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C G Klutke

Publications and source records attributed to C G Klutke.

At least 19 recordsLinked to original sources
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 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↗
PubMed2000

Transvaginal bladder neck suspension with Cooper's ligament fixation. Long-term urodynamic results.

OBJECTIVE: To evaluate the long-term urodynamic efficacy of transvaginal bladder neck suspension with Cooper's ligament fixation. STUDY DESIGN: Nineteen women underwent transvaginal bladder neck suspension with Cooper's ligament fixation. Patients underwent complete clinical and urodynamic testing before and four to five years after surgery. Cure was defined as absence of urine leakage with stress maneuvers at cystometric capacity and lack of symptoms of urine loss. RESULTS: A successful outcome was documented in 12/14 patients. One patient developed de novo detrusor instability, and two had stress incontinence. Five were lost to long-term follow-up. CONCLUSION: Transvaginal bladder neck suspension with Cooper's ligament fixation is an effective surgical option in the treatment of genuine stress incontinence.

Adult↗
PubMed1999

Bladder neck suspension for stress urinary incontinence: how does it work?

The objective of this study was to compare urethral resistance as determined in pressure-flow studies before and after Burch retropubic urethropexy. Urethral resistance was retrospectively determined from pressure-flow studies in 178 patients before and 1 year after Burch retropubic urethropexy. Results of cotton swab tests, pressure transmission to the proximal urethra, and urethral functional length were also recorded. Results were analyzed statistically using the two-tailed paired t-test. Voiding studies in 176 patients were analyzed before and after Burch retropubic urethropexy. Mean urethral resistance increased significantly over preoperative values after successful surgery, from 0.051 to 0.099. The mean urethral resistance in patients in whom surgery failed to cure stress incontinence was unchanged from the preoperative value of 0.041. There was no direct correlation between stabilizing the bladder base, as evaluated by the cotton swab test, and cure of stress incontinence. When successful in curing genuine stress urinary incontinence, the Burch retropubic urethropexy increases urethral resistance. Creating bladder neck support without affecting urethral resistance does not, by itself, restore continence. Neurourol. Urodynam. 18:623-627, 1999.

Adult↗
PubMed1999

Laparoscopic bladder neck suspension fails the test of time.

PURPOSE: Initial reports on laparoscopic bladder neck suspension have suggested success rates similar to those of traditional bladder neck suspension. We compare long-term success rates of laparoscopic and transvaginal Raz bladder neck suspension. MATERIALS AND METHODS: A total of 100 patients with anatomical stress urinary incontinence underwent extraperitoneal laparoscopic bladder neck suspension with securing of the endopelvic fascia to Cooper's ligament (58, laparoscopy group) or transvaginal Raz bladder neck suspension (42, transvaginal group). Patients were evaluated by chart review and telephone questionnaire to determine whether they had urinary incontinence. RESULTS: The 2 groups were similar in terms of age, mean body mass index, preoperative bladder capacity and post-void residual. Mean followup was 45 months (range 14 to 71) in 50 laparoscopy group (86%) and 59 months (range 35 to 72) in 29 transvaginal group (70%) patients. Only 15 of 50 laparoscopy group (30%) and 10 of 29 transvaginal group (35%) patients were completely continent at followup. There was no statistically significant difference in the success rates for the 2 groups. Mean time to failure for both groups was 18 to 24 months. CONCLUSIONS: With long-term followup laparoscopic bladder neck suspension demonstrated poor success rates similar to other minimally invasive surgical therapies for stress urinary incontinence. Any new surgical technique for treatment of stress urinary incontinence should have a mean followup of more than 2 years to determine true clinical efficacy.

Adult↗
PubMed1999

Long-term results after antegrade collagen injection for stress urinary incontinence following radical retropubic prostatectomy.

OBJECTIVE: To evaluate the long-term success of antegrade collagen injection in men with stress urinary incontinence after radical prostatectomy. METHODS: Between October 1994 and January 1996, 20 patients underwent antegrade collagen injection for stress urinary incontinence caused by radical prostatectomy. Evaluation by pad test, urodynamics, and subjective scores was performed before and after injection. RESULTS: At a mean follow-up of 28 months, 10% of the patients were cured and 35% were improved. All patients received a single treatment (mean total volume of collagen injected 14.5 mL). In 11 patients without long-term improvement, 2 had undergone irradiation previously and 7 had failed retrograde collagen injections. Two patients with vesical neck contracture were successfully treated. Preoperative incontinence severity and stress leak point pressure did not correlate with failure. CONCLUSIONS: A 45% cured or improved rate at long-term follow-up is possible in men with stress incontinence after radical prostatectomy using a single antegrade collagen injection. Although antegrade delivery of collagen for stress incontinence minimized short-term, technique-related failures, for a substantial number of patients therapy had failed at long-term follow-up.

