Biomedical subjects
C G Whiteside
Publications and source records attributed to C G Whiteside.
Electrical anal stimulation and the prediction of bladder stability after surgical relief of male outflow obstruction.
In an attempt to predict which unstable bladders in males with outflow obstruction would convert to stability following surgery, we performed functional electrical stimulation (FES) of the anus during pre-operative rapid fill cystometry in 13 patients with benign prostatic hypertrophy (BPH) and 5 patients with bladder neck obstruction (BNO), all of whom had associated instability. Instability was suppressed in only 2 patients with BPH. Although suppression was achieved in 4 patients with BNO, no correlation was found with either post-operative stability or symptomatology in this group or the patients with BPH and we conclude that FES has no predictive value in this context.
A long-term study of the persistence of the urodynamic characteristics of the unstable bladder.
Sixty-four patients with normal bladder function, stress incontinence, idiopathic instability or instability associated with enuresis underwent pressure/flow videocystography. This was repeated from one month to 8 years later (average 19.4 months). Filling cystometry remained qualitatively unchanged in 95% of cases overall, whilst the actual pressure recordings during cystometry in the 37 patients with instability remained identical or very similar in 73%. The results demonstrated the accuracy of cystometry and the consistency of bladder dynamics over the longest period so far reported in these apparently non-progressive disorders.
Radiological trabeculation for the male bladder--a clinical and urodynamic assessment.
Two hundred and fifty patients have been studied by synchronous cine/pressure/flow cystometry to assess the relationship between radiological trabeculation and the urodynamic findings. There is a strong association between detrusor instability and trabeculation. Trabeculation, however, may also occur in the presence of high pressure outflow obstruction, usually at prostate level, in the absence of instability. It is suggested that frequent uninitiated detrusor contraction against a voluntarily closed sphincter is a likely cause of the more prominent varieties of trabeculation. However, the presence of minor degrees of trabeculation noted at cystoscopic examination in the absence of detrusor instability is not disputed.
Unheralded urinary tract infection in the male. A clinical and urodynamic assessment.
Fifty adult males presenting with unheralded single or recurrent urinary tract infections, but without prior urinary symptoms or disorders, were investigated by appropriate urodynamic techniques. Pressure/flow videocystography revealed significant underlying lower urinary tract abnormalities in 40 cases (80%) compared with only 11 (22%) whose abnormalities were also demonstrated by standard intravenous urography or endoscopy. We suggest that videocystography is the most efficient diagnostic procedure for these cases in a specialist unit but recommended the intravenous urodynamogram as a simpler screening test for general use.
A longterm study of the urodynamics of the untreated unstable bladder.
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The results of prostatectomy: a symptomatic and urodynamic analysis of 152 patients.
There were 152 patients with prostatism investigated by inflow cystometry and pressure flow analysis of micturition before and after elective prostatectomy. Many symptoms attributed to obstruction were found to be owing to bladder instability, which was demonstrated in 60 per cent of the patients. The symptomatic improvement postoperatively was accompanied by a decrease in the incidence of instability to 25 per cent. The repeat urodynamic studies and symptom analysis demonstrated a surgical success rate of 88 per cent.
The intravenous urodynamogram.
Modifications to the intravenous urogram are described. It is suggested that the time has come to rationalise the standard procedure. If an evaluation of the lower urinary tract is required, the voiding films may be modified to provide an intranvenous urodynamogram. If an evaluation of the upper urinary tract is directed at a specific question, then the number of spot-films can often be reduced.
Results of prolonged bladder distension as treatment for detrusor instability.
Forty-six patients with urinary symptoms associated with unstable (uninhibitable) detrusor contractions have been treated by a total of 58 bladder distensions; 43 of these were fully re-evaluated urodynamically thereafter and none showed conversion from unstable to stable detrusor behaviour. Four patients with unstable bladders were symptomatically improved but 5 patients reported symptomatic deterioration. We have concluded that while over-distension may sometimes improve a patient's symptoms, it did not result in the abolition of detrusor contractions or the reversal of unstable detrusor behaviour.
Duodenoscopic papillotomy and gallstone removal.
Using an experimental insulated duodenoscope and a diathermy wire, papillotomy has been performed on 10 patients under diazepam sedation. Seven patients had common bile duct stones (6 following cholecystectomy) and 3 had papillary stenosis. Nine of the patients had severe medical or surgical contraindications to further operative treatment. Papillotomy was successful in all patients, with no significant bleeding or other complications. Repeat endoscopy 6-14 days after papillotomy demonstrated a healed biliary orifice of 7-10 mm diameter. Stones had already passed in 3 of the 7 patients; in 2 others, stones were extracted using balloon catheters or Dormia type baskets. Two larger stones could not be removed; in one of these patients the stone and basket became impacted at the papilla and had to be removed surgically 2 days later. Endoscopic papillotomy is an acceptable alternative to surgery in high risk patients, particularly in the treatment of retained common bile duct stones. If long term results prove satisfactory, the technique will have wider application.
Proceedings: Duodenoscopic papillotomy and gallstone removal.
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Persistent primary enuresis: a urodynamic assessment.
Videocystourethrography with synchronous pressure and flow-rate recordings has been carried out on 50 patients referred for the investigation of persistent primary enuresis. Urodynamic studies showed nocturnal enuresis to be associated mainly with normal detrusor function and nocturnal plus diurnal enuresis mainly with abnormal detrusor function. Evidence is presented which suggests that these two distinct types of enuresis occur de novo and do not overlap. Out of 18 of formerly enuretic male patients nine with abnormal detrusor function showed persistent nocturnal plus diurnal symptoms.
A urodynamic view of bladder outflow obstruction in the female: factors influencing the results of treatment.
169 female patients with outlet obstruction have been studied urodynamically. The results of treatment of the outlet obstruction in 102 patients have been analysed and the reason for the failures discussed. Patients with stable detrusors and those with symptoms of recurrent urinary tract infection responded well to treatment, provided this relieved the obstruction adequately; symptomatic relief was less common in patients with unstable detrusors, despite adequate outflow readjustment.
A urodynamic analysis of micturition symptoms in the female.
The presenting symptoms of 570 females with micturition disorders have been studied with particular reference to the urodynamic state of the detrusor in an attempt to define those symptoms and symptom complexes which are associated with the presence of absence of detrusor instability. The results show that patients who complain of recurrent urinary tract infection or stress incontinence in the absence of any other micturition symptoms usually have stable bladders and do not require cystometric confirmation of this fact. When the symptom of urge incontinence is associated with persistent frequency and nocturia, there is a high correlation with detrusor instability, although hypersensitive urethral states which may present with identical symptoms and are usually associated with stable bladders are difficult to differentiate clinically. Groups of patients in whom it was difficult to predict the detrusor state from the symptoms were studied, and the results of a prospective analysis, predicting the detrusor state from the micturition history of 230 incontinent females, have been presented.
Urodynamics of female incontinence: factors influencing the results of surgery.
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A urodynamic view of prostatic obstruction and the results of prostatectomy.
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A urodynamic view of the clinical problems associated with bladder neck dysfunction and its treatment by endoscopic incision and trans-trigonal posterior prostatectomy.
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