PubMed Health⌕ Search

Biomedical subjects

Courtenay Moore

Publications and source records attributed to Courtenay Moore.

7 recordsLinked to original sources
PubMed2006

Patient related risk factors for recurrent stress urinary incontinence surgery in women treated at a tertiary care center.

PURPOSE: We examined patient related risk factors for recurrent stress urinary incontinence in women treated at a tertiary referral center. MATERIALS AND METHODS: A case-control study was done in 18 to 75-year-old women with signs and symptoms of genuine or mixed stress urinary incontinence and no prior surgical treatment who underwent an open anti-incontinence procedure between 1990 and 2002 at our institution. Cases were defined as patients who underwent more than 1 anti-incontinence surgery and controls were defined as patients who underwent only 1 anti-incontinence procedure with followup during that period. Cases and controls were matched for surgery type, surgeon and date of surgery within 1 year. A total of 47 variables were examined, including patient age, parity, incontinence type, urodynamic findings, medical history (peripheral vascular, pulmonary and cardiac disease), past and concomitant pelvic surgery, social history (alcohol and tobacco use) and body mass index. Univariate conditional logistic regression was done first to determine which variables were potential protective or risk factors. Multivariate conditional logistic regression analysis was then used to determine which factors were statistically significant. RESULTS: The records of 2,550 women with stress or mixed urinary incontinence who underwent an open surgical procedure between 1990 and 2002 were reviewed. A total of 53 cases and 146 controls were identified. Each case was matched with 1 to 4 controls. Data on cases and controls were collected using a standardized form. At a significance level of 0.05 the possible risk factors for recurrent stress urinary incontinence based on univariate analysis were diabetes mellitus (OR 3.579, p = 0.026), pelvic organ prolapse (OR 5.635, p = 0.03) and concomitant rectocele repair (OR 5.353, p = 0.04). Smoking was marginally protective (OR 0.497, p = 0.068). After multivariate conditional logistic regression analysis diabetes mellitus (adjusted OR 3.413, p = 0.045), pelvic organ prolapse (adjusted OR 8.195, p = 0.021) and concomitant rectocele repair (adjusted OR 17.079, p = 0.012) remained significant risk factors, while smoking remained a protective factor (adjusted OR 0.264, p = 0.012). Body mass index, age, race, parity and estrogen status were not identified as risk factors for recurrent stress urinary incontinence requiring a second anti-incontinence procedure. CONCLUSIONS: In a cohort of women with stress or mixed urinary incontinence treated at our institution between 1990 and 2002 women with diabetes mellitus, pelvic organ prolapse or concomitant rectocele repair were at increased risk for repeat anti-incontinence surgery, while women who smoked were at slightly decreased risk.

Aged↗
PubMed2006

Diabetic uropathy.

Diabetes mellitus (DM) is becoming more common in the United States affecting an estimated 18.2 million Americans. Not only is the number of American's with DM staggering, but so are the medical and economic costs of DM. DM accounts for nearly 15% of all health care costs in the United States. The chronic hyperglycemia of DM is associated with long-term damage, dysfunction and failure of multiple organ systems, including the genitourinary system. Genitourinary complications are common among diabetics. Of individuals diagnosed with DM, 80% have lower urinary tract complications, while 50% develop nephropathy and 35-75% develop sexual dysfunction. In order to decrease the number and severity of diabetic urologic complications, early recognition and a more comprehensive understanding of how diabetes impacts the genitourinary tract is imperative.

Diabetic Nephropathies↗
PubMed2005

Management of ureteral injuries associated with vaginal surgery for pelvic organ prolapse.

