PubMed Health⌕ Search

Biomedical subjects

C E Hawtrey

Publications and source records attributed to C E Hawtrey.

At least 19 recordsLinked to original sources
PubMed2001

Application of the Cecil-Culp repair for treatment of urethrocutaneous fistulas after hypospadias surgery.

OBJECTIVES: To present our technique and results using a modification of the Cecil-Culp technique of hypospadias repair in a select group of boys with urethrocutaneous fistula during a 6-year period. Urethrocutaneous fistula remains the most common complication of hypospadias repair. Coverage of suture lines with vascularized tissue is thought to decrease fistula formation. METHODS: Between 1994 and 1999, 15 boys with hypospadias fistula underwent repair with a modified two-stage Cecil technique. The records were reviewed with respect to age, type of original hypospadias repair, number of previous fistulas, location of the fistulas, and complications. RESULTS: The average age at the time of the first stage of fistula repair was 3.5 years (range 1.8 to 6.0). Five, four, and two patients had undergone one, two, and three previous fistula repairs, respectively. Four boys in this series had deficient penile skin at the time of their first fistula repair. Most had one fistula at the time of the Cecil repair, including eight at the corona, four along the penile shaft, and three in a more proximal location. No patients had a recurrent fistula, with an average follow-up of 21 months (range 1 to 62). CONCLUSIONS: Boys with recurrent fistula, despite previous fistula repair, and deficient penile skin present a technical reconstructive challenge. The modified Cecil technique for fistula repair takes advantage of penile mobility to place it in a scrotal location, ensuring excellent vascularized tissue coverage. Although this technique requires a brief second-stage operation, no recurrent fistula has occurred in any of our patients.

Child↗
PubMed2001

Intravesical Jackson-Pratt drain for urinary diversion after augmentation cystoplasty.

PURPOSE: Augmentation cystoplasty has become a primary form of bladder management in children with a noncompliant bladder. Excellent urinary drainage is required for anastomotic healing and the removal of mucous buildup. Suprapubic drainage traditionally involves a Malecot catheter, although poor irrigation and dislodgment of this type of catheter are well-known complications. We report the placement of an intravesical Jackson-Pratt drain for urinary diversion in augmented bladders. MATERIALS AND METHODS: We reviewed our use of an intravesical Jackson-Pratt drain for urinary diversion between 1995 and 1999 in 17 patients. Postoperative catheter drainage and irrigation characteristics were assessed as well as catheter related complications. RESULTS: Average patient age was 13 years (range 3 to 27). The majority of patients underwent ileal (11) or sigmoid (4) cystoplasty and 1 each underwent composite and ureteral cystoplasty. Drains remained in place an average of 27 days (range 6 to 57). All patients had excellent drainage during the postoperative period. Irrigation was subjectively easier than with a Malecot catheter. Average cost of a latex-free Malecot catheter was 2.7-fold that of a Jackson-Pratt drain. No catheters became nonfunctional before removal, although 1 was inadvertently pulled during patient transfer. CONCLUSIONS: A Jackson-Pratt drain provides excellent urinary drainage in patients undergoing augmentation cystoplasty. Multiple openings along the tube seem to improve irrigation in contrast to the single opening in a Malecot catheter, which often aspirates a region of the augmented bladder. The ready availability, decreased cost, ease of irrigation, increased pliability with decreased chance of dislodgment and lack of latex make an intravesical Jackson-Pratt drain a superior choice for augmented neurogenic bladder.

Adolescent↗
PubMed1998

Assessment of acute scrotal symptoms and findings. A clinician's dilemma.

Diagnosis of testis torsion relies on the clinical wisdom of the examining physician, supplemented with timely imaging techniques by color Doppler examination or scintigraphy. A knowledge of the pathophysiology of acute scrotal conditions can help to eliminate diagnostic errors but the literature demonstrates that errors can occur even with sophisticated testing. Data from the literature suggests that manual detorsion of the testis can successfully relieve ischemia until surgical correction can eliminate the possibility of testis torsion. Surgical therapy has progressively improved and can save the germinal function of the testis.

Acute Disease↗
PubMed1997

Pediatric Vesicoureteral Reflux Guidelines Panel summary report on the management of primary vesicoureteral reflux in children.

