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Credentials

Education ?

Medical School Score
Wayne State University (1965)
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Awards & Distinctions ?

Associations
American Board of Urology
American Urological Association

Affiliations ?

Dr. McGuire is affiliated with 4 hospitals.

Hospital Affiliations

Score

Rankings

  • University of Michigan Hospitals & Health Centers *
    Urology
    1500 E Medical Center Dr, Ann Arbor, MI 48109
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  • Chelsea Community Hospital
    775 S Main St, Chelsea, MI 48118
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  • Ann Arbor Veterans Affairs Medical Center
    2215 Fuller Rd, Ann Arbor, MI 48105
  • University of Michigan Health System
  • * This information was reported to Vitals by the doctor or doctor's office.

    Publications & Research

    Dr. McGuire has contributed to 233 publications.
    Title Treating the Adult Neurogenic Bladder. Preface.
    Date November 2010
    Journal The Urologic Clinics of North America
    Title Urodynamics of the Neurogenic Bladder.
    Date November 2010
    Journal The Urologic Clinics of North America
    Excerpt

    Many patients with neurogenic bladders require careful monitoring in order to decrease the risk of infectious and renal complications. Urodynamic testing, with particular attention paid to detrusor pressures, is helpful for risk stratification in these patients and provides key information when assessing effectiveness of treatments. This article reviews the history, indications, and contemporary parameters for urodynamic testing in the neurogenic population.

    Title Management of Difficult Cases in Female Urology and Neurourology at the Reed M. Nesbit Society Meeting. Festschrift in Honor of Edward J. Mcguire, Md.
    Date August 2010
    Journal Neurourology and Urodynamics
    Excerpt

    This is a panel discussion of seven complex urologic cases in female urology and neurourology. Differences in diagnosis and management are discussed by this international panel of experts.

    Title Long-term Durability of Pubovaginal Fascial Slings in Women Who then Become Pregnant and Deliver.
    Date August 2010
    Journal International Urogynecology Journal
    Excerpt

    Pubovaginal fascial slings are commonly performed after childbearing is completed. Limited data is available regarding women who become pregnant following a sling procedure.

    Title Use of Aggregate Fitness Indicators to Predict Transition into the National Hockey League.
    Date December 2009
    Journal Journal of Strength and Conditioning Research / National Strength & Conditioning Association
    Excerpt

    Athletes (n = 345) invited to the annual combine conducted by the National Hockey League (NHL) prior to the entry draft were administered tests to measure upper body strength, lower body power, aerobic and anaerobic energy systems, and body composition. Their common variance was extracted using factor analysis from which an overall composite index was derived. A score on this index in the 90th percentile is associated with 72% and 60% probability of playing in the NHL within 4 years after the draft for defensemen and forwards, respectively. These findings demonstrate that by taking into account the shared variance on standard tests of fitness, it is possible to use the athlete's results to gauge his potential for playing in the NHL.

    Title Multiple Perineal Abscesses and Sinus Tracts As a Complication of Vaginal Mesh.
    Date October 2009
    Journal International Urogynecology Journal and Pelvic Floor Dysfunction
    Excerpt

    Understanding the occurrence and management of mesh kit complications has become increasingly important. A 54-year-old woman presented to our tertiary care center with complaints of constant perineal pain, and copious, foul-smelling vaginal discharge after anterior and posterior placement of a synthetic mesh and mid-urethral sling 3 months earlier. She was found to have two vaginocutaneous sinus tracts (to the left ischiorectal fossa and to the left labia majora), as well as bilateral abscess cavities within the ischiorectal fossae. The posterior mesh was completely excised, the tracts were opened, and the wound was packed and allowed to heal by secondary intention.

    Title Combination Drug Therapy Improves Compliance of the Neurogenic Bladder.
    Date September 2009
    Journal The Journal of Urology
    Excerpt

    Typical management of increased bladder storage pressures and decreased compliance related to neurogenic bladder dysfunction consists of antimuscarinic therapy with or without clean intermittent catheterization. However, these measures are often unsuccessful. In this patient group we commonly use combination therapy consisting of antimuscarinics combined with imipramine and/or an alpha-blocker.

    Title "the Cough Game": Are There Characteristic Urethrovesical Movement Patterns Associated with Stress Incontinence?
    Date June 2009
    Journal International Urogynecology Journal and Pelvic Floor Dysfunction
    Excerpt

    This study was carried out to determine whether five experts in female stress urinary incontinence (SUI) could discover a pattern of urethrovesical movement characteristic of SUI on dynamic perineal ultrasound. A secondary analysis of data from a case-control study was performed. Ultrasounds from 31 cases (daily SUI) and 42 controls (continent volunteers) of similar age and parity were analyzed. Perineal ultrasound was performed during a single cough. The five experts, blinded to continence status and urodynamics, classified each woman as stress continent or incontinent. Correct responses ranged from 45.7% to 65.8% (mean 57.4 +/- 7.6). Sensitivity was 53.0 +/- 8.8% and specificity 61.2 +/- 12.4%. The positive predictive value was 48.8 +/- 8.2% and negative predictive value was 65.0 +/- 7.3%. Inter-rater reliability, evaluated by Cohen's kappa statistic, averaged 0.47 [95% CI 0.40-0.50]. Experts could not identify a pattern of urethrovesical movement characteristic of SUI on ultrasound.

    Title Urethral Diverticulum: a New Complication Associated with Tension-free Vaginal Tape.
    Date April 2009
    Journal Urologia Internationalis
    Excerpt

    A case of a urethral diverticulum following the insertion of a tension-free vaginal tape (TVT) is presented. The patient was a woman with stress urinary incontinence who underwent surgery to correct intrinsic sphincter deficiency. Three cases of urethral diverticula have been published thus far as complications of TVT insertions, but this is the first complication associated with intrinsic sphincter deficiency. The high pressures in the proximal urethra that result from positioning the TVT in the middle urethra, especially when obstruction co-exists with an open bladder neck, can be a predisposing factor for this complication. The possibility of a urethral diverticulum when postvoid incontinence occurs after the insertion of a TVT should be carefully evaluated.

    Title Urinary Incontinence After Stress Incontinence Surgery: a Risk Factor for Depression.
    Date February 2009
    Journal Urology
    Excerpt

    To determine whether urinary incontinence after stress incontinence surgery is a risk factor for concomitant symptoms of depression.

    Title Complications Requiring Reoperation Following Vaginal Mesh Kit Procedures for Prolapse.
    Date January 2009
    Journal American Journal of Obstetrics and Gynecology
    Excerpt

    The objective of the study was to the characterize the symptoms and management of vaginal mesh-related complications requiring operative intervention.

    Title The Association of Incontinence Symptom Index Scores with Urethral Function and Support.
    Date January 2009
    Journal American Journal of Obstetrics and Gynecology
    Excerpt

    The objective of this study was to establish categories of symptom severity based on Incontinence Symptom Index (ISI) scores and to show how these categories are associated with urethral function and support.

    Title Are Persistent or Recurrent Symptoms of Urinary Incontinence After Surgery Associated with Adverse Effects on Sexual Activity or Function?
    Date September 2008
    Journal International Urogynecology Journal and Pelvic Floor Dysfunction
    Excerpt

    We sought to determine if postoperative urinary incontinence (UI) symptoms are associated with (1) sexual activity status and (2) sexual function using validated health-related quality of life instruments. In this mailed cross-sectional survey of 687 women who underwent stress incontinence surgery, 437 (63.6%) completed a questionnaire protocol. Clinical and sociodemographic factors independently associated with sexual activity status were identified with logistic regression. Sexually active respondents completed the Pelvic Organ Prolapse and Urinary Incontinence Sexual Function Questionnaire (PISQ-12) as a measure of sexual function. Factors independently associated with sexual function were identified with linear regression. Sexual activity was reported by 57.6% (252/437). The likelihood that a respondent was sexually active was moderated by an interaction between age and UI symptom severity (p = 0.059). Among the sexually active women, increasing UI symptom severity was associated with poorer sexual function (r = -0.42, p < 0.001). The severity of postoperative recurrent or persistent UI is associated with a lower probability of being sexually active and an adverse effect on sexual function.

    Title Long-term Durability and Functional Outcomes Among Patients with Artificial Urinary Sphincters: a 10-year Retrospective Review from the University of Michigan.
    Date May 2008
    Journal The Journal of Urology
    Excerpt

    PURPOSE: The artificial urinary sphincter continues to be one of the most effective and commonly used surgical treatments for severe urinary incontinence. The long-term durability and functional outcome remains unclear. This study sought to report the artificial urinary sphincter complication rates, associated risk factors with complications, and long-term quality of life and durability. MATERIALS AND METHODS: This single institution study reports the outcomes of 124 consecutive index cases of artificial urinary sphincter from 1996 to 2006 for complications (infection, erosion, and mechanical failure). Bivariate statistics and multivariable logistic models were used to identify patient and artificial urinary sphincter characteristics associated with complications. Functional outcomes and long-term durability were assessed using a cross sectional analysis of a validated health related quality of life survey and a product limit estimates, respectively. RESULTS: Among the 124 male patients median followup was 6.8 years. The overall complication rate for patients undergoing an artificial urinary sphincter was 37.0%, with mechanical failure the most common cause (29), followed by erosion (10) and then infection (7). Significant differences between complications and specific patient and artificial urinary sphincter characteristics risk factors were not found. Functional outcomes appeared stable with similar mild-moderate urinary incontinence severity and 0 to 1 daily pad use at intervals of 0 to 4 years, 4 to 8 years and more than 8 years. Long-term durability was notable with 36% having complications (requiring surgical revision or removal) within 10 years and most events occurring within the first 48 months. CONCLUSIONS: Long-term durability and functional outcomes are achievable for the AMS 800, but there are appreciable complication rates for erosion, mechanical failure and infection in the first 48 months from implantation.

    Title Ileovesicostomy for Adults with Neurogenic Bladders: Complications and Potential Risk Factors for Adverse Outcomes.
    Date May 2008
    Journal Neurourology and Urodynamics
    Excerpt

    AIMS: Risk factors for complications following ileovesicostomy have not been well defined. This study's purpose was to examine outcomes following ileovesicostomy in adults and identify possible risk factors that may contribute to post-operative complications. METHODS: Retrospective database review identified ileovesicostomy procedures from August 1999 to September 2003. Demographic, pre-operative, and post-operative data were extracted. Statistical analysis determined whether risk factors influenced outcomes of urethral continence, re-operation, and post-operative complications. Factors included age, tobacco use, diabetes, neurogenic bladder etiology, body mass index, pre-operative indwelling catheterization, or simultaneous procedures including pubovaginal sling/urethral closure. RESULTS: 50 adults status-post ileovesicostomy were identified. At last follow-up, 36 patients (72%) were continent per urethra. The incidence of complications decreased significantly from 3.38 per patient to 1.16 post-operatively (P < 0.0001). Twenty-seven averaged 1.52 inflammatory or infectious post-operative complications per patient, 19 averaged 1.47 stomal complications, and 11 averaged 2.09 ileovesicostomy mechanical obstructions. Overall, 27 required 2.85 re-operations or additional procedures following ileovesicostomy. Sub-group analysis identified BMI (P = 0.0569) as a possible risk factor. Differences in outcomes based on age, tobacco use, diabetes, neurogenic bladder etiology, pre-operative indwelling catheterization, or urethral closure were not significant. CONCLUSIONS: Ileovesicostomy is a valuable management option for adults with neurogenic bladder unable to perform intermittent catheterization. The incidence of urinary tract comorbid events significantly decreased following ileovesicostomy though the onset of other complications should be considered. The morbidity associated with ileovesicostomy requires careful patient selection, close long-term follow-up, and potential subsequent interventions to address post-operative complications.

    Title Transcutaneous Mechanical Nerve Stimulation Using Perineal Vibration: a Novel Method for the Treatment of Female Stress Urinary Incontinence.
    Date November 2007
    Journal The Journal of Urology
    Excerpt

    PURPOSE: We defined basic guidelines for transcutaneous mechanical nerve stimulation in modifying pelvic floor responses in women and determined the efficacy of transcutaneous mechanical nerve stimulation in treating stress urinary incontinence. MATERIALS AND METHODS: Perineal and clitoral transcutaneous mechanical nerve stimulation was performed in healthy volunteers while measuring changes in peak urethral pressure to determine optimal vibration amplitude and site of stimulation. Perineal transcutaneous mechanical nerve stimulation was then performed weekly for 6 weeks in a cohort of women with stress urinary incontinence (33). Reduction in incontinence episodes and pad use on voiding diary were compared from baseline to 6 weeks. Global efficacy was determined at 6 weeks and 3 months after the completion of the program. RESULTS: In healthy subjects a vibration amplitude of 2.0 mm resulted in the highest urethral pressure increase. Although the increase with perineal transcutaneous mechanical nerve stimulation was lower than that seen with clitoral stimulation (80 vs 115 cm H(2)O), perineal transcutaneous mechanical nerve stimulation was more acceptable to the patient and resulted in a better subjective response. Urethral pressure increases with transcutaneous mechanical nerve stimulation at either site were greater than with voluntary contraction (60 cm H(2)O). After 6 weeks of transcutaneous mechanical nerve stimulation in the subjects with stress urinary incontinence, there was a significant reduction in daily incontinence episodes (2.6 +/- 1.1 vs 0.5 +/- 1.1, paired t test p <0.001) and pad use (3.5 +/- 0.9 vs 0.6 +/- 1.3, paired t test p <0.001). At 6 weeks the cure rate (no incontinence episodes) was 73%, with durability through 3 months with 67% still reporting persistent resolution. CONCLUSIONS: Perineal transcutaneous mechanical nerve stimulation has promise as a noninvasive and well tolerated method of treating stress urinary incontinence.

    Title American Academy of Pediatric Dentistry and American Academy of Pediatrics Issue Co-endorsed Sedation Guidelines.
    Date September 2007
    Journal Pennsylvania Dental Journal
    Title Comparative Analysis of Urinary Incontinence Severity After Autologous Fascia Pubovaginal Sling, Pubovaginal Sling and Tension-free Vaginal Tape.
    Date February 2007
    Journal The Journal of Urology
    Excerpt

    PURPOSE: Autologous fascia, Pelvicol implant and polypropylene are common materials used in suburethral anti-incontinence procedures. We explored the relative effectiveness of the autologous fascia pubovaginal sling, Pelvicol pubovaginal sling and Gynecare TVT on self-reported postoperative urinary incontinence. MATERIALS AND METHODS: The study was a mailed cross-sectional survey of health related quality of life 1 to 3 years after suburethral anti-incontinence surgery performed at our institution. The Incontinence Symptom Index was used to assess the presence and severity of urinary incontinence symptoms and the Incontinence Impact Questionnaire-7 was used to assess impairment. Regression models were developed to identify factors with an independent effect on the presence, severity and impairment of urinary incontinence symptoms. RESULTS: The questionnaire was returned by 69% of eligible respondents (173 of 250). Those with previous incontinence surgery (OR 11.0, 95% CI 2.3-51.4) and medical comorbidities (OR 1.6, 95% CI 1.1-2.2) were more likely to report urinary incontinence symptoms, ie incontinence symptom index greater than 0. Symptom severity, which was analyzed only in respondents with urinary incontinence symptoms, was greater in the Pelvicol than in the autologous fascia pubovaginal sling and TVT groups (each p <0.01). No significant difference was observed between the TVT and autologous fascia pubovaginal sling groups (p = 0.15). Also associated with higher urinary incontinence symptom severity scores were body mass index (p = 0.03), a history of incontinence surgery (p = 0.01) and lower education (p <0.01). Impairment from urinary incontinence, as assessed by the Incontinence Impact Questionnaire-7, was associated with body mass index, severe depression and current smoking (each p = 0.01) but not with surgical treatment group. CONCLUSIONS: Women who received an autologous fascia pubovaginal sling or TVT reported lower symptom severity scores than those who had a Pelvicol pubovaginal sling. Impairment was not associated with procedure type. These findings suggest better outcomes with autologous fascia pubovaginal sling and TVT. Randomized, controlled trials are needed to confirm these findings.

    Title Management of the Dysfunctional and Neurogenic Bladder: Myths and Reality.
    Date October 2006
    Journal Current Urology Reports
    Title Urethral Bulking Agents.
    Date July 2006
    Journal Nature Clinical Practice. Urology
    Title Outcome of Urethral Closure in Patients with Neurologic Impairment and Complete Urethral Destruction.
    Date March 2006
    Journal Neurourology and Urodynamics
    Excerpt

    AIMS: The purpose of this study is to describe the problems associated with prolonged urethral catheterization in 12 patients with neurological problems and to report the results of surgical treatment. METHODS: A retrospective study of patients with neurogenic bladder and urethral dysfunction treated with prolonged catheterization resulting in incontinence associated with loss of urethral tissue and or function selected 12 patients. All had video urodynamics. Twelve were continuously incontinent despite a catheter. Bladder compliance, where that could be measured, was low is 10, and there were multiple and serious co-morbidities including sepsis, hypoalbuminemia, skin breakdown, osteomyelitis, respiratory insuffiency, etc. There were 4 males and 8 females, 9 had a spinal cord injury and 3 progressive multiple sclerosis. RESULTS: Male patients underwent transperineal closure of the membranous urethra; females transvaginal closure of the urethra. All patients had a urinary diversion, either an ileovesicostomy, or an augmentation cystoplasty and construction of a neourethra. Continence was ultimately achieved in 11 of 12 patients at a median 20 months. Four patients had one additional procedure to gain continence, but five patients required 3.8 procedures/patient to achieve continence. Closure of the male urethra was more easily accomplished than closure of an extensively damaged eroded female urethra. CONCLUSIONS: Patients with urethral damage and erosion related to prolonged catheter present a formidable challenge in surgical reconstruction. Most have serious co-mobidities and a single operation does not usually solve all the problems. Persistence does almost always result in continence.

    Title Complications Following Surgical Intervention for Stress Urinary Incontinence: a National Perspective.
    Date December 2005
    Journal Neurourology and Urodynamics
    Excerpt

    AIMS: Stress urinary incontinence (SUI) impacts many women. Treatment is primarily surgical. Post-operative morbidity considerably affects individuals and the health care system. Our objective is to describe complications following surgery for SUI and how they affect resource utilization. METHODS: Utilizing the Nationwide Inpatient Sample (a nationally representative dataset), 147,473 patients who underwent surgery for SUI from 1988 to 2000 were identified by ICD-9 codes. Comorbid conditions/complications were extracted using ICD-9 codes, including complication rates, length of stay (LOS), hospital charges, and discharge status. RESULTS: Overall complication rate was 13.0% (not equal to sum of complication sub-types, as each woman may have had = 1 complication), with 2.8% bleeding, 1.4% surgical injury, 4.3% urinary/renal, 4.4% infectious, 0.1% wound, 1.1% pulmonary insufficiency, 0.5% myocardial infarction, 0.2% thromboembolic. The "gold standard" surgical technique for SUI, the pubovaginal sling, had the lowest morbidity at 12.5%. Mean LOS increased with morbidity: from 2.9 to 4.1 to 6.1 days for those with 0, 1, and =2 complications respectively (P < 0.001). Similarly, inflation-adjusted hospital charges increased with morbidity: from 7,918 dollars to 9,828 dollars to 15,181 dollars for those with 0, 1, and =2 complications respectively (P < 0.001). The percentage of patients requiring post-discharge subacute or home care increased with morbidity: from 4.4% to 8.4% to 14.3% for those with 0, 1, and =2 complications (P < 0.001). CONCLUSIONS: A substantial percentage of women experience complications following surgery for SUI. Post-operative morbidity leads to dramatically increased resource utilization. Prospective studies are needed to identify pre-operative risk factors and intraoperative process measures to optimize the quality of care.

    Title Technique for Removal of Symptomatic Bone Anchors Placed During Stress Incontinence Surgery.
    Date December 2005
    Journal Urology
    Excerpt

    INTRODUCTION: To present an uncomplicated, reliable technique for bone anchor removal in patients with anchor-related infections or chronic pain. TECHNICAL CONSIDERATIONS: We removed 17 anchors from 9 patients between 1999 and 2004. The surgical technique used fluoroscopy for localization of the anchors and an orthopedic broken screw removal instrument for resection of the anchor and surrounding bone. Nine patients with bone anchors had been symptomatic with chronic pain and/or wound drainage for a mean of 23.7 months before surgery. After removal, 10 anchors grew positive bacterial cultures. The most common organism was coagulase-negative Staphylococcus. During a mean follow-up period of 6.8 months after hardware removal, 8 of the 9 patients had symptomatic improvement. CONCLUSIONS: Fluoroscopic localization and en bloc resection with a broken screw removal instrument is an effective method of removing symptomatic bone anchors.

    Title Rudolph Hohenfellner.
    Date October 2005
    Journal The Journal of Urology
    Title Changes in the Management of Benign Prostatic Hyperplasia.
    Date October 2005
    Journal Surgical Technology International
    Title Transurethral Collagen Injections for Male Intrinsic Sphincter Deficiency: the University of Texas-houston Experience.
    Date September 2005
    Journal The Journal of Urology
    Excerpt

    Injectable agents are used to increase urethral coaptation for the treatment of intrinsic sphincter deficiency. We evaluated the long-term results and complications of transurethral collagen injections in males.

    Title The Dental Home: a Partial Solution to the Access Challenge.
    Date August 2005
    Journal Pennsylvania Dental Journal
    Title Urinary Incontinence: a Diverse Condition.
    Date May 2005
    Journal The Journal of Urology
    Title Temporary Perineal Urethrostomy for External Sphincter Dilation in a Male Patient with High Risk Myelomeningocele.
    Date October 2003
    Journal The Journal of Urology
    Excerpt

    We describe our use of perineal urethrostomy to facilitate serial external sphincter dilations in a male child with high risk myelomeningocele.

    Title Effects of Ejaculation by Penile Vibratory Stimulation on Bladder Capacity in Men with Spinal Cord Lesions.
    Date June 2003
    Journal The Journal of Urology
    Excerpt

    PURPOSE: We examined the effects of ejaculation by penile vibratory stimulation on bladder capacity in men with spinal cord lesions. MATERIAL AND METHODS: Included in our study were 14 men with spinal cord lesions from C4 to T7 with detrusor hyperreflexia. Cystometry was performed before and immediately after ejaculation by penile vibratory stimulation to establish baseline conditions and repeated after 1 month of ejaculation by penile vibratory stimulation every third day. The third cystometry study was done after 1 month of ejaculation by penile vibratory stimulation every third day at home to determine any long-term effects of treatment. This third cystometry was performed 72 hours after the last ejaculation to exclude any acute effects of ejaculation by penile vibratory stimulation on detrusor hyperreflexia. In addition, 1 to 3 days later ejaculation was induced by penile vibratory stimulation and immediately followed by cystometry to examine whether it was possible to achieve an acute effect as well as a potential long-term effect. RESULTS: Baseline urodynamic investigations revealed bladder hyperreflexia and external sphincter dyssynergia in all individuals. There was no statistically significant difference in bladder capacity at leak point before and immediately after ejaculation by penile vibratory stimulation. However, after 4 weeks of frequent penile vibratory stimulation treatment bladder capacity at leak point increased significantly from a median of 190 ml. (range 17 to 700) at baseline to 293 (range 30 to 700) (Wilcoxon signed rank test p = 0.03). Furthermore, there was a trend toward decreased intravesical pressure during the filling phase. CONCLUSIONS: Ejaculation by penile vibratory stimulation was associated with a significant increase in bladder capacity at leak point after 4 weeks of frequent treatment. This finding may have implications in the management of incontinence in men with spinal cord lesions.

