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Biomedical subjects

E D James

Publications and source records attributed to E D James.

At least 19 recordsLinked to original sources
PubMed2003

Is the conservative management of chronic retention in men ever justified?

OBJECTIVE: To assess the outcome of men presenting with lower urinary tract symptoms (LUTS) associated with large postvoid residual urine volumes (PVR). PATIENTS AND METHODS: The study included men presenting with LUTS and a PVR of > 250 mL who, because of significant comorbidity, a low symptom score or patient request, were managed conservatively and prospectively, and were followed with symptom assessment, serum creatinine levels, flow rates and renal ultrasonography. Patients were actively managed if there was a history of previous outflow tract surgery, prostate cancer, urethral strictures, neuropathy, elevated creatinine or hydronephrosis. In all, 93 men (mean age 70 years, range 40-84) with a median (range) PVR of 363 mL (250-700) were included in the study and followed for 5 (3-10) years. At presentation, the median maximum flow rate was 10.2 (3-30) mL/s and the voided volume 316 (89-714) mL. RESULTS: The measured PVR remained stable in 47 (51%), reduced in 27 (29%) and increased in 19 (20%) patients; 31 patients (33%) went on to transurethral resection of the prostate after a median of 30 (10-120) months, because of serum creatinine elevation (two), acute retention (seven), increasing PVR (eight) and worsening symptoms (14). Of 31 patients 25 were available for evaluation after surgery; their median PVR was 159 (0-1000) mL, flow rate 18.4 (4-37) mL/s and voided volume 321 (90-653) mL. Symptoms were improved in all but five men. There was no difference in initial flow rate, voided volume or PVR between those who developed complications or went on to surgery and those who did not. Urinary tract infections (UTIs) occurred in five patients and two developed bladder stones. CONCLUSIONS: Complications such as renal failure, acute retention and UTIs are uncommon in men with large, chronic PVRs. Conservative management for this group of patients is reasonable but outpatient review is prudent. There were no factors that could be used to predict those patients who eventually required surgery.

Adult↗
PubMed1993

Who needs a prostatectomy? Review of a waiting list.

A total of 118 patients on a waiting list for a transurethral prostatectomy, who had been selected primarily on the basis of their symptoms and the finding of an enlarged prostate, were reassessed by objective tests. Of the 107 finally studied, 44% were retained on the waiting list and a further 8% kept under review; 48% were discharged from any further follow-up. The study reinforces the importance of objectively assessing patients presenting with urinary symptoms.

Aged↗
PubMed1988

Provisional study to quantify and compare parameters of urine leakage in stress and instability incontinence.

Apart from measuring the total volume of urine leaked over prescribed periods of time, the characteristics of urine losses have been ignored. In this provisional study, conducted on 217 female patients, parameters such as the number and volume of the individual losses contributing to the total have been measured and related to the simultaneous pressure changes recorded during natural-filling urodynamic investigations. Each episode of incontinence can thus be attributed unequivocally to stress or to detrusor instability. This enables the quantified parameters of urine losses of both groups to be compared. The results indicate that interesting differences exist between the two types of incontinence, the recognition of which might be valuable for diagnostic purposes and for the design, development and suggested usage of incontinence aids.

Exercise↗
PubMed1987

The vagina as an alternative to the rectum in measuring abdominal pressure during urodynamic investigations.

Pressure in the vagina as well as within the bladder and rectum was measured during urodynamic investigations. Rectal pressure is normally used to represent changes in abdominal pressure which, when subtracted from the total bladder pressure, provides a method of assessing detrusor function. This study showed that vaginal pressure represented changes in abdominal pressure more accurately and consistently than did rectal pressure, and the vagina is therefore recommended as an alternative site in conducting urodynamic studies.

Abdomen↗
PubMed1978

The behaviour of the bladder during physical activity.

The technical difficulties of obtaining reliable recordings of bladder, rectal and detrusor pressures from patients who are standing, walking or exercising have been largely overcome by a method described in this paper. The recordings help us to understand the behaviour of the lower urinary tract during physical activity and are of value in the diagnosis of urological problems, especially incontinence.

Adolescent↗
PubMed1975

Case study using simultaneous bladder pressure and urine loss measurements.

Using an "electronic nappy" of improved design and a miniature pressure manometer of the strain-gauge type mounted at the tip of a catheter, the case of a patient with spina bifida and a large lipoma has been investigated. Some retention exists, but areas on the lipoma surface can be touched lightly, causing an increase in bladder pressure with subsequent voiding as measured by the nappy. Investigations of the same area by electrical stimulation produced rises in bladder pressure sustained for only a few seconds, as in the case of manual stimulation. Local anaesthetic in the "trigger" area prevented bladder pressure changes and urine loss, but triggering returned as the anaesthetic wore off.

Adolescent↗