Biomedical subjects

D R Ostergard

Publications and source records attributed to D R Ostergard.

At least 19 recordsLinked to original sources

PubMed1992

Urinary incontinence: correlation of history and brief office evaluation with multichannel urodynamic testing.

OBJECTIVE: Patients' histories of urinary incontinence and the results of several standard clinical tests were correlated with final diagnoses obtained by multichannel urodynamic testing. We used a combination of clinical test results to predict the final diagnoses. STUDY DESIGN: Ninety consecutive women with a primary complaint of urinary incontinence completed a standardized questionnaire and underwent a structured clinical examination consisting of several standard clinical tests. Each patient later underwent multichannel urodynamic testing to obtain a final diagnosis. RESULTS: Although the symptoms of stress incontinence were significantly associated with genuine stress incontinence and mixed incontinence, overlap in patients with detrusor instability did not allow the histories to be useful diagnostically. The only clinical tests showing significant association with the final diagnoses of incontinence were the cough stress test and single-channel medium-fill cystometry. Reliable prediction of the urodynamic diagnosis of incontinence could not be achieved with either of these two tests or with a combination of variables obtained by discriminant analysis. CONCLUSIONS: Women with complaints of urinary incontinence, especially those for whom surgery is contemplated, should undergo complete urodynamic evaluation when it is available.

Adult↗

PubMed1991

Massive evisceration: a complication following sacrospinous vaginal vault fixation.

This report describes a spontaneous vaginal vault prolapse in association with massive evisceration following sacrospinous vaginal vault fixation. Careful attention to surgical technique is critical to the success of the operation. In particular, good apposition of the vaginal vault to the sacrospinous ligament and adequate repair of an enterocele should avoid this complication.

Female↗

PubMed1990

The prognostic significance of augmentation of urethral closure pressure and functional length.

Sixty-one women with genuine stress incontinence undergoing preoperative and postoperative multichannel urodynamic investigation were tested with augmenting urethral closure pressure profiles during contraction of the pelvic floor muscles to assess voluntary control of the urethral "sphincter." Increases of 20% or more above resting functional length and closure pressure were selected as indicators of augmentation. The presence or absence of augmentation of functional urethral length and/or closure pressure during pelvic floor contraction allowed for the grouping of these patients into six subgroups which were compared for urinary symptoms, prior anti-incontinence procedures and the presence of low urethral pressure, detrusor instability and genuine stress incontinence both pre- and postoperatively. Evaluation of the patient's ability to augment functional length and closure pressure did not affect surgical success nor did its presence or absence correspond to the presence of a low pressure urethra, detrusor instability, or specific urinary symptoms. Evaluation of augmentation of functional length and closure pressure was therefore felt to be of no prognostic value during the performance of multichannel urodynamic testing in incontinent females.

Adult↗

PubMed1990

Prospective study utilizing transdermal scopolamine in detrusor instability.

Ten patients with pure detrusor instability were treated in a prospective fashion with transdermal scopolamine. Seventy percent of patients experienced moderate to severe untoward symptoms requiring discontinuation of medication. Three of 10 patients (30%) demonstrated a subjective improvement although only 1 was able to tolerate the medication. No objective change in detrusor instability was demonstrated.

Administration, Cutaneous↗

PubMed1990

Needle suspension procedures for urinary stress incontinence: a review and historical perspective.

Armand J. Pereyra introduced a new approach in the treatment of female urinary stress incontinence which did not require abdominal retropubic dissection. This operation and subsequent modifications by Pereyra serve as the foundation for various needle suspension procedures. The reported cure rates for the Modified Pereyra Procedure and its variations have exceeded 85 per cent in several studies. There has been some suggestion of an increased late failure rate in the Modified Pereyra Procedure compared to abdominal retroubic urethropexy. Additional long-term studies are needed to answer this important question utilizing preoperative and postoperative urodynamic evaluation. Karram and Bhatia in their review of transvaginal needle bladder neck suspension procedures cited three studies which accomplished this in a total of 60 patients. It seems the popularity of needle suspension procedures continues to grow. Increasingly, needle suspension procedures have been used in the outpatient treatment of urinary stress incontinence. A continuing tribute to the operative contributions of Armand J. Pereyra in the treatment of urinary stress incontinence.

Female↗

PubMed1990

Predictive value of urethroscopy as compared to urodynamics in the diagnosis of genuine stress incontinence.

A retrospective chart review was undertaken of 204 patients who underwent dynamic urethroscopy. Ninety-nine patients with a diagnosis of genuine stress incontinence were evaluated urodynamically and urethroscopically to determine the predictive accuracy of the sensitivity and specificity of each of these diagnostic modalities. The urodynamic cough profile was both highly reactive and specific for genuine stress incontinence, with sensitivity and specificity of 95% and 100%, respectively, whereas dynamic urethroscopy yielded sensitivity and specificity of 60.2% and 79.1%, respectively. Dynamic urethroscopy is a relatively insensitive predictor of genuine stress incontinence, with many equivocal findings (11%) as well. The urodynamic cough urethral pressure profile is recommended for diagnosing this condition.

