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Biomedical subjects

D A Husmann

Publications and source records attributed to D A Husmann.

89 records · Page 5Linked to original sources
PubMed1990

Inguinal pathology and its association with classical bladder exstrophy.

One hundred thirty-four cases of classical bladder exstrophy, managed at our institution, were reviewed. Fifty-six percent of the boys and 15% of the girls developed inguinal hernias over an average follow-up time-span of 10 years. Thirty-one percent of the patients with hernias underwent repair at the time of initial bladder closure. Forty-six percent of the patients who developed a hernia were diagnosed during the first year following their initial procedure. More than 50% of the individuals in the latter category presented with an incarcerated hernia, and required emergent management. Boys managed by staged reconstruction had a statistically significant risk of developing an inguinal hernia (P less than .001) compared with boys undergoing primary cystectomy and diversion. We believe the increased incidence of herniation with this congenital anomaly is secondary to a lack of obliquity of the inguinal canal, due to pubic diastasis along with an increased elevation of intraabdominal pressure following initial closure of the abdominal wall and bladder plate. To decrease the attendant morbidity of incarcerated hernias in this population, we stress the need for careful physical examination of the inguinal region and spermatic cord prior to surgery, along with repair of the patent processus vaginalis at the time of initial repair.

Bladder Exstrophy↗
PubMed1990

Factors predisposing to renal scarring: following staged reconstruction of classical bladder exstrophy.

Preservation of renal function is one of the major goals of staged reconstruction of bladder exstrophy. In 68 exstrophy patients who have completed staged reconstruction, 10 (14.7%) have developed renal scarring. A multiple factorial analysis of these patients showed the following factors to be statistically related to the development of renal scarring: (1) one or more febrile urinary tract infections prior to bladder neck reconstruction (P less than .001); (2) failure to utilize antibiotic prophylaxis following initial bladder closure (P less than .005); (3) elevated urinary residuals greater than 50 mL (P less than .02); (4) a diagnosis of elevated urinary residuals greater than 6 months following the onset of continence (P less than .001); and (5) one or more febrile urinary tract infections following bladder neck reconstruction (P less than .005).

Anti-Bacterial Agents↗
PubMed1990

Prostatomembranous urethral disruptions: management by suprapubic cystostomy and delayed urethroplasty.

Management of prostatomembranous urethral disruptions associated with pelvic fractures remains a major controversy in urology. A group of 64 patients who suffered a prostatomembranous urethral disruption in association with a pelvic fracture and who were managed initially by suprapubic cystostomy with delayed urethroplasty was compared to 17 patients managed initially by primary realignment. No statistically significant difference in the incidence of impotence or urinary incontinence was found between the 2 groups (p greater than 0.5) Secondary reconstructions for impassable strictures developed in 95% of the patients treated by a suprapubic tube alone compared to 53% of those treated by primary realignment. Indeed, only 1 patient in the latter group achieved urethral continuity that did not require further intervention. We conclude that while primary realignment is associated with no increase in the instance of impotence and urinary incontinence, it subjects the patient to a major operation at a critical time and provides little in the way of long-term positive gains for the effort expended. In the final analysis the outcome is more dependent upon the nature of the injury and the quality of the repair than upon the order in which the repair is effected.

Cystostomy↗
PubMed1990

Current status of tumor of the bowel following ureterosigmoidostomy: a review.

