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Biomedical subjects

B Vorstman

Publications and source records attributed to B Vorstman.

12 recordsLinked to original sources
PubMed1988

Periurethral polytetrafluoroethylene injection following urethral reconstruction in female patients with urinary incontinence.

We present our results with periurethral polytetrafluoroethylene (Polytef) injection after urethral reconstruction in 20 female patients with urinary incontinence. These patients have failed previous urethral reconstructive procedures to cure incontinence, including Young-Dees-Leadbetter bladder neck reconstruction, transvaginal urethroplasty, transvaginal urethral plication and vesical flap urethroplasty. Of the patients 4 also underwent a bladder augmentation procedure. After polytetrafluorethylene injection 10 patients (50 per cent) were cured of the incontinence, 2 (10 per cent) had marked improvement from the preoperative condition, 5 (25 per cent) had definite improvement but still wear pads for protection and 3 (15 per cent) had no change from the preoperative condition. Bladder pressure recordings did not demonstrate a difference in results among patients with detrusor stability or instability. Periurethral polytetrafluoroethylene injection remains a valuable procedure in the management of persistent incontinence after bladder neck and urethral reconstruction.

Adult↗
PubMed1988

Repair of secondary genital deformities of epispadias/exstrophy.

The aim of secondary genital surgery in epispadias/exstrophy patients is to produce a dangling penis of satisfactory length and shape. The penis should be able to function sexually as well as serve as a conduit for the passage of urine and sperm. The systematic approach to the correction of this defect as outlined in this article should enhance the possibility of a successful result and lessen the need for secondary genital repair.

Bladder Exstrophy↗
PubMed1987

Investigations on urinary bladder reinnervation. Historical perspective and review.

Although nerve crossover surgery to bypass a spinal cord lesion and recentralize the decentralized bladder was first conceptualized in 1907, surprisingly few studies concerning this goal have been reported since. In addition to direct implantation of nerves into the detrusor, the studies reviewed have investigated the crossover of mixed roots (with and without nerve grafts), dorsal roots, ventral roots, pelvic, obturator and hypogastric nerves both in animal models, in human cadavers, and in human patients. Restoration of the micturition reflex through the use of nonsacral nerves has been achieved in cats. In addition, we have shown that the axons of a suprasacral mixed root (L7) when anastomosed to a sacral mixed root (S1) via a nerve graft can regenerate and recentralize the unilaterally decentralized bladder in the cat. The return of the micturition reflex after reconstruction of severed pelvic nerves has been documented, while the results of obstruction or hypogastric crossover have given diminished returns of bladder function. The direct implantation of nerves into the detrusor has not resulted in restoration of function. In addition, return of useful bladder function in humans after nerve crossover surgery has not been predictable. In part, present inability to achieve restoration of urinary bladder function may be a consequence of the complexity of micturition reflex organization and the inability to use techniques in humans that have given success in animals. Although, some of the technical aspects of nerve crossover surgery to bypass a spinal cord injury and restore functional micturition in those with neurogenic bladder dysfunction have been elucidated, further work is required to develop techniques that will enhance appropriate axonal regeneration to achieve reinnervation and return of useful function. Indeed, restoration of function may be limited by current microsurgical methodologies. Studies directed at understanding the neuropathophysiology of nerve injury and nerve surgery may be more fruitful in identifying factors than can be manipulated to achieve consistent return of useful function. In general, however, the results of the animal and human studies surveyed may be viewed with cautious optimism.

Animals↗
PubMed1987

Nerve crossover techniques for urinary bladder reinnervation: animal and human cadaver studies.

Interruption of spinal pathways integrating central and peripheral bladder control mechanisms will result in neurogenic bladder dysfunction. If central pathways could be restored to the decentralized bladder through a microneural reconstructive technique a return of useful function might be achieved. This anatomical study describes the nerve crossover techniques used in human cadaver dissections for connecting intercostal nerves to sacral roots intraspinally. The techniques were modified from and compared to similar procedures used in an animal model where adjacent extradural roots were connected through a nerve graft. We have shown previously that the unilaterally decentralized bladder of the cat can be recentralized after a nerve crossover procedure. If additional laboratory studies can document return of useful bladder function we anticipate that selected patients may benefit from similar nerve crossover techniques to bypass a spinal cord lesion to recentralize the bladder.