Adult↗

PubMed1990

Stress incontinence and low urethral closure pressure. Correlation of preoperative urethral hypermobility with successful suburethral sling procedures.

Forty-eight women with genuine stress incontinence and low urethral closure pressure were treated with a suburethral sling procedure using polytetrafluoroethylene. All patients underwent a preoperative clinical evaluation and multichannel urodynamic testing. The clinical examination included a "Q-tip" test to determine the presence or absence of urethral hypermobility. Urethral hypermobility was defined as a maximal angle change of greater than or equal to 30 degrees from the horizontal, measured during straining or coughing in the lithotomy position. Thirty-four patients underwent repeat multichannel urodynamic testing three months postoperatively to determine the objective surgical success. Ninety-three percent of patients (27/29) with a positive preoperative Q-tip test were cured. Of patients with a negative preoperative Q-tip test, only 20% (1/5) were cured. Preoperative urethral hypermobility was a good prognostic indicator of operative success when a suburethral sling procedure was used to treat genuine stress incontinence and low urethral closure pressure.

Adult↗

PubMed1990

Endometrial ablation with the neodymium:Yag laser.

The current study was designed to evaluate Nd:Yag laser endometrial ablation as an alternative to hysterectomy in women with uncontrolled benign uterine bleeding. The subjects were candidates for hysterectomy, had benign endometrial histology, had failed hormonal therapy and/or D&C, and did not desire future childbearing. Medication was given to render the endometrium atrophic, and treatment was carried out using a "touch" technique. Forty-two treated patients have been followed 3-36 months, with a success rate of 81%. Fourteen (33%) are amenorrheic and 13 (31%) estimate that they have less than 25% of their pretreatment flow. Those with uterine size over 10 cm or large submucous fibroids were usually excluded because of technical difficulty in performing the procedure. Treatment outcome was not related to patient weight, uterine size, or small intrauterine abnormalities. Twelve patients had medical conditions that were relative contraindications for hysterectomy, and 11 were treated successfully. Endometrial ablation with the Nd:Yag laser is an effective alternative to hysterectomy in patients with uncontrolled benign uterine bleeding.

Adult↗

PubMed1989

Unsuccessful Burch retropubic urethropexy: a case-controlled urodynamic study.

A retrospective comparison was made of the urodynamic parameters of urethral sphincteric function of 21 women with failure of modified Burch retropubic urethropexy and 21 matched control subjects in whom operation was successful. The match criteria included multiple risk factors that contributed to the failure of antiincontinence surgery. The preoperative resting urethral closure pressure and urethral functional length were significantly lower in the study (failure) group than in the control (success) group. These parameters of intrinsic urethral function improved only in the control (success) group after operation. Further study showed that 17 of the 21 patients (81%) in the control (success) group had preoperative closure pressure greater than 20 cm H2O, whereas only five of the 21 patients (24%) in the study (failure) group had initial closure pressure higher than this value. Identification of a low-pressure urethra by preoperative urethral profilometry suggests a greatly increased risk for operative failure.

Adult↗

PubMed1989

Surgical management of uterine prolapse in young women.

A new procedure was developed for the management of uterine prolapse in young women. Transvaginal sacrospinous uterine fixation was employed successfully in five patients. The advantages of the procedure are that it avoids surgical trauma to the cervix, can be accomplished entirely vaginally, maintains the normal vaginal axis and obliterates the space for potential enterocele.

Adult↗

PubMed1989

Cryosurgery versus dilation and massage for the treatment of recurrent urethral syndrome.

One year after the initiation of a prospective, randomized, crossover trial comparing dilation and massage to urethral cryosurgery utilizing a specially designed urethral cryoprobe, our results show that cryosurgery was more effective in the treatment of recurrent urethral syndrome in women. Ninety-one percent of patients first treated with cryosurgery were successful in achieving relief from their symptoms whereas only 33% of the women initially treated with dilation and massage were successful (P = .005). In addition, cryosurgery was more successful in treating women when they crossed over after failing the other therapy (75% vs. 0%). In total, 21 of 24 patients (87.6%) were treated successfully with one of the two modalities. Nineteen of the 22 patients (86.4%) in this select group treated with cryosurgery during the trial were successful, whereas only 5 of 15 (33.3%) treated with dilation and massage were successful (P = .001).

Cryosurgery↗

PubMed1988

Recurrent stress incontinence. Causes and treatment in the female patient.

Recurrent urinary incontinence after surgery requires complete evaluation, including urodynamic testing, to make an accurate diagnosis. Documented genuine stress incontinence, if mild to moderate, may respond to nonsurgical treatment, but more severe cases require surgery. Numerous effective surgical procedures have been developed.

Female↗

PubMed1988

The effect of retropubic urethropexy on detrusor stability.

