitis (1,000-50,000 organisms; n = 15) and compared to high count bacterial cystitis (>100,000 organisms; n = 34) and normal subjects. Statistical analysis was carried out using the Kruskal-Wallis test followed by pairwise testing with Newman-Keuls test., Results: a) The means for normal, microhematuria and bacterial cystitis groups were significantly different (p <0.05) for IL-1beta, IL-1alpha, TNF alpha and IL-6, but not for IL-4. b) Except for IL-4, all cytokines were found to be significantly elevated in low count bacterial cystitis compared to normals. No statistically significant difference was observed between low and high count bacterial cystitis groups for any of the cytokines tested., Conclusions: a) Significant and similar inflammatory responses are present in both low and high count bacterial cystitis groups as compared with the normal group. b) IL-6 and TNF alpha are significantly elevated in patients with microhematuria compared to normals. c) The potential clinical utility of the assays lies in identifying the specific cytokines elevated, understanding the pathways that give rise to their production, and in defining potential virulence factors that may produce significant inflammation at low count bacterial infections.
- Published
- 1997
26. Urinary stress incontinence due to intrinsic sphincteric deficiency: experience with fat and collagen periurethral injections.
- Author
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Haab F, Zimmern PE, and Leach GE
- Subjects
- Aged, Female, Follow-Up Studies, Humans, Injections, Middle Aged, Muscle, Smooth physiopathology, Prospective Studies, Urethra, Urinary Incontinence, Stress etiology, Adipose Tissue, Collagen administration & dosage, Urinary Incontinence, Stress therapy
- Abstract
Purpose: We prospectively compared the efficacy of 2 bulking agents to treat incontinence related to intrinsic sphincter deficiency., Materials and Methods: A total of 67 women underwent periurethral injection for intrinsic sphincter deficiency at the same institution performed by 1 surgeon. Patients were divided into 45 who received fat (group 1) and 22 who received collagen (group 2) injections. Both groups were comparable for age, parity, number of previously failed procedures and number of pads used daily. Preoperative urodynamic evaluation revealed a low Valsalva leak point pressure in both groups (mean plus or minus standard deviation 23.82 +/- 12.41 versus 29.35 +/- 11.32, not significant). Patients rated the subjective degree of postoperative improvement as 0 to 100%., Results: At a mean followup of 7 months after the last injection only 13% of the fat group and 24% of the collagen group were cured. The mean percentage of subjective improvement was significantly greater in the collagen than in the fat group (70.9 +/- 28 versus 31.2 +/- 41.7%, respectively, p < 0.001). The failure rate was significantly greater in the fat group compared to the collagen group (p < 0.001)., Conclusions: Based on results of a prospective comparison of fat and collagen injection, collagen is more effective than fat for treatment of intrinsic sphincter deficiency.
- Published
- 1997
27. Primary bladder neck obstruction: urodynamic findings and treatment results in 36 men.
- Author
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Trockman BA, Gerspach J, Dmochowski R, Haab F, Zimmern PE, and Leach GE
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- Adrenergic alpha-Antagonists therapeutic use, Adult, Humans, Male, Middle Aged, Retrospective Studies, Treatment Outcome, Urinary Bladder Neck Obstruction physiopathology, Urinary Bladder Neck Obstruction therapy, Urodynamics
- Abstract
Purpose: We reviewed the urodynamic findings and treatment outcomes of a large series of men with primary bladder neck obstruction., Materials and Methods: A retrospective review was done of the presenting symptoms and urodynamic findings of 36 men with primary bladder neck obstruction. Outcomes after treatment with alpha-blockers, transurethral incision of the bladder neck and prostate, or no long-term therapy were determined by chart review and patient survey in the majority of cases., Results: Mean age of the men was 41 years. Patients had significant lower urinary tract symptoms, decreased peak urinary flow rates, elevated post-void residual, markedly elevated peak voiding pressures and poor funneling of the bladder neck during voiding. Although most patients initially chose alpha-blocker therapy, only 30% of those beginning alpha-blockers continued them long term, usually due to inadequate symptomatic improvement. A total of 18 men underwent transurethral incision, which resulted in significant improvements in symptom scores, peak urinary flow rates, post-void residual and peak voiding pressures. Patients reported a mean 87% overall improvement in symptoms after transurethral incision., Conclusions: Video urodynamics facilitate diagnosis of primary bladder neck obstruction. Transurethral incision is the most effective therapy for primary bladder neck obstruction.