    Title Intraoperative Nerve Stimulation with Measurement of Urethral Sphincter Pressure Changes During Radical Retropubic Prostatectomy: a Feasibility Study.
    Date June 2003
    Journal The Journal of Urology
    Excerpt

    PURPOSE: We evaluated the feasibility of using intraoperative nerve stimulation and real-time urodynamic monitoring to identify the intrapelvic innervation of the urethral sphincter during radical retropubic prostatectomy. MATERIALS AND METHODS: Using an intraurethral balloon pressure transducer and nerve stimulator changes in urethral pressure were measured in response to stimulation of the neurovascular bundles, pelvic side wall, bladder neck, rectus muscle and other structures in 8 patients undergoing nerve sparing radical retropubic prostatectomy. Intraurethral pressure changes were charted on an urodynamic monitor and correlated with the anatomical location of stimulation. RESULTS: Stimulation of the neurovascular bundles resulted in measurable and significant (greater than 10 cm. H(2)O) increases in intraurethral pressure in all 8 patients. The mean pressure increase was 22 cm. H(2)O. Neither control structure, that is the bladder neck or rectus, resulted in pressure changes with stimulation. In 60% of the subjects pelvic side wall stimulation resulted in urethral pressure increases, while in 40% this stimulation caused pelvic contraction floor but no pressure increase. The mean pressure changes with side wall stimulation was 14 cm. H(2)O. CONCLUSIONS: Intraoperative stimulation of pelvic neural structures and measurement of changes in urethral pressure in response to stimulation are feasible during radical retropubic prostatectomy. Stimulating the neurovascular bundle consistently results in significant increases in urethral pressure. The finding of an intrapelvic urethral innervation supports the previously published observation that nerve sparing radical retropubic prostatectomy may result in improved continence postoperatively.

    Title Obstructive Uropathy Induced Bladder Dysfunction Can Be Reversible: Bladder Compliance Measures Before and After Treatment.
    Date February 2003
    Journal The Journal of Urology
    Excerpt

    We demonstrated that abnormal bladder compliance in the setting of obstructive uropathy can be improved by relief of bladder outlet obstruction.

    Title Editorial: Sling Procedures for Incontinence.
    Date November 2002
    Journal The Journal of Urology
    Title Rodent Carcinogenicity with the Thiazolidinedione Antidiabetic Agent Troglitazone.
    Date November 2002
    Journal Toxicological Sciences : an Official Journal of the Society of Toxicology
    Excerpt

    Carcinogenic potential of the thiazolidinedione antidiabetic troglitazone was assessed in 104-week studies in mice and rats. Mice were given 50, 400, or 800 mg/kg, male rats 100, 400, or 800 mg/kg, and female rats 25, 50, or 200 mg/kg. Vehicle and placebo controls were included. Survival was significantly decreased in both sexes of both species at high doses, but was adequate for valid evaluation of carcinogenicity. Hypertrophy and hyperplasia of brown adipose tissue was observed in both species at all doses, and fatty change and hypocellularity of bone marrow was noted in mice at all doses and in female rats at 50 and 200 mg/kg. Hepatocellular vacuolation was observed in mice at 400 and 800 mg/kg, and centrilobular hepatocellular hypertrophy occurred in rats at > or = 200 mg/kg. Ventricular dilatation, myocardial fibrosis, and atrial myocyte karyomegaly in male rats at 400 and 800 mg/kg and female rats at all doses were morphologically similar to spontaneous lesions, but incidence and severity were increased compared with controls. In mice, the incidence of hemangiosarcoma was increased in females at 400 mg/kg and in both sexes at 800 mg/kg. The incidence of hepatocellular carcinoma was increased in female mice at 800 mg/kg. Troglitazone exposure [AUC((0-24))] at the lowest dose associated with increased tumor incidence in mice was 16 times human therapeutic exposure at 400 mg daily. No tumors of any type were increased in rats at exposures up to 47 times therapeutic exposure.

    Title Long-term Results of Ingelman-sundberg Denervation Procedure for Urge Incontinence Refractory to Medical Therapy.
    Date September 2002
    Journal The Journal of Urology
    Excerpt

    PURPOSE: Urge incontinence refractory to anticholinergic medication and behavioral techniques is a therapeutic challenge. We evaluated the durability of the modified Ingelman-Sundberg detrusor denervation procedure as minimally invasive surgical therapy for intractable urge incontinence. MATERIALS AND METHODS: Patients presenting with severe urge incontinence unresponsive to medical and/or behavioral therapy were injected subtrigonally with 10 ml. 0.25% bupivacaine. The patients were contacted 24 hours later to determine whether they experienced a decrease in urgency and urge incontinent episodes. The 28 patients with temporary resolution of symptoms were offered operative management. All patients were evaluated with history, physical examination and fluoroscopic urodynamics. The procedure consists of transvaginal dissection of the perivesical fascia from the area of the trigone, including sharp division of the terminal branches of the pelvic nerve. RESULTS: A total of 28 patients 28 to 83 years old (mean age 54.6) underwent the Ingelman-Sundberg procedure from April 1993 to September 1997. All patients presented with a history of urge incontinence, 10 reported concomitant stress incontinence and 10 had documented unstable detrusor contractions on urodynamic evaluation. Needle suspension and the pubovaginal sling procedure were performed with the Ingelman-Sundberg procedure in 1 case each. Mean followup was 44.1 months (range 14 to 67). Of the patients 15 (54%) achieved the complete durable resolution of urge incontinence, 4 (14%) were improved and 9 (32%) were unchanged. CONCLUSIONS: Ingelman-Sundberg bladder denervation resulted in a 68% long-term cure or improved rate in a difficult patient population, namely those with intractable urge incontinence. This brief, minimally invasive procedure is an excellent alternative to more aggressive surgical options.

    Title Acute Urinary Retention Associated with the Use of Cyclooxygenase-2 Inhibitors.
    Date September 2002
    Journal The Journal of Urology
    Title Chronic Toxicity in Monkeys with the Thiazolidinedione Antidiabetic Agent Troglitazone.
    Date August 2002
    Journal The Journal of Toxicological Sciences
    Excerpt

    The antidiabetic agent troglitazone was given to groups of 4 cynomolgus monkeys per sex at 300, 600, or 1200 mg/kg daily by gavage for 52 weeks. A group of 4 monkeys per sex received vehicle alone and served as controls. Emesis and soft stool or diarrhea occurred sporadically in all troglitazone-treated groups, but did not compromise animal health. There were no effects on body weight or food consumption, or ophthalmologic, electrocardiographic, or echocardiographic parameters. Erythrocyte count, hemoglobin, and hematocrit decreased 8% to 16% in males at all doses and serum cholesterol decreased 30% to 46% in both sexes at all doses. Urinary ketones were increased in several animals at 600 and 1200 mg/kg. Absolute and relative liver weights increased at all doses in both sexes by 40% to 71%. The only microscopic change attributable to troglitazone treatment was minimal to mild bile duct hyperplasia in males at all doses and in females at 600 and 1200 mg/kg. No differences in systemic exposure were apparent between sexes. Over the dose range tested, AUC(0-24) values were 27 to 102 micrograms.hr/ml of troglitazone, 401 to 2060 micrograms.hr/ml of its sulfate conjugate, and 34 to 312 micrograms.hr/ml of its quinone metabolite. Therefore, oral administration of troglitazone to monkeys at 300, 600, and 1200 mg/kg for 52 weeks resulted in significant systemic exposure, with only minimal gastrointestinal, hematologic, and hepatic effects.

    Title Polypropylene Mesh Tape for Stress Urinary Incontinence: Complications of Urethral Erosion and Outlet Obstruction.
    Date July 2002
    Journal The Journal of Urology
    Excerpt

    PURPOSE: Gynecare tension-free vaginal tape (Ethicon, Inc., New Brunswick, New Jersey) is a propylene mesh tape recently introduced in the United States as minimally invasive treatment for stress urinary incontinence. We report the combined experience at 3 tertiary care institutions with graft erosion and bladder outlet obstruction after procedures performed elsewhere. MATERIALS AND METHODS: We reviewed the records of 5 patients with complications who presented to 1 of 3 institutions after polypropylene mesh tape placement. All pertinent information was obtained from the medical records and the operating surgeon at the referring institution. RESULTS: Treatment was required in 2 patients with urethral erosion, 1 with vaginal and bladder erosion, and 2 with bladder outlet obstruction. Common presenting symptoms included urge, urge incontinence and gross hematuria. Cystoscopy showed polypropylene graft erosion at the urethra or through the bladder wall. Each patient required explantation of the polypropylene mesh tape and further surgery to restore continence. The graft was divided transvaginally in the 2 patients presenting with outlet obstruction. Urge incontinence resolved and they returned to complete spontaneous voiding. CONCLUSIONS: High clinical suspicion is necessary when evaluating patients presenting with urinary symptoms after polypropylene mesh tape placement. Bladder outlet obstruction and possible graft erosion should be considered.

    Title Salvage Cryotherapy for Recurrent Prostate Cancer After Radiotherapy: Variables Affecting Patient Outcome.
    Date June 2002
    Journal Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology
    Excerpt

    PURPOSE: To determine the long-term disease-specific survival (DSS) and disease-free survival (DFS) rates after salvage cryotherapy for locally recurrent adenocarcinoma of the prostate and to identify pretreatment factors that have an impact on DSS and DFS. PATIENTS AND METHODS: Between July 1992 and January 1995, 131 patients who had received definitive radiation therapy (XRT) underwent salvage cryotherapy for locally recurrent adenocarcinoma of the prostate. Cryotherapy failure was defined as an increasing postcryotherapy prostate-specific antigen (PSA) level of > or = 2 ng/mL above the postcryotherapy nadir, a positive prostate biopsy, or radiographic evidence of metastatic disease. Clinical variables were studied to determine whether there was an association with the DSS and DFS. RESULTS: The median follow-up was 4.8 years. The 5-year DSS rates were 87% for patients with a precryotherapy Gleason score < or = 8 and 63% for those with Gleason scores of 9 and 10 (P =.012). The 5-year DFS rates were 57% for patients with a precryotherapy PSA level of < or = 10 ng/mL and 23% for those with a PSA level greater than 10 ng/mL (P =.0004). The 5-year DSS rates for patients with a pre-XRT clinical stage of T1 to T2 and those with a clinical stage of T3 to T4 were 94% and 72%, respectively (P =.0041). The 5-year DFS rates for these groups were 90% and 69%, respectively (P =.0057). CONCLUSION: Androgen-independent local recurrences, Gleason score, and pre-XRT clinical stage were important factors that had an impact on DSS and DFS. The subset of patients cured by salvage cryotherapy seems to be small, and patient selection is important.

    Title Mixed Symptomatology.
    Date April 2002
    Journal Bju International
    Excerpt

    Mixed symptomatology, i.e. both stress and urge incontinence, is reported by patients, either of their own accord or in response to a questionnaire. Our understanding of motor urge incontinence, detrusor instability, stress incontinence and sensory urge incontinence is changing. Detrusor instability is now known to be a urodynamic observation of uncertain clinical significance. Symptoms reported by patients are not equivalent to a urodynamic diagnosis but the problem seems to be more in the urodynamics than in the symptoms. Evidence shows that sensory urge incontinence and motor urge incontinence are probably gradations of the same condition. The relationship between stress incontinence and an overactive bladder is complex. For example, neither detrusor instability nor urge incontinence appear to adversely influence the outcome of surgical treatment for stress incontinence; however, this treatment does not have a good success rate. At present, it is not clear whether this poor outcome reflects a lack of efficacy of the operations used, or their application to inappropriate patients.

    Title Prognostic Value of Urodynamic Testing in Myelodysplastic Patients. 1981.
    Date April 2002
    Journal The Journal of Urology
    Title Pubovaginal Sling Procedure for Stress Incontinence. 1978.
    Date April 2002
    Journal The Journal of Urology
    Title Studies on Coronary Arteriopathy in Dogs Following Administration of Ci-1020, an Endothelin A Receptor Antagonist.
    Date December 2001
    Journal Toxicologic Pathology
    Excerpt

    A selective nonpeptide endothelin A (ETA) receptor antagonist, CI-1020, was administered to beagle dogs intravenously (i.v.) for 4 hours to 4 weeks. One animal/sex received CI-1020 at 1 mg/kg/hr intravenously for 4, 8, or 24 hours to investigate onset of arteriopathy. Control animals (1/sex) received the vehicle only. To determine reversibility of arteriopathy, 8 dogs/sex were given CI-1020 at 1 mg/kg/hr for 4 days. Two dogs/sex were sacrificed 1, 3, 8, and 29 days following cessation of infusion. Lesion development with prolonged exposure was investigated in 1 male dog. It was given CI-1020 by i.v. bolus at 120 mg/kg/day for 4 weeks and Monastral blue dye was administered i.v. to facilitate localization of vascular lesions. Coronary blood flow was determined in 4 dogs infused with CI-1020 at 0.3, 3, and 30 mg/kg for one hour at each dose. Macroscopically, hemorrhage or blue discoloration of Monastral blue was noted in the extramural coronary arteries along the coronary groove and atrium. Histologically, the earliest coronary changes were noted in animals sacrificed after 24 hours of treatment and characterized by medial hemorrhage and necrosis with a few infiltrating neutrophils. In the reversibility study, incidence and severity of arteriopathy was dependent on time of sacrifice following cessation of infusion. Acute necrotizing inflammation of arteries was present in all animals (n = 4) on day 1 postinfusion, whereas on day 8 postinfusion, lesions characterized by medial small pockets of trapped red cells, cell debris, and adventitial thickening were seen in 1 dog/sex. By day 29 postinfusion, coronary arteries were similar to controls. In the dog given daily i.v. bolus injections of CI-1020 for 4 weeks, arterial inflammatory lesions varied from acute to chronic, although most lesions were considered chronic active. Monastral blue pigments were noted in the wall of most arteries with chronic or chronic active lesions. Acute lesions were similar to those noted in day 1 postinfusion of the reversibility study. Medial smooth muscle necrosis and/or fibrosis with mixed inflammatory cell infiltrates characterized chronic or chronic active lesions. Smooth muscle proliferation and migration into the intima were also noted. There were no significant changes in coronary blood flow, coronary vascular resistance, or mean arterial blood pressure following CI-1020 infusion for 3 hours. In the 24-hour infusion study, plasma endothelin 1 (ET-1) levels were mildly elevated (1.5-4 fold) during CI-1020 infusion when compared to either pretest or control values. These results indicate that administration of endothelin antagonist (CI-1020) to dogs was associated with development of coronary arteriopathy, which was completely resolved within 29 days following cessation of treatment. With prolonged (4-week) CI-1020 treatment, arterial lesions at varying stages of development (acute, chronic active, chronic) were seen, suggesting that tolerance to treatment (up to 4 weeks) does not occur.

    Title Revision Rate After Artificial Urinary Sphincter Implantation for Incontinence After Radical Prostatectomy: Actuarial Analysis.
    Date December 2001
    Journal The Journal of Urology
    Excerpt

    PURPOSE: We determined the actuarial revision rate for artificial urinary sphincters implanted in patients who were incontinent after radical prostatectomy. MATERIALS AND METHODS: We reviewed the records of 70 consecutive patients who were incontinent after radical prostatectomy and who underwent primary artificial urinary sphincter implantation at the University of Michigan between 1984 and 1999. Questionnaires were mailed to all patients with an indwelling device, and telephone calls were placed to those who did not respond to the mailing. Information about surgical revision and current continence status was obtained from chart review and questionnaire response. The Kaplan-Meier curves for actuarial freedom from operative revision were constructed. RESULTS: Of the 66 patients with available postoperative data 24 (36%) required reoperation at a mean followup of 41 months. The 5-year actuarial rate for freedom from any operative revision was 50%, and the corresponding rate for cuff revision was 60%. A single operative revision did not predispose the patient to further revision. Questionnaire data indicated a continence rate of 80% (range 0 to 2 pads). CONCLUSIONS: Approximately half of the patients who were incontinent after radical prostatectomy may expect to undergo operative revision within 5 years after artificial urinary sphincter implantation. Despite this high reoperation rate, an excellent level of continence is maintained.

    Title Surgical Procedures for the Treatment of Urge Incontinence.
    Date October 2001
    Journal Techniques in Urology
    Excerpt

    Cure of urge incontinence refractory to conservative management may require the application of several surgical techniques. The Ingelman-Sundberg bladder denervation procedure, detrusor myectomy, and augmentation cystoplasty are among the surgical possibilities aimed at dealing with severe urgency and uninhibited detrusor contractions.

    Title Effects of Ejaculation by Penile Vibratory Stimulation on Bladder Reflex Activity in a Spinal Cord Injured Man.
    Date August 2001
    Journal The Journal of Urology
    Title External Urethral Sphincter Dilation for the Management of High Risk Myelomeningocele: 15-year Experience.
    Date June 2001
    Journal The Journal of Urology
    Excerpt

    PURPOSE: We investigate the long-term outcome using external urethral sphincter dilation for high risk myelomeningocele. MATERIALS AND METHODS: Since 1984 external urethral sphincter dilation was performed in 25 patients with myelomeningocele who demonstrated passive leak point pressure greater than 40 cm. H2O and/or poor bladder compliance. Mean followup from the first dilation was 8.4 years. Overall 2.4 dilations were performed per patient (range 1 to 8). Cystometrography, imaging study and continence status were evaluated retrospectively. RESULTS: Overall external urethral sphincter dilation produced durable improvements in mean leak point pressure (60.9 versus 34.4 cm. H2O), capacity (119.8 versus 233.3 ml.), initial compliance (11.5 versus 28.4 ml./cm. H2O) and terminal compliance (1.1 versus 7.7 ml./cm. H2O). Categorical analysis revealed 3 groups in terms of outcome. Group 1 consisted of 11 patients (44%) who demonstrated durable improvements in urodynamic parameters as well as preservation of the upper tracts. These patients demonstrated a 2-step compliance pattern on pre-dilation cystometrography, in which elevated leak point pressure was associated with excellent initial compliance. Group 2 consisted of 5 patients (20%) who failed to maintain safe leak point pressure and whose upper tracts deteriorated, including 4 who eventually underwent augmentation cystoplasty. This group demonstrated a 1-step hypertonicity in which elevated leak point pressure was associated with a steep pressure increase during early filling. Group 3 consisted of 9 patients (36%) who responded minimally in terms of leak point pressure reduction but whose upper tracts remained well preserved. They demonstrated a high pressure instability pattern associated with excellent baseline compliance. CONCLUSIONS: External urethral sphincter dilation provides an effective long-term solution for select high risk myelomeningocele cases. Those who demonstrate elevated leak point pressure and poor bladder compliance at the time of external urethral sphincter dilation are less likely to respond, suggesting that the bladder may have already undergone irreversible changes due to high outlet resistance. Patients who demonstrate instability patterns are less likely to respond to external urethral sphincter dilation in terms of leak point pressure reduction but the upper tracts appear to be well preserved.

    Title Advantages of Rectus Fascial Slings for Urinary Incontinence in Children with Neuropathic Bladders.
    Date June 2001
    Journal The Journal of Urology
    Excerpt

    PURPOSE: Many surgical procedures to improve outlet resistance in children with neuropathic bladders are obstructive and increase the detrusor leak point pressure. In contrast, fascial slings are designed to achieve continence by increasing the Valsalva or stress leak point pressure without altering the detrusor leak point pressure. We evaluate the effectiveness of fascial slings in achieving continence in pediatric patients with neuropathic bladder. MATERIALS AND METHODS: From October 1994 until February 1999, 10 females and 8 males with neuropathic bladder secondary to myelodysplasia or traumatic spinal cord injury underwent fascial sling procedures. Mean patient age was 14 years (range 8 to 18) and all were incontinent despite aggressive medical management. Urodynamic evaluation was performed preoperatively and postoperatively. Specific urodynamic measurements included detrusor leak point pressure, stress leak point pressure and detrusor compliance. Compliance was only compared in the 12 nonaugmented cases. RESULTS: With a mean followup of 21.2 months (range 6 to 57), preoperative and postoperative urodynamics revealed little change in mean detrusor leak point pressure (23.2 versus 23.22 cm. H2O) but a substantial increase in mean stress leak point pressure (41.6 versus 64.5 cm. H2O). Mean compliance was unchanged in the nonaugmented group (22.00 versus 26.78 ml/cm. H2O). Four patients (22.22%) remained wet after surgery, of whom 2 were successfully treated with a repeat sling procedure and 1 with collagen injection for an overall continence rate of 94.44%. CONCLUSIONS: Fascial slings can be effectively used in pediatric patients for neuropathic incontinence. Furthermore, stress urinary incontinence is corrected by increasing the Valsalva or stress leak point pressure with preservation of the detrusor leak point pressure. Preservation of detrusor leak point pressure is particularly advantageous because other forms of bladder outlet procedures achieve continence at the expense of increasing detrusor pressures, thus placing the upper tracts at risk for damage.

    Title A Brief History of Testosterone.
    Date May 2001
    Journal The Journal of Urology
    Excerpt

    We explore the history of testosterone in the context of medical and scientific developments.

    Title Is Intrinsic Sphincter Deficiency a Complication of Simple Hysterectomy?
    Date September 2000
    Journal The Journal of Urology
    Excerpt

    Intrinsic sphincter deficiency may cause disabling stress urinary incontinence. While some pelvic operations are implicated as a cause of this condition, simple hysterectomy for benign disease is not recognized as one of them. We evaluated the association of simple hysterectomy with intrinsic sphincter deficiency.

    Title Salvage Prostatectomy with Continent Catheterizable Urinary Reconstruction: a Novel Approach to Recurrent Prostate Cancer After Radiation Therapy.
    Date June 2000
    Journal The Journal of Urology
    Excerpt

    PURPOSE: Salvage prostatectomy after full dose radiation therapy is associated with a high risk of urinary incontinence. We evaluated the complications of salvage prostatectomy with continent catheterizable reconstruction and its impact on urinary incontinence. MATERIALS AND METHODS: Between August 1995 and February 1999, 13 patients with biopsy proved, locally recurrent prostate cancer after radiation therapy underwent salvage prostatectomy with complete bladder neck closure and reconstruction with an appendicovesicostomy to the native bladder in 9 and ileovesicostomy in 4. RESULTS: There were no intraoperative complications. Four patients had serious complications necessitating reoperation, including a vesicourethral fistula requiring delayed cystectomy, wound dehiscence with disruption of the appendicovesical anastomosis, leakage from the small bowel anastomosis that resulted in sepsis and death, and stomal stenosis requiring delayed stomal revision in 1 each. Of 12 patients 2 (17%) used pads for incontinence, while 10 were dry during the day and night with a catheterization interval of 2 to 6 hours. CONCLUSIONS: Salvage prostatectomy with continent catheterizable reconstruction is a technically challenging operation with the potential for serious complications. The postoperative continence rate is excellent and appears superior to those in the literature for salvage prostatectomy and vesicourethral anastomosis.

