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Biomedical subjects

A R Mundy

Publications and source records attributed to A R Mundy.

At least 73 records · Page 4Linked to original sources
PubMed1997

The source of urinary nitrosamines in patients with enterocystoplasties.

OBJECTIVE: To assess the factors influencing urinary nitrosamine production in patients with enterocystoplasties. PATIENTS, SUBJECTS AND METHODS: The study comprised 100 patients with an enterocystoplasty, 20 patients with interstitial cystitis, 30 with infective cystitis and 120 control subjects drawn from hospital staff and out-patients. Urinary nitrosamine levels were measured and the urine samples cultured for microorganisms. RESULTS: Nitrosamine levels were significantly higher only in patients with enterocystoplasties who also had higher urinary white cell counts or significant bacteriuria. CONCLUSION: Patients with an enterocystoplasty and significant bacteriuria are most at risk from potential nitrosamine-induced epithelial injury.

Bacteriuria↗
PubMed1997

Transuretero-ureterostomy: a review of 253 cases.

OBJECTIVES: To review our experience of transuretero-ureterostomy (TUU), which can be a dangerous procedure if a problem arises with the anastomosis, because both upper urinary tracts are put at risk to deal with a problem that initially affected only one side. PATIENTS AND METHODS: TUU was performed in 253 patients following undiversion, trauma or strictures of the distal ureter, with a Mitrofanoff-type of continent urinary diversion, or otherwise during reconstructive urological surgery, mainly in association with cystectomy and substitution cystoplasty. The patients were followed and complications or problems reviewed. RESULTS: Five patients had problems with the distal ureter below the TUU and one had problems as a result of stone disease in the transposed ureter some distance proximal to the TUU, but there were no long-term complications as a direct result of the TUU. CONCLUSIONS: Providing the anastomosis is stented until there is radiological evidence of healing of the TUU, then TUU is a safe and reliable procedure.

Adult↗
PubMed1997

Intussuscepted partial-thickness ileal valve in continent urinary diversion.

OBJECTIVE: This study was undertaken to ascertain the feasibility of fashioning a nipple valve from partial-thickness ileum and to assess the competence and durability of that valve. The approach employed was designed to circumvent the necessity for considerable lengths of bowel to be committed to valve formation and to avoid the tendency for desusception, present with other forms of nipple valves. METHODS: A technique in which a subterminal segment of partial-thickness ileum was 'skinned' circumferentially of serosa and muscularis propria and then intussuscepted to form a continent nipple-valve mechanism was studied for up to 4 months in 10 dogs. The intussuscepted partial-thickness ileal valve was in continuity with a terminal ileal segment sutured flush with skin and, internally, with another segment laid open and anastomosed to the bladder. RESULTS: All valves were competent, withstanding intravesical pressures up to 90 cm H2O. Six dogs were catheterized, without difficulty, twice daily up to 104 days. The valve mucosal surfaces were smooth due to a loss of plicae circulares, and, between 'back-to-back' submucosal layers, a fine stroma developed. CONCLUSIONS: This simple technique, which is frugal in its use of bowel, provided a robust and effective ileal continence mechanism. Furthermore, because of denervation and interposing fibrous tissue, this nipple valve is considered most unlikely to desuscept subsequently. The intussuscepted partial-thickness ileal valve approach is recommended now for clinical evaluation.

Anastomosis, Surgical↗
PubMed1996

Neuromodulation of detrusor hyper-reflexia by functional magnetic stimulation of the sacral roots.

OBJECTIVE: To investigate the acute effects of functional magnetic stimulation (FMS) on detrusor hyper-reflexia using a multi-pulse magnetic stimulator. PATIENTS AND METHODS: Seven male patients with established and intractable detrusor hyper-reflexia following spinal cord injury were studied. No patient was on medication and none had had previous surgery for detrusor hyper-reflexia. After optimization of magnetic stimulation of S2-S4 sacral anterior roots by recording toe flexor electromyograms, unstable detrusor activity was provoked during cystometry by rapid infusion of fluid into the bladder. The provocation test produced consistent and predictable detrusor hyper-reflexia. On some provocations, supramaximal FMS at 20 pulses/s for 5 s was applied at detrusor pressures which were > 15 cmH2O. RESULTS: Following FMS there was an obvious acute suppression of detrusor hyper-reflexia. There was a profound reduction in detrusor contraction, as assessed by the area under the curves of detrusor pressure with time. CONCLUSIONS: Functional magnetic stimulation applied over the sacrum can profoundly suppress detrusor hyper-reflexia in man. It may provide a non-invasive method of assessing patients for implantable electrical neuromodulation devices and as a therapeutic option in its own right.