- Published
- 1996
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28. Percutaneous bladder neck suspension.
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Leach GE and Appell R
- Subjects
- Female, Humans, Methods, Punctures, Surgical Instruments, Urology instrumentation, Urinary Bladder surgery, Urinary Incontinence, Stress surgery
- Abstract
The early results after PBNS are extremely encouraging. The procedure is easy to learn, is performed rapidly on an outpatient basis under local anesthesia if desired, and has minimal postoperative morbidity. Continued objective follow up is critical to define the long-term efficacy of this promising technique.
- Published
- 1996
- Full Text
- View/download PDF
29. Postprostatectomy incontinence.
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Haab F, Yamaguchi R, and Leach GE
- Subjects
- Humans, Male, Urethra physiopathology, Urinary Bladder physiopathology, Urinary Incontinence physiopathology, Urodynamics, Prostatectomy adverse effects, Urinary Incontinence etiology
- Abstract
Post-prostatectomy incontinence is a devastating complication that is frustrating for the patient and the surgeon. Bladder dysfunction with or without sphincteric incompetence is the main cause for post-prostatectomy incontinence. Treatment based on the urodynamic evaluation is effective in restoring continence and improving the patient's quality of life.
- Published
- 1996
- Full Text
- View/download PDF
30. Local anesthesia for urologic procedures.
- Author
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Leach GE
- Subjects
- Humans, Male, Penile Prosthesis, Prostatectomy, Urethral Stricture surgery, Urinary Incontinence, Stress surgery, Anesthesia, Local methods, Urinary Tract surgery
- Abstract
The ability to perform a variety of urologic procedures (urethrotomy, prostate surgery, penile prosthesis insertion, and bladder neck suspension) under local anesthesia in an outpatient setting is a significant advance in patient care. The surgical techniques are described that will allow the urologist to incorporate these procedures into practice.
- Published
- 1996
- Full Text
- View/download PDF
31. Female stress urinary incontinence due to intrinsic sphincteric deficiency: recognition and management.
- Author
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Haab F, Zimmern PE, and Leach GE
- Subjects
- Female, Forecasting, Humans, Research, Urethra innervation, Urethra physiopathology, Urinary Bladder innervation, Urinary Bladder physiopathology, Urinary Incontinence, Stress diagnosis, Urinary Incontinence, Stress physiopathology, Urinary Incontinence, Stress therapy, Urinary Incontinence, Stress etiology
- Abstract
Purpose: The recent literature on intrinsic sphincteric deficiency is reviewed., Materials and Methods: We performed an extensive literature search related to the diagnosis, management and treatment of intrinsic sphincteric deficiency., Results: Stress urinary incontinence results from insufficient urethral resistance and/or support during increases in intra-abdominal pressure. Since treatment of stress urinary incontinence is closely related to the mechanism of urinary leakage, recognition of intrinsic sphincteric deficiency is of the utmost importance in its evaluation. Furthermore, to date there is no consensus on the treatment of intrinsic sphincteric deficiency and various procedures may be considered., Conclusions: The pathophysiology of urinary incontinence in female patients is still controversial. Intrinsic sphincteric deficiency is best recognized by history and clinical examination in conjunction with documentation of severe stress urinary incontinence, a fixed urethra and a low Valsalva leak point pressure. The pubo-vaginal sling procedure still represents the most widely accepted treatment to correct intrinsic sphincteric deficiency.
- Published
- 1996
32. Needle suspension procedures: past, present, and future.
- Author
-
Trockman BA and Leach GE
- Subjects
- Female, Humans, Surgical Procedures, Operative methods, Urinary Bladder surgery, Surgical Procedures, Operative trends, Urinary Incontinence, Stress surgery
- Abstract
This article reviews the history, evolution, and future of transvaginal needle suspension procedures for stress urinary incontinence. Although numerous technical modifications to the original Pereyra transvaginal needle suspension procedure have been described, the true success rates of these procedures are difficult to ascertain. In general, outcomes reported in the literature are variable, and few long-term studies exist. Only the results of well-designed, prospective, and long-term studies will determine whether recent advances in patient selection and continuing technical modifications will improve the outcome of bladder neck suspension procedures.