PURPOSE: The American Urological Association convened the Pediatric Vesicoureteral Reflux Guidelines Panel to analyze the literature regarding available methods for treating vesicoureteral reflux diagnosed following a urinary tract infection in children and to make practice policy recommendations based on the treatment outcomes data insofar as the data permit. MATERIALS AND METHODS: The panel searched the MEDLINE data base for all articles from 1965 to 1994 on vesicoureteral reflux and systematically analyzed outcomes data for 7 treatment alternatives: 1) intermittent antibiotic therapy, 2) bladder training, 3) continuous antibiotic prophylaxis, 4) antibiotic prophylaxis and bladder training, 5) antibiotic prophylaxis, anticholinergics and bladder training, 6) open surgical repair and 7) endoscopic repair. Key outcomes identified were probability of reflux resolution, likelihood of developing pyelonephritis and scarring, and possibility of complications of medical and surgical treatment. RESULTS: Available outcomes data on the various treatment alternatives were summarized in tabular form and graphically, and the relative probabilities of possible outcomes were compared for each alternative. Treatment recommendations were based on scientific evidence and expert opinion. The panel concluded that only a few recommendations can be derived purely from scientific evidence of a beneficial effect on health outcomes. CONCLUSIONS: For most children the panel recommended continuous antibiotic prophylaxis as initial treatment. Surgery was recommended for children with persistent reflux and other indications, as specified in the document.

Child↗
PubMed1992

Follow-up of clean intermittent catheterization for children with neurogenic bladders.

Intermittent catheterization remains the primary method of treatment in the management of patients with neurogenic bladders such as those with meningomyelocele. In a follow-up of a previous study, we re-examined the urologic status of patients with neurogenic bladders continuing on a regimen of clean intermittent catheterization five years after the completion of the first study. Thirty-seven of the original 49 patients were available for follow-up, and no significant differences were found between those lost to follow-up and those included in this study. Among the patients re-evaluated, reflux remained unchanged or improved in most patients, renal function was maintained, and the urinary tract infection rate remained low. Additionally, continuation of an intermittent catheterization program does provide independence and social continence in most young adults with meningomyelocele. We conclude that a long-term intermittent catheterization program is associated with stable reflux status, renal function, and infection rate, and that compliance with a catheterization program can result in improved social continence and independence.

Adolescent↗
PubMed1992

Variations in practice among urologists and nephrologists treating children with vesicoureteral reflux.

To analyze the current management recommendations among physicians treating children with vesicoureteral reflux, the American Urological Association Reflux Practice Guidelines Panel surveyed 100 pediatric urologists, 100 general urologists and 100 pediatric nephrologists by questionnaire, and received a 60% response. In the evaluation of a 4-year-old girl with bilateral grade 2 reflux general urologists were more likely than the other 2 groups to recommend cystoscopy and urethral dilation. At followup nuclear cystography was recommended by 76% of pediatric urologists, 48% of general urologists and 71% of pediatric nephrologists, while the latter 2 groups were less likely to recommend any subsequent upper tract evaluation. Pediatric urologists were significantly more likely to recommend antireflux surgery if the child had 1 breakthrough febrile urinary tract infection, poor compliance with medical management or persistent reflux at age 11 years. In a 6-year-old girl with unilateral grade 4 reflux and detrusor instability 44% of pediatric urologists recommended antimicrobial prophylaxis and anticholinergic therapy compared to 12% of general urologists and 6% of pediatric nephrologists. Antireflux surgery was recommended by 29% of pediatric urologists, 60% of general urologists and 59% of pediatric nephrologists. In older girls with persistent grade 2 or 3 reflux pediatric urologists were much more likely to recommend antireflux surgery. In contrast, they were less likely to recommend surgery in young girls and boys with newly diagnosed grade 4 reflux. These data demonstrate significant differences in therapeutic recommendations among pediatric urologists, general urologists and pediatric nephrologists, and suggest the need for outcomes research to determine the optimal management of children with vesicoureteral reflux.

Child↗
PubMed1991

Radical prostatectomy and adjuvant radioactive gold seed placement: results of treatment at 5 and 10 years for clinical stages A2, B1 and B2 cancer of the prostate.

Between 1977 and 1988, 131 patients with adenocarcinoma of the prostate underwent combined radical prostatectomy and intraoperative radioactive gold seed placement. Of these 131 patients 80 were clinically assessed as having stage A2 (12), B1 (43) or B2 (25) cancer and they are the subject of this review. The average dose of radioactivity administered to each patient was 96.6 mCi, and mean followup was 65 months (median 64 months). No patient in this series received any other form of adjuvant therapy until disease recurrence was demonstrated. Local recurrences were observed in 2 patients (2.5%) in this series while distant recurrences were observed in 10 (12.5%). Cancer specific survival free of disease at 5 years was 100% for clinical stage A2, 91% for B1 and 75% for B2 cancers. The 10-year survival free of disease was 100% for clinical stage A2, 82% for B1 and 68% for B2 cancers. Covariants of clinical stage and seminal vesicle involvement influenced survival free of disease in a statistically significant manner (p less than 0.05) while pathological stage and degree of tumor differentiation did not. Mild to severe complications were observed in 12 patients (15%). Intraoperative placement of radioactive gold seeds into unresected pelvic tissues surrounding the site of prostatectomy offers a theoretical advantage in treatment by delivering tumoricidal levels of irradiation to residual foci of cancer not appreciated at the time of surgery. Our results suggest that increases in cancer specific survival free of disease over that previously reported for prostatectomy alone may be achieved through this combined treatment regimen. Furthermore, it is our opinion that therapeutic gains can be achieved without the attendant increases in morbidity and treatment delay often associated with adjuvant external beam radiotherapy.