    Title Bladder Endometriosis: Conservative Management.
    Date June 2000
    Journal The Journal of Urology
    Excerpt

    PURPOSE: We evaluate the characteristics of women with bladder endometriosis successfully treated with hormonal therapy. MATERIALS AND METHODS: The records of 14 patients with a mean age of 48.7 years (range 26 to 71) diagnosed with bladder endometriosis on cystoscopic evaluation were reviewed for presenting complaints, findings and response to therapy. RESULTS: The most frequent presenting complaints were urgency (78%), frequency (71%), suprapubic pain (43%), urge incontinence (21%) and dyspareunia (21%). Of the patients 86% did not have a history of recurrent urinary tract infections, 6 (42%) had a history of endometriosis, including 3 who were previously treated with hysterectomy/oophorectomy and 8 (57%) were on some form of therapy for estrogen deficiency. In all patients endometrial implants were identified on cystoscopic examination. In 2 patients the endometrioma correlated to lesions on the serosal surface of the bladder during laparoscopic evaluation. Of the patients 13 were treated either with low dose oral contraceptives, decrease or elimination of the estrogen component of the present regimen or addition of progesterone to therapy, and 12 (92%) reported sustained improvement of symptoms at a mean of 18.6 months (range 8 to 24). CONCLUSIONS: In more than 70% of cases the presenting symptoms of bladder endometriosis are identical to those of interstitial cystitis. Therefore, endometriosis should always be considered in the patient referred for frequency, urgency and pain with no documented infection. Hormonal therapy is reasonable and effective management for bladder endometriosis. This option preserves fertility, making it especially attractive to younger women.

    Title Pubovaginal Sling: 4-year Outcome Analysis and Quality of Life Assessment.
    Date June 2000
    Journal The Journal of Urology
    Excerpt

    Stress urinary incontinence is a common disease with a devastating impact on patient quality of life. Needle suspension procedures, which produce disappointing long-term results for type II stress incontinence, are being replaced by pubovaginal slings which previously were reserved solely for the treatment of type III stress incontinence. We report the long-term outcomes of pubovaginal slings for the treatment of types II and III stress urinary incontinence, and assess its quality of life impact.

    Title Balloon Dilation of Posterior Urethral Stricture Secondary to Radiation and Cryotherapy in a Patient with a Functional Artificial Urethral Sphincter.
    Date January 2000
    Journal Journal of Endourology / Endourological Society
    Excerpt

    Severe urethral stricture disease as an isolated entity can be a management dilemma. In the patient described here, this problem was associated with prior external-beam radiation and cryosurgical ablation of the prostate, and a functional artificial urethral sphincter (AUS) had been placed. An attempt to relieve partial urinary obstruction while preserving AUS function led to successful balloon dilation proximal to the sphincter cuff.

    Title Collagen Injection Therapy for Postprostatectomy Incontinence.
    Date November 1999
    Journal Urology
    Title Quality of Life After Salvage Cryotherapy: the Impact of Treatment Parameters.
    Date August 1999
    Journal The Journal of Urology
    Excerpt

    PURPOSE: Cryotherapy has emerged as a promising salvage therapy option for treatment of locally recurrent prostate cancer after initial therapy. In this retrospective study we evaluate patient quality of life after salvage cryotherapy and correlate complications impairing quality of life with specific cryotherapy treatment parameters. MATERIALS AND METHODS: A modified UCLA Prostate Cancer Index measuring health related quality of life was sent to 150 patients who underwent salvage cryotherapy between July 1992 and April 1995. We evaluated the relationships among incontinence, pain, impotence, sloughing of tissue and problematic voiding symptoms, and cryotherapy treatment parameters, including use of a urethral warming catheter, number of cryotherapy probes and number of freeze-thaw cycles. We also evaluated patient overall degree of satisfaction with the procedure. RESULTS: Of 150 surveys 112 (74%) were returned. Mean followup was 16.7 months (range 0.5 to 31.5). Treatment without an effective urethral warming catheter was highly associated with urinary incontinence (p<0.003), perineal pain (p<0.001), tissue sloughing (p<0.003) and American Urological Association symptom score greater than 20 (p<0.004). Impotence was higher in the double freeze-thaw cycle group (p<0.05). Overall satisfaction with cryotherapy was 33%. CONCLUSIONS: Quality of life may be compromised by urinary incontinence, impotence, tissue sloughing, problematic voiding symptoms and/or perineal pain in a substantial number of patients following salvage cryotherapy. Effective urethral warming is essential in reducing complications and maximizing quality of life. Salvage cryotherapy does not appear to offer any quality of life advantages compared to salvage prostatectomy.

    Title Long-term Outcome of Incontinent Ileovesicostomy Management of Severe Lower Urinary Tract Dysfunction.
    Date June 1999
    Journal The Journal of Urology
    Excerpt

    We evaluated the extended 5-year followup outcome of incontinent ileovesicostomy.

    Title Do Urinary Symptoms Correlate with Urodynamic Findings?
    Date June 1999
    Journal The Journal of Urology
    Excerpt

    We determined whether urinary symptomatology correlates with video urodynamic findings.

    Title Coronary Arteriopathy in Monkeys Following Administration of Ci-1020, an Endothelin A Receptor Antagonist.
    Date June 1999
    Journal Toxicologic Pathology
    Excerpt

    A selective non-peptide endothelin A (ETA) receptor antagonist, CI-1020, was administered to cynomolgus monkeys intravenously (i.v.) for 2 or 4 wk and orally for 4 wk. Groups consisting of 3 animals of each sex received CI-1020 at 1, 5, and 10 mg/kg/hr (i.v.) or orally at 250, 500, and 750 mg/kg body weight for 4 wk. Control animals received the vehicle only. In a separate experiment, 1 male was infused with 10 mg/kg/hr for 2 wk, and Monastral blue dye was administered i.v. to facilitate localization of lesions to the vascular walls. One female was administered saline and the dye and served as a control. One female at 1 mg/kg/hr was found dead at week 2, and 1 female at 5 mg/kg/hr was euthanatized during week 4 as a result of severe thigh swelling at the catheter site. Macroscopically, extramural coronary arteries appeared thickened and nodular in the 4-wk i.v. study in the female found dead at 1 mg/kg/hr, in 1 male and 1 female at 5 mg/kg/hr, and in 2 females at 10 mg/kg/hr. Histologically, Monastral blue pigment trapped in the walls of coronary arteries with arteriopathy was observed in the male treated with CI-1020 at 10 mg/kg/hr for 2 wk. Extramural coronary arteriopathy occurred at all doses in the 4-wk i.v. study, with higher incidence occurring in females than in males (7 of 9 treated females compared with 3 of 9 treated males). In the oral study, 1 female at 500 mg/kg/day and 1 male and 2 females at 750 mg/kg/day had coronary arteriopathy. Histological changes after 2 wk of treatment were characterized by intimal thickening, fragmentation of the internal elastic lamina, necrosis and edema of the media, and mixed inflammatory-cell infiltrates in the intima, media, and adventitia. After 4 wk of i.v. administration, arteriopathy was characterized by segmental disruption of the elastic lamina and intimal and medial fibrosis with complete replacement of smooth muscle with fibrous tissue. The adventitia was thickened as a result of fibrosis and mixed or mononuclear inflammatory-cell infiltrates. CI-1020 concentrations were higher in males (1.57 to 29 micrograms/ml) than in females (0.974 to 24.4 micrograms/ml) in the i.v. study. Transient systemic exposure with high maximum plasma concentration (Cmax) (120-352 micrograms/ml) in the oral study was insufficient to provoke arterial changes of the same magnitude as those noted with continuous i.v. administration. The regeneration of the media by fibrous tissue and the disruption of the elastic lamina may weaken the arterial wall and increase the susceptibility of the artery to the development of aneurysm.

    Title Reconstructive Surgery for Urinary Incontinence.
    Date April 1999
    Journal The Urologic Clinics of North America
    Excerpt

    The clinical urologist often is faced with the referral of a patient with urinary incontinence refractory to conservative measures. Given the broad spectrum of causes of urinary incontinence, the clinician must base evaluation and therapeutic management on current principles of urinary tract pathophysiology. This article organizes the pertinent diagnostic considerations that must be addressed in guiding the clinician to the appropriate surgical treatment option.

    Title Urological Diseases of Women, and Women in Urology.
    Date March 1999
    Journal The Journal of Urology
    Title Enterocystoplasty or Detrusor Myectomy? Comparison of Indications and Outcomes for Bladder Augmentation.
    Date March 1999
    Journal The Journal of Urology
    Excerpt

    We review our experience with enterocystoplasty and detrusor myectomy to delineate clinical indications and compare operative outcomes with both types of bladder augmentation.

    Title Bladder Neck Competency at Rest in Women with Incontinence.
    Date February 1999
    Journal The Journal of Urology
    Excerpt

    PURPOSE: We determine the presence of an open bladder neck during video urodynamic studies and relate that finding to the presence of stress urinary incontinence. MATERIALS AND METHODS: Patients presenting with urinary incontinence, voiding dysfunction or pelvic floor prolapse underwent video urodynamics. With the patient upright and after 200 ml. contrast material had been instilled into the bladder the bladder neck was viewed to determine if it was open or closed. At that point the abdominal leak point pressure was measured. RESULTS: Of 102 women, average age 56.5 years (range 31 to 82), 13% had an open bladder neck and demonstrable stress incontinence on video urodynamics with an average abdominal leak point pressure of 45 cm. water (range 26 to 90). Of those with stress incontinence on urodynamics 23% had an open bladder neck. No continent patient had an open bladder neck. CONCLUSIONS: The presence of an open bladder neck with the bladder filled to 200 ml. correlates strongly with the presence of stress incontinence.

    Title Epidemiology and Etiology of Urinary Incontinence in the Elderly.
    Date December 1998
    Journal World Journal of Urology
    Title Management of Female Genitourinary Fistulas: Transvesical or Transvaginal Approach?
    Date December 1998
    Journal The Journal of Urology
    Excerpt

    PURPOSE: We reviewed 25 female genitourinary fistula repairs performed at our institution from 1993 to 1997. MATERIALS AND METHODS: Our series comprised 7 primary vesicovaginal, 6 recurrent vesicovaginal, 7 complex, 1 ureterovaginal and 4 urethrovaginal fistulas. Postoperative followup ranged from 8 months to 5 years. RESULTS: Overall, 92% of the patients were cured (23 of 25). The 2 failures occurred in patients with a history of pelvic malignancy involving adjuvant therapy. CONCLUSIONS: Complex irradiated vesicovaginal fistulas require staged repairs, often with pedicle flaps. However, primary repair of uncomplicated vesicovaginal fistulas is highly successful. Limited transvesical repair of these fistulas offers reliable success with minimal morbidity and hospital stay comparable to those of the transvaginal approach.

    Title Management of Female Urethral Diverticula: a New Classification.
    Date October 1998
    Journal The Journal of Urology
    Excerpt

    Symptomatic female urethral diverticula may be managed by a number of operative techniques. However, to avoid persistent or recurrent diverticula definitive therapy requires analysis of the type and nature of the diverticulum. We propose a simple classification system for the management of female urethral diverticula.

    Title Pelvic Prolapse: Diagnosing and Treating Cystoceles, Rectoceles, and Enteroceles.
    Date October 1998
    Journal Medscape Women's Health
    Excerpt

    The current generation of women is maintaining a healthier and more active lifestyle into an older age. Treatable conditions such as stress urinary incontinence and pelvic prolapse detract from this active lifestyle. In many cases, an improved quality of life can be maintained by treating pelvic prolapse conditions with relatively minor surgical procedures. Optimal treatment requires a knowledge of pelvic floor anatomy, an understanding of the various pelvic floor defects, and experience in selecting the appropriate procedure. The unequivocal diagnosis of pelvic prolapse conditions can only be made on physical examination. Each section of the vagina -- anterior, posterior, lateral, and apex -- must be inspected and evaluated separately to define the true nature and degree of prolapse. The examination should be performed with a moderate amount of urine in the bladder, and the patient must strain forcefully during the procedure. In some cases, this requires that the patient stand or sit upright during part of the examination to allow all areas of prolapse to become manifest. When the proper procedures are performed, excellent long-term results can be anticipated. The successful treatment of cystoceles requires an evaluation for both lateral and central defects, as inadequate treatment of either defect will lead to recurrences. The treatment of rectoceles is more controversial: Most clinicians would repair symptomatic rectoceles, but many choose not to treat asymptomatic rectoceles because there is little documented benefit to justify the risk of postoperative dyspareunia. Small asymptomatic enteroceles may be treated with a pessary; however, large symptomatic enteroceles usually require surgery.

    Title Pelvic Prolapse: Diagnosing and Treating Uterine and Vaginal Vault Prolapse.
    Date October 1998
    Journal Medscape Women's Health
    Excerpt

    Uterine prolapse is often associated with a concomitant rectocele, cystocele, and/or an enterocele. Moderate degrees of prolapse are often associated with a feeling of pelvic heaviness or fullness or low back pain. The symptoms usually worsen with exertion and ease with bed rest. In severe prolapse, the cervix may descend outside the vaginal introitus, and patients may complain that a "mass" is protruding from the vagina. Bleeding from mucosal ulcerations or from the cervical os may occur due to rubbing of the prolapsed tissue against the patient's clothing. The commonly associated problems of cystoceles and rectoceles may lead the patient to complain of difficulty voiding, recurrent urinary infections, and/or "splinting" to defecate. Mild cases of uterine prolapse do not require therapy unless the patient is symptomatic; in most cases of second- or third-degree prolapse, however, patients may be quite uncomfortable and desire therapy. Nonsurgical options, such as a pessary, are usually tried first if the patient desires conservative therapy. Operative repair for uterine prolapse is usually approached vaginally if the uterus is small. An abdominal approach may be preferred if the uterus is large or if the woman has had multiple previous pelvic procedures or has extensive endometriosis or other processes that may obliterate the cul-de-sac. In either approach, the uterosacral and cardinal ligaments must be carefully ligated and tied together, and the cul-de-sac must be obliterated to reduce the risk of subsequent enterocele and to properly suspend the vaginal vault.

    Title Pubovaginal Fascial Slings.
    Date May 1998
    Journal Techniques in Urology
    Excerpt

    The first pubovaginal fascial sling was reported in 1907, however, until recently this procedure was rarely utilized except after other incontinence procedures had failed. Currently, a pubovaginal sling is indicated as the primary incontinence procedure if intrinsic sphincter deficiency or coexisting intrinsic sphincter deficiency and urethral hypermobility are diagnosed preoperatively. Additionally, incontinence secondary to urethral hypermobility should be treated with a pubovaginal sling if the patient has a high risk of postoperative failure due to obesity, chronic cough, or repetitive strenuous activity. Pubovaginal slings are relatively easy to perform and yield reliably good results with minimal morbidity. We describe our current technique and results using pubovaginal slings for stress incontinence in women.

    Title Our Experience with Pubovaginal Slings in Patients with Stress Urinary Incontinence.
    Date April 1998
    Journal The Journal of Urology
    Excerpt

    Pubovaginal slings successfully treat stress urinary incontinence in women with intrinsic sphincter deficiency. Because of its durability, it has been an attractive procedure in select patients with urethral hypermobility. We examine our experience with pubovaginal sling.

    Title Transvaginal Urethrolysis for Urethral Obstruction After Anti-incontinence Surgery.
    Date April 1998
    Journal The Journal of Urology
    Excerpt

    Urethral obstruction following a stress incontinence procedure occurs in 5 to 20% of patients. We examine the success of transvaginal urethrolysis in resolving voiding dysfunction.

    Title The Use of the Appendix As a Continent Catheterizable Stoma.
    Date March 1998
    Journal The Journal of Urology
    Excerpt

    PURPOSE: We review the results of 5 years of using the unmodified appendix for reconstruction of neobladders and native bladders, and describe the mechanism of continence. MATERIALS AND METHODS: Between 1993 and 1997, 24 patients have undergone continent urinary diversion using the unaltered appendix. Median patient age at the time of surgery was 62 years. Patients were followed at the urological outpatient clinic for a mean of 18 months (range 7 to 47). Video urodynamic studies were performed once in the first 6 months postoperatively and repeated if there was any history of incontinence or bladder problems. RESULTS: Of the patients with an appendicovesicostomy onto the native bladder 80% were dry during the day and night. This figure was improved to 94% when 2 patients with incontinence catheterized more frequently. Patients with a neobladder were more likely to be continent and had a longer interval between catheterizations, which reflects the larger reservoir volume rather than better continence mechanism in these patients. The level of continence is at the appendiceal bladder junction in the native bladder and the appendicocecal junction in the neobladder, which is able to withstand reservoir pressures of 30 to 40 cm. water. Stress incontinence driven by abdominal pressure did not occur. Instead incontinence occurred when the bladder became over full and the pressure increased, or during an unstable contraction. CONCLUSIONS: The appendix does not need to be tunneled through the bladder wall to achieve satisfactory continence. In a low pressure reservoir continence may be achieved simply by anastomosing the appendix directly onto the bladder or leaving it in situ when creating a neobladder.

    Title The Incidence of Helicobacter Pylori in Patients with Interstitial Cystitis.
    Date March 1998
    Journal The Journal of Urology
    Excerpt

    The cause of interstitial cystitis is unknown. We evaluated the incidence of Helicobacter pylori antibodies in patients with interstitial cystitis to determine whether such infection may be a causative factor.

    Title Frederick C. Mclellan and Clinical Cystometrics.
    Date February 1998
    Journal Urology
    Excerpt

    Precise analysis of lower urinary tract function was an unfulfilled dream only a century ago. By the late 19th century, water manometers and plethysmographs were utilized to measure bladder pressures. In the early 1900s, Rose developed a cystometer that was later improved by Munro. In 1938 Frederick C. McLellan, active in clinical research under Reed Nesbit at the University of Michigan, was the first to apply the earlier principles and cystometric tools to a large group of patients and created the first modern paradigm of bladder dysfunction. McLellan's work brought clinical relevance to the cystometer and thus precision to the analysis of lower urinary tract function.

    Title The Guarding Reflex Revisited.
    Date February 1998
    Journal British Journal of Urology
    Title A Followup on Transurethral Collagen Injection Therapy for Urinary Incontinence.
    Date December 1997
    Journal The Journal of Urology
    Excerpt

    Transurethral collagen injection therapy has been used successfully in treating stress urinary incontinence due to intrinsic sphincter deficiency since United States Food and Drug Administration approval in October 1993.

    Title Periurethral Collagen Injection for Male and Female Sphincteric Incontinence: Indications, Techniques, and Result.
    Date December 1997
    Journal World Journal of Urology
    Excerpt

    Intrinsic sphincter deficiency is characterized by a poorly functioning intrinsic urethral sphincter, which leaks urine at relatively low pressures. Patients with this sort of incontinence are candidates for collagen implant therapy. Collagen is injected in the region of the bladder neck with success, depending on the precise placement of the collagen. There is generally a need to implant more collagen into men. The percentage of patients showing improvement in their incontinence after therapy is 58-100%. Over time the collagen is absorbed and there is a need to repeat the treatment. Collagen increases the abdominal leak-point pressure without reducing the flow rate or increasing the residual volume. Treatment failure does not prevent the performance of other procedures.

    Title Failure of an Acucise Balloon Device to Inflate Resulting in Treatment Failure.
    Date November 1997
    Journal The Journal of Urology
    Title Ventral Bladder Hernia Following Vesica Percutaneous Bladder Neck Suspension for Stress Urinary Incontinence.
    Date November 1997
    Journal The Journal of Urology
    Title Standards of Efficacy for Evaluation of Treatment Outcomes in Urinary Incontinence: Recommendations of the Urodynamic Society.
    Date August 1997
    Journal Neurourology and Urodynamics
    Title Definition and Classification of Urinary Incontinence: Recommendations of the Urodynamic Society.
    Date August 1997
    Journal Neurourology and Urodynamics
    Title Treatment Results Using Pubovaginal Slings in Patients with Large Cystoceles and Stress Incontinence.
    Date August 1997
    Journal The Journal of Urology
    Excerpt

    We determined the efficacy of performing a pubovaginal sling concurrently with a formal cystocele repair in patients with grade III to IV cystoceles.

    Title Preclinical Toxicology Studies with the Angiotensin-converting Enzyme Inhibitor Quinapril Hydrochloride (accupril).
    Date March 1997
    Journal The Journal of Toxicological Sciences
    Excerpt

    Acute, subacute, and chronic toxicity studies, carcinogenicity bioassays, and reproductive and genetic toxicology studies were performed with quinapril, an ACE inhibitor used in the treatment of hypertension. Acute toxicity is minimal in rodents, and repeated dosing elicits gastric irritation, juxtaglomerular apparatus (JGA) hypertrophy and hyperplasia and tubular degenerative changes in the kidney, and reduced red cell parameters and heart weights in rodents and/or dogs. Other manifestations of toxicity, including hepatic lesions in dogs, reduced offspring weights in rats, marked sensitivity of the rabbit, and clastogenic effects at cytotoxic doses in the in vitro V79 chromosome aberration assay, have been reported with other drugs of this class.

    Title Structural Diversity of Peroxisome Proliferators and Their Effects on Mammalian Liver Cells in Vivo.
    Date February 1997
    Journal Annals of the New York Academy of Sciences
    Title Blunt Urethral Trauma: a Unified, Anatomical Mechanical Classification.
    Date January 1997
    Journal The Journal of Urology
    Excerpt

    PURPOSE: We propose a simple, anatomically based classification of blunt urethral injury as a replacement for currently used classifications, which are not comprehensive, anatomically inconsistent or based on a mixed anatomical/mechanistic formula. The latter are difficult to learn and use, and have not been universally adopted. MATERIALS AND METHODS: We reviewed most of the currently used general uroradiological, emergency radiological and urological textbooks to define the classification of urethral injuries that is most widely accepted. Most authors use the Colapinto and McCallum classification, modifications thereof or the older surgical classification of urethral injuries, which simply divides such injuries anatomically into anterior and posterior. However, there is little consensus about the best classification and none includes all of the blunt injuries of the urethra. To correct these difficulties we devised a comprehensive and anatomically consistent classification. RESULTS: The proposed classification categorizes blunt urethral trauma as I-posterior urethra intact but stretched (Colapinto and McCallum type I), II-partial or complete pure posterior injury with tear of membranous urethra above the urogenital diaphragm (Colapinto and McCallum type II), III-partial or complete combined anterior/posterior urethral injury with disruption of the urogenital diaphragm (Colapinto and McCallum type III), IV-bladder neck injury with extension into the urethra, IVA-injury of the base of the bladder with periurethral extravasation simulating a true type IV urethral injury and V-partial or complete pure anterior urethral injury. CONCLUSIONS: The proposed classification is anatomically valid and includes all of the common types of blunt urethral injuries. Universal adoption of this system should permit comparison of various management/treatment modalities at various institutions.

    Title Long-term Followup of Incontinence and Obstruction After Salvage Cryosurgical Ablation of the Prostate: Results in 143 Patients.
    Date January 1997
    Journal The Journal of Urology
    Excerpt

    PURPOSE: We report long-term followup of patients with incontinence and obstruction after salvage cryosurgical ablation of the prostate. MATERIALS AND METHODS: We reviewed the records of 143 patients who underwent cryosurgical ablation of the prostate for treatment failure after radiation therapy. Data were collected by telephone interview with each patient and chart review. Median followup was 27 months (range 12 to 42). RESULTS: Of 107 patients who underwent cryosurgical ablation of the prostate using a commercially available urethral warmer 15 (14%) had significant obstruction or retention that required transurethral resection of the prostate in 10, of whom 6 became incontinent. Urinary incontinence occurred in 45 patients (42%) and resolved in 21 (47%), for an overall 28% long-term incontinence rate. Of 28 patients who underwent cryosurgical ablation of the prostate using an alternative urethral warmer 13 (46%) had incontinence and 15 (54%) had significant obstruction or retention. Resolution was rare and 89% of the patients are currently incontinent. Eight patients underwent 2 separate cryosurgical ablations with an 88% incontinence rate (43% overall). The double freezing technique did not increase postoperative obstruction or incontinence. CONCLUSIONS: Incontinence and urinary retention rates are increased in patients undergoing cryosurgical ablation of the prostate after failure of radiation therapy but spontaneous resolution occurs in half of the patients within 1 year if an effective urethral warmer is used. Incontinence treatments should be delayed until after this period. Postoperative incontinence and obstruction rates are significantly greater when an effective urethral warmer is not used and spontaneous resolution is rare.

