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Biomedical subjects

Edward J McGuire

Publications and source records attributed to Edward J McGuire.

At least 19 recordsLinked to original sources
PubMed2007

Comparative analysis of urinary incontinence severity after autologous fascia pubovaginal sling, pubovaginal sling and tension-free vaginal tape.

PURPOSE: Autologous fascia, Pelvicol implant and polypropylene are common materials used in suburethral anti-incontinence procedures. We explored the relative effectiveness of the autologous fascia pubovaginal sling, Pelvicol pubovaginal sling and Gynecare TVT on self-reported postoperative urinary incontinence. MATERIALS AND METHODS: The study was a mailed cross-sectional survey of health related quality of life 1 to 3 years after suburethral anti-incontinence surgery performed at our institution. The Incontinence Symptom Index was used to assess the presence and severity of urinary incontinence symptoms and the Incontinence Impact Questionnaire-7 was used to assess impairment. Regression models were developed to identify factors with an independent effect on the presence, severity and impairment of urinary incontinence symptoms. RESULTS: The questionnaire was returned by 69% of eligible respondents (173 of 250). Those with previous incontinence surgery (OR 11.0, 95% CI 2.3-51.4) and medical comorbidities (OR 1.6, 95% CI 1.1-2.2) were more likely to report urinary incontinence symptoms, ie incontinence symptom index greater than 0. Symptom severity, which was analyzed only in respondents with urinary incontinence symptoms, was greater in the Pelvicol than in the autologous fascia pubovaginal sling and TVT groups (each p <0.01). No significant difference was observed between the TVT and autologous fascia pubovaginal sling groups (p = 0.15). Also associated with higher urinary incontinence symptom severity scores were body mass index (p = 0.03), a history of incontinence surgery (p = 0.01) and lower education (p <0.01). Impairment from urinary incontinence, as assessed by the Incontinence Impact Questionnaire-7, was associated with body mass index, severe depression and current smoking (each p = 0.01) but not with surgical treatment group. CONCLUSIONS: Women who received an autologous fascia pubovaginal sling or TVT reported lower symptom severity scores than those who had a Pelvicol pubovaginal sling. Impairment was not associated with procedure type. These findings suggest better outcomes with autologous fascia pubovaginal sling and TVT. Randomized, controlled trials are needed to confirm these findings.

Cross-Sectional Studies↗
PubMed2006

Outcome of urethral closure in patients with neurologic impairment and complete urethral destruction.

AIMS: The purpose of this study is to describe the problems associated with prolonged urethral catheterization in 12 patients with neurological problems and to report the results of surgical treatment. METHODS: A retrospective study of patients with neurogenic bladder and urethral dysfunction treated with prolonged catheterization resulting in incontinence associated with loss of urethral tissue and or function selected 12 patients. All had video urodynamics. Twelve were continuously incontinent despite a catheter. Bladder compliance, where that could be measured, was low is 10, and there were multiple and serious co-morbidities including sepsis, hypoalbuminemia, skin breakdown, osteomyelitis, respiratory insuffiency, etc. There were 4 males and 8 females, 9 had a spinal cord injury and 3 progressive multiple sclerosis. RESULTS: Male patients underwent transperineal closure of the membranous urethra; females transvaginal closure of the urethra. All patients had a urinary diversion, either an ileovesicostomy, or an augmentation cystoplasty and construction of a neourethra. Continence was ultimately achieved in 11 of 12 patients at a median 20 months. Four patients had one additional procedure to gain continence, but five patients required 3.8 procedures/patient to achieve continence. Closure of the male urethra was more easily accomplished than closure of an extensively damaged eroded female urethra. CONCLUSIONS: Patients with urethral damage and erosion related to prolonged catheter present a formidable challenge in surgical reconstruction. Most have serious co-mobidities and a single operation does not usually solve all the problems. Persistence does almost always result in continence.

Adult↗
PubMed2005

Complications following surgical intervention for stress urinary incontinence: a national perspective.

