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Biomedical subjects

B I Carlin

Publications and source records attributed to B I Carlin.

12 recordsLinked to original sources
PubMed2001

United States experience with tension-free vaginal tape procedure for urinary stress incontinence: assessment of safety and tolerability.

PURPOSE: The tension-free vaginal tape (TVT) procedure is an operation for treatment of stress urinary incontinence. A polypropylene mesh tape is placed to support the midurethra through a small vaginal incision. In this study, we present our preliminary results evaluating the safety, tolerability, and perioperative morbidity of this procedure. MATERIALS AND METHODS: One hundred patients with stress urinary incontinence underwent the TVT procedure as part of an observational study. Patients were evaluated prospectively with history and pelvic examination, urodynamic studies, perioperative protocol, outcome and satisfaction questionnaire, and postoperative visits at 3 weeks and 2 months. RESULTS: The procedure was performed with the patient under local anesthesia, using intravenous sedation in 97 patients and regional anesthesia in 3. Mean surgical time was 35.5 minutes. Bladder penetration occurred in 24 patients. Forty-two required overnight urethral catheterization. Mean hospital stay was 0.18 days. By 24 hours after the procedure, 95% were able to void. At 3-week follow-up, 88% of patients were completely continent and 9% significantly improved. CONCLUSIONS: The TVT procedure for stress urinary incontinence is a safe, minimally invasive operation with minimal perioperative morbidity. Considering these preliminary findings and long-term European data of 1 to 3 years' experience with continence rate averaging 85%, the TVT procedure may prove to be the operation of choice to treat stress urinary incontinence for many women.

Adult↗
PubMed2000

The tension-free vaginal tape procedure for the treatment of stress incontinence in the female patient.

The newest development in the treatment of female stress incontinence is the tension-free vaginal tape (TVT) procedure. This procedure was first described by Ulmsten et al. in 1996 and involves recreating suburethral support with a polypropylene mesh, without repositioning the bladder or urethra. In their initial study, Ulmsten et al. reported an 84% cure rate at 2-year follow-up. The purpose of this report is to discuss the evolution and technical aspects of the TVT procedure and to outline the pre- and postoperative care recommended. A brief summary of our initial experience in our first 100 patients is included.

Female↗
PubMed2000

The natural history, skeletal complications, and management of bone metastases in patients with prostate carcinoma.

BACKGROUND: Prostate carcinoma poses a significant public health problem. Although a minority of men with newly diagnosed prostate carcinoma manifest bone metastases or skeletal abnormalities, a significant proportion of men will develop these complications over the course of their lives. Patients at highest risk for bone metastases include those with high grade, high stage neoplasms, those who fail primary curative therapies such as radical prostatectomy or radiation therapy, and those who develop biochemical recurrence after hormonal therapy. METHODS: The relative risks and prognostic factors for bone metastases in each of these settings will be reviewed. RESULTS: In comparison with men without prostate carcinoma, benign skeletal complications (osteopenia and fractures) occur at significantly increased rates among men with untreated prostate carcinoma. Moreover, the incidence rate of these conditions increases dramatically among those men who are receiving endocrine therapy. The duration and intensity of the endocrine therapy may be associated with the incidence rate and severity of skeletal complications. CONCLUSIONS: Given the significant incidence rate and quality of life implications of skeletal complications and bone metastases, there is an urgent need to identify effective preventive therapies and treatments. Bisphosphonates may have a role in preventing osteopenia and, potentially, bone metastases among men with prostate carcinoma.

Bone Neoplasms↗
PubMed2000

The tension-free vaginal tape procedure: correction of stress incontinence with minimal alteration in proximal urethral mobility.

OBJECTIVES: To prospectively assess the degree of urethral hypermobility in the preoperative and postoperative periods after the tension-free vaginal tape (TVT) procedure and correlate our findings with surgical outcome. METHODS: Twenty patients with stress incontinence underwent the TVT procedure. A Q-tip test was performed before the procedure and at the 3-week postoperative follow-up visit. Cure was defined as the absence of the subjective complaint of urine leakage and the absence of stress incontinence on stress testing at cystometric capacity. RESULTS: Seventeen patients (85%) were cured by the TVT procedure, 2 patients (10%) were improved, and 1 patient (5%) was unchanged. The mean preoperative and postoperative Q-tip values were 42.75 degrees and 31.75 degrees, respectively. Twelve patients had a Q-tip test result of 30 degrees or greater after surgery and 11 (92%) of these 12 patients were cured by the procedure. CONCLUSIONS: On the basis of these results, we propose that the cure of stress incontinence does not require the correction of proximal urethral hypermobility.