Due to the anatomic proximity of the urinary and genital tracts, iatrogenic ureteral injury during pelvic organ prolapse repairs is a serious complication that we have managed in increasing number at our institution. However, few centers have reported on their experience with ureteric injuries associated with gynecologic reconstructive surgery. These ureteral injuries may lead to much morbidity, in particular the formation of ureterovaginal fistula, and the potential loss of renal function especially when diagnosed postoperatively. It is necessary, therefore, for surgeons to have a thorough knowledge of ureteral anatomy and to take precautions to prevent such injuries. The purpose of this article is to review this pertinent anatomy and the key principles of management of ureteric complications of transvaginal surgery for pelvic organ prolapse. The present study illustrates the application of our treatment algorithm based on the time of presentation and the patient condition.

Female↗
PubMed2005

Urologic applications of botox.

Botulinum toxin (BTX), a neurotoxin produced by the gram-positive, rod-shaped anaerobic bacterium Clostridium botulinum, was isolated in 1897 by Belgian scientist Professor Pierre Emile van Ermengem. BTX acts by blocking the release of acetylcholine at the neuromuscular junction. As a result of this chemodenervation, a temporary flaccid paralysis ensues. Different medical disciplines have taken advantage of this temporary paralysis to treat muscular hypercontraction. BTX was first approved by the US Food and Drug Administration in 1989 for use in patients with strabismus and blepharospasm. Since then, BTX has been used to treat a number of different neuromuscular disorders. Although not approved by the US Food and Drug Administration, BTX has been used successfully in urology to treat neurogenic and non-neurogenic detrusor overactivity, detrusor-sphincter dyssynergia, motor and sensory urge, and chronic pain syndromes.

Botulinum Toxins, Type A↗
PubMed2005

Voiding dysfunction after the tension-free vaginal tape procedure.

Throughout the past decade, pubovaginal slings have become the most widely used surgical procedure for the treatment of stress urinary incontinence. However, despite its widespread use and success rates, it is associated with a significant complication rate. In response to the high complication rate, the tension-free vaginal tape (TVT) was introduced. Based on the integral theory that stress urinary incontinence results from defective urethral support, the TVT consists of a loosely placed piece of prolene mesh under the urethra to recreate the pubourethral ligament. However, despite its tension-free nature, studies have shown that the TVT causes postoperative voiding dysfunction in 2.8% to 14% of patients. Radiologic and urodynamic studies suggest that postoperative voiding dysfunction is related to a change in outflow resistance during voiding, not to a change in the bladder neck positioning at rest. Although voiding dysfunction appears to be less after TVT than colposuspensions and the early pubovaginal slings, it does exist and patients should be warned of the potential complication.

Female↗
PubMed2004

Impact of urinary incontinence on self-concept in children with spina bifida.

PURPOSE: Low self-concept and self-esteem are thought to be the main predictors of psychological problems in children and adolescents. Children with spina bifida are thought to be at an increased risk for low self-concept and self-esteem given their disabilities. We examined the impact of urinary continence on self-concept in children with myelomeningocele. MATERIALS AND METHODS: A total of 50 patients 7 to 19 years old with spina bifida were evaluated using the Hartner self-perception profile. Each patient was asked to self-rate on a scale of 1 to 4 using specific domains of self-concept, including scholastic competence, social acceptance, athletic competence, physical appearance, behavioral conduct and global self-worth. Continence and several other factors, namely ambulatory status, family situation and insurance status, were reviewed simultaneously. RESULTS: There were no statistically significant differences between continent patients with spina bifida and controls. Overall children with spina bifida rated lower in scholastic competence, social acceptance and behavioral conduct than controls. Girls with spina bifida scored lower in perceived athleticism, physical appearance and global self-worth than boys with spina bifida. Continent girls were self-rated higher in social acceptance and global self-worth than incontinent girls. Continent boys were self-rated higher in scholastic competence, social acceptance, physical appearance and behavior compared to incontinent boys. CONCLUSIONS: Continence is associated with better self-concept in children with spina bifida and incontinent girls are at particularly high risk for poor self-esteem. Urologists' efforts to promote continence are likely to have a positive effect on self-concept in boys and girls with spina bifida.

Adolescent↗