AIMS: Stress urinary incontinence (SUI) impacts many women. Treatment is primarily surgical. Post-operative morbidity considerably affects individuals and the health care system. Our objective is to describe complications following surgery for SUI and how they affect resource utilization. METHODS: Utilizing the Nationwide Inpatient Sample (a nationally representative dataset), 147,473 patients who underwent surgery for SUI from 1988 to 2000 were identified by ICD-9 codes. Comorbid conditions/complications were extracted using ICD-9 codes, including complication rates, length of stay (LOS), hospital charges, and discharge status. RESULTS: Overall complication rate was 13.0% (not equal to sum of complication sub-types, as each woman may have had = 1 complication), with 2.8% bleeding, 1.4% surgical injury, 4.3% urinary/renal, 4.4% infectious, 0.1% wound, 1.1% pulmonary insufficiency, 0.5% myocardial infarction, 0.2% thromboembolic. The "gold standard" surgical technique for SUI, the pubovaginal sling, had the lowest morbidity at 12.5%. Mean LOS increased with morbidity: from 2.9 to 4.1 to 6.1 days for those with 0, 1, and =2 complications respectively (P < 0.001). Similarly, inflation-adjusted hospital charges increased with morbidity: from 7,918 dollars to 9,828 dollars to 15,181 dollars for those with 0, 1, and =2 complications respectively (P < 0.001). The percentage of patients requiring post-discharge subacute or home care increased with morbidity: from 4.4% to 8.4% to 14.3% for those with 0, 1, and =2 complications (P < 0.001). CONCLUSIONS: A substantial percentage of women experience complications following surgery for SUI. Post-operative morbidity leads to dramatically increased resource utilization. Prospective studies are needed to identify pre-operative risk factors and intraoperative process measures to optimize the quality of care.

Adult↗
PubMed2005

Technique for removal of symptomatic bone anchors placed during stress incontinence surgery.

INTRODUCTION: To present an uncomplicated, reliable technique for bone anchor removal in patients with anchor-related infections or chronic pain. TECHNICAL CONSIDERATIONS: We removed 17 anchors from 9 patients between 1999 and 2004. The surgical technique used fluoroscopy for localization of the anchors and an orthopedic broken screw removal instrument for resection of the anchor and surrounding bone. Nine patients with bone anchors had been symptomatic with chronic pain and/or wound drainage for a mean of 23.7 months before surgery. After removal, 10 anchors grew positive bacterial cultures. The most common organism was coagulase-negative Staphylococcus. During a mean follow-up period of 6.8 months after hardware removal, 8 of the 9 patients had symptomatic improvement. CONCLUSIONS: Fluoroscopic localization and en bloc resection with a broken screw removal instrument is an effective method of removing symptomatic bone anchors.

Adult↗
PubMed2005

Transurethral collagen injections for male intrinsic sphincter deficiency: the University of Texas-Houston experience.

PURPOSE: Injectable agents are used to increase urethral coaptation for the treatment of intrinsic sphincter deficiency. We evaluated the long-term results and complications of transurethral collagen injections in males. MATERIALS AND METHODS: We reviewed the charts of 322 men (mean age 67.2 years, range 40 to 91) with intrinsic sphincter deficiency after therapy for prostate carcinoma (307) or benign prostatic hyperplasia (15) who received transurethral collagen injections. The analysis included types and combinations of treatment for prostate cancer or benign prostatic hyperplasia, pre-procedure voiding symptoms, total collagen received, maximal percentage improvement and durability of effect. RESULTS: The mean length of followup was 40.1 (+/-13.2) months. Overall, the mean number of injections was 4.37 (+/-2.09). Mean percent improvement after a series of injections was 44.59 (+/-38.26). Mean pad use before and after injection was statistically different (5.15 vs 2.98, p=0.0001). Mean duration of response was 6.3 (+/-8.14) months. In those who achieved complete continence (17%), the mean duration of response was 11.1 (+/-8.87) months. Within this group the mean number of injections and ml of collagen injected were 3.83 and 29.27, respectively. Five patients (1.5%) complained of a quantitative increase in leakage after their series of collagen injections. CONCLUSIONS: Transurethral collagen injections are a good option for short-term therapy in men with post-prostatectomy incontinence. The mean number of injections to achieve a plateau is 3 to 4, regardless of initial severity of incontinence. Those in the radical prostatectomy only treatment group are statistically more likely to achieve continence than all other treatment groups.

Adult↗
PubMed2004

Pathophysiology of stress urinary incontinence.