- Published
- 1996
- Full Text
- View/download PDF
33. Post-prostatectomy incontinence: urodynamic findings and treatment outcomes.
- Author
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Leach GE, Trockman B, Wong A, Hamilton J, Haab F, and Zimmern PE
- Subjects
- Aged, Aged, 80 and over, Cholinergic Antagonists therapeutic use, Humans, Male, Middle Aged, Postoperative Complications therapy, Treatment Outcome, Urinary Incontinence etiology, Urinary Incontinence, Stress etiology, Urinary Sphincter, Artificial, Postoperative Complications physiopathology, Prostatectomy, Urinary Incontinence physiopathology, Urinary Incontinence therapy, Urodynamics
- Abstract
Purpose: We examined urodynamic findings and treatment outcomes in a large population of men with post-prostatectomy incontinence., Materials and Methods: A total of 215 men was referred for evaluation and treatment of significant post-prostatectomy incontinence. Urodynamic evaluation consisted of provocation multichannel medium fill cystometry with vigorous attempts to demonstrate incontinence. Treatment was directed by the results of the urodynamic study. A pad scoring system was used to gauge the severity of incontinence before and after treatment., Results: Based on the results of urodynamic studies 40% of the men had genuine stress incontinence alone and approximately 60% had a major component of bladder dysfunction contributing to incontinence. Treatment results of 135 men demonstrated a significant decrease in pad score (p<0.001) for those treated with anticholinergics, those undergoing artificial sphincter insertion and those treated pharmacologically before sphincter placement., Conclusions: In our large series most men with prostatectomy incontinence did not have genuine stress incontinence alone. Thus, urodynamic studies are critical, not only to define cause of incontinence but to direct effective therapy.
- Published
- 1996
- Full Text
- View/download PDF
34. Dimethyl sulfoxide does not trigger urine histamine release in interstitial cystitis.
- Author
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Stout L, Gerspach JM, Levy SM, Yun SK, Lad PM, Leach GE, and Zimmern PE
- Subjects
- Administration, Topical, Creatinine urine, Female, Humans, Regression Analysis, Anti-Inflammatory Agents pharmacology, Cystitis, Interstitial urine, Dimethyl Sulfoxide pharmacology, Histamine Release drug effects
- Abstract
Objectives: Dimethyl sulfoxide (DMSO), an agent that provides symptomatic relief in patients with interstitial cystitis (IC) works via an unknown mechanism. We investigated whether DMSO acts as a chemical stimulant of mast cell degranulation., Methods: A radioimmunoassay (RIA) specific for histamine was used to test this hypothesis. Twelve women with strictly diagnosed IC were treated with intravesical instillations of DMSO. Treatments were repeated at varying intervals, and each patient received three to six treatments. Urine histamine levels were measured before and after each intravesical instillation of DMSO. Dilutional effects of DMSO were corrected for by conversion of urine histamine concentration to urine histamine:creatinine ratio., Results: The RIA was unaffected by the addition of DMSO to urine. No consistent change in the urine histamine:creatinine ratio following DMSO instillation was found. Trend analysis revealed no trend in the histamine:creatinine ratio with time., Conclusions: The relief of symptoms reported in 50% to 77% of patients treated with intravesical DMSO is not related to detectable mast cell release of histamine. Other mechanisms of action must be investigated to explain the beneficial effect of this agent.
