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Biomedical subjects

Firouz Daneshgari

Publications and source records attributed to Firouz Daneshgari.

At least 19 recordsLinked to original sources
PubMed2006

Complications and troubleshooting of two-stage sacral neuromodulation therapy: a single-institution experience.

OBJECTIVES: With the increasing use of sacral neuromodulation therapy, urologists are faced with postimplantation challenges. The purpose of this study was to identify these events and their causes and management in our large single-institution experience. METHODS: From July 2002 to September 2004, all patients who underwent sacral neuromodulation therapy for refractory bladder conditions were identified. Their medical records were retrospectively evaluated for history, operative intervention, and programming visits. Events after implantation of the implantable pulse generator (IPG) unit were noted. The evaluation, troubleshooting, management, and resolution of events at the last follow-up visit were extracted. RESULTS: A total of 214 patients underwent sacral neuromodulation therapy at our institution. The mean patient age was 53.5 +/- 15.4 years. Of the 214 patients, 161 underwent IPG implantation during a mean follow-up period of 16 months (range 5 to 30). The second-stage explantation and revision rate was 10.5% and 16.1%, respectively. The indications for explantation were infection (8 of 17) and failure to maintain a response (9 of 17). Revisions were done for decreases in response with abnormal (12 of 26) or normal (5 of 26) impedance measurements, IPG site discomfort (4 of 26), draining sinus at the IPG site (4 of 26), and lead migration (1 of 26). Equalization of impedance measurements was the most commonly observed impedance abnormality. These were managed by drying fluid from the connection in 4 patients and lead change in the rest. CONCLUSIONS: After IPG implantation, a decline in response may occur. Although some were explanted, most were revised, with most of the revisions functional on follow-up. Familiarity with impedance evaluation and development of algorithms for postimplant management are essential for troubleshooting and maintenance of the device.

Electric Stimulation Therapy↗
PubMed2006

Temporal diabetes- and diuresis-induced remodeling of the urinary bladder in the rat.

The natural history of diabetes mellitus-induced remodeling of the urinary bladder is poorly understood. In this study, we examined temporal remodeling of the bladder in diabetic and diuretic rats. Male Sprague-Dawley rats were divided into three groups: streptozotocin-induced diabetic, 5% sucrose-induced diuretic, and age-matched control. Micturition and morphometric characteristics were evaluated using metabolic cages and light-microscopic examination of the bladder 4 days and 1, 2, 3, and 9 wk after induction. Digital image analysis was used to quantify equatorial cross-sectional areas of bladder tissue and lumen, as well as relative content of the three primary tissue components: smooth muscle, urothelium, and collagen. Diabetes and diuresis caused significant increases in fluid intake, urine output, and bladder weight. In both groups, progressive increases were observed in lumen area from 4 days to 3 wk after induction and in wall area from 2 to 3 wk after induction. Wall thickness decreased within the first 2 wk in the diabetic and diuretic rats but returned to control at 3 and 9 wk. As a percentage of total cross-sectional area, smooth muscle area increased, urothelium area was unchanged, and collagen area decreased in diabetic and diuretic rats after 2-3 wk compared with control rats. In conclusion, diabetes and diuresis induced similar bladder remodeling. Diabetes-induced diuresis caused adaptive physical changes in rat bladder by 4 days after induction; remodeling was observed by 2-3 wk after induction and remained stable from 3 to 9 wk.

Animals↗
PubMed2006

Temporal differences in bladder dysfunction caused by diabetes, diuresis, and treated diabetes in mice.

Diabetic bladder dysfunction is a common complication of diabetes mellitus (DM) with poorly understood natural history. This study examined the temporal changes in bladder function 3, 9, 12, and 20 wk after induction of DM by streptozotocin (STZ) in male C57BL/6 mice compared with that in age-matched diabetic mice treated with insulin, 5% sucrose-induced diuretic mice, and sham-treated control mice. Conscious cystometrograms of mice were examined in addition to the measurements of micturition cycle. Diabetes resulted in decreased body weight. Bladder weight, urine output, bladder capacity, and compliance increased in the DM and diuretic groups. Peak voiding pressure (PVP) increased initially in both DM and diuretic mice. However, in DM mice, PVP dropped dramatically at and after 12 wk. Similar changes in the capacity, compliance, and emptying ability of the bladder were seen during the first 9 wk of the diabetes or diuresis, whereas significant decline in the emptying ability of the bladder was only seen in diabetes after 12 wk of disease in mice. Long-term insulin replacement effectively reversed most changes in bladder function. These results suggest that the transition from a compensated to a decompensated bladder dysfunction occurs 9-12 wk after induction of DM in mice by STZ.