Animals↗
PubMed1987

Current hypospadias techniques.

Hypospadias repairs must encompass straightening of the penis and construction of the neourethra at the tip of the penis. In addition to an outline of preoperative and postoperative management, five techniques of single-stage surgical repair are discussed. All hypospadias defects can be repaired using one of these five basic procedures.

Humans↗
PubMed1987

Hidden penis release: adjunctive suprapubic lipectomy.

We believe the hidden penis may be caused and concealed by a prominent suprapubic fat pad in addition to the restrictive fibrous bands of the dartos fascia fixing the shaft of the penis proximally while loose skin folds prolapse distally over the phallus. A penis of inadequate length or appearance may affect body image. Patients with this problem often require psychological support. Hidden penis may be distinguished from micropenis by palpating adequate corpora and showing a stretched penile length within 2 SD of normal. Excision of suprapubic fat with sectioning of the tethering dartos bands will release and increase the length of the penis. Suprapubic fat pad resection may also be helpful to elongate a short penis in cases of adult microphallus, or after partial penectomy because of trauma or cancer. Circumcision is contraindicated.

Adipose Tissue↗
PubMed1986

Urinary bladder reinnervation.

The ability of mixed spinal nerve roots to regenerate and reinnervate the urinary bladder was examined in young adult female cats. Using microsurgical technique, a unilateral extradural spinal nerve root anastomosis of a lumbar (L7) to a sacral root (S1) either with or without a nerve graft was performed. Remaining ipsilateral sacral roots were transected. The contralateral normal sacral roots remained intact and allowed the animals adequate urination during the period necessary for axonal regeneration. At the time of restudy seven months later, stimulation of the anastomosed nerve root proximal to the anastomosis (isolated from the spinal cord) elicited a bladder contraction. Significant lumbar axonal regeneration was substantiated by compound action potentials recorded across the anastomosis. In addition, redirection of axons from a lumbar to a sacral distribution was demonstrated. The contralateral normal sacral roots provided control cystometric and electrophysiological data against which responses from the previously anastomosed nerve roots were compared. In conclusion, significant bladder reinnervation can occur after an anastomosis of a lumbar and sacral root with or without a nerve graft. This technique, or variations thereof, may have a clinical role in selected patients with neurogenic bladder dysfunction to reinnervate the bladder and restore central control.

Animals↗
PubMed1986

Sphincterotomy failure in neurogenic bladder disease.

Among 60 spinal cord injury patients who underwent external urethral sphincterotomy 45 experienced success and 15 failed. Failure was established when symptomatic urinary tract infections and high vesical residuals persisted. Urodynamic findings demonstrated detrusor areflexia in 10 patients (66 per cent), detrusor-sphincter dyssynergia in 2 (13.2 per cent), detrusor hyperreflexia with unsustained bladder contractions in 1 (6.6 per cent), and detrusor hyperreflexia and bladder neck obstruction in 2 (13.2 per cent). Among these failures poor detrusor contractility predominated. Detrusor-sphincter dyssynergia may indicate an inadequate surgical relief of obstruction. Bladder neck obstruction may indicate that a bladder neck incision should be considered when an external sphincterotomy is performed.

Adult↗
PubMed1985

Urethroplasty using diverticular tissue.

Diverticula that occur in the neourethra following repair of hypospadias, epispadias or urethral stricture generally are associated with obstruction distal to the dilated segment. This diverticular tissue can be moderately elastic and well vascularized. We have been able to relieve the stenosis by developing and advancing a diverticular flap, simultaneously reducing the size of the diverticulum.

Adolescent↗
PubMed1985

Polytetrafluoroethylene injection for urinary incontinence in children.

We have treated 11 children for urinary incontinence with one or more endoscopic injections of polytetrafluoroethylene (Teflon) into the external urethral sphincter region. The procedure is simple to perform and without significant complications. Long-term results have been gratifying, with cure or improvement in 8 of the 11 patients.

Adolescent↗