- Published
- 1995
- Full Text
- View/download PDF
35. Modified Pereyra bladder neck suspension: 10-year mean followup using outcomes analysis in 125 patients.
- Author
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Trockman BA, Leach GE, Hamilton J, Sakamoto M, Santiago L, and Zimmern PE
- Subjects
- Female, Follow-Up Studies, Humans, Middle Aged, Recurrence, Reoperation, Surveys and Questionnaires, Treatment Outcome, Urinary Bladder surgery, Urinary Incontinence surgery
- Abstract
Purpose: We attempt to determine the long-term success rate of the modified Pereyra bladder neck suspension, identify preoperative factors predictive of long-term outcome, and investigate the influence of method and length of followup on reported continence status after modified Pereyra bladder neck suspension., Materials and Methods: The charts of 177 patients who underwent modified Pereyra bladder neck suspension at our institution more than 5 years ago were reviewed. An attempt was made to contact all patients either by mail or telephone to complete a patient survey questionnaire., Results: Of 177 patients 125 (71%) completed the patient survey with a mean followup of 9.8 years. At survey followup 20% of the patients reported no incontinence of any type and 51% reported stress urinary incontinence with or without urge incontinence. Of the patients 71% reported significant improvement in the incontinence and 73% were satisfied with the results of the procedure. No accurate preoperative predictors of long-term outcome were identified. The method and length of followup had significant impact on reported continence status after modified Pereyra bladder neck suspension., Conclusions: This long-term study using outcomes analysis reveals a high rate of recurrent stress incontinence after modified Pereyra bladder neck suspension. However, most patients maintain significant subjective improvement and remain satisfied with the results of the operation.
- Published
- 1995
- Full Text
- View/download PDF
36. How potent is potent before nerve sparing radical retropubic prostatectomy?
- Author
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Zimmern PE, Kaswick J, and Leach GE
- Subjects
- Aged, Alprostadil pharmacology, Humans, Male, Middle Aged, Penis blood supply, Prospective Studies, Surveys and Questionnaires, Ultrasonography, Doppler, Duplex, Penile Erection, Prostatectomy methods
- Abstract
Purpose: We objectively evaluated potency before nerve sparing radical retropubic prostatectomy., Materials and Methods: A total of 45 consecutive potent, neurologically normal and sexually active candidates 47 to 70 years old (mean age 62) completed a detailed questionnaire (separate from their partner), and underwent penile biothesiometry, RigiScan* testing for 3 nights, and duplex Doppler scanning of the cavernous arteries before and after prostaglandin E1 injection., Results: Of the patients 8 noted moderate and the remainder normal erections on the questionnaire. RigiScan testing and penile biothesiometry correlated poorly with potency status. Duplex scanning demonstrated excellent peak velocities in 93% of the patients., Conclusions: This well studied prospective series underscores the importance of careful objective assessment of potent surgical candidates, and underlines a strong correlation between preoperative potency status and duplex Doppler scanning.
- Published
- 1995
37. Surgical treatment of intrinsic urethral dysfunction: injectables (fat).
- Author
-
Trockman BA and Leach GE
- Subjects
- Female, Humans, Injections, Methods, Transplantation, Autologous, Urethra, Urethral Diseases complications, Urinary Incontinence etiology, Adipose Tissue transplantation, Urethral Diseases therapy, Urinary Incontinence therapy
- Abstract
Injection of autologous fat has been used for many years to correct cosmetic surgical defects. More recently, autologous fat injection has been applied to the treatment of urinary incontinence. The background and technique of periurethral fat injection are described in this article. The technique is safe, and preliminary results are encouraging in women with intrinsic sphincter deficiency. Long term follow-up and comparative trials will determine the ultimate utility of periurethral fat injection for the treatment of women with intrinsic sphincter deficiency.
- Published
- 1995
38. The urologist as a discriminating diagnostician and surgeon.
- Author
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Leach GE
- Subjects
- Female, Humans, Male, Prostatectomy, Vagina surgery, Female Urogenital Diseases diagnosis, Female Urogenital Diseases surgery, Male Urogenital Diseases, Urology
- Published
- 1995
- Full Text
- View/download PDF
39. Fluorescein angiography of the bladder: technique and relevance to bladder cancer and interstitial cystitis patients.