Animals↗
PubMed2006

Effects of cold storage on the function and morphology of isolated urinary bladder in rat.

AIMS: We investigated the effects of 24- and 48-hr storage at 4 degrees C in Krebs solution on the function and morphology of isolated, rat urinary bladders. METHODS: Strips of bladder were obtained from eight male Sprague-Dawley rats. Six strips were harvested from each bladder and randomized to storage for 24 or 48 hr at 4 degrees C in Krebs solution or examination immediately after harvest. Contractile responses of the strips to potassium chloride (KCl), electric field stimulation (EFS), adenosine 5'-triphosphate (ATP) and carbamylcholine (CCh) were assessed. Histological examination of the bladder strips was performed. The pO(2), pCO(2), and pH of the solution in each storage container were measured at each storage time point. RESULTS: Cold storage induced a significant decrease in the amplitude of contraction in response to KCl and EFS after 24 or 48 hr of storage compared with control. The response of the bladder strips to ATP and CCh was significantly reduced after 48-hr storage compared with control, but not 24-hr storage. The pO(2) and pCO(2) decreased after cold storage. The pH increased after 24 hr of storage and remained stable between 24 and 48 hr of storage. Histological evaluation of the strips showed tissue swelling after 24 and 48 hr of storage. CONCLUSIONS: These results suggest that the morphology and function of bladder strips stored for 24 to 48 hr at 4 degrees C in Krebs solution undergo significant changes. Further studies are needed to assess the allowable time for storage of bladder tissue.

Adenosine Triphosphate↗
PubMed2006

Surgical innovations in pelvic organ prolapse and incontinence.

Pelvic organ prolapse (POP) and urinary incontinence (UI) are common problems facing the geriatric woman. Many patients may find great benefit from medical or conservative treatments; however, surgical options are commonly used in many cases. This article examines the current medical and surgical innovations for POP and UI that have the potential to improve the patient's quality of life.

Aged↗
PubMed2006

Patient related risk factors for recurrent stress urinary incontinence surgery in women treated at a tertiary care center.

PURPOSE: We examined patient related risk factors for recurrent stress urinary incontinence in women treated at a tertiary referral center. MATERIALS AND METHODS: A case-control study was done in 18 to 75-year-old women with signs and symptoms of genuine or mixed stress urinary incontinence and no prior surgical treatment who underwent an open anti-incontinence procedure between 1990 and 2002 at our institution. Cases were defined as patients who underwent more than 1 anti-incontinence surgery and controls were defined as patients who underwent only 1 anti-incontinence procedure with followup during that period. Cases and controls were matched for surgery type, surgeon and date of surgery within 1 year. A total of 47 variables were examined, including patient age, parity, incontinence type, urodynamic findings, medical history (peripheral vascular, pulmonary and cardiac disease), past and concomitant pelvic surgery, social history (alcohol and tobacco use) and body mass index. Univariate conditional logistic regression was done first to determine which variables were potential protective or risk factors. Multivariate conditional logistic regression analysis was then used to determine which factors were statistically significant. RESULTS: The records of 2,550 women with stress or mixed urinary incontinence who underwent an open surgical procedure between 1990 and 2002 were reviewed. A total of 53 cases and 146 controls were identified. Each case was matched with 1 to 4 controls. Data on cases and controls were collected using a standardized form. At a significance level of 0.05 the possible risk factors for recurrent stress urinary incontinence based on univariate analysis were diabetes mellitus (OR 3.579, p = 0.026), pelvic organ prolapse (OR 5.635, p = 0.03) and concomitant rectocele repair (OR 5.353, p = 0.04). Smoking was marginally protective (OR 0.497, p = 0.068). After multivariate conditional logistic regression analysis diabetes mellitus (adjusted OR 3.413, p = 0.045), pelvic organ prolapse (adjusted OR 8.195, p = 0.021) and concomitant rectocele repair (adjusted OR 17.079, p = 0.012) remained significant risk factors, while smoking remained a protective factor (adjusted OR 0.264, p = 0.012). Body mass index, age, race, parity and estrogen status were not identified as risk factors for recurrent stress urinary incontinence requiring a second anti-incontinence procedure. CONCLUSIONS: In a cohort of women with stress or mixed urinary incontinence treated at our institution between 1990 and 2002 women with diabetes mellitus, pelvic organ prolapse or concomitant rectocele repair were at increased risk for repeat anti-incontinence surgery, while women who smoked were at slightly decreased risk.

