Biomedical subjects

B A Lipski

Publications and source records attributed to B A Lipski.

3 recordsLinked to original sources

PubMed1998

Voiding dysfunction after bilateral extravesical ureteral reimplantation.

PURPOSE: Voiding dysfunction has been reported after bilateral extravesical ureteral reimplantation. We evaluate the incidence and duration of voiding dysfunction, and the effects of minimizing surgical dissection in a cohort of children after bilateral extravesical reimplantation. MATERIALS AND METHODS: A retrospective chart review was performed on 33 consecutive children who underwent bilateral extravesical ureteral reimplantation for reflux. Preoperative and postoperative radiological studies, and postoperative post-void residuals were reviewed. Of the 33 patients 11 underwent ureteroneocystostomy using a modified Lich-Gregoir technique with ureteral advancement and 22 underwent a modified procedure in which the detrusor dissection was minimized and the obliterated umbilical artery was preserved. Both groups had similar preoperative characteristics. Postoperative surgical success and signs of voiding dysfunction were evaluated and compared between groups. RESULTS: The average length of time until patients were able to void at least half of the bladder volume was 5.9 +/- 3.1 days. The average length of time until successful postoperative Foley catheter or suprapubic tube removal was 7.4 +/- 4.2 days. All children were able to void adequately eventually. Postoperative voiding cystourethrogram demonstrated that reflux was cured in 97% of the ureters. There was no postoperative vesicoureteral obstruction. There was no significant difference in length of time necessary to void, the duration of catheterization or operative success between the children who underwent standard versus limited detrusor dissection procedures. CONCLUSIONS: Extravesical ureteral reimplantation is an effective method for repairing reflux without ureteral obstruction but it can also result in a high rate of transient postoperative urinary retention even when detrusor dissection is minimized.

Adolescent↗

PubMed1998

A unique new model to study the effects of urinary diversion in the developing rabbit bladder.

PURPOSE: Little is known about the developmental effects of high urinary diversion and bladder defunctionalization in infancy. Although clinical experience shows that a poorly functional bladder may result from urinary diversion in infancy, the mechanisms of change and specific bladder wall alterations have not been well characterized. We hypothesized that cyclic filling and emptying are necessary for normal bladder development. To investigate this important question we created a new animal model. MATERIALS AND METHODS: We designed a new method of hemibladder urinary diversion in 3-week-old New Zealand white rabbits. After vertical midline bladder division half of the bladder was formed into a functional reservoir, which remained in continuity with the ipsilateral ureter and urethra. The other bladder half was defunctionalized and isolated from the urine flow by ureteral ligation. Diversion was created for 3, 7, 14 and 28 days. Urodynamic evaluation was done in the functionalized hemibladders and age matched normal rabbit bladders to test the validity of the functionalized hemibladder as an internal control. Functional and defunctionalized hemibladders as well as age matched, nonoperated normal rabbit bladders were weighed, sectioned and stained to demonstrate muscle and connective tissue components. RESULTS: In 22 of the 27 healthy rabbits (81%) good quality diverted and functional bladder specimens were obtained after diversion. Defunctionalized hemibladders grew more slowly than functionalized bladders and normal age matched control bladders. Histological staining of the bladder wall demonstrated increased connective tissue between the muscle bundles within the diverted specimens than in functional bladders. CONCLUSIONS: Our successful model of urinary diversion may be used to study the developmental and histological effects of urinary diversion in the young bladder. Bladder growth and histological appearance are altered when the stimulus of cyclic filling and emptying is removed. Further studies using this model are warranted to define fully bladder changes that result from diversion and investigate the mechanism of the observed changes.

Age Factors↗

PubMed1996

Prostatic intraepithelial neoplasia: significance and management.

Prostatic intraepthelial neoplasia (PIN) is a putative premalignant change that bears a morphological similarity to prostatic cancer and shows increased frequency, severity, and extent in patients with prostate cancer. This article discusses the evidence for PIN as a premalignant lesion, reviews the morphology, terminology, appropriate grading system, and diagnostic significance of PIN, as well as describes management recommendations for further evaluation when PIN is diagnosed in prostate resection and biopsy specimens. Clinical management of high-grade PIN found in transurethral resection of the prostate (TURP) or prostate biopsy specimens should include repeat transrectal ultrasound (TRUS) and prostate biopsy for early detection of prevalent coexistent prostate cancer. In cases of high-grade PIN, increased surveillance methods have the potential to decrease morbidity and mortality by early cancer diagnosis.

Humans↗