    Title Decreased Bladder Compliance in Patients with Myelomeningocele Treated with Radiological Observation.
    Date December 1996
    Journal The Journal of Urology
    Excerpt

    PURPOSE: Recently others advocated frequent radiological surveillance to detect upper urinary tract deterioration in children with neurogenic bladder secondary to spina bifida. We reviewed the consequences of such expectant management on bladder compliance and urinary continence. MATERIALS AND METHODS: We retrospectively reviewed the records of 214 children presenting to our spina bifida clinic in a 13-year period. Follow-up is available for 95 girls and 86 boys. Imaging studies of the kidneys were repeated at 6 to 12-month intervals. Urodynamics were performed when upper urinary tracts deteriorated or in incontinent school age children. RESULTS: On radiographic study there was evidence of upper urinary tract deterioration in 79 children, including hydronephrosis in 34, hydronephrosis and vesicoureteral reflux in 19, and reflux only in 26. Follow up studies performed after clean intermittent catheterization and pharmacological therapy were instituted revealed resolution or improvement of upper tract deterioration in 52 patients (69%), while bladder compliance improved in only 42%. Surgical intervention was required in 34 children, despite improvement of upper tract changes in many of these patients on follow up radiographic studies. CONCLUSIONS: Although radiological surveillance of patients with myelomeningocele allows recognition of upper tract changes, the effects of elevated outlet resistance on bladder compliance are not as readily reversible as the initial radiographic findings. The incidence of enterocystoplasty exceeds that reported for patients treated prospectively based on urodynamic findings, which should be considered in the treatment of these children.

    Title Modified Ingelman-sundberg Bladder Denervation Procedure for Intractable Urge Incontinence.
    Date November 1996
    Journal The Journal of Urology
    Excerpt

    We determined the efficacy of the modified Ingelman-Sundberg procedure in women with urge incontinence and intractable detrusor instability.

    Title Bladder Preservation and Continent Urinary Diversion in T3b Transitional Cell Carcinoma of the Bladder.
    Date October 1996
    Journal Seminars in Urologic Oncology
    Excerpt

    The patient with T3b transitional cell carcinoma (TCC) of the bladder has traditionally been treated with radical cystectomy and urinary diversion, but initial success with systemic chemotherapy and renewed interest in quality-of-life issues has increased interest in bladder preservation treatments. Unfortunately, despite multiple trials using limited surgical procedures and neoadjuvant or adjuvant chemotherapy, no combined modality has consistently improved survival over the achieved with radical cystectomy alone in patients with T3b disease. Additionally, continent stomal diversions and orthotopic neobladders allow almost normal continence and voiding in both male and female patients, which calls into question the need for bladder preservation. Although no single treatment modality or urinary diversion is right for all patients, a radical cystectomy with continent diversion provides the best chance for survival and allows the best postoperative quality of life. If bladder preservation treatments are used, inclusion in a clinical trial is recommended.

    Title Stress Incontinence: New Alternatives.
    Date October 1996
    Journal International Journal of Fertility and Menopausal Studies
    Excerpt

    Stress incontinence is a symptomatic disease that can be defined as urinary loss resulting from activities that increase abdominal pressure. Treatment of stress incontinence includes behavioral modification, pelvic floor exercises, biofeedback, various medications including estrogens and alpha adrenergic agonists, and surgery, including the surgical implantation of materials, and the use of artificial sphincters. Unfortunately, no standard method of diagnosis exists, and most diagnoses are purely clinical, or based on "tests" that are non-validated. Results of treatment are difficult to assess since the starting point is unknown generally, and the precise effect of a given "treatment" or "intervention" is, thus, usually not determinable. Until we know precisely what we are treating, we will not be able to choose the most effective, or least noxious, treatment for a particular patient, even though effective, non-destructive treatments do exist for specific types of female stress incontinence, a multifactorial problem.

    Title Proper Diagnosis: a Must Before Surgery for Stress Incontinence.
    Date October 1996
    Journal Journal of Endourology / Endourological Society
    Excerpt

    Stress urinary incontinence is just one of many possible reasons for incontinence in a female patient. It is important to determine the exact etiology of the urinary incontinence because successful treatment depends on an accurate diagnosis. Many additional factors such as age, level of activity, presence and degree of pelvic prolapse, detrusor abnormalities, and coexisting medical conditions must be considered during the incontinence evaluation. The physical examination should assess urethral mobility and genital prolapse abnormalities. Bladder storage abnormalities such as poor compliance are accurately assessed using current urodynamic methods, but detrusor control abnormalities, such as detrusor instability, are not. The urodynamic evaluation is directed toward identifying and quantifying urinary leakage attributable to excursions of abdominal pressure utilizing abdominal (Valsalva) leak-point pressure testing. A focused evaluation allows the appropriate operative procedure to be selected, yielding optimal long-term results.

    Title Urodynamic Assessment of Urethral Sphincter Function in Post-prostatectomy Incontinence.
    Date September 1996
    Journal The Journal of Urology
    Excerpt

    Direct measurement of maximum urethral pressure by urethral profilometry has been used widely to assess urethral sphincter function. We attempted to determine if there was any relationship between maximum urethral pressure, which is measured at the level of the membranous urethra, or extrinsic urethral sphincter function, and the amount of abdominal pressure needed to cause leakage (abdominal leak point pressure) in men with post-prostatectomy incontinence. We also examined the relationship between external sphincter function and continence or incontinence.

    Title Leak-point Pressures.
    Date July 1996
    Journal The Urologic Clinics of North America
    Excerpt

    The pressure based management of patients with neurogenic vesical dysfunction has led to greatly improved outcomes with respect to upper and lower urinary tract complications. At the heart of this management is detrusor leak-point pressure testing that verifies that a low intravesical pressure is achieved and subsequently maintained. The abdominal (or Valsalva) leak-point pressure that quantifies the degree and type of urethral sphincter dysfunction, is an essential test in selecting the appropriate treatment for stress urinary incontinence. The authors discuss the history, importance, and application of these two very different tests.

    Title Videourodynamic Studies.
    Date July 1996
    Journal The Urologic Clinics of North America
    Excerpt

    Videourodynamic evaluation that incorporates radiographic imaging with simultaneous measurement of bladder and urethral pressure is the most precise method available for diagnosing complex incontinence and voiding disorders. In addition, videourodynamics has been instrumental to the development of our present knowledge about urethral and bladder function including the concepts of detrusor and abdominal leak point pressures. Although these studies are more expensive and time consuming, the authors have found videourodynamic evaluation indispensable when the diagnosis remains in question after simple urodynamics and when the studies and clinical scenario do not agree.

    Title This Month in Investigative Urology. Commentary on Antibody Production in Response to Collagen Injection.
    Date June 1996
    Journal The Journal of Urology
    Title Glutaraldehyde Cross-linked Collagen in the Treatment of Urinary Incontinence in Children.
    Date February 1996
    Journal The Journal of Urology
    Excerpt

    Prospective analysis was done to assess the efficacy of glutaraldehyde cross-linked collagen in the treatment of pediatric structural urinary incontinence.

    Title Collagen Injection for Intrinsic Sphincteric Deficiency in Men.
    Date January 1996
    Journal The Journal of Urology
    Excerpt

    PURPOSE: We evaluated the efficacy of collagen injections in the treatment of male urinary incontinence due to intrinsic sphincteric deficiency. MATERIALS AND METHODS: A total of 88 men (mean age 68 years) with mild to severe intrinsic sphincter deficiency underwent a mean of 3.5 transurethral injections of collagen (mean total volume injected 25 ml.). Patients were subdivided into 2 groups based on use of more than 3 or 3 or fewer pads per day. Patient age, pad use before treatment, duration of leakage, number of injections, volume of collagen used and etiology of incontinence were compared for the 2 groups. RESULTS: Of the patients 42 became nearly completely dry, 19 had substantial improvement but still required 1 to 3 pads per day, 14 consistently used fewer pads but still more than 3 per day and 13 showed no improvement. Most injections were performed with the patient under local anesthesia and no significant morbidity occurred. CONCLUSIONS: In select patients collagen injections appear to be effective, easy to deliver and safe. Pretreatment incontinence severity, concomitant detrusor abnormalities and etiology of intrinsic sphincteric deficiency other than radical retropubic prostatectomy were associated with a worse response to collagen therapy.

    Title Long-term Results and Complications Using Augmentation Cystoplasty in Reconstructive Urology.
    Date December 1995
    Journal Neurourology and Urodynamics
    Excerpt

    One hundred and twenty-two augmentation cystoplasties performed over an 8-year period were reviewed. Mean age at surgery was 37 years (range 2-82 years). There were 82 female patients. The primary urodynamic diagnosis was reduced compliance in 92 (77%) patients and detrusor hyperreflexia/instability in the remainder. The clinical diagnostic groups were: spinal cord injury/disease in 32 (27%), myelodysplasia in 27 (22%), interstitial cystitis in 21 (17%), idiopathic detrusor instability in 13 (11%), radiation cystitis in 8 (7%), Hinman-Allen syndrome in 5 (4%), and miscellaneous in 11 (9%). A detubularized ileal augmentation was used in 82 (67%) patients. In 36 (30%) a detubularized ileocecocystoplasty was fashioned and in the remainder detubularized sigmoid was used. In 19 patients augmentation accompanied undiversion. Sixteen patients had a simultaneous fascial sling for urethral incompetence. Mean follow-up was 37 months (range 6-96 months). There was no postoperative mortality. During follow-up 4 patients died from unrelated causes, 11 have been lost to follow-up, and 5 patients await planned transplantation. Bladder capacity was increased from a preoperative mean of 108 ml (range 15-500 ml) to 438 ml (200-1,200 ml) postoperatively. Of the 106 assessable patients, 80 (75%) had an excellent result, 21 (20%) were improved, and 5 (5%) had major ongoing problems. During the period of follow-up, 17 (16%) patients underwent revision of their augmentation. Twenty-four (21%) patients developed bladder stones and 30% of these did so more than once. Urinary incontinence became manifest in 15 (13%) patients but required surgical treatment in only half of these. Pyelonephritis occurred in 13 (11%) patients. Five patients developed small bowel obstruction following discharge from hospital. There were 7 instances of reservoir rupture in 5 (4%) patients. Augmentation cystoplasty has a pivotal role in the treatment of a broad range of lower and upper urinary tract problems. Careful patient selection and close follow-up are essential.

    Title Transurethral Collagen Therapy in Women.
    Date October 1995
    Journal The Journal of Urology
    Excerpt

    We evaluated our recent experience with transurethral collagen therapy in women.

    Title Urodynamic Evaluation of Stress Incontinence.
    Date September 1995
    Journal The Urologic Clinics of North America
    Excerpt

    A careful history points the urodynamic examination in the right direction and enables the examiner to ask the correct questions. The individual who does the test is the only reliable interpreter of the results of that study. No urodynamic technique is as sensitive or specific as a blood glucose, or even an electrocardiogram. A history of urgency and urge incontinence suggests uninhibited contractility and is a better index of that condition than a cystometrogram. Leakage occurring shortly after a previous operative procedure for stress incontinence suggests type III stress incontinence. A past history of radiation, prior pelvic surgery, neurologic disease, herniated disc conditions, or prior chemotherapy all require a simple cystometrogram to rule out abnormal bladder compliance. Following a simple history and urodynamic evaluation, a physical examination should be performed, searching for urethra hypermobility and genital prolapse. Abdominal leak-point pressure testing is useful to assign broad categories of incontinence. Relatively high leak-point pressures with hypermobility suggest suspension operations will be effective. Low leak-point pressures with hypermobility often require a sling, and very low leak-point pressures with no hypermobility indicate a suitable candidate for a trial of injection therapy.

    Title Surgical Treatment of Intrinsic Urethral Dysfunction. Slings.
    Date September 1995
    Journal The Urologic Clinics of North America
    Excerpt

    Slings are a durable and effective treatment for intrinsic sphincter deficiency, regardless of its etiology. The history of slings throughout the 20th century, and the current surgical technique, is described in this article. A comparison of slings with alternative treatments of intrinsic sphincter deficiency, such as artificial sphincters and collagen is presented. Slings play a significant role in the treatment of stress incontinence.

    Title Diagnosis and Treatment of Intrinsic Sphincter Deficiency.
    Date August 1995
    Journal International Journal of Urology : Official Journal of the Japanese Urological Association
    Excerpt

    The urethra resists two expulsive forces, detrusor pressure and abdominal pressure. The high pressure area of the urethra resists detrusor pressure, while the lower pressure maximal urethra resists abdominal pressure. At the moment of flow driven by detrusor pressure, however it is produced, detrusor pressure is directly proportional to urethral resistance (pressure) at that moment. Abdominal pressure has no fixed relationship to urethral pressure. A normal urethral sphincter will not leak at any abdominal pressure, while a poorly closed maximal urethra will leak at very low abdominal pressure, despite normal high pressure zone function and pressure. A study of the abdominal pressure required to induce leakage in males after prostatectomy, and in women with incontinence or general prolapse, showed no relationship between maximum urethral pressure and the abdominal pressure required to cause leakage, or the presence or even absence of leakage. These data indicate that urethral pressure and "continence" are not directly related, that and measurement of the force produces leakage is a more accurate assessment of urethral sphincter function. Injectable agents have been found to be effective in females with involuntary urine leakage related to low or very low abdominal pressure in the absence of urethral hypermobility.

    Title Fluid Management by the Urinary Tract and Vice Versa.
    Date August 1995
    Journal The Journal of Urology
    Title Toxicologic Effects of a Novel Acyl-coa:cholesterol Acyltransferase Inhibitor in Cynomolgus Monkeys.
    Date April 1995
    Journal Toxicologic Pathology
    Excerpt

    PD 132301-2, an acyl-CoA: cholesterol acyltransferase (ACAT) inhibitor, was administered orally to cynomolgus monkeys for 2 wk at doses of 25, 50, 100, and 200 mg/kg to assess potential subacute toxicity. Sporadic episodes of soft feces and diarrhea increased in incidence from 100 to 200 mg/kg. Histopathologic alterations in adrenocortical cells of treated monkeys consisted of a dose-related decrease in cytoplasmic fine vacuolation and an increase in cytoplasmic eosinophilia most conspicuous in the zona fasciculata and reticularis. At 50, 100, and 200 mg/kg, a narrow discontinuous zone of cytotoxic cortical cell degeneration occurred in the outer zona fasciculata. Decreased fine vacuolation of cortical cells correlated ultrastructurally with reduced size and number of intracellular lipid vacuoles and biochemically with a dose-related decrease in adrenal total cholesterol (from 56 to 13% of control) and cholesteryl ester (from 51 to 3% of control) concentrations. Other ultrastructural changes noted in zona fasciculata cortical cells at all doses were an apparent increase in both smooth endoplasmic reticulum and variably sized autophagic vacuoles. Ovarian corpora lutea in some females at all doses had increased coarse vacuolation of luteal cells, foci of cellular degeneration, increased numbers of cholesterol clefts, and slight infiltrates of mononuclear cells. Sebaceous glands were atrophic in all treated monkeys due largely to a reduction in size and number of differentiated foam cells. Sebaceous gland reserve cells were hypertrophic and hyperplastic. Toxicity data from this study indicated that PD 132301-2 at 25-200 mg/kg targeted cholesterol-rich cells of the adrenals, ovaries, and skin adnexa.

    Title Comparative Biochemical Characteristics of the Cat and Rabbit Urinary Bladder.
    Date November 1994
    Journal Neurourology and Urodynamics
    Excerpt

    The cat and the rabbit are two of the most popular models for the study of lower urinary bladder function. The cat has been used extensively for in vivo studies of spinal and supra-spinal micturition reflexes. In contrast, the rabbit has been used extensively for the in vitro study of bladder function. Although the cat and rabbit bladders are approximately the same mass, the cat bladder can generate approximately 6 times the intravesical pressure than the rabbit bladder at the same volume (in vitro response to field stimulation). In order to determine if the increased pressure generation is related to increased cellular energetics, we compared the intracellular concentrations of ATP and creatine phosphate (CP), and the enzyme activities of three enzymes which have important functions in cellular energetics: creatine kinase, citrate synthase, and malic dehydrogenase between the cat and rabbit urinary bladder. The results can be summarized as follows: (1) The bladder weight of the cat and rabbit are similar. (2) The isolated cat bladder can generate approximately 6 times the intravesical pressure of the isolated rabbit bladder. (3) The ATP and CP concentrations of the rabbit are significantly greater than the concentrations in the cat bladder. (4) The hydroxyproline concentration is significantly greater in the cat than the rabbit. (5) The maximum activities of creatine kinase, citrate synthase, and malic dehydrogenase are significantly lower in the cat than the rabbit. In general, it is clear that the ability of the cat to generate high intravesical pressures is not correlated with increased tissue high energy phosphate concentrations, or high enzymatic activities of three specific cytosolic or mitochondrial enzymes.

    Title Surgery for Ovarian Remnant Syndrome. Lessons Learned from Difficult Cases.
    Date November 1994
    Journal The Journal of Reproductive Medicine
    Excerpt

    Ten cases of ovarian remnant syndrome jointly managed by gynecology and urology departments are presented. Complications of the surgery included a high incidence of ureteral and bowel injury. Preoperative, intraoperative and postoperative considerations may reduce the complications or minimize their significance. One case of ovarian cancer developed among the instances of ovarian remnant syndrome in this series. Preoperative, intraoperative and postoperative considerations can reduce the complications of surgery for ovarian remnant syndrome.

    Title Outcome of Reflux in Children with Myelodysplasia Managed by Bladder Pressure Monitoring.
    Date November 1994
    Journal The Journal of Urology
    Excerpt

    From June 1984 to December 1992 voiding cystourethrography performed on 209 patients with myelodysplasia revealed vesicoureteral reflux in 57 (27%). High grade reflux (3 to 5/5) occurred in 33 patients (58%). Bladder pressure at typical capacity, defined as the pressure at average catheterization volume or bladder leak point pressure, was determined urodynamically. After a mean of 56 months vesicoureteral reflux resolved or improved in 55% of patients and remained unchanged in 28%. There was no correlation between the grade of reflux and the rate of spontaneous resolution. Pressure at typical capacity of 40 cm. water or more was significantly more common in patients with reflux (44%) than in those with no reflux (20%) (p < 0.001). There was a strong association between pressure at typical capacity of 40 cm. water or more and upper tract deterioration (p < 0.0001). However, there was no correlation between pressure at typical capacity and grade of reflux (p = 0.18). Treatment of pressure at typical capacity of 40 cm. water or more led to resolution or improvement of vesicoureteral reflux in 8 of 10 reevaluated patients. Hydronephrosis resolved (7) or improved (1) in 8 of 9 cases. Measurement of intravesical pressure is of paramount importance in the management of spina bifida patients with vesicoureteral reflux. Maintaining the pressure at typical capacity at less than 40 cm. water is associated with increased spontaneous resolution of vesicoureteral reflux and a lower incidence of upper tract deterioration.

    Title Fiberoptic Microtransducer Pressure Technology: Urodynamic Implications.
    Date October 1994
    Journal Neurourology and Urodynamics
    Excerpt

    The FST 200 is a novel commercially available pressure measurement system that combines microtechnology and fiberoptics and is particularly well suited for invasive urodynamic studies. Pressure recording with this system is highly accurate and reproducible. The pressure curves obtained parallel those from standard water cystometry. Being small and portable, the system lends itself to invasive transurethral monitoring in the privacy of an examination room. Additionally, the 5F catheter size allows the performance of leak point pressures and pressure/flow voiding studies with minimal urethral stenting artifact often seen with larger catheters. The technical aspects of this system are presented.

    Title Pubovaginal Slings for the Management of Urinary Incontinence in Female Adolescents.
    Date July 1994
    Journal The Journal of Urology
    Excerpt

    A pubovaginal sling is an effective treatment for type III incontinence secondary to poor proximal urethral sphincter function. We used a pubovaginal sling to treat incontinence in 15 female adolescents. The etiology of incontinence was spinal dysraphism in 10 patients and prior trauma in 3. Simultaneous bladder augmentation was performed in the remaining 2 patients for poor bladder compliance. Three patients required additional procedures including repeat slings in 2 and repeat augmentation in 1. Of 13 patients followed for more than 6 months 11 remain dry, 1 leaks small amounts and wears 1 pad per day, and 1 did not achieve acceptable continence and was subsequently managed with bladder augmentation and a Mitrofanoff procedure. The upper urinary tracts have remained normal in all 13 patients. The pubovaginal sling has proved to be safe and successful in these children. The overall continence rate of 92% compares favorably to other available modalities.

    Title Early Clinical Experience with Adult Bladder Auto-augmentation.
    Date July 1994
    Journal The Journal of Urology
    Excerpt

    Five patients 18 to 73 years old underwent auto-augmentation for a small capacity, poorly compliant bladder. The mean operative time and hospital stay were 106 minutes and 6 days, respectively. No postoperative complications occurred. Followup ranged from 12 to 82 weeks. Bladder capacity increased from 75 to 310 cc or 40 to 310%. Compliance also improved in all patients. Three patients had reflux preoperatively, which resolved in 1 and improved in 2. Of 4 patients who were incontinent preoperatively 3 became continent postoperatively and extended the interval between catheterizations. Upper tract function has remained stable. No patient required enterocystoplasty to control bladder pressures.

    Title Incontinent Ileo-vesicostomy Urinary Diversion in the Treatment of Lower Urinary Tract Dysfunction.
    Date June 1994
    Journal The Journal of Urology
    Excerpt

    The combination of high spinal cord injury and neurovesical dysfunction can present formidable problems in urological management. The lack of upper extremity function often prevents intermittent catheterization and leads to alternative methods. A total of 23 patients underwent incontinent ileo-vesicostomy in an effort to gain a low pressure bladder and control of urinary soiling: 17 had been previously treated by catheter drainage, 9 had bladder and/or renal calculi, 9 experienced recurrent sepsis, and 7 had urethrocutaneous fistula and total urinary incontinence. Most patients had poorly compliant bladder dysfunction associated in 9 cases with poor urethral continence function. At a mean followup of 45 months (range 3 to 240 months) 22 of 23 patients had a low pressure reservoir with low pressure degrees of urine into a collection device. Complications included stomal stenosis in 3 patients and poor drainage across the ileovesical junction requiring revision in 2. One of these patients ultimately underwent ileal loop diversion. Upper tract function improved or remained stable in all patients.

