PubMed Health⌕ Search

Biomedical subjects

D W Keetch

Publications and source records attributed to D W Keetch.

27 records · Page 2Linked to original sources
PubMed1994

Optimal therapy for the distal ureteral stone: extracorporeal shock wave lithotripsy versus ureteroscopy.

Extracorporeal shock wave lithotripsy (ESWL not equal to) is the optimal therapy for renal calculi less than 2 cm. in diameter and for proximal ureteral calculi. Controversy continues over the initial approach to distal ureteral calculi (that is below the bony pelvis): in situ ESWL versus ureteroscopy. Since February 1990, 76 distal ureteral calculi were treated at our institution using either in situ ESWL (Dornier HM3 ESWL with a Stryker frame modification in 27 patients or Siemen's Lithostar electromagnetic ESWL in 22) or ureteroscopy (27 patients). Patient age and stone size were similar among the groups. All ESWL treatments were performed with the patient under intravenous sedation and on an outpatient basis. Stone-free rates were 96% for the HM3 device, 84% for the Lithostar and 100% for ureteroscopy. Retreatment was required in 3 Lithostar cases (14%) and 1 HM3 case (4%). When compared to ESWL ureteroscopy for distal ureteral stones was more time-consuming, entailed routine placement of a ureteral stent, often required general anesthesia, more often led to hospitalization and doubled the convalescence period. From a cost standpoint, ESWL on an HM3 unit was a few hundred dollars more expensive than ureteroscopy. In summary, we believe that in situ ESWL provides optimal first line therapy for distal ureteral calculi, while ureteroscopy is better reserved as a salvage procedure should ESWL fail.

Adult↗
PubMed1994

Development of a mouse model for nonbacterial prostatitis.

Nonbacterial prostatitis is a common clinical entity which is often difficult to diagnose and treat. Little is known with regard to the etiology and pathogenesis of this disease process. To develop an animal model and characterize the immune parameters of nonbacterial prostatitis, we harvested the prostates from SJL, AJ, Balb/c, C57bl/6 and C57bl/6 lpr mice. These prostates were homogenized and injected into syngeneic mice. Controls were injected with Freund's complete adjuvant only. Mice from each group were sacrificed 30 days after injection, and the prostates were harvested. Prostatic tissue was examined histologically for degree of inflammation. None of the Balb/c mice exhibited prostatic inflammation. The SJL and AJ mice exhibited varying degrees of prostatic inflammation. All of the C57bl/6 mice were found to have lymphocytic infiltration of the stroma and periglandular region. The C57bl/6 lpr mice did not appear to be more susceptible than the parental strain. Adoptive transfer studies demonstrated the prostatic inflammation to be at least in part immune mediated. We conclude that injection of syngenic prostate antigen induces prostatic inflammation similar to clinical nonbacterial prostatitis. Nonbacterial prostatitis may be an autoimmune process.

Animals↗
PubMed1994

Serial prostatic biopsies in men with persistently elevated serum prostate specific antigen values.

The objective of this study was to determine the need for repeat prostatic biopsies in men whose initial biopsy results revealed no evidence of cancer or atypia. We evaluated 1,136 men who underwent 1 or more prostatic biopsies in a longitudinal prostate specific antigen (PSA) based prostate cancer screening study that called for biopsy if the serum PSA level was greater than 4.0 ng./ml. (Hybritech assay) and findings on rectal examination or ultrasonography were abnormal or suspicious for cancer. Of the 1,136 men who underwent prostatic biopsy 391 (34%) had prostate cancer on the initial biopsy. Of 427 men who had negative initial biopsy results, a persistent serum PSA level of greater than 4.0 ng./ml. and abnormal rectal or ultrasound examination findings 82 (19%) had cancer on biopsy 2. Of 203 men with persistent abnormalities 16 (8%) had cancer on biopsy 3 and 6 of 91 (7%) had cancer on biopsy 4 or later. Thus, 96% of the cancers were detected through either biopsy 1 or 2. The median initial PSA level, followup PSA levels and the yearly rate of change in PSA were significantly greater in men whose cancer was detected compared with those of men whose cancer was not detected (6.4 versus 5.4 ng./ml., 7.4 versus 6.6 ng./ml. and 1.1 versus 0.7 ng./ml. per year, respectively). There was a trend for a higher percentage of tumors detected through serial screening to be pathologically organ confined with those detected through initial screening (73% versus 62%, p = 0.07). We conclude that men with a persistently elevated serum PSA value after an initial negative prostatic biopsy should routinely undergo at least 1 repeat biopsy to exclude adequately the presence of detectable prostate cancer.

Aged↗
PubMed1993

Modification of Mitrofanoff principle for continent urinary diversion.

In 1980, Mitrofanoff described a method of achieving continent urinary diversion by surgically closing the bladder neck and creating a continent catheterizable stoma from the appendix, which had been implanted in a non-refluxing manner into the bladder, or from a non-refluxing distal ureter. We describe a modification of the Mitrofanoff procedure for continent urinary diversion in 7 children in whom a standard Mitrofanoff procedure was not possible due to either body habitus or appendiceal anatomy. All 7 patients are continent both day and night. Four have required stomal revisions. Renal function has remained stable or improved in all patients. Although the revision rate was high, this modification of the Mitrofanoff principle has provided good long-term results in these patients and may be useful when patient's anatomy does not allow the creation of a standard appendicovesicostomy.

Adolescent↗
PubMed1993

Transitional cell carcinoma of bladder in children and adolescents.

Transitional cell carcinoma of the bladder is rare in patients under sixteen years of age. A case is described in a ten-year-old boy, and the literature is reviewed. The diagnosis and treatment of this tumor is the same in childhood as in older patients. Recurrence as well as death have been reported in this age group; therefore, these patients warrant careful long-term follow-up.

Adolescent↗
PubMed1992

Late decompensation of neobladder.

We report on 6 patients in whom we constructed detubularized ileocolonic neobladders in conjunction with cystectomy to treat invasive transitional cell carcinoma of the bladder. The patients had delayed complete or partial decompensation of the neobladder after an initial interval of normal voiding. Two patients experienced complete decompensation with inability to empty in the absence of urodynamic, cystoscopic or radiographic evidence of outlet obstruction. The other 4 patients had greater than 400 cc residual urine without evidence of outlet obstruction. The mean interval to decompensation after the initial period of normal voiding was 12.8 months (range 4 to 21). All 6 patients had a reservoir capacity of greater than 800 cc. We also constructed neobladders in 3 other patients for similar indications. These 3 patients have a neobladder capacity of less than 800 cc and all are voiding to completion with followup of 19 to 32 months. We hypothesize that neobladder decompensation is due either to creation of an excessively large pouch alone or in combination with a poor Valsalva ability. Until we know the neobladder capacity required for continence that will simultaneously allow for complete emptying, all patients should be advised of the possible need for intermittent self-catheterization. Urological followup should include monitoring of post-void residual urine volume to detect failure to empty early before irreversible decompensation occurs.

Adult↗