- Author
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Zimmern PE, Laub D, and Leach GE
- Subjects
- Arterioles pathology, Carcinoma in Situ blood supply, Carcinoma in Situ diagnosis, Carcinoma, Transitional Cell blood supply, Carcinoma, Transitional Cell diagnosis, Cystitis pathology, Cystoscopy, Feasibility Studies, Fluoresceins administration & dosage, Follow-Up Studies, Humans, Injections, Intravenous, Neoplasm Invasiveness, Neovascularization, Pathologic pathology, Pilot Projects, Urinary Bladder Neoplasms blood supply, Venules pathology, Cystitis diagnosis, Fluorescein Angiography methods, Urinary Bladder blood supply, Urinary Bladder Neoplasms diagnosis
- Abstract
Purpose: Fluorescein angiography has been used in the study of bleeding vessels, neovascularity, tumors and ischemic tissues in a variety of disorders. This pilot study was designed to evaluate the feasibility, safety and relevance of this interesting technology for the evaluation of bladder wall vessels in patients with interstitial cystitis and bladder cancer., Materials and Methods: Five patients with National Institutes of Health defined interstitial cystitis symptoms and 10 with bladder cancer were studied during cytoscopy while they were under general anesthesia. A yellow-green barrier filter (520 nm.) was placed over the cystoscope eyepiece and a blue exciter filter (465 nm.) was attached to the light source. Patients received a 5 ml. bolus of 10% fluorescein intravenously., Results: After hydrodistension, glomerulations in interstitial cystitis patients were more prominent with fluorescein angiography and occurred in the venule phase. Areas of papillary transitional cell tumor and carcinoma in situ developed a brilliant yellow-green fluorescence. Adjacent normal urothelium was nonfluorescent and provided a contrasting dark background facilitating the detection of all lesions. No allergic reaction or other adverse effect related to the fluorescein injection was observed., Conclusions: These unique observations in a limited number of patients suggest that fluorescein angiography of the bladder is a safe and simple procedure. This preliminary report underscores the relevance of fluorescein angiography in the detection of bladder tumor and offers a new approach to the evaluation of bladder wall vessels in interstitial cystitis patients.
- Published
- 1995
- Full Text
- View/download PDF
40. [Diverticulum of the female urethra].
- Author
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Ganabathi K, Dmochowski R, Sirls LT, Zimmern PE, and Leach GE
- Subjects
- Diverticulum etiology, Diverticulum pathology, Diverticulum surgery, Female, Humans, Postoperative Complications prevention & control, Recurrence, Urethral Diseases etiology, Urethral Diseases pathology, Urethral Diseases prevention & control, Urethral Diseases surgery, Urinary Fistula prevention & control, Vaginal Fistula prevention & control, Diverticulum diagnosis, Urethral Diseases diagnosis
- Abstract
The diagnosis and successful treatment of female urethral diverticulum can be facilitated by a heightened clinical awareness coupled with appropriate evaluation and perioperative management. In particular, it is important to address all the preoperative factors to avoid complications de treatment such as recurrence of the diverticulum or urethro-vaginal fistula. The authors also report their clinical experience of evaluating 59 women with urethral diverticula over the last 11 years and describe the technique and complications of diverticulectomy in 49 women.
- Published
- 1995
41. Local anesthesia for laser prostatectomy.
- Author
-
Leach GE
- Subjects
- Aged, Aged, 80 and over, Follow-Up Studies, Humans, Male, Middle Aged, Anesthetics, Local, Laser Therapy methods, Prostatectomy methods, Prostatic Hyperplasia surgery
- Abstract
The technique of visual laser-assisted prostatectomy (VLAP) with a noncontact right-angle delivery system (Urolase) under local anesthesia is described. The advantages of local anesthesia include the facilitation of early patient discharge (2-3 hours after the procedure), avoidance of the risks of spinal and general anesthesia in high-risk patients, and, potentially, the enabling of VLAP as an outpatient office procedure. This technique was employed in 52 men with symptomatic benign prostatic hyperplasia (BPH) as an outpatient procedure without significant morbidity. The mean AUA Symptom Scores and uroflow measures all improved significantly with 1-year follow-up. Outpatient VLAP under local anesthesia is a promising treatment alternative for men with BPH.
- Published
- 1995
- Full Text
- View/download PDF
42. Post-prostatectomy incontinence: the importance of bladder dysfunction.
- Author
-
Leach GE
- Subjects
- Humans, Male, Prostatectomy methods, Urinary Incontinence physiopathology, Prostatectomy adverse effects, Urinary Bladder physiopathology, Urinary Incontinence etiology