Aged↗
PubMed1999

Urodynamics changes in voiding after anti-incontinence surgery: an insight into the mechanism of cure.

OBJECTIVES: To measure the effect on voiding pressure and flow rate of three different operations for stress urinary incontinence. METHODS: In a previous study of cure rates, 289 women with genuine stress incontinence and genital prolapse were prospectively allocated in a randomized manner to one of three procedures: the Burch retropubic urethropexy, anterior repair, or the modified Pereyra procedure. In the current derivative study, we retrospectively evaluated the urodynamic indicators of voiding dysfunction in the original subjects preoperatively and at the 1-year postoperative follow-up visit. RESULTS: One hundred thirty-two charts were available for review. One year after surgery, pressure and flow during voiding were altered to more obstructive levels with the suspension procedures (Burch and modified Pereyra). The proportion of patients with obstructive and equivocal voiding patterns after the suspension procedures was significantly greater than after anterior repair. CONCLUSIONS: This post hoc comparison of randomized data shows a difference in postoperative voiding indexes between suspension procedures and anterior colporrhaphy. Successful bladder neck suspension depends on altering the pressure and flow during voiding to more obstructive levels. Suspension procedures alter the voiding pressure and flow toward obstruction to a greater extent than anterior repair.

Adult↗
PubMed1998

Periurethral pseudocyst following cystoscopic collagen injection.

Periurethral injection of collagen is widely used for treatment of stress urinary incontinence. It has been shown to be an effective, low risk, minimally invasive surgical procedure to treat carefully selected patients with intrinsic sphincter deficiency. Adverse reactions and complications from this technique are rare. We report an unusual complication following cystoscopic injection of collagen.

Aged↗
PubMed1998

Comparison of anchors used in anti-incontinence surgery.

OBJECTIVES: To compare the resistance to caudally directed force at different fixation points used in female anti-incontinence surgery. METHODS: Sutures were placed in Cooper's ligament, rectus fascia, and in bone anchors on the pubic symphysis in 6 fresh, unembalmed cadavers and transposed vaginally with a ligature carrier. Force was applied in a caudal direction to each suture. Displacement of the suture with increasing force and the force required to overcome the cranial fixation point were measured with a highly precise force gauge. Two measurements were made for each anchor point and the measurements were averaged. RESULTS: With caudally directed force, sutures fixed to Cooper's ligament were displaced to an equal extent as sutures attached to a bone anchor. Sutures anchored to the rectus fascia were displaced the most with increasing force. The maximal force supported by Cooper's ligament fixation and bone anchors was similar. The event limiting each test was suture breakage, except when one suture anchored in the rectus fascia tore out. CONCLUSIONS: In a cadaver model, bone anchors placed in the pubic symphysis offer no structural advantage over Cooper's ligament fixation.

Cadaver↗
PubMed1998

Sonography of the female urethra.

OBJECTIVE: The purpose of this study was to explore the role of sonography for women with urethral symptoms and a suspected urethral diverticulum. SUBJECTS AND METHODS: Nineteen women with urethral symptoms underwent voiding cystourethrography (VCUG) and transvaginal, transperineal, and urethral sonography (using a catheter-based transducer). VCUGs and sonograms were evaluated for diverticula, defined on sonography by direct visualization of the neck connecting the periurethral sac with the urethral lumen. The diverticular neck, size, location, and shape were noted. Lesions revealed by sonography as not connected to the urethra were also noted. RESULTS: Of 19 women, 14 had urethral diverticula and one had two diverticula, for a total of 15 diverticula. On sonography the diverticula ranged in diameter from 2 mm to 5 cm. Both sonography and VCUG showed 13 of the 15 diverticula. In addition, sonography revealed two infected periurethral cysts, a periurethral leiomyoma, a diffuse urethritis, and scarring or deformity of one patient's urethra from a prior diverticulectomy. On sonography, eight of the 13 diverticula wrapped around more than 50% of the urethral circumference. The neck was precisely seen (by definition) in 13 of 15 diverticula on sonography and in two of 13 diverticula on VCUG. CONCLUSION: Sonography is useful in this group of women with urethral symptoms and suspected urethral diverticula. It provides information on the extent and location of the diverticular neck, both of which are important in surgical excision. Also, sonography provides information on lesions not connected to the urethra. Sonography may prove useful in a broader group of women with urethral symptomatology.

Adult↗
PubMed1998

Bladder injury during the Burch retropubic urethropexy: is routine cystoscopy necessary?