All cases of stress urinary incontinence (SUI) are not the same; urethral pressures, prolapse conditions, and congenital and acquired sphincteric dysfunction all contribute to SUI pathophysiology. In order to optimally manage SUI, a thorough understanding of the pathophysiology behind the condition is necessary. Unsuccessful treatment of incontinence can result from the procedure itself or from a poor fit between the patient's condition and the treatment chosen. Proper patient evaluation, including videourodynamics and measurement of Valsalva leak point pressure, is key to making the best treatment decisions and obtaining optimal patient outcomes.

Journal Article↗
PubMed2003

Obstructive uropathy induced bladder dysfunction can be reversible: bladder compliance measures before and after treatment.

PURPOSE: We demonstrated that abnormal bladder compliance in the setting of obstructive uropathy can be improved by relief of bladder outlet obstruction. MATERIALS AND METHODS: A cohort of 9 men with nonneurogenic lower urinary tract symptoms and videourodynamics proven bladder outlet obstruction were identified prospectively from a university urology practice. Study exclusion criteria ensured absence of active urinary infection, hematuria and neurourological pathology. Testing specifically focused on assessment of the bladder compliance curve, and a compliance value was calculated (ml./cm. H2O). Treatment intervention consisted of transurethral incisions or resection of the prostate in 8 cases and transurethral balloon dilation of a urethral stricture in 1. Followup videourodynamics testing was performed 1 month after treatment to confirm relief of outlet obstruction and reassess bladder compliance. RESULTS: Mean patient age was 75.2 +/- 6.16 years. Pretreatment mean bladder compliance +/- SE was 3.06 +/- 0.45 ml./cm. H2O. At 1 month after treatment videourodynamics testing confirmed relief of obstruction in the cohort. Posttreatment mean bladder compliance +/- SE was 13.53 +/- 0.45 ml./cm. H2O. Nonparametric paired t test analysis determined that the difference between pretreatment and posttreatment bladder compliance was statistically significant at p = 0.0117. CONCLUSIONS: This pilot study suggests that relief of obstructive uropathy even in elderly patients with long-standing lower urinary tract symptoms, can significantly improve bladder compliance.

Aged↗
PubMed2003

Intraoperative nerve stimulation with measurement of urethral sphincter pressure changes during radical retropubic prostatectomy: a feasibility study.

PURPOSE: We evaluated the feasibility of using intraoperative nerve stimulation and real-time urodynamic monitoring to identify the intrapelvic innervation of the urethral sphincter during radical retropubic prostatectomy. MATERIALS AND METHODS: Using an intraurethral balloon pressure transducer and nerve stimulator changes in urethral pressure were measured in response to stimulation of the neurovascular bundles, pelvic side wall, bladder neck, rectus muscle and other structures in 8 patients undergoing nerve sparing radical retropubic prostatectomy. Intraurethral pressure changes were charted on an urodynamic monitor and correlated with the anatomical location of stimulation. RESULTS: Stimulation of the neurovascular bundles resulted in measurable and significant (greater than 10 cm. H(2)O) increases in intraurethral pressure in all 8 patients. The mean pressure increase was 22 cm. H(2)O. Neither control structure, that is the bladder neck or rectus, resulted in pressure changes with stimulation. In 60% of the subjects pelvic side wall stimulation resulted in urethral pressure increases, while in 40% this stimulation caused pelvic contraction floor but no pressure increase. The mean pressure changes with side wall stimulation was 14 cm. H(2)O. CONCLUSIONS: Intraoperative stimulation of pelvic neural structures and measurement of changes in urethral pressure in response to stimulation are feasible during radical retropubic prostatectomy. Stimulating the neurovascular bundle consistently results in significant increases in urethral pressure. The finding of an intrapelvic urethral innervation supports the previously published observation that nerve sparing radical retropubic prostatectomy may result in improved continence postoperatively.

Electric Stimulation↗
PubMed2003

Effects of ejaculation by penile vibratory stimulation on bladder capacity in men with spinal cord lesions.