Female↗
PubMed1997

Role of finasteride in the treatment of recurrent hematuria secondary to benign prostatic hyperplasia.

OBJECTIVES: We evaluated the efficacy of finasteride for the treatment of gross hematuria secondary to benign prostatic hyperplasia in a prospective fashion. METHODS: Twelve patients with recurrent episodes of gross hematuria secondary to benign prostatic hyperplasia were treated with finasteride 5 mg/day. Before initiating treatment, we excluded other sources of hematuria using intravenous urography, cystoscopy, and urine culture. RESULTS: Bleeding subsided within 2 weeks of treatment in all 12 patients. Minimum follow-up was 6 months. Finasteride was well tolerated by all 12 patients. CONCLUSIONS: Finasteride appears to be effective in treating recurrent gross hematuria secondary to benign prostatic hyperplasia. This therapy should be considered an alternative to transurethral resection of the prostate or hormonal ablation in patients with recurrent hematuria and no significant obstructive uropathy or adenocarcinoma of the prostate.

Enzyme Inhibitors↗
PubMed1997

Comparison of the ileal conduit to the continent cutaneous diversion and orthotopic neobladder in patients undergoing cystectomy: a critical analysis and review of the literature.

In recent years, many investigators have devised innovative urinary diversions to improve the quality of life of patients requiring urinary diversions after cystectomy. In this article, we report a literature review in which we compare the outcomes of patients receiving an ileal conduit to those receiving either a continent cutaneous diversion or an orthotopic neobladder. In this discussion, we analyze the data in the literature that pertains to quality of life, incontinence rates, and metabolic complications. We conclude that although the newer urinary diversions are promising, randomized prospective trials comparing patients receiving these diversions to those receiving an ileal conduit need to be performed.

Aged↗
PubMed1995

Indications and techniques for urologic evaluation of the trauma patient with suspected urologic injury.

Injury to the urinary tract occurs in 3% to 10% of patients suffering from blunt or penetrating trauma. Timely assessment of these patients is fundamental in minimizing associated morbidity and mortality rates. We introduce a review of the current treatment of patients with suspected injury to the urinary tract in which we focus on the appropriate diagnostic approach and current advances in the field. This review is divided into sections concentrating on injuries to the kidneys, bladder, and urethra. Pertinent anatomy, mechanism of injury, classification of injury, and indications for evaluation are addressed in each section. Illustrative case studies are also provided to complement relevant teaching points.

Adolescent↗
PubMed1995

Anatomic approach to radical perineal prostatectomy.

The recent development of the laparoscopic pelvic lymphadenectomy has obviated the need for open transabdominal surgery for the staging of prostate cancer. In addition, it has become clear that all patients undergoing surgical treatment of localized prostate cancer do not require lymphadenectomy. This has led to the resurgence of the perineal approach to prostate surgery. This operation has been proven to be an effective cancer operation, having low associated morbidity and mortality. An increased understanding of pelvic anatomy has allowed the perineal approach to match the retropubic approach in efficacy and complication rate. Thus, this article serves to integrate an anatomic description of pelvic anatomy with the surgical technique of perineal prostatectomy.

Humans↗
PubMed1994

PR92 antigen in human prostate fluid: elevated levels in prostate cancer.

In this preliminary study, we report that an enzyme-linked immunofluorescence assay (EFLA) was developed for the determination of PR92 antigen in prostatic fluid, utilizing anti-PR92 monoclonal antibody. Fluid samples from 64 patients were assayed. PR92 antigen was expressed as unit per microgram (U/microgram) of prostatic fluid proteins. One hundred percent of men (7 out of 7) less than 50 years of age demonstrated concentrations less than 25 U/micrograms; 91% of men (10 out of 11) with documented carcinoma, and only 9.5% of men (2 out of 21) with benign prostatic hyperplasia, demonstrated concentrations above 230 U/micrograms. The mean concentration of PR92 antigen in prostatic fluid of a group of patients suspected of having prostate cancer (high-risk group; 227 +/- 42 U/micrograms) was significantly greater than that of those with benign prostatic hyperplasia (87 +/- 23 U/micrograms; P = 0.05). Further evaluation of this potential marker and of other antigens within the prostatic fluid is warranted.

Adult↗