The aim of this study was to investigate the incidence of operative injury to the lower urinary tract after retropubic urethropexy. We prospectively evaluated the incidence of lower urinary tract injury in 97 consecutive patients after pelvic surgery, which included primary Burch retropubic urethropexy. None of the subjects sustained intraoperative injury of the bladder or ureters as evidenced by an intact bladder mucosa and prompt efflux of dye from both ureteral orifices. In our experience, the incidence of lower urinary tract injury with retropubic urethropexy is low. We do not support the routine use of intraoperative cystoscopy with Burch retropubic urethropexy.

Adult↗
PubMed1997

Antegrade techniques of collagen injection for post-prostatectomy stress urinary incontinence: the Washington University experience.

Treatment of sphincteric incontinence after radical retropubic prostatectomy remains a clinical challenge. Antegrade techniques of collagen injection are a relatively new method for treatment of post-prostatectomy incontinence. Early experience with this approach has demonstrated improved outcomes compared to the traditional retrograde technique. Overall response rates of 70% cure or significant improvement compare favorably with previously reported series. The theoretical advantages of this method include improved visualization of vesicourethral anastomosis and improved access to the bladder neck. Furthermore, suprapubic catheter drainage avoids the risks of collagen molding around the catheter. The use of a flexible cystoscope for this approach is a recent modification. The smaller diameter of the flexible cystoscope has facilitated access and reduced anesthetic requirements. This system affords unimpeded delivery of collagen to regions of the bladder neck where the submucosa accommodates the injectable agent. In addition, this modality allows more precise needle positioning to provide correct angle and depth of penetration into the submucosal plane. Short-term success rates of this procedure are encouraging and suggest that it may become the primary approach. While these antegrade techniques are more aggressive than the traditional retrograde approach, they are relatively simple and draw upon principles familiar to all urologists. It is hoped that the new flexible antegrade approach will further improve our results. Longer-term follow-up studies with larger numbers of patients will be required to see whether we can accomplish this goal.

Aged↗
PubMed1996

Transvaginal bladder neck suspension to Cooper's ligament: a modified Pereyra procedure.

We describe a modified Pereyra procedure with fixation of the bladder neck to Cooper's ligament. The anterolateral attachments of the paraurethral tissue to the inferior pubic ramus are exposed through a vaginal incision. Sutures are placed in the detached endopelvic fascia together with vaginal wall without epithelium and passed suprapubically through small ipsilateral skin and fascial incisions made slightly lateral to and at the level of the pubic symphysis, allowing visualization of Cooper's ligament. The sutures are passed through Cooper's ligament and tied to suspend the bladder neck. All ten women in whom we have done this operation have been subjectively cured of stress incontinence. Five have had long-term urodynamic follow-up. Four of these were dry by objective criteria, after a mean follow-up time of 18 months (range 15-23). The other patient was subjectively dry but had urodynamic evidence of recurrent stress incontinence.

Female↗
PubMed1996

Laparoscopic bladder seromyotomy: laboratory experience.

Twelve female microminipigs with normal bladder capacity underwent laparoscopic bladder seromyotomy. Three other female microminipigs were added to the study as controls. Urodynamic studies and cystograms were performed preoperatively and at 2 and 4 months after a laparoscopic bladder seromyotomy. Histologic studies of the treated bladders were performed when the animals were euthanized at 4 months. The operation was completed in all 12 test animals. There was no significant difference in bladder capacity or leak-point pressure between the 12 seromyotomy and the 3 control bladders at any time point. Histologically, over the seromyotomy site, the urothelium remained intact; however, the muscularis was attenuated, and a thin layer of fibrotic tissue replaced the normal serosal covering of the bladder. Laparoscopic bladder seromyotomy can be performed reliably in the porcine animal model. Not surprisingly, no significant changes in bladder capacity or bladder compliance were seen in our study of normal bladders. An animal model of a neuropathic contracted bladder is needed to assess more accurately the physiological impact of laparoscopic seromyotomy.

Animals↗
PubMed1996

Antegrade collagen injection for stress incontinence after radical prostatectomy: technique and early results.

This article describes the technique and early results of antegrade collagen injection into the bladder neck and proximal urethra of men with stress incontinence postprostatectomy. Twenty men underwent collagen injection under general anesthesia. Follow-up ranges from 5 to 15 months, with a mean of 9.5 months. A mean of 14.5 cc of collagen was injected (range 5-25 cc). According to a subjective self-grading system, preoperative and postoperative urodynamics, and pad usage before and after treatment, significant improvement was seen in 14 patients (70%), and subjective cure was reported by 5 (25%). Six patients (30%) had no subjective or objective improvement after the injection. The antegrade collagen injection technique is a promising and simple method of correcting postprostatectomy stress urinary incontinence. Further study and longer follow-up is necessary to determine its precise role in the treatment of men with this problem.

Aged↗