- Published
- 1995
- Full Text
- View/download PDF
43. Peyronie's disease: surgical treatment based on penile rigidity.
- Author
-
Ganabathi K, Dmochowski R, Zimmern PE, and Leach GE
- Subjects
- Adult, Aged, Follow-Up Studies, Humans, Male, Middle Aged, Polytetrafluoroethylene, Severity of Illness Index, Penile Induration surgery
- Abstract
Operative treatment of Peyronie's disease has the risk of penile shortening and/or loss of erection. To avoid these complications, we used plaque incision together with polytetrafluoroethylene (Gore-Tex) graft insertion in men with preserved penile rigidity and only implanted a penile prosthesis in men with erectile failure. Between August 1986 and July 1992, 24 men 36 to 72 years old (mean age 53 years) underwent surgery. Of the men 16 with adequate penile rigidity by history and/or RigiScan study, and severe curvature underwent plaque incision and polytetrafluoroethylene graft insertion. Eight men had erectile failure, including 4 with distal flaccidity as demonstrated by RigiScan study. These 8 men received a penile prosthesis (semirigid in 6 and inflatable in 2). In addition, 2 of these men also required plaque incision because of persistent curvature. With a mean followup of 47 months (range 20 to 92), all 16 men with incision and a polytetrafluoroethylene graft had excellent erections with satisfactory intercourse. Minimal curvature away from the plaque incision site, not causing any difficulty with sexual performance, occurred in 7 patients. The men with a penile prosthesis engage in normal intercourse without residual or recurrent curvature. Incision of Peyronie's plaque and polytetrafluoroethylene graft insertion is associated with an excellent functional result in men with normal preoperative penile rigidity. A penile prosthesis should be reserved for men with erectile failure.
- Published
- 1995
44. Non-operative management of the urinary tract in spinal cord injury.
- Author
-
Dmochowski RR, Ganabathi K, and Leach GE
- Subjects
- Adolescent, Adult, Aged, Child, Child, Preschool, Humans, Middle Aged, Urinary Bladder, Urinary Catheterization, Urodynamics, Urologic Diseases surgery, Follow-Up Studies, Spinal Cord Injuries therapy, Urologic Diseases therapy
- Abstract
Various options exist for the management of the lower urinary tract in chronic spinal cord injury. These options include chronic indwelling catheterization, urethral sphincterotomy, and intermittent catheterization supplemented with anticholinergic agents. Sixty-four spinal cord injured patients, treated with intermittent catheterization and anticholinergic therapy, were evaluated for long-term efficacy in maintaining upper tract status and preservation or improvement in continence. Complications of therapy were also evaluated. Therapy was based upon initial urodynamic evaluation followed by limited subsequent evaluation of the urinary tract. Mean follow-up was 54 months. Only 1 patient developed hydronephrosis. Fifty-nine patients either became continent or experienced improved continence on therapy. Eight patients required surgical procedures either to increase outlet resistance (2) or to decrease intravesical pressures (6). The most common complication of therapy was urinary tract infection. Thirty-nine infections occurred in 23 patients, 16 of which were febrile. Fifteen patients were non-compliant with treatment recommendations. The only factor related to therapeutic complications which reached statistical significance was non-compliance with therapy. The combined use of intermittent catheterization and anticholinergic agents provides an effective means to prevent hydronephrosis and establish continence in chronic spinal injury.
- Published
- 1995
- Full Text
- View/download PDF
45. Benign female periurethral masses.
- Author
-
Dmochowski RR, Ganabathi K, Zimmern PE, and Leach GE
- Subjects
- Diagnosis, Differential, Female, Humans, Urethra anatomy & histology, Urethra embryology, Vagina anatomy & histology, Vaginal Diseases diagnosis, Urethral Diseases diagnosis, Urethral Diseases therapy