In the final analysis the major question that arises is whether urinary diversion to the intact colon should be performed at all for benign conditions in which a relatively long life expectancy may be anticipated. In answer to this question we believe that if exstrophy is the problem early primary closure with the staged reconstruction should be attempted first. If such efforts are marred by persistent incontinence management with an artificial urinary sphincter should be considered. In individuals with multiple bladder dehiscences after attempts at primary bladder closure, or in an individual with persistent incontinence despite multiple procedures surgical alternates should include diversion by a bowel conduit, continent urinary diversion, a variant of the ureterosigmoidostomy or standard ureterosigmoidostomy. Indeed, despite the appropriate concern regarding the development of tumor in ureterosigmoidostomy, this diversion may still have a major role in the educational process of urology throughout the next decade. Specifically, we must apply the knowledge gained from our clinical and laboratory investigations of ureterosigmoid diversion to the current more popular means of diversion. Of particular concern are the clinical findings of adenocarcinoma in enteric augmentations. This discovery must serve as a warning for the possibility of urocolonic tumors developing within alternative continent urinary diversions within the next 20 to 30 years. Certainly, at least annual evaluations of any diversions are mandatory until we can define accurately the morbidity and mortality arising from our interventional management.

Adenocarcinoma↗
PubMed1990

Attempted nonoperative management of blunt renal lacerations extending through the corticomedullary junction: the short-term and long-term sequelae.

A total of 50 patients who sustained a renal laceration extending through the corticomedullary junction following blunt trauma underwent an attempt at nonoperative (expectant) management of the urological injury. Of the patients 18% could not be stabilized and they subsequently underwent emergency laparotomy. Among our stabilized patients 2 major categories existed: 1) 30 patients with vascularized renal fragments and 2) 11 in whom a fragment of the kidney was devascularized. A statistically significant difference in the length of hospital stay (p equals 0.01) and the need for delayed surgical intervention (p less than 0.001) was noted between the 2 groups. We recommend that the physician must have a heightened awareness of probable complications in patients with major renal lacerations associated with devitalized fragments and suggest that early surgical management should be considered.

Blood Pressure↗
PubMed1990

Antipeptide antibodies to two distinct regions of the androgen receptor localize the receptor protein to the nuclei of target cells in the rat and human prostate.

We have developed polyclonal antibodies to two synthetic peptides corresponding to the amino-(N-)terminal or carboxyl-(C-)terminal segments of the human androgen receptor (hAR) protein, as deduced from the nucleic acid sequence of the androgen receptor cDNA. Immunoreactive antisera were identified by solid phase enzyme-linked immunosorbent assay and purified by peptide affinity chromatography. Specific immunoreactivity with the hAR was confirmed by immunoblotting, using both a fusion protein produced in E. coli that contains the C-terminal 880-amino acid sequence of hAR and the full-length receptor protein produced in COS cells after transfection with a plasmid containing the entire hAR-coding region. Immunohistological evaluation of rat and human prostatic tissue using anti-C-terminal or anti-N-terminal antibodies demonstrated similar patterns of specific staining of the nuclei of epithelial and stromal cells. Castration resulted in a decrease in the amount of nuclear AR detected in the rat prostate after a short time of exposure to anti-C-terminal antibodies (less than 4 h), but did not alter the level of specific staining obtained with anti-N-terminal antibodies. This decrease in nuclear staining using anti-C-terminal antibodies could be reversed by treating castrated animals with dihydrotestosterone. When longer times of exposure to the primary antibodies were used, high levels of nuclear staining were obtained with both types of antibodies in prostate specimens from castrate as well as as intact rats. This immunohistochemical staining pattern contrasts with receptor measurements in rat prostate homogenates that indicate the partition of AR binding into the low salt (cytosolic) fraction in the castrate animal and into the high salt (nuclear) fraction in the intact animal. Our results suggest that the AR is predominantly a nuclear protein even in the absence of ligand and that dihydrotestosterone serves to tighten its association with the nucleus. These data also suggest that the immunoreactivity of anti-C-terminal antibodies is influenced by the presence of dihydrotestosterone, presumably via an alteration in the physical state of the receptor protein.

Amino Acid Sequence↗
PubMed1989

Ureteropelvic junction obstruction associated with ureteral hypoplasia.