Adult↗
PubMed1996

The effects of detubularization and outflow competence in substitution cystoplasty.

OBJECTIVE: To assess the effects of detubularization and outflow competence on the clinical and urodynamic results of patients undergoing substitution cystoplasty. PATIENTS AND METHODS: The study included 142 patients undergoing orthotopic substitution cystoplasty, of whom 85 underwent a 'straight' and 57 a detubularized substitution cystoplasty using the ileo-colonic segment. All were assessed clinically and by video-urodynamic studies before and after surgery. RESULTS: In patients voiding spontaneously, detubularization produced a capacity 38% greater than that found with a 'straight' cystoplasty, but there was no difference in the contractility of the substitute bladder between the groups. In patients requiring clean intermittent self-catheterization to empty, outflow competence was a more important factor in increasing capacity and reducing contractility. CONCLUSIONS: Detubularization produces a modest increase in bladder capacity but far less than that predicted by mathematical models. It has no substantial effect on contractility when compared with straight substitution cystoplasty. The effects of detubularization on both capacity and contractility are less than the 'chronic retention' effect produced by increasing outflow competence. Detubularization is therefore only one of several factors that influence the results of substitution cystoplasty.

Cystitis, Interstitial↗
PubMed1996

Urethroplasty for posterior urethral strictures.

OBJECTIVE: To assess the long-term results and complications of urethroplasty for patients with pelvic fracture injuries of the posterior urethra and to determine which type of of procedure is most appropriate. PATIENTS AND METHODS: Eighty-two patients were followed prospectively after undergoing transperineal bulboprostatic anastomotic urethroplasty (AU). The results and complications in these patients were compared with 59 patients who had a 'patch' urethroplasty (PU) for a short stricture which in other circumstances might have been amenable to AU. RESULTS: The 1-, 5- and 10-year re-stricture rates were 7, 12 and 12%, respectively, for AU and 12, 20 and 31% for PU. Four of the 10 patients who re-strictured during the 5-year follow-up after AU were > 55 years of age and four of the seven patients who had an AU and who were > 55 years old re-strictured. All the patients who re-strictured were impotent. The commonest complications after AU were principally a consequence of the original injury rather than the surgery, whereas the complications after PU were principally related to the surgery. Impotence sometimes occurred after both types of urethroplasty. CONCLUSIONS: Anastomotic urethroplasty is the best available procedure for traumatic proximal urethral strictures but was not tolerated well in the elderly and caused impotence in a small but significant proportion. The results of PU were less satisfactory and the difference became progressively more marked with a longer follow-up.

Aged↗
PubMed1996

Stones in enterocystoplasties.

OBJECTIVES: To assess the aetiology of stones which occur in enterocystoplasties and continent diversions, generally attributed to the presence of foreign material, e.g. staples, or to recurrent urinary infection, in patients with augmented or substituted bladders. PATIENTS AND METHODS: The study comprised 467 patients who had undergone reconstruction of the lower urinary tract and had been followed up for at least 3 years using videourodynamics and ultrasonography. RESULTS: Stones were found in 42 patients (9%); 50% were found incidentally and the remaining patients presented with symptomatic infections (27%) or deterioration in urinary continence (23%). Stones occurred in 6% of patients with augmentation, in 7% of those with substitution cystoplasty and in 22% of patients with continent diversions. Most patients with stones (88%) used clean intermittent self-catheterization (CISC). Stones were 5-10 times commoner in patients using CISC than in patients voiding spontaneously. CONCLUSION: Urinary stasis was a more important cause of stone formation than was bacteriuria in patients with cystoplasty. The presence of mucus and bacteriuria are presumed to be contributory. To reduce the risk of stone formation, orthotopic cystoplasty and spontaneous voiding are to be preferred to continent diversion and CISC. Periodic bladder washouts may be an alternative solution.

Homeostasis↗
PubMed1995

Malignant change in enterocystoplasty: a histochemical assessment.