    Title Transurethral Collagen Injection for Urinary Incontinence.
    Date May 1994
    Journal Urology
    Title Intravesical Instillation of Gentamicin Sulfate: in Vitro, Rat, Canine, and Human Studies.
    Date May 1994
    Journal Urology
    Excerpt

    OBJECTIVE. Intravesical instillation of gentamicin sulfate has been used empirically as prophylaxis and to treat bacilluria in spinal-cord-injured patients undergoing clean intermittent catheterization. To assess the risks of absorption and the effects of storage conditions on antimicrobial potency, a series of studies were conducted. METHODS. Four studies were carried out: (1) An infected fulgurated rat bladder model was created to determine the effects of inflammation and infection on absorption. (2) A canine model with bilateral vesicoureteral reflux and elevated bladder pressures (> 40 cmH2O) assessed the effects of reflux and storage pressure. (3) The effects in patients with associated conditions including renal transplantation, myelomeningocele, vesicoureteral reflux, and bladder augmentation, were analyzed. (4) To determine the effects of storage conditions, solutions of gentamicin sulfate (480 mg gentamicin sulfate in 1 L 0.9% NaCl) were made that controlled for pH, storage temperature, and duration. RESULTS. (1) Increased absorption was found in 43 percent of rat serum samples. (2) None of the dogs demonstrated measurable absorption. (3) None of the patients likewise had measurable absorption. (4) All solutions were equally potent when tested against a panel of common urinary pathogens. Storage up to two months at room temperature without alkalinization had no effect on potency. CONCLUSIONS. Instilled intravesical gentamicin sulfate has a low risk of absorption and is highly effective. Severe bladder inflammation can increase transvesical absorption. It has prolonged stability without special storage conditions and should be considered as a route of prophylaxis in patients who perform intermittent catheterization.

    Title The Effect of Terazosin on Bladder Function in the Spinal Cord Injured Patient.
    Date April 1994
    Journal The Journal of Urology
    Excerpt

    We prospectively studied the effect of terazosin on bladder compliance in 12 spinal cord injured patients. All study patients had demonstrated previously poor compliance despite clean intermittent catheterization and maximum anticholinergic therapy. Patients were started on 5 mg. terazosin nightly for 4 weeks. They were evaluated with a history, physical examination, symptom score, and synchronous cystoscopy and cystometry before, during and after terazosin therapy. Detrusor compliance improved in all patients during the treatment phase. The change in bladder pressure and the safe bladder volume were statistically and clinically significant. Patients also reported fewer episodes of incontinence and dysreflexia. The improvement in compliance and continence suggests that in the spinal cord injured patient terazosin may have an effect on alpha receptors in the detrusor muscle or central effects and that improved compliance is not due to decreased outlet resistance.

    Title Bladder Compliance.
    Date April 1994
    Journal The Journal of Urology
    Title A Brief History of Urethral Catheterization.
    Date February 1994
    Journal The Journal of Urology
    Title Periurethral Collagen for Urinary Incontinence After Gender Reassignment Surgery.
    Date November 1993
    Journal Urology
    Excerpt

    We report on 2 patients, one female and one male transsexual; in both, Type III stress urinary incontinence developed after gender reassignment surgery. Both patients were treated by periurethral injection of gluteraldehyde cross-linked collagen resulting in a marked symptomatic improvement in association with a significant rise in abdominal leak point pressures. We believe these are the first reported cases of collagen injection being used for urinary incontinence after gender reassignment surgery.

    Title Specificity of the American Urological Association Voiding Symptom Index: Comparison of Unselected and Selected Samples of Both Sexes.
    Date November 1993
    Journal The Journal of Urology
    Excerpt

    The American Urological Association voiding symptom index questionnaire for benign prostatic hypertrophy was administered to an elderly unselected sample and a selected urology clinic sample of both sexes to investigate the ability of this instrument to identify prostatic pathological conditions. The female subjects in these cohorts provided a control. In the large unselected sample the male subjects scored statistically higher in only 2 categories, weak stream (487 subjects) and strain (507) (p < 0.05 for both categories). The clinical significance of these scores is questionable, however, since they were low (less than 2 of 5). In the selected group (145 subjects) the female subjects showed a higher total mean score due to the contribution of statistically higher irritative scores (p < 0.05). We conclude that the American Urological Association voiding symptom index does not specifically identify prostatic pathological conditions, and that elderly men and women have similar voiding symptom scores. Therefore, treatment that results in improvement in symptom scores may not specifically affect the prostate. Other factors, such as an aging detrusor, changes in physiological production of urine or other unknown factors, may contribute to the symptoms.

    Title Management of Urethral Obstruction with Transvaginal Urethrolysis.
    Date November 1993
    Journal The Journal of Urology
    Excerpt

    Transvaginal urethrolysis was performed in 48 patients with urethral obstruction following 1 or more urethral suspension procedures. A needle suspension procedure had been performed in 19 patients (40%), retropubic urethropexy in 17 (35%) and pubovaginal sling in 10 (21%). A good response as indicated by normal voiding with minimal or no irritative symptoms was achieved in 33 patients (65%). The most common presenting complaints were irritative voiding symptoms (71%) and urinary retention (60%). Fluoroscopic urodynamic evaluation frequently demonstrated urethral hypersuspension, a cystocele and/or elevated voiding pressures. No patient had stress urinary incontinence as a result of the procedure. Urethral obstruction should be recognized as a potential complication following surgical correction of female stress urinary incontinence. Transvaginal urethrolysis is a safe and effective method to manage this problem.

    Title Clinical Assessment of Urethral Sphincter Function.
    Date November 1993
    Journal The Journal of Urology
    Excerpt

    Measurements of urethral pressures, such as maximum urethral pressure, are widely believed to have relevance in the management of urinary incontinence despite evidence to the contrary. In this study maximum urethral pressure and the abdominal pressure required to cause stress incontinence were measured in 125 women with stress incontinence. In women the abdominal pressure required to cause stress incontinence was unrelated to maximum urethral pressure. These findings indicate that maximum urethral pressure has little relationship to urethral resistance to abdominal pressure. In the 9 children with myelodysplasia we compared the detrusor pressure with the abdominal pressure required to induce urethral leakage. These values also were quite different, indicating that as far as the urethra is concerned abdominal pressure and detrusor pressure are not equivalent forces.

    Title Enterocystoplasty in Renal Transplantation Candidates: Urodynamic Evaluation and Outcome.
    Date November 1993
    Journal The Journal of Urology
    Excerpt

    In anticipation of renal transplantation 11 patients with end stage renal disease and small volume, poorly compliant bladders underwent enterocystoplasty. The etiology of bladder dysfunction included myelodysplasia in 4 patients, posterior urethral valves in 4 and vesicoureteral reflux in 3. Mean patient age at the time of bladder augmentation was 16.4 years (range 10 to 28). Detubularized bowel segments were used in all patients and included ileum in 7, ileocecal segment in 3 and sigmoid in 1. Urodynamic evaluation before and after enterocystoplasty demonstrated marked improvement in bladder capacity and compliance. These 11 patients have received 13 renal transplants with an 85% graft survival at a mean followup of 30.1 months. No bladder ruptures or other perioperative complications have occurred. All patients remain continent on clean intermittent catheterization. Our experience suggests that enterocystoplasty is a safe and effective method of restoring lower urinary tract function in the patient with end stage renal disease and a small, noncompliant bladder.

    Title Subacute Toxicity of a Halogenated Pyrrole Hydroxymethylglutaryl-coenzyme A Reductase Inhibitor in Wistar Rats.
    Date October 1993
    Journal Toxicologic Pathology
    Excerpt

    Wistar rats received an hydroxymethylglutaryl-coenzyme A (HMG-CoA) reductase inhibitor, a halogenated pyrrole designated PD 123244-15, orally by gavage for 14 days at 10, 50, 150, 300, and 600 mg/kg. Doses of 150-600 mg/kg caused death and marked systemic toxicity involving stomach, esophagus, liver, gonads, lymphoid tissues, and skeletal muscle. Histopathologic findings included hyperkeratosis in esophagus and forestomach, increased hepatic mitotic activity, ovarian follicular necrosis, testicular atrophy and arrested spermatogenesis, and skeletal muscle necrosis and regeneration. Elevated serum aspartate aminotransferase correlated with muscle necrosis and hepatocellular damage. Marked systemic effects associated with high plasma concentrations were consistent with toxicity defined for other HMG-CoA reductase inhibitors, with the exception of pathologic alterations in the esophagus and ovaries. Direct mucosal irritation may have contributed to forestomach and esophageal lesions induced by this halogenated pyrrole.

    Title Urinary Incontinence.
    Date September 1993
    Journal Journal of Et Nursing : Official Publication, International Association for Enterostomal Therapy
    Title Synchronous Cystoscopy and Cystometry in the Management of Neurogenic Bladder Dysfunction.
    Date August 1993
    Journal The Journal of Urology
    Excerpt

    The physical difficulties associated with cystoscopy and cystometry in the spinal cord injury patient led to a clinical trial of synchronous cystoscopy and cystometry in these individuals. Following a disappointing experience with external transducer methodology, a recently available fiberoptic microtransducer system was used and an effective system was developed. A total of 20 individuals with spinal cord injury underwent a standard water cystometrogram on an examination table followed by synchronous flexible cystoscopy and cystometry using a 5F fiberoptic microtransducer while seated in a chair. The results showed both pressure tracings to be clinically identical. Uninhibited contraction spikes, compliance curves and leak point pressures were essentially the same by both methods and artifact was not a problem. Given the speed, ease and reproducibility of this method, the difficulties with patient transfer for these studies have been virtually eliminated. Two urethral instrumentations have been replaced by 1. Examination room time was decreased from 60 to approximately 10 to 15 minutes with half of the required personnel. Perhaps more importantly, these occasionally problematic individuals clearly prefer this streamlined approach and patient compliance with followup has improved.

    Title Stress Leak Point Pressure: a Diagnostic Tool for Incontinent Children.
    Date August 1993
    Journal The Journal of Urology
    Excerpt

    The stress leak point pressure is the lowest bladder pressure at which leakage occurs during prompted increases in intra-abdominal pressure. The stress leak point pressure is distinct from the simple bladder leak point pressure and can be determined using simple urodynamic equipment without fluoroscopy. In 15 incontinent girls and boys 2.5 to 15 years old the mean stress leak point pressure was 54.7 cm. water (range 11 to 100), whereas the mean leak point pressure was 19.9 cm. water (range 5 to 50, paired t test p < 0.0001). The stress leak point pressure is a useful diagnostic tool that provides specific data on bladder neck and proximal urethral function.

    Title Pubovaginal Sling for Treatment of Female Stress Urinary Incontinence Complicated by Urethral Diverticulum.
    Date May 1993
    Journal The Journal of Urology
    Excerpt

    To evaluate the practicality of combining urethral diverticulectomy with a procedure for stress urinary incontinence, the records of 14 patients who underwent urethrodiverticulectomy during a 3-year period were reviewed. Noteworthy was that 10 patients (71%) had urinary incontinence as the chief complaint, while 8 (57%) had symptoms of stress urinary incontinence and underwent fluoroscopic urodynamic testing and the others had post-void dribbling. Of the latter 8 patients 7 (50%) demonstrated type II or type III stress urinary incontinence and 1 had a normal study. The 7 women then underwent transvaginal diverticulectomy with a concomitant pubovaginal sling. Of the diverticula 4 (57%) were true diverticula and 3 (43%) appeared to be pseudodiverticula or traction diverticula related to a previous urethral suspension. At 3 to 21 months (mean 17) all patients were cured of stress urinary incontinence. One patient exhibited detrusor instability postoperatively, which was ultimately treated with an Ingelman-Sundberg procedure. Postoperatively, 1 diverticulum recurred, for a recurrence rate of 14%. We conclude that the presence of a urethral diverticulum does not compromise successful repair of associated stress urinary incontinence when the pubovaginal sling procedure is used.

    Title Toilet Habits and Continence in Children: an Opportunity Sampling in Search of Normal Parameters.
    Date May 1993
    Journal The Journal of Urology
    Excerpt

    An opportunity sampling of 1,192 children regarding parameters of toilet training and elimination status was obtained by interview and questionnaire. Toilet training ages ranged from 0.75 to 5 years, with a mean of 2.4 +/- 0.6 years (standard deviation). Voiding frequency was inversely related to age; most children between 3 and 12 years old urinated 5 to 6 times per day. Influences of gender, urinary infections and parental recall were investigated. Nocturnal and diurnal enuresis was reported in 18% and 10% of our sample, respectively. Bowel movements per week ranged from 1 to 21, with a mean of 6.8 +/- 2.5.

    Title Collagen Injection for the Dysfunctional Urethra.
    Date May 1993
    Journal Contemporary Urology
    Title Vulvar Vestibulitis and Interstitial Cystitis: a Disorder of Urogenital Sinus-derived Epithelium?
    Date May 1993
    Journal Obstetrics and Gynecology
    Excerpt

    BACKGROUND: Vulvar vestibulitis and interstitial cystitis are enigmatic and controversial conditions. They are increasingly recognized as important causes of genitourinary pain in young women. This report proposes an etiologic association between the two conditions. CASES: We report three patients with both vulvar vestibulitis and interstitial cystitis. Although an association between these conditions has previously been proposed, these are the first case reports of the coexistence of these conditions in the same patient. CONCLUSION: Because both the vestibule of the vulva and the bladder are derived from the urogenital sinus, we propose that the coexistence of vulvar vestibulitis and interstitial cystitis in some patients represents a generalized disorder of urogenital sinus-derived epithelium.

    Title Aortic Occlusion and Lower Extremity Exercise Induced Stress Urinary Incontinence.
    Date April 1993
    Journal The Journal of Urology
    Excerpt

    An unusual case of intermittent stress urinary incontinence associated with lower extremity exercise in a patient with aortoiliac occlusive disease is reported. Preoperative noninvasive vascular testing revealed severe compromise of lower extremity and pelvic blood flow. Fluoroscopically guided preoperative urodynamic evaluation without exercise revealed a competent urethral sphincter mechanism that became incompetent following exercise sufficient to induce claudication. The claudication and exercise-induced incontinence resolved after aortobifemoral bypass, and postoperative urodynamic studies were normal.

    Title Subacute Toxicity of a Novel Inhibitor of Acyl-coa: Cholesterol Acyltransferase in Beagle Dogs.
    Date April 1993
    Journal Fundamental and Applied Toxicology : Official Journal of the Society of Toxicology
    Excerpt

    PD 132301-2 is a substituted urea hypolipidemic and antiatherosclerotic agent that is a potent inhibitor of acyl-CoA:cholesterol acyltransferase (ACAT). To determine its subacute toxicity, PD 132301-2 was administered orally to beagle dogs at 0, 6, 12, 25, 50, 200, 400, or 800 mg/kg/day for 2 weeks. Clinico-pathologic evaluations were completed on all dogs. Liver and adrenal total and esterified cholesterol concentrations, adrenocorticotrophic hormone (ACTH) responsiveness, and adrenal ultrastructure were determined at 0, 6, 12, and 25 mg/kg. At 12 mg/kg or greater, salivation, epiphora, conjunctivitis, emesis, anorexia or decreased food consumption, and soft to mucoid feces and/or diarrhea were noted. Suppression of ACTH response occurred by Day 6 at all doses. Adrenocortical degeneration and/or necrosis in zona fasciculata and reticularis was seen at all doses; adrenal free and esterified cholesterol were normal at 6 mg/kg and decreased at 12 and 25 mg/kg. Increases in serum alanine aminotransferase (2- to 15-fold), aspartate aminotransferase (2- to 12-fold), and alkaline phosphatase (2- to 7-fold) were noted at 50 mg/kg or greater. Periportal hepatocellular hypertrophy and hypereosinophilia occurred at 50 mg/kg or greater; hepatic cholesterol values were not significantly affected by treatment. Dose-dependent ultrastructural alterations in adrenocortical cells included decreased numbers of mitochondria and smooth endoplasmic reticulum profiles, qualitative and quantitative changes in lipid globules, and increased numbers of autolysosomes. PD 132301-2 or one of its metabolites has potent adrenocorticolytic properties and limited hepatotoxic properties by mechanism(s) that are likely independent of systemic ACAT inhibition.

    Title Treatment of Anejaculation with Electroejaculation.
    Date March 1993
    Journal Acta Urologica Belgica
    Excerpt

    Male infertility caused by anejaculation is common after spinal cord injury (SCI) and following retroperitoneal lymph node dissection (RPLND) for testicular cancer. Other conditions sometimes associated with neurogenic ejaculation loss are diabetes mellitus, multiple sclerosis, extensive pelvic surgery and adult myelodysplasia. Primary absence of ejaculation also has been described. Few treatment options exist for these patients, if they wish to father a child. With electroejaculation (EEJ), or the low-current stimulation of the ejaculatory organs via a rectal probe, emission of semen can be initiated in these men. In non-SCI-patients EEJ requires general anaesthesia. The collected semen is washed and the motile sperm fraction isolated before artificial insemination (AI) of the partner. At the University of Michigan 198 men have been treated between 1986 and December 1991. An ejaculate could be obtained from nearly all patients. A major obstacle to success is the severe asthenozoospermia and the poor functional quality of the obtained sperm samples. This can be caused by the EEJ-technique itself, as well as by the long anejaculatory status. A semen sample with at least 10 million progressively motile sperm cells, useful for AI, was obtained in 75% of the SCI men and in 87% of the men following RPLND. In the couples wishing insemination, 49 pregnancies were induced, accounting for an overall pregnancy rate of 35% per couple. Thirty five healthy babies have been born. Only three complications were encountered. At Hannover Medical School only few patients have been stimulated to date. We could obtain an adequate sperm sample for AI from all of them. No complications were seen. As the first couple has just entered the phase of AI with husband sperm, an analysis of these results would be premature. Electroejaculation combined with artificial insemination is an efficient and safe treatment of male infertility due to neurogenic anejaculation.

    Title Intermittent Self-catheterization of the Renal Pelvis: Report of 2 Cases.
    Date February 1993
    Journal The Journal of Urology
    Excerpt

    We review the long-term outcome of 2 patients in whom cutaneous ureterostomies were performed. Complications included necrosis and distal ureteral stenosis, peristaltic dysfunction, urosepsis, calculus formation and renal impairment. Fluoroscopic ureterometry confirmed high pressure collecting systems in both patients 14 to 17 years postoperatively. Subsequent management during the last 4 to 6 years with clean intermittent self-catheterization has resulted in a significant improvement in the urological status.

    Title The Role of Urodynamic Investigation in the Assessment of Benign Prostatic Hypertrophy.
    Date October 1992
    Journal The Journal of Urology
    Title Studies on Experimental Bladder Outlet Obstruction in the Cat: Long-term Functional Effects.
    Date September 1992
    Journal The Journal of Urology
    Excerpt

    Experimental bladder outlet obstruction in cats induces a significant increase in the in vivo leakage pressure. The effects of obstruction on the detrusor function were analyzed, using control, 3, 6 and 12 month obstructed cats. The in vivo leakage pressures were substantially increased in all obstructed groups. From a previous study on the short-term effects of obstruction in the cat; although there was an immediate increase in pressure, there were no significant differences between control bladders and two week obstructed bladders in: bladder weight, peak pressure response to field stimulation and bethanechol, and emptying of the in vitro whole bladder model. In this current study, although there was no direct relationship between duration of obstruction and severity of the impaired pharmacological response of the isolated whole bladder, there was a direct relationship between the magnitude of the increase in bladder weight, leakage pressure, and impaired functional response of the in vitro whole bladder. In this regard the cats were separated into four groups: controls and shams (average bladder weight 2.95 gm.), obstructed group 1 with bladder weights less than 6.0 gm. obstructed group 2 with bladder weights between 6 and 10 gm., and obstructed group 3 with bladder weights greater than 10 gm. The results can be summarized as follows: A) In vivo leakage pressures were significantly increased in all obstructed groups, and progressively higher in proportion to the bladder weights. B) Bladder capacity significantly increased in all, being greatest in obstructed group 3. C) The magnitude of the response to field stimulation of obstructed groups 1 and 2 were significantly greater than the response of control bladders at virtually all frequencies. The frequency response curve of obstructed group 3 was similar to control. D) The ability of the bladder to empty in response to field stimulation was significantly reduced in all obstructed groups. The magnitude of the decrease was proportional to the increase in bladder weight. E) There were no differences between control and obstructed bladders in the pressure response to bethanechol or KCl; the ability of both bethanechol and KCl to empty the bladder was reduced in the obstructed groups. In general, the presence of bladder enlargement was accompanied by significant alterations in the ability of the in vitro bladder to empty in response to field stimulation, bethanechol, and KCl.(ABSTRACT TRUNCATED AT 400 WORDS)

    Title Urinary Tract Status of Patients with Neurogenic Dysfunction Presenting with Upper Tract Stone Disease.
    Date September 1992
    Journal The Journal of Urology
    Excerpt

    We treated 71 patients with neurogenic vesical dysfunction between September 1983 and June 1990 for upper tract stones. We studied these patients to determine the time course of stone development and the presence of associated urological abnormalities. There were 44 male and 27 female patients 6 to 72 years old. Lower urinary tract dysfunction resulted from spinal cord injuries in 34 patients (48%), myelodysplasia in 19 (27%), multiple sclerosis in 12 (17%) and other diagnoses in 6 (8%). Of 71 patients 21 (30%) were managed by an ileal loop, 12 (17%) by a Foley catheter, 10 (14%) by a suprapubic tube, 10 (14%) by ureterostomy, 5 (7%) by vesicostomy, 8 (11%) by intermittent catheterization, and 5 (7%) by diaper, Créde's voiding or condom catheterization. Stone disease developed within 1 to 22 years. Patients with an indwelling catheter or supravesical diversion fared worse than those managed by intermittent catheterization or vesicostomy; they had higher rates of renal unit loss, renal parenchymal damage, decreased renal function, hydroureter, and staghorn and bilateral calculi. All of the listed methods of management were contemporaneous, suggesting the continued use of methods proved to be associated with upper tract deterioration.

    Title The Treatment of Urinary Incontinence in Children Using Glutaraldehyde Cross-linked Collagen.
    Date July 1992
    Journal The Journal of Urology
    Excerpt

    Periurethral injection of polytetrafluoroethylene (PolyTef) paste has been used to correct urinary incontinence for 2 decades. The controversy over distant migration of the paste has led to an interest in alternative materials particularly for the pediatric patient. Glutaraldehyde cross-linked collagen, derived from bovine dermal collagen, is effective in treating urinary incontinence in adults. Eight children with structural urinary incontinence underwent glutaraldehyde cross-linked collagen injection. Fluorourodynamic studies preceded and followed the injections. An average of 10.9 cc glutaraldehyde cross-linked collagen was injected per treatment (range 2.5 to 20). The number of injections per child ranged from 1 to 6 (mean 2.1) and followup averaged 13.75 months (range 6 to 33). Overall, 88% of the patients were cured or improved: 5 (63%) became continent, 2 were improved and 1 had no effect.

    Title Comparative Autonomic Responses of the Cat and Rabbit Bladder and Urethra.
    Date July 1992
    Journal The Journal of Urology
    Excerpt

    The cat and the rabbit have both been utilized extensively in the study of lower urinary tract function. Previous studies have demonstrated that although both the cat and rabbit bladder are approximately the same weight, the in-vitro cat bladder can generate over 6 times the intravesical pressure of the rabbit bladder. The current study was designed to compare the ability of the isolated bladder to generate pressure with the pressures required to maintain flow through the isolated urethra for both the cat and the rabbit. The results can be summarized as follows. 1) The cat bladder is visibly much thicker than the rabbit bladder, and in vitro cystometry demonstrates that it is far less compliant than the rabbit bladder. 2) Over 20 cm.H2O pressure is required to begin flow through the isolated cat urethra preparation, whereas 5 cm.H2O begins flow through the rabbit urethra. 3) Increasing the flow rate (up to 7-fold) through both the isolated cat and rabbit urethra increases intraurethral pressure only slightly. 4) Both the isolated cat and rabbit urethra respond strongly to field stimulation and alpha-adrenergic stimulation (relative to the opening pressure required to begin flow), but not to cholinergic stimulation. 5) Field stimulation following pre-stimulation by methoxamine induces a strong relaxation of the pre-stimulated cat urethra, but an additive contraction in the pre-stimulated rabbit urethra. These studies demonstrate that in order for the cat to empty its bladder, it must generate a comparatively high intravesical pressure, whereas the rabbit is required to generate a relatively low intravesical pressure.