- Published
- 1994
- Full Text
- View/download PDF
46. Nonsurgical management of threatened upper urinary tracts and incontinence in children with myelomeningocele.
- Author
-
Hernandez RD, Hurwitz RS, Foote JE, Zimmern PE, and Leach GE
- Subjects
- Adolescent, Child, Child, Preschool, Female, Humans, Hydronephrosis therapy, Infant, Male, Mandelic Acids therapeutic use, Parasympatholytics therapeutic use, Propantheline therapeutic use, Urinary Catheterization, Urodynamics, Vesico-Ureteral Reflux therapy, Kidney physiology, Meningomyelocele therapy, Urinary Incontinence therapy
- Abstract
The 2 major urological objectives in treating the child with myelomeningocele are to preserve renal function and achieve continence. We report our success in managing these cases with nonsurgical therapy. From 1981 to 1991, 45 patients with myelomeningocele 1 to 15 years old were evaluated urodynamically before and after initiating nonsurgical treatment. Pretreatment urodynamics identified 2 groups. Group 1 consisted of 31 patients with leak point pressure of 40 cm. water or more of whom 10 had grades II to V/V vesicoureteral reflux and 4 had moderate or severe hydronephrosis. Group 2 consisted of 14 incontinent patients with leak point pressure of less than 40 cm. water and no reflux or hydronephrosis. Both groups were treated with intermittent catheterization, anticholinergic medications and fluid restriction. Within a mean followup of 5.5 years nonsurgical intervention resulted in lowering maximum detrusor pressure at maximum cystometric capacity to less than 40 cm. water in 22 of 31 group 1 patients (71%), and in resolving vesicoureteral reflux in 7 of 10 (70%) and hydronephrosis in 3 of 4 (75%) group 1 patients. Of 4 patients in group 1 with persistent high grade vesicoureteral reflux or severe hydronephrosis 3 (10%) required augmentation cystoplasty. With nonsurgical management 18 patients (40%) were completely continent, 18 (40%) required 2 or less pads daily and 9 (20%) required more than 2 pads daily. Nonsurgical management alone was effective in preserving the upper urinary tract in 90% of patients and it provided satisfactory continence in 80%. Surgical management should be reserved for the minority of patients whose upper tract changes do not resolve and for those whose degree of continence is not satisfactory with nonsurgical management.
- Published
- 1994
- Full Text
- View/download PDF
47. Experience with the management of urethral diverticulum in 63 women.
- Author
-
Ganabathi K, Leach GE, Zimmern PE, and Dmochowski R
- Subjects
- Adult, Aged, Female, Follow-Up Studies, Humans, Middle Aged, Postoperative Complications, Urinary Incontinence etiology, Urodynamics, Diverticulum diagnosis, Diverticulum surgery, Urethral Diseases diagnosis, Urethral Diseases surgery
- Abstract
The presentation and management are reviewed of 63 women with urethral diverticulum seen at a single institution in 10 years. Of the women 36 (61.9%) had urinary incontinence as a presenting symptom and 20 (31.7%) had incontinence as the only presenting complaint. Diverticula were suspected in 57 cases (90.5%) based on the presence of a periurethral mass during pelvic examination. Investigations included voiding cystourethrogram, excretory urogram, urodynamic studies and recently transvaginal ultrasound. Voiding cystourethrography adequately demonstrated the diverticulum in 60 of the 63 women (95.2%). Urodynamic studies performed in 58 women revealed abnormal findings in 36 (62%), including genuine stress urinary incontinence in 28 (48.3%). The location/number/size/configuration, communication, continence classification was used to define the characteristics of the diverticula. Seven women either refused operation or had small asymptomatic diverticula not requiring treatment. Transvaginal diverticulectomy was performed using a 3-layer closure in 56 women. Concomitant bladder neck suspension was performed in 27 women with documented stress urinary incontinence and/or urethral hypermobility. With a mean followup of 70 months (range 6 to 136) 48 women (85.7%) were completely relieved of the presenting complaint. Complications of diverticulectomy included 2 small distal recurrent diverticula, 1 urethrovaginal fistula and 6 transient early urinary tract infections. None of the women had urethral stricture or recurrent urinary tract infection. Six women (22.2%) who underwent diverticulectomy and bladder neck suspension, and 3 (10.3%) treated with diverticulectomy alone had minimal urinary incontinence requiring less than 2 pads a day.
- Published
- 1994
- Full Text
- View/download PDF
48. Use of the neodymium:YAG laser to control refractory bleeding from the prostate.
- Author
-
Kurtz SB, Sirls LT, and Leach GE
- Subjects
- Aged, Humans, Male, Recurrence, Hemorrhage surgery, Hemostasis, Surgical methods, Laser Coagulation methods, Prostatic Diseases surgery
- Abstract
Prostatic hemorrhage is a condition that often requires hospitalization and can be life-threatening. We present a simple, effective method using the neodymium:YAG laser with a right angle energy delivery system to control prostatic hemorrhage successfully in 3 difficult clinical situations.