Increasing numbers of cases of malignant tumours occurring in enterocystoplasties are being reported. Material from five cases of adenocarcinoma arising in such patients were studied using standard mucin and carbohydrate lectin staining methods. Sections from the tumour and adjacent and distant mucosa were stained to determine the pattern of histochemical changes. The abnormal staining patterns seen suggest that the adenocarcinomata arising at the enterovesical anastomosis are of intestinal origin. A hypothesis is advanced to explain the pathogenesis of these tumours.

Adenocarcinoma↗
PubMed1995

The long-term results of skin inlay urethroplasty.

OBJECTIVE: To report the results of a 10-year follow-up of 73 patients who underwent skin-inlay urethroplasty for the treatment of strictures that failed to respond to a trial of endoscopic surgery. PATIENTS AND METHODS: The 10 year follow-up of 48 patients with patch urethroplasties and 25 with tube urethroplasties of pedicled preputial, penile and scrotal skin is reported. RESULTS: The patients with patch urethroplasties tended to do well in the medium term whatever the source of skin, although there was a steady annual attrition rate after 4 years of about 5%/year requiring revision. The 25 patients with tube urethroplasties did less well, particularly those with scrotal skin tubes. The patients with preputial/penile tube urethroplasties did rather better but, in general, all these tube urethroplasties seem to narrow uniformly with time. Urethrotomy was never curative when a stricture recurred in relation to a urethroplasty. CONCLUSION: If the initial result is satisfactory, then patch urethroplasties tend to do well in the medium term whatever the source of the flap. No matter how good the initial result, scrotal skin tube urethroplasties do badly; preputial/penile skin performs better but tube urethroplasties tend to narrow down nonetheless. In the long term--more than 10 years--all skin inlays seem to have a tendency to deteriorate.

Adolescent↗
PubMed1995

The role of urodynamic studies in the evaluation of patients with augmentation cystoplasties.

OBJECTIVE: To assess the role and value of videourodynamic studies (VUD) in the post-operative evaluation of 100 patients who were continent following augmentation (clam) enterocystoplasty. PATIENTS AND METHODS: Fifty patients had non-neuropathic detrusor instability and 50 had neuropathic bladder dysfunction. All underwent standard dual channel medium fill cystometry and synchronous video screening before and at 6 months and 2 years after a clam ileocystoplasty. RESULTS: Pre-operative capacity was variable in non-neuropathic patients but post-operative capacity in this group, and both pre- and post-operative capacity in the neuropathic group, were more reproducible. Of non-neuropathic patients, 88% became stable and 83% became normally compliant, compared with only 38 and 50% respectively of neuropathic patients. More surprisingly, two of eight neuropathic patients previously stable became unstable and four of 12 of those previously normally compliant became poorly compliant. In all patients voiding spontaneously there was a tendency for capacity to increase and voiding efficiency to decrease with time. CONCLUSIONS: From these results, standard VUD studies contributed little to the post-operative assessment of patients with clam cystoplasties beyond that which could be obtained by ultrasonography of the bladder before and after voiding. The effect or lack of effect of augmentation cystoplasty on compliance in the neuropathic bladder suggests a neuropathic effect on bowel contractility and warrants further investigation. The meaning and significance of 'urodynamic' observations when bowel is incorporated into the bladder also needs careful investigation.

Adolescent↗
PubMed1995

Is cystoplasty a safe alternative to urinary diversion in patients requiring renal transplantation?

The study aimed to assess the methods of urinary drainage in patients requiring renal transplantation in whom the native lower urinary tract was unsuitable. Twenty-one patients had a transplant into an abnormal urinary tract. Eight of them into a cystoplasty, 8 into an ileal conduit and 5 had a cutaneous ureterostomy. All patients transplanted into an ileal conduit (mean follow-up 4.6 years) and into a cutaneous ureterostomy (mean follow-up 3.2 years) have had a satisfactory outcome. Five of 8 patients transplanted into a cystoplasty have had a satisfactory outcome, 2 patients suffered graft loss due to rejection and 1 developed necrosis of cystoplasty following transplantation. In terms of graft survival, excellent results in the medium term were obtained for transplantation with an ileal conduit or cutaneous ureterostomy. Cystoplasty was less successful but was not the direct cause of graft loss in any patient and as such is as safe a technique in patients with end-stage renal failure so long as care is taken to avoid the vascular pedicle at the time of transplantation.

Adult↗
PubMed1995

Pregnancy after lower urinary tract reconstruction in women.