    Title Abnormal Galactosylation of Complex Carbohydrates in Cultured Fibroblasts from Patients with Galactose-1-phosphate Uridyltransferase Deficiency.
    Date July 1992
    Journal Pediatric Research
    Excerpt

    An abnormality in galactosylation of complex carbohydrates may be important in the pathogenesis of the long-term complications of classic (galactose-1-phosphate uridyltransferase-deficient) galactosemia. The ability of nine galactosemic fibroblast preparations to be galactosylated with a purified galactosyltransferase was measured as an indicator of vacant sites where galactose would normally reside. The amount of galactose transferred to cell protein from galactosemic patients was significantly higher than that transferred to a group of seven controls (p less than 0.005). Galactosyltransferase activity of the galactosemic cell preparation toward N-acetylglucosamine was also significantly higher than normal (p less than 0.01), and there was a linear relationship between these two parameters in galactosemic but not normal cells. These findings suggest that there is defective galactosylation of galactosemic cell complex carbohydrates and that such cells increase their galactosyltransferase levels in an attempt to compensate for the defect. Defective galactosylation may be implicated as an etiologic factor in complications observed in galactosemic patients even when treated with galactose-restricted diets.

    Title Chronic Toxicity and Carcinogenicity Studies with the Beta-adrenoceptor Antagonist Levobunolol.
    Date July 1992
    Journal Fundamental and Applied Toxicology : Official Journal of the Society of Toxicology
    Excerpt

    The chronic toxicity and carcinogenicity of levobunolol, a nonselective beta-adrenoceptor antagonist, was evaluated in Swiss mice and Wistar rats. The drug was administered in the diet to mice at 0, 12, 50, and 200 mg/kg/day for 80 weeks and to rats at 0, 0.5, 2, 5, 30, and 180 mg/kg/day for 2 years. In mice, uterine leiomyomas were present in 4 of 50 females at 200 mg/kg but not in any other group. The incidences of other tumor types, as well as pathologic findings, were comparable among groups. In rats, significant body weight gain suppression occurred at 5, 30, and 180 mg/kg. Brown discoloration of perianal fur and steel-gray discoloration of hairless skin were evident in high-dose rats. A generalized steel-gray discoloration of internal organs and tissues occurred in the 30 and 180 mg/kg groups. No other differences between treated and control groups were evident. The clinical relevance of the increased incidence of uterine leiomyoma in mice is questionable because it occurred only in one species at more than 200 times the projected therapeutic dose.

    Title Fertility of Spinal Cord Injured Males: Effect of Genitourinary Infection and Bladder Management on Results of Electroejaculation.
    Date June 1992
    Journal The Journal of the American Paraplegia Society
    Excerpt

    Thirty-eight men undergoing electroejaculation (EEJ) procedures for anejaculatory infertility were examined for the presence or absence of infection in urine and semen. In 29 spinal cord injury patients, a high incidence of infected urine and infected semen (41% and 56%, respectively) was seen, in contrast to patients with normal bladder function (0% and 11%). Urinary infection was associated with slightly lower sperm quality and lower pregnancy rates (10% vs 30% in the presence of sterile urine). Semen infection had no effect on sperm counts or pregnancy rates. If intermittent self-catheterization (ISC) was used to empty the neurogenic bladder, slightly better sperm quality was seen, the total failure rate was less, and much better pregnancy rates (44%) resulted than for patients using an alternative bladder management (7%). Antibiotics did not reduce the incidence of urine or semen infection, but did improve sperm counts slightly. Continuous prophylaxis was associated with bacterial resistance to many oral antibiotics and had no advantage over a short course of antibiotics prior to the procedure. Despite the above associations, the sperm quality in our patient population was never normal compared with that of men who ejaculate normally. We conclude that the low sperm quality seen in electroejaculation specimens from spinal cord injured males is not due entirely to infection or to the type of bladder management. Short courses of antibiotics, instead of continuous antibiotic prophylaxis, may be beneficial. Intermittent catheterization is superior to other methods of neurogenic bladder management in maintaining the fertility of spinal cord injured men.

    Title Calcium Valproate-induced Uterine Adenocarcinomas in Wistar Rats.
    Date February 1992
    Journal Toxicology
    Excerpt

    Calcium valproate is an anticonvulsant agent with pharmacokinetic properties similar to sodium valproate and valproic acid. Potential carcinogenesis of calcium valproate was evaluated in B6C3F1 mice and Wistar rats given 125, 250 and 500 mg/kg in the diet for 104 weeks. Survival in treated rats increased in a dose-related pattern despite a tumorigenic response in females. Adenocarcinomas of the uterus and cervix were increased in treated rats when compared to controls. The incidence of uterine neoplasia was 8, 20, 14 and 32% in the control, 125, 250 and 500 mg/kg groups, respectively. Neoplasia in treated rats were detected against a higher than expected background of adenocarcinomas in concurrent controls, since 8% incidence in controls was substantially above the laboratory historical database value of 0.6%. Tumors varied from epithelial masses confined to the endometrium, to transmural, highly desmoplastic neoplasms that invaded the serosa lining and the peritoneal cavity. These tumors metastasized in treated rats but not in controls. The statistically significant (P less than 0.01) increase in uterine adenocarcinomas found in females given 500 mg/kg of calcium valproate contrasts the absence of this tumor type in a previous rat carcinogenicity bioassay with valproic acid. Subcutaneous fibrosarcomas were significantly increased in valproic acid-treated males, but no uterine tumors were reported in females. It is puzzling that a true carcinogenic potential would be expressed by markedly different target organs as obtained with the acid and calcium salt of this moiety.

    Title The Effects of Early Removal of Indwelling Urinary Catheter After Radical Hysterectomy.
    Date January 1992
    Journal Gynecologic Oncology
    Excerpt

    Radical hysterectomy has long been a primary mode of therapy for selected gynecologic malignancies. The lower urinary tract is an area associated with complications following this procedure. Lack of satisfactory reflex micturition and urinary retention, diminished bladder sensation, infection, and fistula formation are common adverse sequelae. Prolonged indwelling catheterization is a cornerstone of postoperative management after radical hysterectomy. An alternative regimen consisting of early postoperative catheter removal, with a strict voiding schedule, and intermittent self-catheterization (ISC) for postvoid residuals (PVR) was prospectively investigated. Intermittent self-catheterization was initiated only if the PVR 12 hr after catheter removal was greater than 75 ml. Twenty-six patients who underwent radical hysterectomy were studied. Catheters were removed between the fifth and ninth postoperative day. Eighteen patients (69%) had PVRs less than 75 ml at 12 hr and were successfully managed with a strict voiding schedule only. Eight patients (31%) had 12-hr PVRs greater than 75 ml and were managed with a strict voiding schedule and ISC until the PVR was less than 75 ml for two consecutive voids. These patients were evaluated with fluorourodynamics and none had an abnormal study. Compared to 25 historical control patients, study group median indwelling catheter duration was less (6.0 days compared to 30.0 days) with no increase in postoperative complications. On the basis of these data, early removal of indwelling urinary catheters after radical hysterectomy appears to be an acceptable alternative to long-term catheterization.

    Title Peroxisome Induction Potential and Lipid-regulating Activity in Rats. Quantitative Microscopy and Chemical Structure-activity Relationships.
    Date August 1991
    Journal The American Journal of Pathology
    Excerpt

    Structurally diverse lipid-regulating agents induce hepatomegaly, hepatic peroxisome proliferation, and hepatocarcinoma in rats by mechanisms not fully understood. Nevertheless the initial hepatic response is a prompt, florid proliferation of peroxisomes. In investigations reported here, changes in the rat hepatic peroxisome compartment were measured by quantitative microscopy to determine chemical structure requirements that relate to peroxisome proliferation and lipid regulation. Aryloxyalkanoic acids plus amide analogs, and thio, benzimidazole, phenylpiperazine, and oxazole derivatives induced peroxisome proliferation and generally decreased plasma triglyceride and total cholesterol levels. These compounds contain an acidic function or are readily metabolized to a chemical with an acidic function. Substitution of the acidic function with an adamantyloxy eliminated peroxisome proliferation and induced contrasting effects on lipid profile, increasing triglycerides and decreasing total cholesterol. A previously unreported, direct correlation emerged between peroxisome proliferation and plasma high-density lipoprotein-cholesterol levels. These effects could not be elicited separately, negating identification of functional groups that could be associated with either activity. Chemical structure and resulting peroxisome proliferation with changes in plasma lipoproteins are therefore closely interrelated in rats.

    Title Stress Incontinence and Cystoceles.
    Date June 1991
    Journal The Journal of Urology
    Excerpt

    We studied prospectively 62 women with cystoceles by video-urodynamics before and after operative repair. Of 29 women with grades 1 and 2 cystoceles 8 had residual urine, 14 had urge incontinence and 24 had symptoms of stress urinary incontinence. Of these women 23 had urodynamic evidence of stress incontinence, as did 3 of 5 without stress incontinence symptoms. Of 33 women with large cystoceles 22 had symptoms of stress urinary incontinence but 10 more had urodynamic evidence of stress urinary incontinence. Of these 33 women 18 had significant residual urine and 24 had urge incontinence. Operative repair resolved stress incontinence in 51 of 54 women, urge incontinence in 33 of 38 and residual urine in 24 of 26. Cystoceles recurred in 3 patients, and enteroceles developed in 3 and recurred in 2. These findings indicate that cystoceles may cause voiding dysfunction and lack of symptoms of stress incontinence is unreliable in patients with cystoceles. In addition, cystoceles are associated with other symptoms, most of which actually resolve after operative repair.

    Title Correction of Vesicoureteral Reflux by Intravesical Injection of Collagen in a Canine Model.
    Date May 1991
    Journal Journal D'urologie
    Excerpt

    A reflux model was created in 12 dogs to test the application of subureteric injection of collagen as a biodegradable substitute for ureteroneocytostomy. The injection technique was initially successful in 64% of dogs. Failure was related to deficiency in intramural tunnel and was unrelated to bladder function. Cystograms in 4 successfully corrected survivors showed resumption of reflux, although postmortem histology showed persistence of the collagen implant at the injection sites.

    Title Treatment of Incontinence with Pelvic Prolapse.
    Date May 1991
    Journal The Urologic Clinics of North America
    Excerpt

    There is a surprising lack of prospective data on genital and pelvic prolapse and the relation of these conditions to incontinence. Several abnormalities may be important: uterine prolapse, rectoceles, enteroceles, total vaginal eversion, and cystoceles. The authors describe their experience in 65 cases of various etiologies.

    Title Creation of a Feline Model of Obstructive Uropathy.
    Date April 1991
    Journal The Journal of Urology
    Excerpt

    The aim of this project was to create a reproducible, quantifiable feline model of obstructive uropathy. Seventy-three adult female cats of comparable age were evaluated to obtain the normal control urodynamic data base. Twenty-four cats had a silastic cuff installed around the urethra to induce bladder outlet obstruction, and eight underwent a sham operation. Repeated urodynamic evaluations were performed at predetermined postoperative intervals. The obstructed and normal cats inhibited detrusor contractility by reflex striated urethral sphincter activity. Measurements of voiding pressure to verify the presence, and to assess the degree of induced outlet obstruction, required paralysis of the sphincter by curare. Following cuff implantation, voiding pressure increased from a mean normal of 17.2 cm./H2O to 31.6 to 42.5 cm./H2O in animals designated as moderately obstructed, and to 101.7-125.0 cm./H2O in animals designated as severely obstructed. 84.6% of the high pressure bladders developed vesicoureteral reflux. Analysis of resting, low bladder volume, urethral pressure profile (UPP) data and voiding pressures indicate a compensatory sphincteric response to filling in non-curarized animals, and a lack of that response in curarized animals. It appears that implantation of a silastic cuff to prevent full opening of the urethra during voiding, without actually compressing it, is a reasonable model of obstructive uropathy. The observation that the relationship between striated urethral sphincter activity and inhibition of detrusor contractility is influenced by administration of curare was unexpected, and may have clinical implications.

    Title Augmentation Cystoplasty and Closure of the Urethra for the Destroyed Lower Urinary Tract.
    Date December 1990
    Journal The Journal of the American Paraplegia Society
    Excerpt

    Five paraplegic patients with pressure ulceration complicated by incontinence related to fistula formation were treated by deliberate closure of the urethra and augmentation cystoplasty with a continent stoma. This procedure is similar in scope to urinary diversion but preserves a low-pressure reservoir and obviates the use of tubes for drainage of urine. Overall outcome was excellent. Valvular failure occurred in one patient and required revision. The follow-ups range from 1 to 5 years, with a mean of 24 months. One patient developed reservoir calculi as a late complication, necessitating removal with flexible endoscopy via the continent conduit. All patients have preserved normal upper tracts. Augmentation cystoplasty with closure of the urethra is a reasonable procedure in such patients providing for low-pressure urinary storage and permitting secondary or simultaneous plastic surgical procedures on perineal pressure ulceration and osteomyelitis.

    Title Urethral Dilation Improves Bladder Compliance in Children with Myelomeningocele and High Leak Point Pressures.
    Date August 1990
    Journal The Journal of Urology
    Excerpt

    Among 350 children with myelomeningocele 18 with elevated leak point pressures were managed by urethral dilation and followed for 1 to 5 years. Longitudinal measurements of bladder compliances revealed durable improvement in the pressure-volume relationships after dilation. These data suggest that noncompliant bladders are acquired because of high outlet resistance, and early intervention may improve long-term bladder storage characteristics.

    Title This Month in Investigative Urology: Bladder Physiology.
    Date June 1990
    Journal The Journal of Urology
    Title Identifying and Managing Stress Incontinence in the Elderly.
    Date June 1990
    Journal Geriatrics
    Excerpt

    Stress incontinence is common in elderly women, as it is in childbearing and perimenopausal women, but it often presents differently and has different causes. Surgical repair remains the most effective therapy, but no one procedure will resolve all cases and sometimes other forms of therapy are preferable. The physician is urged to remain alert for signs and symptoms, to pursue the diagnosis, and to make informed referrals for care.

    Title Further Characterization of the Mouse Sperm Surface Zona-binding Site with Galactosyltransferase Activity.
    Date May 1990
    Journal Molecular Reproduction and Development
    Excerpt

    One of the mouse sperm surface binding sites for zona pellucida ligands exhibits galactosyltransferase (GT) enzyme activity. The present study was undertaken to ascertain whether the GT site behaves as a noncatalytic binding site in its physiological capacity, with no glycosylation of zona ligands, or whether glycosylation of zona ligands is an integral part of sperm-zona binding. The effects of Mn2+, the obligatory cation for GT catalysis, on enzyme activity and sperm-zona binding were examined. With uridine-5'-diphosphogalactose (UDPgal) as galactose donor, and N-acetylglucosamine (GlcNAc) as galactose acceptor, increasing concentrations of Mn2+ in the range of 0.1-10 mM increased GT enzyme activity, with half-maximal activation at 0.65 mM Mn2+ (Vmax = 20 pmol/hr/10(6) cells). In the presence of 0-2 mM Mn2+, sperm-zona binding was inhibited in a concentration-dependent manner; 50% inhibition occurred at 1.25 mM Mn2+. At this concentration, GT enzyme activity was at 65% Vmax. To determine the specificity of the GT site for glycoprotein terminal carbohydrate residues, spermatozoa were incubated with, asialo-ovine submaxillary mucin (N-acetylgalactosamine residues), asialo-, -alpha 1-acid glycoprotein (beta 1-4 galactose residues) ovalbumin (Ov; GlcNAc residues), and asialo-agalacto-/alpha 1-acid glycoprotein (AsAgAGP; GlcN-Ac residues). Only Ov and AsAgAGP acted as acceptors for galactose in the enzyme assay and inhibitors in the sperm-zona binding assay. The kinetics of the interaction of AsAgAGP with the GT site were determined: the Km was 3.6 mg/ml, with Vmax of 33 pmol/hr/10(6) cells.(ABSTRACT TRUNCATED AT 250 WORDS)

    Title Short Term Functional Effects of Bladder Outlet Obstruction in the Cat.
    Date May 1990
    Journal The Journal of Urology
    Excerpt

    Experimental bladder outlet obstruction in cats was produced by surgical placement of a silastic cuff around the urethra. Two sizes of cuff were used to produce either moderate or severe obstruction. The following is a summary of the short-term effects on bladder function. Obstruction induced a significant increase in the in vivo voiding pressure, in proportion to severity of the obstruction. There were no significant differences between control and obstructed cats in bladder mass, response of the isolated whole bladder to field stimulation or bethanechol, response of isolated bladder strips to field stimulation, bethanechol and ATP, or muscarinic receptor density in the bladder body. Although there were no differences in bladder mass between control and obstructed bladders, the hydroxyproline concentration of the severely obstructed bladders was significantly reduced. Creatine phosphate concentration was also significantly reduced in obstructed bladders. Although all whole cat bladder preparations displayed spontaneous contractile activity during in vitro cystometry, the obstructed bladders had a greater amplitude and frequency of spontaneous contractions with a lower volume threshold. In addition, the obstructed bladders had a greater tetrodotoxin-resistant contractile response to field stimulation. These results suggest that the obstructed cat bladder can compensate for increased outlet resistance without induction of bladder hypertrophy or significant functional changes, as seen in both rat and rabbit.

    Title The Use of Modified Martius Graft As an Adjunctive Technique in Vesicovaginal and Rectovaginal Fistula Repair.
    Date April 1990
    Journal Obstetrics and Gynecology
    Excerpt

    The use of the Martius graft, a labial fibro-fatty tissue graft, is described as an adjunctive technique in the repair of 37 complex fistulas in 35 patients. The graft was used to repair three groups of patients with non-radiation-induced vesicovaginal fistulas: 12 patients with large (greater than 4 cm) obstetric fistulas, six patients with obstetric fistulas that caused urethral sloughing, and six patients with recurrent obstetric or post-hysterectomy fistulas. Five other patients had radiation-induced fistulas, and six others had rectovaginal fistulas. The overall success rate was 86.5%. Anatomical studies undertaken of the graft in a cadaver demonstrated that it is composed of fibroadipose tissue from the labium majus, and not from the bulbocavernosus muscle. It receives its blood supply anteriorly from the external pudendal artery and posteriorly from the internal pudendal artery. These vessels form a plexus within the graft. The prominence of fibrous tissue in this fibroadipose tissue arises from a superficial tunic of fibrous tissue similar to the tunica dartos in the male, as well as from the considerable fibrous septa within the adipose tissue itself. Although the labial graft used today differs from that originally described by Heinrich Martius, it remains a safe, simple, and helpful technique in difficult fistula repairs.

    Title Comparative Physiology and Pharmacology of the Cat and Rabbit Urinary Bladder.
    Date April 1990
    Journal The Journal of Urology
    Excerpt

    The cat and the rabbit are two of the most popular models for the study of lower urinary bladder function. The cat has been used extensively for in-vivo studies of spinal and supra-spinal micturition reflexes. In contrast, the rabbit has been used extensively for the in-vitro study of bladder function. In order to determine if the results obtained using one species can be applied to another, we have compared the in-vitro physiology and pharmacology of the cat and rabbit bladder using isolated strips and whole bladder preparations. The results can be summarized as follows: 1) The cat displays significant spontaneous activity during in-vitro cystometry, but the rabbit shows no such activity (whole bladder studies). 2) Although the bladder weights of the cat and rabbit are similar, the rabbit bladder has a capacity three times that of the cat. 3) The maximal response to field stimulation was obtained at one gram of passive tension for the rabbit isolated strips, whereas five grams of passive tension was required for the cat strips. 4) Atropine inhibited the response of isolated strips of cat bladder to field stimulation by approximately 13% whereas the response of rabbit bladder strips was inhibited by approximately 45%. 5) The magnitude of the response of rabbit bladder strips to ATP was similar to the response to field stimulation in the presence of atropine; the response of cat bladder strips to ATP was only 20% of the response of that of the rabbit bladder strips, and approximately 10% of the response of the cat strips to field stimulation in the presence of atropine. 6) Field stimulation produced a 10fold greater rise in intravesical pressure in the cat isolated bladder than in the isolated rabbit bladder; in response to bethanechol, the cat bladder generated a 6-fold greater response than the rabbit bladder. It is clear that the in-vitro pharmacological responses of the cat urinary bladder are qualitatively and quantitatively different from that of the rabbit bladder.

    Title Light Microscopic Localization of Glycosyltransferase Activities in Cells and Tissues.
    Date January 1990
    Journal The Journal of Histochemistry and Cytochemistry : Official Journal of the Histochemistry Society
    Excerpt

    We describe an assay for light microscopic visualization of specific glycosyltransferases on tissue sections or on cells. The assay uses a sequence of enzyme reactions that yields two moles of NADH for each mole of the uridine-5'-diphosphate (UDP) released during transfer of a monosaccharide from a UDP sugar to an acceptor. When diaphorase and tetrazolium salts are present in the incubation mixture, the tetrazolium salts are reduced to colored diformazans, which precipitate at the sites of glycosyltransferase activity. The validity of the assay was established by applying the technique to spermatozoa and liver, in which some glycosyltransferases have previously been localized. When suspensions of mouse spermatozoa were assayed for galactosyltransferase (GalTase) activity, diformazan precipitates appeared on the plasma membranes overlying the anterior heads of the spermatozoa, in agreement with immunochemical localizations. In mouse liver slices assayed with bilirubin as acceptor for glucuronyltransferase (GluTase) activity, dense diformazan deposits appeared on the hepatocytes but not on endothelial cells, also in agreement with immunochemical data. In the absence of acceptor or UDP sugar donor, diformazan deposits were minimal and random in all tissues tested. The assay's versatility was tested by incubating tissues with different sugar donors and acceptors to localize other sites of transferase activity. In mouse frozen liver sections, GalTase activity occurred in both hepatocytes and endothelial cells; in sections of rat submaxillary glands, GalTase activity was detected in mast cells. In liver sections, GlcuTase activity with o-aminophenol as acceptor was located primarily on the endothelial cells. With the appropriate sugar donor and acceptor, this assay should detect any transferase, other than the glucosyltransferases, that utilizes UDP sugars.

    Title Predictors of Success in Electroejaculation of Spinal Cord Injured Men.
    Date December 1989
    Journal The Journal of Urology
    Excerpt

    Rectal probe electroejaculation was attempted in 48 spinal cord injury men and greater than 10 million sperm were obtained in 71%. Patient age and interval since injury had no effect on outcome. The best performance was seen in thoracic paraplegics and in those using intermittent catheterization for bladder management. Indwelling urethral catheters and high pressure reflex voiding had a negative impact on electroejaculation results.

    Title A Scrotal Graft Technique for the Repair of Prostatic-cutaneous Fistulas.
    Date December 1989
    Journal The Journal of Urology
    Excerpt

    Three patients who had a prostatic urethral fistula into the presacral space and perineal urinary drainage after rectal resection or vascular injury with rectal sloughing were treated successfully by a transperineal, extraurethral scrotal inlay flap.

