Biomedical subjects
Publications and source records attributed to A C Joseph.
There is an intricate relationship between structure, position, and function within the lower urinary tract. To understand the individual problems that may occur with post-prostatectomy incontinence, it is necessary to be aware of these relationships.
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Americans are living longer. As a result, an increased number of pathologic prostates are being detected and treated. As a consequence of complications from surgical treatment, such as prostatectomy, urinary incontinence may occur. However, it is important to understand urinary continence in the male and the anatomic changes that result with prostatectomy. Having objective measures that are cost-effective and accessible can assist with equaling subjective and objective assessments of continence, as well as determining successful outcomes and the need for more complex behavioral treatments.
The development of the nursing clinical practice guideline was methodically structured to create a research-based guideline to assist nurses in caring for bladders of neurologically impaired individuals. The rigor with which it was developed is reflected in the end product.
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OBJECTIVE: To compare subjective assessments of erectile function with results obtained from nocturnal penile tumescence and rigidity (NPTR) monitoring in patients with spinal cord injury (SCI). DESIGN: A prospective study. SETTING: Erectile function questionnaires were completed by each patient. NPTR monitoring was performed at the patient's home with the Rigiscan system. PATIENTS: Thirty SCI patients (8 cervical, 16 thoracic, 5 lumbar, 1 sacral) were between 22 and 75 (mean 48) years old. Twenty patients (67%) had complete SCI and 10 patients (33%) had incomplete SCI with mean duration since injury of 14 years. MAIN OUTCOME MEASURES: The results from two consecutive nights of NPTR monitoring were compared with each patient's own response to our erectile function questionnaire. RESULTS: Twenty-three patients (77%) reported normal erectile function: 16 had normal NPTR studies and the remaining 7 had abnormal NPTR studies. Seven patients (23%) reported poor-to-absent erectile function: 3 had normal NPTR studies and 4 had abnormal NPTR studies. All 10 patients (100%) with incomplete SCI had NPTR studies that corroborated their own assessment of erectile function, compared to 11 of 20 patients (55%) with complete SCI. NPTR studies in the remaining 9 patients (45%) with complete SCI were inconsistent with their own assessment of erectile function. CONCLUSION: A direct correlation (p<.05) existed between incomplete SCI patients' NPTR studies and their own assessment of erectile function. Complete SCI patients demonstrated significant discrepancy between their own assessments of erectile function and results from NPTR studies. Incomplete SCI patients tended to maintain normal erectile function, as opposed to complete SCI patients. Ten percent of SCI patients who reported erectile dysfunction may actually be suffering from psychogenic impotence.
Neuropathic voiding dysfunction with detrusor sphincter dyssynergia (DSD) is a common complication of spinal cord injury (SCI) and multiple sclerosis. Sphincterotomy has been recommended for treatment of DSD if the patient lacks the ability to do intermittent self catheterization. We report our preliminary results of the Urolume urethral wallstent for the treatment of DSD in 10 patients. The insertion technique proved simple, with a short hospital stay and low morbidity; however, its long term safety has not yet been established.
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Neurogenic bladders with detrusor sphincter dyssynergia (DSD) are common in persons with spinal cord injury and with multiple sclerosis. Treatment options such as sphincterotomy, urethral foley and suprapubic catheters are not without complications or failure; however, they are recommended for patients who are unable to do intermittent catheterization. An endourethral prosthesis for DSD has been developed for experimental use in the United States. We report one year results of the clinical trials with endourethral prostheses implanted in ten patients. Initial subjective and objective results show an 80% success rate. At present, preliminary data show that an endourethral prosthesis, which is simple to insert and has few complications, appears to offer an alternative to conventional treatment. A key to success is to prepare for changes in life style that impact the patient's quality of life. Both patient and staff education are necessary pre-operatively to achieve successful outcomes post-operatively.
The authors describe the ongoing development of a nurse-managed incontinence clinic that focuses on patient responses, adaptions, and goals. They discuss four stages patients must experience when pursuing their goal of continence. Case studies are presented.
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Urinary incontinence after prostatectomy can be psychologically and socially disabling. We reviewed our experience with 27 patients who were incontinent between 5 and 198 months after either radical retropubic, total perineal or transurethral prostatectomy. These patients were entered into our bladder behavior clinic, which was administered by nursing staff with physician supervision. Patients were strongly encouraged to discontinue the incontinence devices, and were then evaluated for the type and extent of incontinence. Perineal exercises were demonstrated in detail, tested for their correct use via simultaneous rectal and abdominal examination, and applied to the pattern of incontinence. Patients were evaluated frequently for compliance and their progress was followed with instruction repeated as needed. Pharmaceutical agents were not used. Among the 24 patients evaluable over-all improvement in the number of incontinent episodes was 56.6% (p less than 0.001). Two patients (8.3%) achieved total continence, 10 (42%) improved greatly, 4 showed moderate improvement and 8 (33%) showed essentially no change. Transurethral and perineal prostatectomy patients improved by 74 and 61%, respectively, versus only 33% in the radical retropubic group (p = 0.14). In addition, patients who previously underwent transurethral resection before total prostatectomy did worse (18%) than did those who did not (67%). We conclude that a significant number of patients who are incontinent after prostatectomy (especially those without a prior transurethral resection) can improve dramatically with a behavioral training program that provides a strong support system.
Budget constraints, loss of staff, and the inability of administrators to define nursing needs in the outpatient department lead to the development of a tool to define the role of the healthcare provider in the outpatient department. The author discusses the tool's use in categorizing and quantifying nursing activities. Administrators in ambulatory care now have an opportunity to use this readily adaptable method in their outpatient areas to assist in developing quality, cost-effective nursing.
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