- Published
- 1994
- Full Text
- View/download PDF
49. Role of limited evaluation and aggressive medical management in multiple sclerosis: a review of 113 patients.
- Author
-
Sirls LT, Zimmern PE, and Leach GE
- Subjects
- Adult, Aged, Electromyography, Female, Follow-Up Studies, Humans, Hydronephrosis etiology, Male, Middle Aged, Multiple Sclerosis diagnosis, Retrospective Studies, Urination Disorders physiopathology, Urodynamics, Multiple Sclerosis complications, Urination Disorders etiology, Urination Disorders therapy
- Abstract
Multiple sclerosis has frequent urological manifestations. Medical management, based on clinical symptoms and urodynamic findings, incorporates clean intermittent catheterization, oral pharmacological agents (that is oral oxybutynin) or their combination (the desired end point of treatment being complete retention with clean intermittent catheterization). Our objectives were to evaluate the efficacy of medical management in multiple sclerosis patients, determine the incidence of hydronephrosis at presentation and during treatment, and evaluate the impact of electromyography on patient management. We reviewed retrospectively 113 patients with documented multiple sclerosis (mean age 45 years, range 20 to 75 years and mean followup 41 months, range 6 to 136 months). Presenting symptoms were irritative alone or combined with obstructive symptoms in 94 patients (83%). On cystometrography 79 patients (70%) had detrusor hyperreflexia and 17 (15%) had an areflexic bladder. Coaxial needle electromyography was performed on 54 patients and 15 (28%) had detrusor-sphincter dyssynergia. Patients with detrusor-sphincter dyssynergia had more advanced neurological disease. A total of 105 patients had radiological imaging of the upper tracts. Only 7 patients (6.6%) had hydronephrosis at presentation and all were stable or improved with medical management. No patient had hydronephrosis with aggressive medical management. No patient with detrusor-sphincter dyssynergia had hydronephrosis or elevated creatinine levels at presentation or during treatment. Medical management failed in 8 patients (7%) who required surgical intervention. Limited evaluation (voiding symptoms, post-void residual and cystometrography) of multiple sclerosis patients is sufficient to formulate an effective treatment program. Electromyography is not necessary in the routine evaluation of patients with documented multiple sclerosis. After baseline upper tract imaging, routine yearly evaluations are unnecessary (unless initially abnormal or indicated by a change in clinical status). Medical management of patients with multiple sclerosis is safe and effective. In this series, no patient had hydronephrosis on therapy, and only 7% of the patients failed aggressive medical management and required surgical intervention.
- Published
- 1994
- Full Text
- View/download PDF
50. [Transurethral incision of the prostate: an objective and subjective evaluation of long-term efficacy].
- Author
-
Sirls T, Ganabathi K, Zimmern PE, Roskamp DA, Wolde-Tsadik G, and Leach GE
- Subjects
- Adult, Aged, Aged, 80 and over, Follow-Up Studies, Humans, Male, Middle Aged, Urodynamics, Prostatectomy, Prostatic Hyperplasia surgery
- Abstract
The emergence of less invasive therapies has demanded the reassessment of surgical procedures for the treatment of benign prostatic hyperplasia. This study was designed to evaluate the long term efficacy of transurethral incision of the prostate (TUIP) using objective (urodynamic), and subjective (symptom score and assessment of satisfaction) parameters, and investigate sexual function. Forty one men after TUIP (mean age of 63.4 years) were reviewed, with a mean follow up of 53 months (range 12-96). Pre operative symptom score (based on Madsen-Iversen score) and urodynamic evaluation were compared to recent post TUIP symptom score, urodynamic evaluation, and satisfaction interview. Total symptom score, as well as obstructive and irritative components, significantly decreased after TUIP (p < 0.0001). Mean detrusor pressure at peak flow decreased from 85 to 44 cm H2O (p < 0.0001), and mean maximal detrusor pressure decreased from 114 to 55 cm H2O (p < 0.0001). Mean peak uroflow rates increased from 10.3 to 15.3 cc/sec (p = 0.019). Thirty two of the men (82%) reported long term improvement after TUIP, with an overall satisfaction rate of 67% (range 0-100). Regardless of objective urodynamic criteria (indicating obstruction or relief of obstruction), the number of men reporting subjective improvement, and the degree of improvement, were similar. Only 4 men (11%) reported new retrograde ejaculation. The proportion of men improved after TUIP compares favorably to long term data available on TURP. Assessing the degree of improvement (overall satisfaction) is unique and has not been previously reported. These results clearly demonstrate that, in selected patients, TUIP is an effective procedure for long term relief of outlet obstruction.
- Published
- 1994
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