PURPOSE: We examined the effects of ejaculation by penile vibratory stimulation on bladder capacity in men with spinal cord lesions. MATERIAL AND METHODS: Included in our study were 14 men with spinal cord lesions from C4 to T7 with detrusor hyperreflexia. Cystometry was performed before and immediately after ejaculation by penile vibratory stimulation to establish baseline conditions and repeated after 1 month of ejaculation by penile vibratory stimulation every third day. The third cystometry study was done after 1 month of ejaculation by penile vibratory stimulation every third day at home to determine any long-term effects of treatment. This third cystometry was performed 72 hours after the last ejaculation to exclude any acute effects of ejaculation by penile vibratory stimulation on detrusor hyperreflexia. In addition, 1 to 3 days later ejaculation was induced by penile vibratory stimulation and immediately followed by cystometry to examine whether it was possible to achieve an acute effect as well as a potential long-term effect. RESULTS: Baseline urodynamic investigations revealed bladder hyperreflexia and external sphincter dyssynergia in all individuals. There was no statistically significant difference in bladder capacity at leak point before and immediately after ejaculation by penile vibratory stimulation. However, after 4 weeks of frequent penile vibratory stimulation treatment bladder capacity at leak point increased significantly from a median of 190 ml. (range 17 to 700) at baseline to 293 (range 30 to 700) (Wilcoxon signed rank test p = 0.03). Furthermore, there was a trend toward decreased intravesical pressure during the filling phase. CONCLUSIONS: Ejaculation by penile vibratory stimulation was associated with a significant increase in bladder capacity at leak point after 4 weeks of frequent treatment. This finding may have implications in the management of incontinence in men with spinal cord lesions.

Adult↗
PubMed2003

Temporary perineal urethrostomy for external sphincter dilation in a male patient with high risk myelomeningocele.

PURPOSE: We describe our use of perineal urethrostomy to facilitate serial external sphincter dilations in a male child with high risk myelomeningocele. MATERIALS AND METHODS: A 5-month-old boy with lumbar myelomeningocele presented with poor bladder compliance, increased detrusor leak point pressure and high grade vesicoureteral reflux. Urodynamic parameters failed to improve with clean intermittent catheterization and anticholinergic therapy. Given the persistent risk to the upper urinary tract, perineal urethrostomy was performed to facilitate external sphincter dilation in a serial fashion. RESULTS: The patient underwent 2 aggressive external sphincter dilations (30Fr) under direct vision. The second dilation was performed in the outpatient clinic without anesthesia. Subsequent cystometrographic evaluation revealed dramatic improvement in bladder storage properties with improved compliance and a safe detrusor leak point pressure. Moreover, followup imaging demonstrated complete resolution of vesicoureteral reflux. CONCLUSIONS: Creation and maintenance of perineal urethrostomy is a valuable innovation in the treatment of some boys with high risk myelomeningocele. This easily reversible diversion allows aggressive, sequential external sphincter dilation and produces substantial improvements in bladder storage properties.

Dilatation↗
PubMed2002

Salvage cryotherapy for recurrent prostate cancer after radiotherapy: variables affecting patient outcome.

PURPOSE: To determine the long-term disease-specific survival (DSS) and disease-free survival (DFS) rates after salvage cryotherapy for locally recurrent adenocarcinoma of the prostate and to identify pretreatment factors that have an impact on DSS and DFS. PATIENTS AND METHODS: Between July 1992 and January 1995, 131 patients who had received definitive radiation therapy (XRT) underwent salvage cryotherapy for locally recurrent adenocarcinoma of the prostate. Cryotherapy failure was defined as an increasing postcryotherapy prostate-specific antigen (PSA) level of > or = 2 ng/mL above the postcryotherapy nadir, a positive prostate biopsy, or radiographic evidence of metastatic disease. Clinical variables were studied to determine whether there was an association with the DSS and DFS. RESULTS: The median follow-up was 4.8 years. The 5-year DSS rates were 87% for patients with a precryotherapy Gleason score < or = 8 and 63% for those with Gleason scores of 9 and 10 (P =.012). The 5-year DFS rates were 57% for patients with a precryotherapy PSA level of < or = 10 ng/mL and 23% for those with a PSA level greater than 10 ng/mL (P =.0004). The 5-year DSS rates for patients with a pre-XRT clinical stage of T1 to T2 and those with a clinical stage of T3 to T4 were 94% and 72%, respectively (P =.0041). The 5-year DFS rates for these groups were 90% and 69%, respectively (P =.0057). CONCLUSION: Androgen-independent local recurrences, Gleason score, and pre-XRT clinical stage were important factors that had an impact on DSS and DFS. The subset of patients cured by salvage cryotherapy seems to be small, and patient selection is important.

Adenocarcinoma↗