We present 3 cases in which a neonate had unilateral hydronephrosis associated with a ureter hypoplastic throughout its length. In all 3 infants the affected kidney failed to visualize on excretory urography and function of the kidney proved to be disappointing despite its relatively normal appearance on external examination. In each case significant renal dysplasia was present microscopically and ultimately the kidney had to be removed. A retrograde pyelogram should be considered whenever a hydronephrotic kidney in an infant fails to visualize, and if this shows a long hypoplastic ureter that cannot be bypassed easily associated renal dysplasia should be suspected and consideration given to nephrectomy rather than pyeloplasty as the primary treatment modality.

Female↗
PubMed1989

Closure of the exstrophic bladder: an evaluation of the factors leading to its success and its importance on urinary continence.

To determine what factors could affect the success of initial bladder closure in classical bladder exstrophy, 80 patients who have completed staged bladder reconstruction were reviewed. Evaluations comparing early bladder closure performed with or without bilateral iliac osteotomy versus delayed closure performed with iliac osteotomy revealed no statistical difference among the 3 populations in regard to the development of bladder dehiscence or onset of urinary continence (p greater than 0.5). Individuals undergoing delayed bladder closure without iliac osteotomy had no notable difference in the incidence of bladder dehiscence (p greater than 0.5) but they had a statistically significant difference in the ability to gain urinary continence (p less than 0.01). Bladder prolapse, abdominal distension or loss of urinary drainage catheters was significantly related to bladder dehiscence (p less than 0.02). Urinary continence was obtained in 75 per cent of the patients with successful bladder closure, compared to 30 per cent if the initial closure dehisced (p less than 0.01).

Anti-Bacterial Agents↗
PubMed1989

Phallic reconstruction in cloacal exstrophy.

During the last 25 years 8 genotypic male subjects with cloacal exstrophy have undergone phallic reconstruction. All 8 patients had phallic inadequacy after completion of the reconstruction with penile lengths at or below 2 standard deviations below the mean. Of the patients 4 have reached puberty and 2 have documented physiological impotence by nocturnal penile tumescence testing. Three patients have required intensive psychiatric counseling, ranging from 18 months to 3 years because of feelings of sexual inadequacy. Of 2 patients who have attempted sexual relations 1 is unable to penetrate the vagina because of phallic size and 1 is presently engaged in successful vaginal intercourse. As a consequence of phallic inadequacy and its associated psychological trauma in these individuals we strongly recommend sexual conversion as part of the initial management plan.

Adult↗
PubMed1989

Nonrefluxing colonic conduits: a long-term life-table analysis.

We evaluated 25 patients undergoing urinary diversion with a nonrefluxing colonic conduit. Renal scarring developed in 10% of the kidneys during a median followup of 12.7 years. In 11 renal units (22%) deterioration of the ureteroenteric anastomosis occurred due to the development of reflux or stricture. Of these kidneys 45% had scarring; no renal unit in which the anastomosis remained intact had renal scars (p less than 0.001). Of our patients 96% had bacterial colonization of the colonic conduit but this was not associated with renal scarring if the urinary diversion was anatomically intact.

Bacteriuria↗
PubMed1988

Management of the hindgut in cloacal exstrophy: terminal ileostomy versus colostomy.

In the management of cloacal exstrophy, controversy exists regarding use of the rudimentary hindgut as a terminal colostomy v salvage of the hindgut for urinary or genital tract reconstruction. Over the past 26 years, 19 patients with cloacal exstrophy have undergone surgical reconstruction at our institution. Ten were managed by terminal ileostomy with an average follow-up of 9 years; nine were managed by permanent colostomy with an average follow-up of 8 years. The number of in-hospital days required due to gastrointestinal (GI) complications and the number of days required for supplemental parenteral hyperalimentation were significantly higher in patients managed by terminal ileostomy than by colostomy (P less than .05 and P less than .03, respectively). All patients have had continued long-term follow-up evaluations in regard to their weight and growth velocities. There is essentially no difference in regard to these characteristics within the two patient population groups. In summary, patients with terminal ileostomies require more frequent hospitalization and prolonged intravenous nutrition during their initial management phase. However, as the child matures and adaptation of the intestine develops, it appears that there are no substantial differences between the growth characteristics of the two patient populations.