    Title Drug-induced Myopathy in Beagle Dogs.
    Date December 1989
    Journal Toxicologic Pathology
    Title A Human Milk Galactosyltransferase is Specific for Secreted, but Not Plasma, Iga.
    Date November 1989
    Journal Journal of Immunology (baltimore, Md. : 1950)
    Excerpt

    IgA from human milk and colostrum is a substrate for a galactosyltransferase also present in milk and colostrum. The secreted IgA that serves as the best acceptor for the transferase activity is the IgA that fails to bind readily to jacalin lectin. Upon becoming galactosylated by the transferase, however, the IgA shows an increased affinity for jacalin. Glycosidase and electrophoretic results indicate that the transferred galactose is beta-linked to the alpha-chain of the IgA. The IgA:transferase activity can be purified by gel filtration and cation exchange chromatographies, as well as by affinity chromatography on Sepharose derivatized with UDP or IgM. The enzyme has an apparent Mr of about 64 kDa, is prevalent in both milk and colostrum, but has a sixfold higher sp act in colostrum.

    Title Transvaginal Urethrolysis After Obstructive Urethral Suspension Procedures.
    Date October 1989
    Journal The Journal of Urology
    Excerpt

    Obstructive uropathy after an operation for stress incontinence was treated by transvaginal urethrolysis in 13 women. Bladder outlet obstruction developed after retropubic urethropexy in 6 patients, after needle suspension in 4 and after a pubovaginal sling operation in 3. Transvaginal urethrolysis was accompanied by a needle suspension in 2 patients, an Inglemann-Sundberg denervation in 1 and a pubovaginal sling in 1. Of 13 patients 10 are voiding and none has stress incontinence but 3 continue to perform intermittent self-catheterization.

    Title Urethral Dilation in the Management of Urological Complications of Myelodysplasia.
    Date October 1989
    Journal The Journal of Urology
    Excerpt

    Urethral dilation was performed in 11 of 65 myelodysplastic children with high intravesical pressures. These 11 children had persistent bladder pressure elevations uncontrolled by intermittent catheterization and anticholinergic agents. After dilation intravesical pressures decreased, and upper tract function and measured bladder compliance improved. No discernible effect on continence function occurred. The procedure appears to be a safe alternative to temporary vesicostomy in myelodysplastic children with high intravesical pressures that cannot be controlled by intermittent catheterization and anticholinergic agents.

    Title The Late Occurrence of Urinary Tract Damage in Patients Successfully Treated by Radiotherapy for Cervical Carcinoma.
    Date June 1989
    Journal The Journal of Urology
    Excerpt

    Urinary tract complications apparently resulting from radiation therapy for carcinoma of the cervix can occur as long as 30 years after cessation of such treatment. Patients generally present with urinary incontinence and often are treated by standard operative methods that usually are unsuccessful. Incontinence is related to bladder fibrosis, urethral nonfunction and vesicovaginal fistuLa formation, and may be accompanied by bilateral ureteral obstruction. Of 11 patients with late complications of radiotherapy 4 had upper tract deterioration, 4 had vesicovaginal fistulas, 5 had an incompetent urethra aNd 9 had a fibrotic, noncompliant areflexive bladder. Treatment was aimed at providing adequate low pressure storage capacity and consisted of augmentation cystoplasty in 5 patients, repair of the fistula in 4 and correction of urethral dysfunction in 5. Women who complain of incontinence and/or irritable bladder symptoms with a history of radiotherapy for cervical carcinoma should be evaluated for fistuLa formation, urethral incompetence, and detrusor areflexia and fibrosis before treatment is done.

    Title Bladder Compliance in Meningomyelocele Children.
    Date June 1989
    Journal The Journal of Urology
    Excerpt

    The 2 components of detrusor compliance were analyzed in 32 children with myelomeningocele and compared to compliance in 15 age-matched controls with nonneuropathic enuresis. In myelomeningocele initial compliance was variable, whereas terminal compliance was relatively constant. Low terminal compliance corresponded with vesicoureteral reflux, deterioration of upper tract morphology and diminished renal function.

    Title The Role of Laparoscopy in Management of Nonpalpable Testes.
    Date May 1989
    Journal Journal D'urologie
    Excerpt

    Laparoscopy is the ideal first operative step in management of boys with nonpalpable testes. No other investigation is as reliable in locating a nonpalpable testis or in confirming its absence. Whatever the laparoscopic findings, further operative intervention is generally necessary and the laparoscopic findings determine the subsequent operative steps. Laparoscopy also permits endoscopic manipulation such as application of a spermatic vessel clip for staged Fowler-Stephens orchidopexy. Herein we report our experiences with laparoscopy in 30 patients with nonpalpable testes.

    Title A Bladder Pressure Management System for Myelodysplasia--clinical Outcome.
    Date January 1989
    Journal The Journal of Urology
    Excerpt

    A program for the management of neurogenic bladder in patients with myelodysplasia was instituted in July 1983. Of the 114 patients entered into the program who have been followed for a minimum of 18 months 42 per cent required treatment for high intravesical pressures. None of this group or the larger group with low bladder pressures showed progressive upper urinary tract deterioration. In 8 children (17 per cent of those with high pressure bladder dysfunction) high intravesical pressure persisted despite anticholinergic medication and intermittent catheterization, and they required an operation to achieve a low pressure bladder. These results confirm the findings in other studies that about 40 per cent of myelodysplastic children are at high risk for the development of upper tract changes, and that approximately 6 to 8 per cent will not respond sufficiently to anticholinergic agents and intermittent catheterization.

    Title Myelodysplasia.
    Date November 1988
    Journal Seminars in Neurology
    Title Sexual Dysfunction and Electroejaculation in Men with Spinal Cord Injury: Review.
    Date March 1988
    Journal The Journal of Urology
    Title Fascial Sling to Correct Male Neurogenic Sphincter Incompetence: the Mcguire/raz Approach.
    Date March 1988
    Journal The Journal of Urology
    Excerpt

    We report the surgical approach used in 4 male myelomeningocele patients suffering from severe urinary incontinence owing to poor bladder compliance and sphincter incompetence. While bladder compliance was corrected by enlargement cystoplasty the sphincteric incompetence was treated by an autologous fascial sling around the bladder neck with excellent results. We consider this operation as an alternative to the artificial urinary sphincter in cases of male neurogenic sphincter incontinence.

    Title Electroejaculation of Paraplegic Males Followed by Pregnancies.
    Date January 1988
    Journal Fertility and Sterility
    Excerpt

    Semen obtained by electroejaculation was used to achieve pregnancies in the spouses of T5-6 and T4-5 paraplegics. Viable semen was recovered in both an antegrade and retrograde fashion. In both cases, the SPA test was positive. Semen recovered for AIH IUI was washed and swum up prior to insemination.

    Title Experience with Pubovaginal Slings for Urinary Incontinence at the University of Michigan.
    Date October 1987
    Journal The Journal of Urology
    Excerpt

    In July 1983 pubovaginal slings were used first at our university to treat incontinence in female patients with poor urethral function. From then until July 1, 1986, 82 such procedures were performed on a diverse group of patients, including a male patient. Initial success occurred postoperatively in 67 patients, with 15 failures. Of these failures 7 were related to urethral dysfunction. Another sling procedure was done in 2 patients and they are continent, while 3 were treated with medication: 2 became dry and 1 remains wet. A total of 8 patients suffered detrusor-related incontinence postoperatively (2 required augmentation cystoplasty for poor bladder compliance). To date 78 patients (95 per cent) are continent. Of the patients 2 required periodic intermittent catheterization for more than a year postoperatively and 12 are managed by chronic intermittent self-catheterization on a planned basis for neurogenic vesical dysfunction.

    Title Urodynamic Evaluation of Ileal Conduit Function.
    Date May 1987
    Journal The Journal of Urology
    Excerpt

    Bilateral hydroureteronephrosis following ileal conduit urinary diversion is not uncommon. It may be owing to ureteroileal stenosis, stomal stenosis or a poorly compliant ileal conduit. The standard evaluation of stoma size, conduit residual urine and a loopogram often fail to allow determination of the cause of ureteral dilatation. In addition to these standard tests, we have used conduit urodynamics to study conduit function with a triple lumen urodynamic catheter to measure simultaneously conduit pressure proximal and distal to the fascia during filling under fluoroscopy. In 4 control patients with normal upper tracts who were studied with this technique conduit leak point pressures ranged from 5 to 20 cm. water pressure. Six patients with bilateral hydroureteronephrosis were studied to evaluate conduit function. We found abnormalities in 5 patients, including functional stomal stenosis in 2, an atonic loop in 1, segmental obstruction in 1 and a high pressure noncompliant distal segment in 1.

    Title Extratesticular Dermoid Cyst and Fibrous Dysplasia of Epididymis.
    Date May 1987
    Journal The Journal of Urology
    Title Treatment of Intractable Bacterial Cystitis with Intermittent Catheterization and Antimicrobial Instillation: Case Report.
    Date March 1987
    Journal The Journal of Urology
    Excerpt

    Intractable bacterial cystitis associated with residual urine formation was treated successfully in 4 women by intermittent self-catheterization with instillation of an aminoglycoside directly into the bladder after other methods had failed.

    Title Electroejaculation for Recovery of Semen After Retroperitoneal Lymph Node Dissection: Case Report.
    Date March 1987
    Journal The Journal of Urology
    Excerpt

    Electroejaculation with a rectal probe was used successfully for semen recovery 8 years after bilateral suprarenal hilar lymph node dissection for stage IIB embryonal cell cancer. An adequate ejaculate was obtained in relation to total sperm count, motility and normal morphology. Prior use of sympathomimetic drugs, including imipramine and ephedrine, was unsuccessful in producing an ejaculation. Electrostimulation via a rectal probe seems to be a useful technique for semen recovery in the patient with anejaculation after retroperitoneal lymph node dissection.

    Title A Comparison of Endoscopic Suspension of the Vesical Neck Versus Anterior Urethropexy for the Treatment of Stress Urinary Incontinence.
    Date December 1986
    Journal The Journal of Urology
    Excerpt

    Endoscopic suspension of the vesical neck has been reported to be as effective as anterior urethropexy in the treatment of female stress urinary incontinence. We compared our first 29 patients treated with endoscopic suspension of the vesical neck between 1982 and 1985 to our last 21 patients treated with anterior urethropexy between 1979 and 1985. Both groups were comparable in regard to age, parity, duration of symptoms and previous surgery for stress urinary incontinence. All patients underwent thorough preoperative urodynamic testing. Endoscopic suspension of the vesical neck successfully cured stress urinary incontinence in 26 patients (90 per cent), while anterior urethropexy resolved the incontinence in 20 (95 per cent). Of the 3 failures of endoscopic suspension 2 probably were related to technique or material failure. Hospitalization was reduced for endoscopic suspension versus anterior urethropexy (mean 4.04 versus 6.00 days, respectively). The most common complication after endoscopic suspension of the vesical neck was transient urinary retention (34 per cent). We conclude that endoscopic suspension of the vesical neck is an effective method to treat stress urinary incontinence, and that it also reduces hospital stay and postoperative recovery.

    Title Structure-activity Relationships in the Induction of Mammary Gland Neoplasia in Male Rats with Substituted Aminopyrazoles.
    Date October 1986
    Journal The American Journal of Pathology
    Excerpt

    In toxicity studies with a potential antipsychotic agent, N-(4-[2-fluorobenzoyl]-1,3-dimethyl-1H-pyrazol-5-yl)-2-([3- (2-methyl-1-piperidinyl)propyl]amino)-acetamide(Z)-2-butenedioate (1:2) (FP-1), mammary gland neoplasia in male rats was induced within 13 weeks. Tumor induction by the parent compound (FP-1) and structural analogs was also explored. Rats were given 50 mg/kg/day of FP-1 or the diethyl glycine analog, FP-2. Other experimental groups received the FP nucleus, a benzoylpyrazolylacetamide, or the FP side chains alone or administered concurrently with the nucleus. Most animals survived the 13 weeks without significant clinical effects. Clinically detectable, gross subcutaneous mammary nodules developed only in rats given FP-1 or the FP nucleus coadministered with the FP-1 side chain. Additional mammary gland neoplasms were found at necropsy or on histopathologic examination of mammary glands from rats receiving FP-1, FP-2, and the FP nucleus. The neoplastic effect was not influenced by the structure of the side chains. Since these substituted aminopyrazoles are novel chemicals, the mechanism for this neoplastic effect is not yet clearly established; however, the proliferating effect resides in the nucleus of this series of compounds and is likely related to alteration of DNA in target mammary tissue.

    Title The Innervation and Function of the Lower Urinary Tract.
    Date September 1986
    Journal Journal of Neurosurgery
    Excerpt

    Vesical and urethral function are closely controlled by neural activity, both reflex and volitional. Relatively subtle abnormalities have serious consequences. Understanding of the natural history of neurogenic vesical dysfunction has improved over the past few years and is summarized in this review article.

    Title Preclinical Toxicology Studies with the Lipid-regulating Agent Gemcadiol.
    Date June 1986
    Journal Fundamental and Applied Toxicology : Official Journal of the Society of Toxicology
    Excerpt

    Gemcadiol is a medium-length diol moiety with lipid-regulating properties in animals and man. The compound was not toxic when single doses were administered to rodents with the lethal dose greater than 7000 mg/kg in rats and mice. Rats treated for 13 or 52 weeks with 30 to 300 mg/kg had reversible food intake suppression and weight gain inhibition, decreased blood cholesterol, slight anemia, and generally dose-related but reversible decreases in glucose, and increases in alkaline phosphatase and blood urea nitrogen. Liver weights were increased, and there was accompanying hypertrophy and increased cytoplasmic eosinophilia of hepatocytes with associated peroxisome proliferation. Rats treated for 52 weeks also had mild renal tubular dilatation. Dogs given 25 to 300 mg/kg of gemcadiol for up to 52 weeks tolerated the compound better than rats. Effects related to compound administration were elevated serum alanine aminotransferase activity in female animals only, and microscopic cytoplasmic vacuolation and hyaline body formation in both sexes. Monkeys given 25 to 300 mg/kg gemcadiol for 13 weeks had slightly decreased serum cholesterol and slightly increased serum creatine phosphokinase. Teratology studies in rats or rabbits indicated no teratogenic response. Gemcadiol affects principally the liver, and the hepatic alterations seen in rats and dogs may reflect compensatory manifestations of altered metabolism related to the lipid-regulating activity of the compound.

    Title Evaluation of Chronic Toxicity and Carcinogenesis in Rodents with the Synthetic Analgesic, Tilidine Fumarate.
    Date May 1986
    Journal Toxicology
    Excerpt

    The carcinogenic potential of tilidine fumarate, a synthetic analgesic, was studied for 80 and 104 weeks in mice and rats, respectively. Groups of 50 albino CF1 mice and 65 albino Wistar rats of each sex received tilidine fumarate-lactose blend (1:1) at doses of 100, 40 and 16 mg/kg. The control groups consisted of 100 mice and 115 rats of each sex and received the lactose vehicle only. Treatment-related non-neoplastic changes consisted of reversible, increased cytoplasmic eosinophilia of hepatocytes in high and mid dose rats corresponding to areas of proliferating smooth endoplasmic reticulum; and an increased incidence in high dose rats of proliferative or cystic lesions of the biliary epithelium. Adequate survival rates allowed stringent statistical analysis of neoplasia. Tilidine did not evoke increased tumor incidences or changes in the average latency or onset of tumors in either species. The most frequent tumors represented spontaneous neoplasia characteristic of historical background incidence in these strains. In mice, the only statistically significant (P less than 0.01) variation in tumor incidence was an increased rate of lung alveologenic adenocarcinomas in females at 100 mg/kg (24%), compared with the concurrent untreated controls (10%), but without a statistically significant difference from historical control data (27%). Female rats given 100 mg/kg showed statistically significant (P less than 0.01) decreased incidences of mammary fibroadenoma and pituitary adenoma. From these data, it was concluded that the synthetic analgesic tilidine does not possess tumorigenic potential in rodents.

    Title Comparative Urological Outcome in Women with Spinal Cord Injury.
    Date May 1986
    Journal The Journal of Urology
    Excerpt

    We evaluated 35 women for urological complications followed for 2 to 12 years after spinal cord injury. Of the patients 13 were treated with a Foley catheter, while 22 were managed by intermittent catheterization. Urological complications in the chronic catheterization group were frequent and serious compared to those in patients treated by intermittent catheterization.

    Title Modified Pubovaginal Sling in Girls with Myelodysplasia.
    Date January 1986
    Journal The Journal of Urology
    Excerpt

    A pubovaginal sling provides excellent urethral compression in girls with intractable incontinence owing to proximal urethral nonfunction. Provided patients are selected by simple urodynamic criteria, an improvement in incontinence can be achieved by an operation.

    Title Abdominal Procedures for Stress Incontinence.
    Date October 1985
    Journal Clinics in Obstetrics and Gynaecology
    Title Clinical Evaluation of New Urodynamic Catheter.
    Date August 1985
    Journal Urology
    Excerpt

    A commercially available triple lumen urodynamic catheter has been utilized for urodynamic recordings in more than 650 patients. The recordings have been highly accurate and reproducible, and we recommend this catheter for those who perform liquid perfusion urodynamic studies.

    Title Bacterial and Mammalian Cell Mutagenesis, Sister-chromatid Exchange, and Mouse Lung Adenoma Bioassay with the Antineoplastic Acridine Derivative Amsacrine.
    Date March 1985
    Journal Journal of Toxicology and Environmental Health
    Excerpt

    Amsacrine is a DNA intercalating agent with antineoplastic properties in lymphoproliferative disorders. This report describes a group of short-term tests with multiple endpoints to characterize the mutagenic and carcinogenic properties of this drug. In vitro studies included bacterial and mammalian cell mutagenesis, and sister-chromatid exchange and chromosome aberrations in mammalian cells. In vivo, mice were given amsacrine for 7 wk at 2, 5, and 10 mg/kg and were observed for an additional 17 wk. The standard bacterial assay revealed cytotoxicity at 2000 and 5000 micrograms/plate in the preincubation assay. No significant increase in revertants occurred in Salmonella strains, except for TA1537 in the activation phase. Amsacrine at 4.0 micrograms/ml was cytotoxic to V-79 cells in the cell mutation assay, and at lower dose levels was a direct-acting mutagen for the HGPRT locus. Sister-chromatid exchange rate of Chinese hamster ovary cells was increased more than twofold at 2 micrograms/ml without metabolic activation. Cell anomalies included changes in metaphase cell kinetics and chromosome damage. Mice in the lung adenoma bioassay failed to show increased numbers of tumors, while indicating lack of tolerance and survival beyond 5 mg/kg. The results indicate clear genotoxicity to mammalian cell systems with a spectrum of changes from point mutation and SCE induction to cell-cycle alterations, irrespective of exogenous metabolic activation. These results corroborate previous findings in animal and human cell systems in vitro. The reduction of genotoxicity in bacterial assays after exogenous metabolic activation may suggest some detoxification, and the magnitude of effects observed in mammalian cells indicates that exogenous metabolic activation is not required to manifest amsacrine's activity. The lack of tumor-inducing potential in mice may be attributed to strong cytotoxic effects in this species, or to an insensitivity of the target organ, or to assay systems that may mask the carcinogenic potential.

    Title Carcinogenicity Studies in Rodents and Ripazepam, a Minor Tranquilizing Agent.
    Date July 1984
    Journal Fundamental and Applied Toxicology : Official Journal of the Society of Toxicology
    Excerpt

    The carcinogenesis potential of ripazepam , a benzodiazepine derivative, was studied in mice and rats for 78 and 104 weeks, respectively. Groups of 50 male and 50 female CD1 mice and CD rats each were given doses of 15 and 150 mg/kg of ripazepam in the diet. Survival rates were adequate for statistical analysis. Significant suppression of body weight gains occurred in rats but not in mice given 150 mg/kg/day. The compound failed to increase tumor rates or alter the average latency of neoplasm in the rat, the number of male animals with tumors was increased at 150 mg/kg and this was related to a significant increase in the number of animals with hepatocellular tumors. Hepatocellular tumors were increased also in female mice but the increase was not statistically significant. All but one of these hepatic neoplasms were hepatocellular adenomas and the one carcinoma had not metastasized. Other tumor types were not increased.

    Title Toxicology Studies with a Stable Intravenous Formulation of Nitroglycerin.
    Date November 1983
    Journal Journal of Applied Toxicology : Jat
    Excerpt

    The preclinical toxicologic profile of Nitrostat, a stable parenteral formulation of nitroglycerin, was determined in mice, rats, rabbits and dogs. Single-dose i.v. studies in rodents yielded LD50 values of 17.3 and 18.2 mg kg-1 in male and female mice, and 24.4 and 23.2 mg kg-1 in male and female rats, respectively. Subacute i.v. studies in rats at doses of 2.5, 5.0 and 10.0 mg per kg per day, and in dogs at doses 1.0 and 3.0 mg per kg per day for two weeks, elicited minimal reactions. In rats, suppression of body-weight gain and food consumption occurred among treated and vehicle-control animals. Mild tissue irritation at injection sites was noted in treated and vehicle-control groups. There were no clearly drug-related clinical or pathological findings in dogs. In rabbits, repeated intravenous administration of Nitrostat did not induce significant local venous irritation. The results of these studies indicated that the stabilized parenteral formulation of nitroglycerin did not elicit unusual toxic properties in intravenous infusion studies.

    Title Upper Urinary Tract Deterioration in Patients with Myelodysplasia and Detrusor Hypertonia: a Followup Study.
    Date June 1983
    Journal The Journal of Urology
    Excerpt

    We report on 6 patients with myelodysplasia who had undergone previously urodynamic evaluation that demonstrated detrusor hypertonia. At the time of the initial studies no patient had vesicoureteral reflux or significant upper urinary tract dilatation. Subsequently, upper urinary tract deterioration and/or vesicoureteral reflux developed in all patients and persisting detrusor hypertonia was demonstrated on followup urodynamic testing. Marked clinical and radiographic improvement followed treatment by intermittent catheterization with concomitant pharmacologic therapy. Our experience indicates that detrusor hypertonia can lead to ureteral complications in patients with previously radiographically normal upper urinary tracts. We believe that detrusor hypertonia should be treated with anticholinergic medication, frequently in conjunction with intermittent catheterization. The clinical presentation of upper tract deterioration after many years of normality, and occurring as late as the mid teenage years, demonstrates that these patients require prolonged and careful urologic and radiographic followup.

    Title Treatment of Motor and Sensory Detrusor Instability by Electrical Stimulation.
    Date April 1983
    Journal The Journal of Urology
    Excerpt

    A new application of electrical stimulation to inhibit detrusor activity has been used in 15 patients with a variety of neural lesions. The results were astonishingly good and the device was well tolerated. In patients treated successfully for detrusor instability an absence of urgency occurred as a by-product of electrical stimulation. Therefore, stimulation was used to treat uncomfortable bladder urgency without detrusor instability and was successful in the majority of patients.

    Title Detrusor Hypertonicity As a Late Complication of a Wertheim Hysterectomy.
    Date August 1982
    Journal The Journal of Urology
    Excerpt

    An extended radical Wertheim hysterectomy is commonly used in the primary treatment of carcinoma of the cervix. Postoperative voiding dysfunction, characterized by a hypotonic or atonic detrusor, commonly occurs. It is not generally appreciated that hypertonic bladder dysfunction can also occur as a late postoperative complication. We describe 3 patients with postoperative detrusor hypertonia resulting in radiographic changes of the upper urinary tract. The etiology, diagnosis and management of detrusor hypertonia following a Wertheim hysterectomy are discussed.