Adenocarcinoma↗
PubMed1991

Clinical management issues in males with sex chromosomal mosaicism and discordant phenotype/sex chromosomal patterns.

The recent availability of Y DNA probes has made it possible to identify two forms of 46,XX male syndrome: Y DNA positive and Y DNA negative. The Y DNA positive male results from a X;Y translocation with a low recurrence risk; the Y DNA negative males are due to a mutation with a high recurrence risk. 46,XX males and mosaic forms are phenotypically indistinguishable. A review of the case histories for 11 individuals indicates that affected males have highly variable genital and nongenital phenotypes. Physical findings may be clearly apparent or nonexistent. With the exception of external genitalia, the basis for this variability is unknown. It may be related to differences in Y chromatin expression as the result of variable inactivation of the X chromosomes, or to the existence of minor deletions or point mutations secondary to an exchange of genetic material. Common and uncommon clinical problems in these individuals require evaluation and follow-up care that is provided through a cooperative, interdisciplinary approach.

Adolescent↗
PubMed1985

Radical prostatectomy with adjuvant radioactive gold for prostatic cancer: a preliminary report.

A total of 71 patients with prostatic carcinoma underwent radical prostatectomy combined with instillation of radioactive gold seeds between January 1, 1977 and July 1, 1982. Gold seeds were implanted intraoperatively into the region of the prostatic vascular pedicles and surrounding fibrolymphatic tissue after removal of the prostate and seminal vesicles. Of the patients with disease confined to the prostate clinically 46.7 per cent had microscopic extraprostatic local tumor extension. We believe that patients with extraprostatic local tumor derive therapeutic benefit from the addition of adjuvant radioactive gold seeds at prostatectomy. Because of the inaccuracy of clinical staging by rectal examination, we have elected to use radioactive gold seeds in all of our patients at prostatectomy. To date, local recurrence has been noted in 5.6 per cent of our patients and systemic progression in 14.1 per cent.

Adenocarcinoma↗
PubMed1984

Cryotherapy.

Since 1969 cryosurgical perineal destruction of the prostate has been developed at the University of Iowa for treatment of patients with prostatic cancer. The technique of this procedure has been the subject of previous reviews. This is a summary of our experience of patient survival and the effect on local prostatic cancer growth in those patients with various stages of the disease subjected to perineal cryosurgical destruction of their cancer. We also report briefly on our experience in the laboratory where the Dunning tumor model is used to study the effect of cryosurgery as well as combinations of immunological modifications.

Adult↗
PubMed1984

Urological injury and assessment in patients with fractured pelvis.

Of 200 patients with pelvic fractures 32 (25 male and 7 female patients) had urological injury. Of these 32 patients 31 had pubic ramus or symphyseal fractures: 29 had gross hematuria and a urine specimen was not obtained in 2. Only 1 of 77 patients with microscopic hematuria had serious urological injury. We believe that excretory urography is not necessary in all cases of pelvic fracture, and that urethrography and cystography are indicated only in cases of gross hematuria or when other clinical signs indicate a high likelihood of bladder or urethral trauma.

Adolescent↗
PubMed1983

Cryosurgery in prostatic cancer: elimination of local lesion.

From 1969 through 1976, we performed cryosurgery in 229 cases of prostatic cancer. Most of these patients had bulky, locally extensive primary tumors, and one-half had disseminated disease. Through the open perineal approach, which gives exposure for an adequate freeze, cryosurgery has been well tolerated. The primary surgical goal has been to reduce or eliminate the local lesion to minimize subsequent cancer-related lower urinary tract problems and to cure those patients with truly localized disease. In every case cryosurgery produced dramatic shrinkage of the local lesion. After four to eight weeks a local recurrence was suspected in 13 per cent, and 41 per cent eventually had some evidence of a recurrent cancer nodule or persistent cancer in the bladder neck. In a series of statistical analyses we have related these recurrences to other clinical factors. Cryosurgery has been a safe, effective way to reduce or eliminate the primary prostatic cancer, even in patients with large local lesions.

Aged↗
PubMed1983

Ureterovesical reflux in an adolescent and adult population.

The records and radiographic data on 177 adolescents and adults with vesicoureteral reflux were reviewed. The anatomic characteristics of 255 renal units and ureterovesical junctions were characterized using criteria reported previously. A total of 125 renal units demonstrated grades III to V reflux (International). Abnormal ureteral orifices were observed in 145 renal units and 155 submucosal tunnels were short or absent. Excretory urograms outlined renal scars in 192 renal units. Pre-treatment and post-treatment creatinine clearances were analyzed in 188 renal units. Ureteral reconstruction resulted in stabilization or improvement in the mean creatinine levels in 53 renal units. Other forms of surgical and medical treatment also resulted in improved renal function during observation.

Adolescent↗