Aged↗
PubMed2006

Diabetic uropathy.

Diabetes mellitus (DM) is becoming more common in the United States affecting an estimated 18.2 million Americans. Not only is the number of American's with DM staggering, but so are the medical and economic costs of DM. DM accounts for nearly 15% of all health care costs in the United States. The chronic hyperglycemia of DM is associated with long-term damage, dysfunction and failure of multiple organ systems, including the genitourinary system. Genitourinary complications are common among diabetics. Of individuals diagnosed with DM, 80% have lower urinary tract complications, while 50% develop nephropathy and 35-75% develop sexual dysfunction. In order to decrease the number and severity of diabetic urologic complications, early recognition and a more comprehensive understanding of how diabetes impacts the genitourinary tract is imperative.

Diabetic Nephropathies↗
PubMed2006

Time dependent changes in diabetic cystopathy in rats include compensated and decompensated bladder function.

PURPOSE: Diabetic bladder dysfunction is among the most common and bothersome complications of diabetes mellitus. While bladder filling and voiding problems have been reported, the precise functional changes in diabetic bladders remain unclear. We investigated time dependent changes in bladder function in streptozotocin induced diabetic rats. MATERIALS AND METHODS: Cystometrograms and detrusor muscle contractility were examined in male age matched control and diabetic Sprague-Dawley rats (Harlan, Indianapolis, Indiana) 3, 6, 9, 12 and 20 weeks after diabetes induction with streptozotocin. RESULTS: Diabetes decreased average body weight and increased bladder weight, capacity and compliance. Peak detrusor leak pressure increased gradually from weeks 3 to 6 to 9 in diabetic rats (mean +/- SEM 47.3 +/- 2.5, 50.8 +/- 3.0 and 56.0 +/- 3.6 cm H(2)O) and in controls (36.9 +/- 1.4, 37.7 +/- 1.5 and 41.6 +/- 1.81 cm H(2)O, respectively). However, at 12 and 20 weeks diabetic rats deviated strongly from this trend with peak detrusor leak pressure decreasing vs controls (41.6 +/- 2.8 and 37.3 +/- 0.9 vs 45.2 +/- 1.7 and 49.6 +/- 1.4 cm H(2)O, respectively) and post-void resting pressures increasing from 9-week levels vs controls (interactions p <0.0001). In contractility studies increased contractile force responses of diabetic animals to carbamylcholine chloride, potassium chloride, adenosine 5'-triphosphate and electric field stimulation peaked at 6 or 9 weeks but at 12 to 20 weeks they generally reverted toward those of controls (carbamylcholine chloride and electrical field stimulation interactions p = 0.0022 and 0.01, respectively). CONCLUSIONS: Diabetic bladders may undergo a transition from a compensated to a decompensated state and transition in the streptozotocin rat model may begin 9 to 12 weeks after induction.

Animals↗
PubMed2006

Reliability and agreement of urodynamics interpretations in a female pelvic medicine center.

OBJECTIVE: To estimate the reliability and interobserver consistency of urodynamic interpretations of female bladder and urethral function. METHODS: Three urogynecologists and three female urologists at a tertiary care medical center reviewed masked, abstracted clinical and urodynamic information from 100 charts, selected for adequate completeness from a consecutive series of 135 women referred for urodynamic testing. For each of the 100 cases, the reviewers assigned International Continence Society filling and voiding phase diagnoses, and overall clinical diagnoses. Raw agreement proportions and weighted kappa chance-corrected agreement statistics (kappa) were used jointly to describe both reliability and interobserver agreement. Reliability was estimated from duplicate reviews, masked and separated by at least 4 months, of each case by each physician. Interobserver agreement was estimated from comparisons of all pairs of responses from different physicians. RESULTS: For clinical diagnosis of stress incontinence (present, absent, indeterminate), the within- and across-physician weighted kappa's were, respectively, 0.78 and 0.68. Corresponding results were 0.40 and 0.13 for detrusor overactivity without incontinence, 0.58 and 0.38 for detrusor overactivity with incontinence, and 0.51 and 0.26 for voiding dysfunction. Standard errors of each kappa were between 0.023 and 0.043. CONCLUSION: In our group, lower urinary tract diagnoses of stress urinary incontinence from both clinical and urodynamic data demonstrated substantial reliability and interobserver agreement. However, by conventional interpretation of kappa-statistics, reliability of diagnoses of detrusor overactivity or voiding dysfunction was only moderate, and interobserver agreement on these diagnoses was no better than fair. Urodynamic interpretations may not be satisfactorily reproducible for these diagnoses.