    Title Technique for Detection of Detrusor Hypertonia in the Presence of Urethral Sphincteric Incompetence.
    Date June 1982
    Journal The Journal of Urology
    Title The Manx Cat As an Animal Model for Neurogenic Vesical Dysfunction Associated with Myelodysplasia: a Preliminary Report.
    Date April 1982
    Journal The Journal of Urology
    Excerpt

    The Manx cat breeds consistently for spinal dysraphism (myelodysplasia) and has spinal cord neuropathologic abnormalities similar to those of myelodysplastic humans. The results of detailed urodynamic and histochemical evaluation of 1 Manx kitten and limited anatomic study of another Manx kitten are described. Urodynamic evaluation revealed significant abnormalities of vesicourethral function: detrusor areflexia, autonomous pressure response to bladder filling, a dysfunctional proximal urethra and poor quality pelvic floor electromyographic activity. Of particular interest, catecholaminergic histochemical studies of the bladder and urethra demonstrated a complete absence of adrenergic fibers, even in the trigone area where they are reported to be abundant. This finding correlated with the urodynamic dysfunction of the proximal urethra. Cholinergic histochemical studies were normal. Examination of the spinal cord revealed moderate hydromyelia throughout the entire length of the cord. The similarities of normal vesicourethral function in man and the cat and our preliminary findings of vesicourethral dysfunction in the Manx cat suggest that this animal may be a particularly valuable model for further research.

    Title Carcinogen Bioassay and Mutagenicity Studies with the Hypolipidemic Agent Gemfibrozil.
    Date January 1982
    Journal Journal of the National Cancer Institute
    Excerpt

    Gemfibrozil, a novel hypolipidemic agent identified chemically as 2,2-dimethyl-5-(2,5-xylyoxy) valeric acid, was evaluated for mutagenic potential in in vitro assays with Salmonella typhimurium. For evaluation of tumorigenic potential, gemfibrozil was administered in the diet (0.30, and 300 mg gemfibrozil/kg) to groups of noninbred CD-1 mice (72/sex) and noninbred CD rats (50/sex) for 78 and 104 weeks, respectively. In the bacterial mutagenesis assays, between 100 and 2,500 microgram gemfibrozil/plate failed to induce a significant increase in revertant bacterial colonies. Neither was a mutagenic response in bacterial assays induced at concentrations up to 300 microgram of five in vivo metabolites of gemifibrozil isolated from rat urine/plate. In mice, gemfibrozil did not significantly increase the frequency or the mean latency period of tumors. In rats, the statistically significant increases in hepatocellular tumors and interstitial cell tumors of the testes were dose related. Adrenal medullary and pancreatic acinar tumors were increased in male rats but were inversely dose related. Under the conditions of this assay, gemfibrozil did not elicit a tumorigenic potential in mice and female rats. In male rats and related to the hepatocellular tumor response, the peroxisome proliferation seen did not occur in humans chronically administered hypolipidemics.

    Title Urinary Undiversion in Patients with Myelodysplasia and Neurogenic Bladder Dysfunction. Report of a Workshop.
    Date November 1981
    Journal Urology
    Excerpt

    This workshop was conducted in an attempt to analyze critically the role of reconstruction of the myelodysplastic patient who had undergone urinary diversion and to develop guidelines for selecting those patients in whom urinary undiversion might be undertaken safely. The collective experience initially seems to be acceptable; however, the authors emphasize the gravity of the decision and the complexity of the evaluation which must be undertaken prior to embarking on such reconstructive surgery. Contrary to some reports, we believe that the defunctionalized bladder frequently can be evaluated. Further, many of the contraindications to urinary undiversion have been identified and several of the hazards involved therein can be avoided. We believe that the neurogenic bladder is no longer an absolute contraindication to undiversion. Our experience suggests that undiversion is a reasonable surgical treatment in select patient with neurogenic bladder dysfunction. But, the decision to remove a satisfactorily functioning conduit must not be undertaken lightly. Patients should be selected only after a thorough, detailed, and properly conducted evaluation. A protocol has been developed which will hopefully assist in this evaluation. Perhaps additional shared experience will further refine and delineate the circumstances appropriate for reconstruction of these patients.

    Title Prognostic Value of Urodynamic Testing in Myelodysplastic Patients.
    Date October 1981
    Journal The Journal of Urology
    Excerpt

    We herein describe the clinical progress of 42 myelodysplastic patients studied urodynamically and followed for a mean of 7.1 years. Urodynamic evaluation included urethral pressure profilometry, simultaneous determination of urethral pressure, intravesical pressure and external anal or external urethral sphincter electromyography with fluoroscopic voiding cystourethrography. Assessment of urethral function showed 36 patients (86 per cent) with an open vesical outlet and nonfunctional proximal urethral. Cystometrography revealed that 7 of 42 patients (17 per cent) had reflex detrusor activity: 4 with coordinated micturition and 3 with detrusor-sphincter dyssynergia. Thirty-five patients (83 per cent) had areflexic detrusor dysfunction: 5 with atomic detrusor response and 30 with a progressive increase in pressure with increasing volume. The intravesical pressure at the time of urethral leakage was 40 cm. water or less in 20 patients and at pressures greater than this value in 22 patients. No patient in the low pressure group had vesicoureteral reflux and only 2 showed ureteral dilatation on excretory urography. In contrast, of the patients in the higher pressure group 15 (68 per cent) showed vesicoureteral reflux and 18 (81 per cent) showed ureteral dilatation on excretory urography. Thus, a striking relationship between the urethral closure pressure and intravesical pressure at the time of urethral leakage and the clinical course in this group of myelodysplastic patients is demonstrated. Every patient with a normally closed vesical outlet was continent on intermittent catheterization and an anticholinergic agent, while only 60 per cent of patients with open bladder outlets similarly treated achieved good urinary control and none was dry. An artificial sphincter device would seem to be a reasonable method to achieve urinary control in the latter patients but the detrusor response to filling also must be considered. Detrusor hypertonia should be controlled or controllable before a sphincter augmenting device can be used safely. Treatment options for patients with high urethral closure pressures include intermittent catheterization and anticholinergic medications or a sphincter ablative procedure to decrease the outlet resistance combined with anticholinergic therapy and implantation of an artificial sphincter. However, only longer followup will determine if these therapeutic regimens will prevent upper urinary tract deterioration.

    Title Diagnostic Advantages of Fluoroscopic Monitoring During Urodynamic Evaluation.
    Date August 1981
    Journal The Journal of Urology
    Excerpt

    Clinical abnormalities of micturition exist in which measurements of urethral, bladder and rectal pressures, and electromyography determination do not allow a precise diagnosis. The diagnostic accuracy of urodynamic evaluation can be improved by the addition of fluoroscopic monitoring. It allows the detection of even small amounts of urinary leakage, the recognition of disassociation of electromyography activity of the pelvic floor musculature, the diagnosis of dysfunction of the smooth muscular urethral sphincter and the accurate localization of urethral obstruction. In our experience fluoroscopy is essential to accurate interpretation of urodynamic results.

    Title Carcinogenesis Bioassay of Prazepam (verstran) in Rats and Mice.
    Date May 1981
    Journal Toxicology and Applied Pharmacology
    Title Preclinical Toxicology Studies with a New Antiarrhythmic Agent: Pirmenol Hydrochloride (ci-845).
    Date April 1981
    Journal Toxicology and Applied Pharmacology
    Title The Effects of Epidural Anesthesia on the Urethral Closure Pressure Profile in Patients with Prostatic Enlargement.
    Date January 1981
    Journal The Journal of Urology
    Excerpt

    In 10 patients with obstructive manifestations of prostatic enlargement the urethral closure pressure profile was observed before and after the effective blockade of thoracolumbar sympathetic outflow by epidural anesthesia. While epidural anesthesia significantly decreased urethral closure pressure considerable profile responses still remained in these patients. This fact suggests that the bulk of the prostatic tissue is responsible for the bladder outlet obstruction, since urethral closure pressure persists despite urethral smooth and skeletal muscular relaxation as a result of epidural anesthesia. After transurethral resection of the prostatic tissue in these patients the urethral closure pressure did decrease to zero. The result of the prostatic resection is to decrease the urethral closure pressure and, thereby, increase the efficiency of voiding.

    Title The Value of Urodynamic Testing in Stress Urinary Incontinence.
    Date October 1980
    Journal The Journal of Urology
    Excerpt

    Preoperative urodynamic testing for the identification of specific types of urinary incontinence was found useful to select an appropriate operative procedure. Failure of the operation to relieve stress incontinence was unusual in 346 patients followed for a minimum of 2 years. Of the total group of patients with stress incontinence 27 per cent also had detrusor instability identified urodynamically preoperatively. However, identification of the syndrome is of limited prognostic significance since the majority of these patients had no difficulty with the syndrome postoperatively and some other patients appeared to have the syndrome only postoperatively.

    Title Suprapubic Suspension of Kaufman Urinary Incontinence Prosthesis: New Technique.
    Date May 1980
    Journal Urology
    Excerpt

    Many operative procedures have been devised to treat postprostatectomy urinary incontinence. The most widely employed technique today is implantation of the Kaufman urinary incontinence prosthesis. This device maintains continence by passive compression of the bulbous urethra. Unfortunately, it is associated with a 39-per cent failure rate. We have modified Kaufman's operative technique by suspending the posterior straps of the device to the anterior rectus fascia. Passive urethral compression is thus augmented by partial transmission of increases in intra-abdominal pressure. This article describes the details of the surgical procedure and the results in 3 cases.

    Title Infections and Antibiotic Prophylaxis in the Fulgurated Rat Bladder.
    Date March 1980
    Journal Investigative Urology
    Excerpt

    A model is described for establishing infection in a fulgurated rat bladder. Persistence of bacteriuria was dependent upon the size of the bacterial inoculum. Infection in an injured bladder exposed to a single predictable bacterial inoculum may be prevented by a single dose of antibiotic. The appropriate timing of antibiotic administration varies with the infecting organism.

    Title A Simple Inexpensive Urodynamic Catheter.
    Date February 1980
    Journal The Journal of Urology
    Excerpt

    Described herein is an easily constructed and inexpensive triple lumen urodynamic catheter. The catheter permits accurate and reproducible simultaneous measurements of urethral and bladder pressure.

    Title Calyceal Injury Due to External Ureteric Compression During Urography.
    Date October 1979
    Journal British Journal of Urology
    Title The Use of Percutaneous Antegrade Renal Perfusion in Kidney Transplant Recipients.
    Date September 1979
    Journal The Journal of Urology
    Excerpt

    Percutaneous antegrade renal perfusion under ultrasound control may be performed safely in human renal transplant recipients with dilated pelviocaliceal systems. The study can be useful to define whether the presence of anatomic changes is accompanied by significant functional obstruction.

    Title Urethral Hypotonicity After Suprasacral Spinal Cord Injury.
    Date September 1979
    Journal The Journal of Urology
    Excerpt

    Established suprasacral spinal cord injuries usually are associated with detrusor hyperreflexia and varying degrees of detrusor-sphincter dyssynergia. Occasionally, such injuries result in detrusor areflexia or urethral hypotonicity or both. The results of the urodynamic evaluation of 4 patients with suprasacral spinal cord injuries are described. Detrusor areflexia and urethral hypotonicity were demonstrated in 3 cases and urethral smooth muscular hypotonia but preserved reflex detrusor function in 1. It is shown that destruction of the thoracolumbar sympathetic outflow can cause the complete loss of urethral smooth muscular closing function and that resting urethral closure is totally independent of preganglionic cholinergic influences.

    Title Results of Biopsy After Early Stage Prostatic Cancer Treatment by Implantation of 125i Seeds.
    Date June 1979
    Journal The Journal of Urology
    Excerpt

    We have treated 77 patients for clinically early stage carcinoma of the prostate, 9 stage A2, 63 stage B and 5 stage C, with direct implantation of 125I seeds into the prostate and pelvic lymphadenectomy. It is estimated that a minimum dose of 15,000 rad but a maximum dose of 35,000 rad is delivered to the prostate over several months. Of the 77 patients 14 (18 per cent) had metastatic disease in the pelvic lymph nodes. In 22 cases perineal needle biopsy was done 12 to 18 months after treatment and in 3 cases a second biopsy was performed after 2 to 3 years. Persistent tumor was present in 11 biopsies. Cytological changes were observed in 8 of these, primarily cytoplasmic vacuolation and nuclear pyknosis. There seemed to be no relationship between grade and stage of disease and histological evidence of persistence of tumor after radiation. One patient with persistent tumor in the postoperative biopsy has shown progression of disease after 2 years and another with a negative biopsy has a bony metastasis. The remaining 10 patients with persistent tumor have shown no sign of progression of disease during a 2 to 4-year interval.

    Title Effect of Pelvic and Retroperitoneal Surgery on the Urethral Pressure Profile and Perineal Floor Electromyogram in Dogs.
    Date November 1977
    Journal Investigative Urology
    Excerpt

    Study of the urethral pressure profile and perineal floor electromyogram in 12 dogs subjected to colonic resection, abdominal vascular stripping, and pudenal nerve transection suggest that specific defects in urethral continence function may follow pelvic and retroperitoneal surgical dissection. These alterations, attributable to damage of the pudendal nerves and the sympathetic fibers in the posterior peritoneum, must be accurately evaluated before treatment of postoperative urodynamic problems.

    Title Thioridazine-induced Priapism.
    Date June 1977
    Journal British Journal of Urology
    Title Pressure Measurements in Ileal Conduits.
    Date May 1977
    Journal The Journal of Urology
    Excerpt

    To study the dynamic properties of ileal conduits and to attempt to diagnose obstruction at an early point in time, that is prior to the development of conduit or upper urinary tract dilatation, a continuously perfused catheter technique was used to measure pressures within the conduit during filling and emptying, and to measure the resistance to flow at the stomal level. The mean values of residual urine, resting pressure, voiding pressure and stomal profile pressure were significantly higher in obstructed than in non-obstructed conduits. However, there was an overlap between values in each parameter, thus necessitating analysis of the entire pressure data in any given case. The data also show that even a small increase in residual urine above normal, 4.0 plus or minus 0.9 cc, may be an indication of early obstruction and that stomal caliber does not necessarily correlate with the degree of obstruction.

    Title Bacterial Prostatitis: Treatment with Trimethoprim-sulfamethoxazole.
    Date August 1976
    Journal Urology
    Excerpt

    Fifteen patients with chronic bacterial prostatitis were treated with trimethoprim-sulfamethoxazole for three months. In 60 per cent of the patients a recurrence of chronic bacterial prostatitis developed during a follow-up period of from one to two and one-half years. It appears that factors other than a diffusion barrier to effective antimicrobial agents into the prostatic gland are responsible for the persistence of chronic bacterial infections of the prostate.

    Title Management of Urinary Fistulas After Renal Transplantation.
    Date May 1976
    Journal The Journal of Urology
    Excerpt

    Urinary fistulas developed in 13 of 134 patients after renal transplantation. Bladder fistulas originating from the anterior suture line in 6 patients were satisfactorily managed by urethral or paravesical drainage. Fistulas arising from the donor ureter were best treated by surgical repair using the recipient's own ureter. Caliceal fistulas in 3 patients were successfully treated with nephrostomy drainage. A favorable outcome was achieved in 11 of the 13 patients, with closure of the fistula and preservation of renal function.

    Title Stress Urinary Incontinence.
    Date April 1976
    Journal Obstetrics and Gynecology
    Excerpt

    Stress urinary incontinence (SUI) was studied in 125 women who were subjected to simultaneous urodynamic and radiologic evaluation. This included cystometry, urethral pressure profiles, measurement of effective urethral length, estimation of urethral mobility, and alterations in the urethrovesical angles during stress. The most common abnormality was a hypermobility of the proximal urethra with loss of its intraabdominal position during stress, associated with changes in the urethrovesical angle. Fixation of the posterior urethra, loss of effective urethral length, low resting urethral pressure, and true neurovesical dysfunction were also found in some of the patients. Uninhibited bladder contractions were found in 22% of cases, but in most instances they were the result of SUI and ceased after surgical repair.

    Title Hemorrhagic Radiation Cystitis. Treatment.
    Date April 1974
    Journal Urology
    Title Interstitial Cystitis Following Colocystoplasty.
    Date February 1974
    Journal Urology
    Title Results of Objective Evaluation of Postgraduate Urologic Seminar.
    Date January 1974
    Journal The Journal of Urology
    Title Treatment of Metastatic Transitional Cell Carcinoma with Adriamycin: a Case Report.
    Date December 1973
    Journal The Journal of Urology
    Title Evaluation of Female Urinary Incontinence.
    Date
    Journal Medscape Women's Health
    Excerpt

    History and physical examination, along with simple diagnostic tests, are the best means for evaluating urinary incontinence. History assesses the severity of the incontinence and its effect on the patient's life. Physical examination is necessary to evaluate the degree of incontinence and possible neurologic disorders. A cystometrogram can be used to evaluate bladder compliance. It is easy to perform and may be the most important and useful urodynamic test for this problem.

    Title Selecting the Best Surgical Option for Stress Urinary Incontinence.
    Date
    Journal Medscape Women's Health
    Excerpt

    Although there are many surgical procedures available to treat urinary incontinence, obtaining the best results depends on a thorough preoperative evaluation of the patient. Traditional urodynamic evaluation of stress urinary incontinence (SUI) focusing on maximum urethral closing pressures has been found to be less useful than the abdominal leak point pressure (ALPP) test in detecting intrinsic sphincter deficiency (ISD). An ALPP less than or equal to 60cm H2O indicates a significant degree of ISD, whereas a leak point pressure greater than or equal to 90cm H2O is usually associated with pure urethral hypermobility. When combined with the history, physical examination, and a filling cystometrogram, the additional objective data obtained from ALPP permit an accurate classification of the stress incontinence and are useful to the clinician in choosing the most appropriate treatment. Anterior colporrhaphy is still commonly used by gynecologists to treat SUI, but the narrow indications (type I SUI only) and poor long-term results have decreased its popularity. It is a poor choice for treating SUI related to urethral hypermobility. Retropubic urethropexy is the treatment standard for SUI procedures against which all other procedures have been compared. Five-year cure rates are in the range of 80% to 90%. Other procedures for treating SUI related to urethral hypermobility include laparoscopic bladder neck suspension, abdominal paravaginal repair, and needle bladder neck suspension. Surgical treatment for ISD differs from that for urethral hypermobility and includes pubovaginal sling procedures, injectable agents, and insertion of the artificial urinary sphincter. Concurrent pelvic prolapse conditions should be treated simultaneously and may dictate the surgical approach. When the proper procedure is utilized, good long-term results can be expected.

    Title Assessing and Managing Urinary Incontinence in Primary Care.
    Date
    Journal Medscape Women's Health
    Excerpt

    Incontinence generally results from a problem either with the urethra or with the bladder. The urethra can permit urine to leak when it moves incessantly due to poor support or when it closes poorly, as can occur with a neurologic disorder. In the bladder, hyperactivity due to involuntary contractions, or low compliance, can lead to urinary incontinence. A thorough history and physical examination guide management. The history should elicit information that can allow the clinician to assess how severe the problem is (eg, number of pads used per day, frequency of leakage) and factors that may cause or influence the problem, such as medications used, previous surgical and obstetric history, and urologic history including prior therapy for incontinence. Information about when leakage is at its worst is useful. Leakage that worsens in winter is typically associated with detrusor instability. Leakage that worsens at night can indicate a problem with bladder compliance. Incontinence that started after the onset of an antihypertensive or antipsychotic medication may be due to alpha-receptor antagonist effects of drugs such as prazosin or chlorpromazine. Difficulty emptying the bladder may be associated with medications that block cholinergic and calcium-channel activity, such as sedatives, antidepressants, antispasmodics, antiemetics, antipsychotics, antiarrhythmics, and anticonvulsants. Mild incontinence can be managed conservatively in a primary care setting, with pelvic-floor exercise, behavior therapy, or anticholinergic therapy. Patients with severe incontinence or an unclear etiology of incontinence should be referred to a specialist for urodynamic testing.

    Title Completeness in Configuration-interaction Calculations.
    Date
    Journal Physical Review. A
    Title Reply to Comments of Bichsel Et Al. on "mean Excitation Energy for the Stopping Power of Metallic Aluminum"
    Date
    Journal Physical Review. A
    Title Demonstration of Population Inversion by Resonant Photopumping in a Neon Gas Cell Irradiated by a Sodium Z Pinch.
    Date
    Journal Physical Review Letters
    Title Measurements of Acceleration Gap Dynamics in a 20-tw Applied-magnetic-field Ion Diode.
    Date
    Journal Physical Review Letters
    Title Li-beam-heated Hohlraum Experiments at Particle Beam Fusion Accelerator Ii.
    Date
    Journal Physical Review Letters
    Title Effect of Prior Therapy on Survival After Salvage Cryotherapy for Recurrent Prostate Cancer.
    Date
    Journal Prostate Cancer and Prostatic Diseases
    Title Pubourethral Sling Simultaneous with Radical Retropubic Prostatectomy for Patients at High Risk for Postprostatectomy Incontinence.
    Date
    Journal Prostate Cancer and Prostatic Diseases
    Title Pathophysiology of Stress Urinary Incontinence.
    Date
    Journal Reviews in Urology
    Excerpt

    All cases of stress urinary incontinence (SUI) are not the same; urethral pressures, prolapse conditions, and congenital and acquired sphincteric dysfunction all contribute to SUI pathophysiology. In order to optimally manage SUI, a thorough understanding of the pathophysiology behind the condition is necessary. Unsuccessful treatment of incontinence can result from the procedure itself or from a poor fit between the patient's condition and the treatment chosen. Proper patient evaluation, including videourodynamics and measurement of Valsalva leak point pressure, is key to making the best treatment decisions and obtaining optimal patient outcomes.

    Title Relationship of Physical Fitness Test Results and Hockey Playing Potential in Elite-level Ice Hockey Players.
    Date
    Journal Journal of Strength and Conditioning Research / National Strength & Conditioning Association
    Excerpt

    The primary purpose of this study was to determine the fitness variables with the highest capability for predicting hockey playing potential at the elite level as determined by entry draft selection order. We also examined the differences associated with the predictive abilities of the test components among playing positions. The secondary purpose of this study was to update the physiological profile of contemporary hockey players including positional differences. Fitness test results conducted by our laboratory at the National Hockey League Entry Draft combine were compared with draft selection order on a total of 853 players. Regression models revealed peak anaerobic power output to be important for higher draft round selection in all positions; however, the degree of importance of this measurement varied with playing position. The body index, which is a composite score of height, lean mass, and muscular development, was similarly important in all models, with differing influence by position. Removal of the goalies' data increased predictive capacity, suggesting that talent identification using physical fitness testing of this sort may be more appropriate for skating players. Standing long jump was identified as a significant predictor variable for forwards and defense and could be a useful surrogate for assessing overall hockey potential. Significant differences exist between the physiological profiles of current players based on playing position. There are also positional differences in the relative importance of anthropometric and fitness measures of off-ice hockey tests in relation to draft order. Physical fitness measures and anthropometric data are valuable in helping predict hockey playing potential. Emphasis on anthropometry should be used when comparing elite-level forwards, whereas peak anaerobic power and fatigue rate are more useful for differentiating between defense.

    Title Efficacy of the Bulbourethral Autologous Sling in Treating Male Stress Urinary Incontinence: a Three-year Experience from a Single Center.
    Date
    Journal International Urology and Nephrology
    Excerpt

    To evaluate the efficacy of the bulbourethral rectus autologous sling in treating male stress urinary incontinence.

    Title Bone-anchored Sling for Male Stress Urinary Incontinence: Assessment of Complications.
    Date
    Journal Urology
    Excerpt

    To evaluate the complications associated with the male bone-anchored sling (BAS) to determine the appropriate preoperative counseling for men considering surgery. The BAS is a surgical option for the treatment of stress urinary incontinence (SUI) due to intrinsic sphincter deficiency.

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