Adolescent↗
PubMed1988

A comparison of renal function in the exstrophy patient treated with staged reconstruction versus urinary diversion.

To assess the preservation of renal function in bladder exstrophy 91 patients with classical bladder exstrophy managed with either staged reconstruction or urinary diversion were reviewed. Renal damage was defined as the development of a renal scar or a persistent elevation in serum creatinine. Of the patients 72 have completed the bladder reconstruction; 51 (71 per cent) are continent and renal damage occurred in 10 (13 per cent) of the reconstructed patients. Median followup was 12.7 years. In a comparable group of 23 exstrophy patients managed by urinary diversion the occurrence of renal damage was notably higher: 82 per cent for ileal conduits, 22 per cent for nonrefluxing colonic conduits and 33 per cent for ureterosigmoidostomy. Based on these results we believe that staged reconstruction of the patient with classical bladder exstrophy offers a low risk for renal injury, an excellent chance for urinary continence and a more acceptable cosmetic appearance.

Bladder Exstrophy↗
PubMed1987

Blunt urinary tract trauma: identifying those patients who require radiological diagnostic studies.

We evaluated prospectively 506 consecutive patients who presented with a history of blunt trauma and hematuria. All patients initially underwent excretory urography and cystography. Of the 506 patients 25 had detectable urinary tract injuries that were confirmed either by the initial studies or by computerized tomography, angiography or direct intraoperative inspection. Diagnoses included 7 renal contusions, 7 renal lacerations (1 major and 6 minor), 1 renal artery, 3 intraperitoneal and 5 extraperitoneal bladder ruptures, and 2 urethral injuries. Of the 25 patients 21 presented with gross hematuria, including all of those with lower tract injuries. One of the 4 patients who presented with microhematuria was hospitalized in shock. Of the remaining 3 patients with microhematuria and no shock 1 had a minor renal laceration and 2 had renal contusions. All 3 patients were managed conservatively and all 3 were hospitalized chiefly for associated nonurological injuries. If the patients who presented with microhematuria and no shock were excluded from initial radiographic evaluation, 1 minor renal laceration and 2 renal contusions would have been missed. If we had added 1 more exclusion criterion, that of absence of major associated injuries, we would not have missed an injury.

Angiography↗
PubMed1987

Incontinence and enuresis.

Most children with incontinence not associated with known neurologic impairment will have either functional immaturity of the nervous system or inflammatory conditions of the lower urinary tract as the etiology for incontinence. By using the criteria outlined in this article, one can manage selective urologic evaluation of the diurnally incontinent and enuretic child, saving most patients the cost and stress of more in-depth diagnostic evaluations.

Child↗
PubMedDate not supplied

The hormonal control of testicular descent.

Descent of the testes is a complex event mediated by hormonal and mechanical factors. At present we hypothesize that testicular descent occurs as the result of the secretion of descendin from a normal testicle. Descendin secretion results in selective growth of the gubernacular cells. Gubernacular outgrowth results in masculinization of the inguinal canal. At the beginning of testicular descent, the patent processus migrates into the inguinal canal, transmitting intraabdominal pressure to the gubernaculum. The gubernaculum in turn applies traction to the testicle to introduce the testicle into the inguinal canal. Descent of the testes into and through the inguinal canal is an interplay between intraabdominal pressure transmitted by a patent processus vaginalis and androgen-induced gubernacular regression. Specifically, we hypothesize that androgens under control of an intact fetal hypothalamic-pituitary axis alter the viscoelastic properties of the gubernaculum. Reductions in the turgidity of the gubernaculum allow intraabdominal pressure to push the testicle into the scrotum. Functional abnormalities in any of the above factors will result in cryptorchidism.

Abdomen↗