Diagnostic Techniques, Urological↗
PubMed2005

Management of ureteral injuries associated with vaginal surgery for pelvic organ prolapse.

Due to the anatomic proximity of the urinary and genital tracts, iatrogenic ureteral injury during pelvic organ prolapse repairs is a serious complication that we have managed in increasing number at our institution. However, few centers have reported on their experience with ureteric injuries associated with gynecologic reconstructive surgery. These ureteral injuries may lead to much morbidity, in particular the formation of ureterovaginal fistula, and the potential loss of renal function especially when diagnosed postoperatively. It is necessary, therefore, for surgeons to have a thorough knowledge of ureteral anatomy and to take precautions to prevent such injuries. The purpose of this article is to review this pertinent anatomy and the key principles of management of ureteric complications of transvaginal surgery for pelvic organ prolapse. The present study illustrates the application of our treatment algorithm based on the time of presentation and the patient condition.

Female↗
PubMed2005

Alterations in neurogenically mediated contractile responses of urinary bladder in rats with diabetes.

Diabetic bladder dysfunction (DBD) is among the most common and bothersome complications of diabetes mellitus. Autonomic neuropathy has been counted as the cause of DBD. In the present study, we compared the alterations in the neurogenically mediated contractile responses of urinary bladder in rats with streptozocin-induced diabetes, 5% sucrose-induced diuresis, and age-matched controls. Male Sprague-Dawley rats were divided into three groups: 9-wk diabetic rats, diuretic rats, and age-matched controls. Micturition and morphometric characteristics were evaluated using metabolic cage and gross examination of the bladder. Bladder detrusor muscle strips were exposed to either periodic electrical field stimulation (EFS) or to EFS in the presence of atropine, alpha,beta-methylene adrenasine 5'-triphosphate, or tetrodotoxin. The proportions of cholinergic, purinergic, and residual nonadrenergic-noncholinergic (NANC) components of contractile response were compared among the three groups of animals. Diabetes caused a significant reduction of body weight compared with diuresis and controls, although the bladders of diabetic and diuretic rats weighed more than the controls. Both diabetes and diuresis caused significant increase in fluid intake, urine output, and bladder size. Diabetes and diuresis caused similarly increased response to EFS and reduced response to cholinergic component compared with controls. However, the purinergic response was significantly smaller in diuretic bladder strips compared with controls but not in diabetic rats. A residual NANC of unknown origin increased significantly but differently in diabetics and diuretics compared with controls. In conclusion, neurogenically mediated bladder contraction is altered in the diabetic rat. Diabetic-related changes do not parallel diuretic-induced changes, indicating that the pathogenesis of DBD needs further exploration.

Acetylcholine↗
PubMed2005

Current indications for neuromodulation.

Neuromodulation is becoming a part of the clinical armamentarium for treatment ofa variety of lower urinary tract conditions. Its increased usage stems from the needs of patients who have exhausted all other therapeutic options. Currently, neuromodulation may consist of the use of nerve stimulation and injectable therapies. This article concentrates on nerve stimulation.

Electric Stimulation Therapy↗
PubMed2005

Future directions in pelvic neuromodulation.

In view of the success of sacral nerve stimulation, new lines of research are enabling us to do more selective stimulation of the innervation of the bladder at more peripheral sites,such as pudendal nerve stimulation, and with the use of less invasive devices, such as Bion and other in situ implantable devices. The aim of this research is to determine ifa less invasive, more selective stimulation or an event-driven (detrusor overactivity ora desire for micturition) stimulus would allow for a more improved and durable response.

Botulinum Toxins, Type A↗