A group of 86 women with genuine stress incontinence who underwent retropubic urethropexy were evaluated with both pre- and postoperative urodynamics. Twenty of these 86 women (23.3%) also had unstable detrusors preoperatively. Eleven of these 20 women (55%) had stable detrusors after retropubic urethropexy. Five of the 66 patients (7.6%) who had stable detrusors preoperatively were found to have unstable detrusors on postoperative urethrocystometry. The overall cure rate for women with detrusor instability and genuine stress incontinence was only 30%. Analysis of symptoms, previous anti-incontinence procedures, age, parity, and cystometric parameters revealed no differences between those women who had stable detrusors after retropubic urethropexy and those who remained unstable. Similarly, patients whose bladders became unstable after retropubic urethropexy could not be distinguished from those who remained stable. Patients undergoing retropubic urethropexy should understand the possibility that the operation may cause urinary incontinence due to detrusor instability even if it cures their genuine stress incontinence, and that if they have both genuine stress incontinence and detrusor instability, their chances for an operative cure of both conditions are low.

Adult↗

PubMed1988

Incontinence history as a predictor of detrusor stability.

Between January 1983 and July 1985, 218 women underwent preliminary evaluation and urodynamic testing in our laboratory. Their symptoms and urodynamic diagnoses were compared to evaluate the ability of a patient's history to predict the stability of the detrusor. The symptom of stress incontinence was a sensitive detector of genuine stress incontinence (100% sensitivity) but was not very specific (65.2%). The symptoms of urgency and urge incontinence were found to have limited sensitivity (77.9%) and specificity (38.7%) in the detection of detrusor instability. Even patients with isolated complaints of stress incontinence had an incidence of detrusor instability of 34.9%, whereas 76.9% of those with a history of isolated urgency and urge incontinence had detrusor instability. Three percent of patients complaining of either type of incontinence had no objective evidence of incontinence on urodynamic investigation. The results of this study demonstrate that a patient's history is a poor predictor of the underlying cause of incontinence.

Adolescent↗

PubMed1988

Hysterectomy and prior incontinence surgery as risk factors for failed retropubic cystourethropexy.

The effects of prior hysterectomy and incontinence surgery were evaluated retrospectively in 86 women undergoing modified Burch cystourethropexy. These women were evaluated before and three months after surgery with multichannel urodynamic testing. Forty percent of the 50 women with prior incontinence surgery remained incontinent after the cystourethropexy even though 94% of them had undergone anatomic correction. This result was not statistically different from the 28% failure rate in patients without prior incontinence surgery. Forty-two percent of the 62 women who had previously undergone hysterectomy failed cystourethropexy despite anatomic correction in 95%. This finding was significantly different from the 17% failure rate in women without prior hysterectomy (P less than .025). This retrospective analysis suggests that prior hysterectomy may place women at increased risk of continued incontinence following cystourethropexy despite anatomic correction of urethrovesical junction descent. Contrary to the results of other investigators, women with prior incontinence surgery in this study were not found to be at significantly greater risk of incontinence after cystourethropexy.

Female↗

PubMed1988

A suburethral sling procedure with polytetrafluoroethylene for the treatment of genuine stress incontinence in patients with low urethral closure pressure.

One indication for suburethral sling procedures has been recurrent genuine stress incontinence after previous incontinence surgery. Patients with low urethral closure pressures (20 cm H2O or less) in association with genuine stress incontinence are at particular risk for failure of standard anti-incontinence procedures. Urodynamic evaluation was used to select 17 patients with genuine stress incontinence and low urethral closure pressures for surgical treatment with a sling procedure using polytetrafluoroethylene. The technique of the procedure, cure rate, and postoperative complications were assessed. An 85% subjective and objective cure rate was found on urodynamic testing three months postoperatively. Complications included wound seroma, urinary tract infection, and urinary retention.

Adult↗

PubMed1987

Ultrasonography in urinary incontinence.

Linear array ultrasound techniques were utilized in place of conventional radiologic procedures to study the dynamics of the urethrovesical junction and proximal urethra in patients with urinary incontinence. This ultrasound procedure provided an objective demonstration of the mobility of the urethrovesical junction and documented the presence of an anatomic defect. It aided in the selection of patients suitable for surgical correction of stress incontinence and their postoperative follow-up. Ultrasound was also employed to demonstrate uninhibited detrusor contractions in patients with vesical instability.

Female↗

PubMed1987

Cryotherapy for the treatment of proximal urethral condyloma acuminatum.

Between March and November 1985 we treated 89 female patients with condyloma acuminatum of the lower genital tract. All patients were evaluated with colposcopy, urethroscopy and anoscopy. Carbon dioxide laser vaporization was used to treat condylomata in the cervix, vagina, vulva, anus and distal urethra. Urethral involvement by condylomata was found in 31 patients (35 per cent). Eight patients had biopsy proved proximal urethral condylomata (9 per cent). Cryotherapy was used to treat these lesions. Six patients required only 1 treatment, while 2 required 2 treatments to cure the proximal urethral condylomata.

Adult↗