PURPOSE: We determined if pregnant women with reconstructed lower urinary tracts experience complications related to the urological reconstruction. MATERIALS AND METHODS: A total of 27 women (34 pregnancies) with reconstructed lower urinary tracts underwent regular urinalysis, blood biochemistry studies and ultrasound examinations during pregnancy and for a minimum of 1 year after delivery. RESULTS: There were 28 normal, full-term vaginal deliveries without complication. A total of 6 patients underwent cesarean section, with injury to the vascular pedicle of the cystoplasty without sequelae occurring in 1. Temporary postpartum incontinence occurred in 6 patients. CONCLUSIONS: Patients with reconstructed lower urinary tracts can experience normal deliveries but require close surveillance. The route of delivery should be determined by obstetrical indications.

Female↗
PubMed1994

Peptides related to thyrotrophin-releasing hormone (TRH) in human prostate and semen.

The TRH-related peptide, pGlu-Glu-ProNH2, which was first identified in rabbit prostate has recently been named fertilization-promoting peptide (FPP) because of its ability to enhance the in vitro fertilizing potential of mouse epididymal spermatozoa. This study set out to examine the nature of the TRH-related peptides in human prostate and semen but, first, the optimal conditions for collection of semen samples were investigated. FPP was degraded slowly (t1/2 = 163 min, S.E. +/- 51.3, n = 6) in seminal plasma which has allowed us to measure accurately the concentrations of FPP, after extraction of the peptide in acidified acetone precisely 5 min after ejaculation. In this way, high levels of FPP (mean: 49.5 nmol/l) were detected in normal human semen, from young men, although other TRH-related peptides did not appear to be present. We have also examined the TRH-related peptides present in prostate samples from clinical patients both with and without evidence of benign prostatic hyperplasia (BPH), by ion-exchange chromatography followed by radioimmunoassay. Substantial concentrations of FPP were observed in normal (4.10 pmol/g tissue, S.E. +/- 1.46) and BPH prostate (6.27 pmol/g tissue, S.E. +/- 1.65). In addition, a second, neutral TRH-immunoreactive peptide was always detected in BPH tissue (7.40 pmol/g tissue, S.E. +/- 1.98) with only low levels generally present in normal prostate. The possibility that the presence of high levels of the neutral peptide in prostate may be used as an indicator of the onset of BPH deserves further scrutiny.

Adult↗
PubMed1993

Results and complications of urethroplasty and its future.

A consecutive series of 200 patients undergoing urethroplasty has been reviewed to assess the results and complications of surgery and thereby assess the role of urethroplasty in the treatment of urethral strictures with particular reference to the current interest in intraluminal "stenting" of strictures. Anastomotic urethroplasty for post-traumatic strictures and "patch" urethroplasty for post-infective strictures give satisfactory results which at present do not seem to be bettered by any other form of treatment. Urethroplasty for so-called "ischaemic" strictures gives less satisfactory results which could almost certainly be improved upon by intraluminal "stenting" or some other novel form of treatment. The incidence of impotence, temporary and permanent, after urethroplasty is probably greater than is generally realised and the aetiology of this complication warrants serious investigation as this is the single most important limiting factor in urethroplasty.

Adolescent↗
PubMed1993

Relative indications for orthotopic lower urinary tract reconstruction, continent urinary diversion and conduit urinary diversion.

Continent urinary diversion has become increasingly popular in the last few years and there are now several situations in which ileal conduit diversion, continent diversion and orthotopic reconstruction of the lower urinary tract are equally valid options. This review was intended to determine specific indications for each. Of 513 patients treated for severe lower urinary tract problems in the last 10 years, 399 underwent orthotopic reconstruction, 68 underwent continent diversion and 46 had an ileal conduit. Problems occurred 2 to 3 times more commonly in the continent diversion group than in either of the other groups. Given a free choice, most patients would choose an orthotopic reconstruction and this should probably be regarded as the gold standard. Continent diversion is specifically indicated in male patients who require a total cystourethrectomy for bladder cancer, in severe post-radiotherapy problems, and in patients with neuropathic bladder dysfunction in whom, for various reasons, self-catheterisation is impossible. Ileal conduit diversion remains the simplest and safest technique in high-risk patients and does not preclude a subsequent continent diversion or orthotopic reconstruction.

Humans↗