PubMed Health⌕ Search

Biomedical subjects

G D Webster

Publications and source records attributed to G D Webster.

At least 19 recordsLinked to original sources
PubMed1997

Voiding dysfunction following incontinence surgery: diagnosis and treatment with retropubic or vaginal urethrolysis.

PURPOSE: A retrospective analysis was done of women undergoing urethrolysis for post-cystourethropexy voiding dysfunction to identify possible predictors of outcome. MATERIALS AND METHODS: The charts of 51 sequential women who underwent 54 urethrolysis procedures between 1986 and 1996 were reviewed. The most common presenting symptoms were irritative in 38 patients, obstructive in 31, de novo urge incontinence in 28 and persistent retention in 12. Onset was immediate after suspension in 84% of the patients. Median time from last cystourethropexy or sling to urethrolysis was 15 months (range 4 to 268). Initial evaluation consisted of multichannel video urodynamics and cystoscopy in all women. The techniques of urethrolysis were retropubic in 35 cases, vaginal in 15 or infrapubic in 4, with simultaneous repeat suspensions performed in 63%. RESULTS: A successful outcome with complete resolution of symptoms or significant improvement was achieved in 86% (retropubic), 73% (vaginal) and 25% (infrapubic) of the cases with a median followup of 10 months. No parameter examined, namely urodynamic variables, number of previous suspensions, time from suspension to urethrolysis or surgical approach, was a statistically significant predictor of outcome. CONCLUSIONS: Urodynamics may not show classic obstructive voiding in women who benefit from urethrolysis. Our only absolute selection criterion for offering urethrolysis is a clear temporal relationship of symptoms to cystourethropexy. Retropubic and vaginal techniques for urethrolysis provide similar results but morbidity is seemingly less with the vaginal approach. Omental or Martius fat pad interposition may be of benefit.

Adult↗
PubMed1997

Treatment of complex anterior urethral stricture disease with mesh graft urethroplasty.

PURPOSE: Treatment of complex anterior urethral strictures complicated by a lack of sufficient penile skin for primary flap repair has generally consisted of 2-stage scrotal inlay urethroplasty. Scrotal skin has shortcomings, most notably hair formation, diverticula and stricture recurrence from urine induced dermatitis. As an alternative, we present our results with staged mesh graft urethroplasty using split-thickness skin, which is nonhair-bearing, easier to size and seemingly less permeable to urine penetration. MATERIALS AND METHODS: Between 1990 and 1995, 20 men underwent mesh graft urethroplasty for complex strictures, most after failed urethroplasty. Meshed split-thickness skin graft from the thigh (17 men) or full-thickness foreskin (3) was used. RESULTS: Overall median time to closure was 5.5 months, and 6 men required revision before closure (revision of ostia in 3, chordee release in 2 and lysis of graft adhesions in 1). A successful outcome, as evidenced by retrograde urethrography and history, was achieved in 12 of 15 men (80%) with a median followup of 38 months. Five men have not undergone closure due to patient refusal (2) or because the graft is not ready to be closed (3). Of the failures 2 men had retrograde urethrographic evidence of stricture at the proximal anastomosis and 1 had recurrent stenosis of the entire neourethra by 2 years. CONCLUSIONS: Mesh graft urethroplasty is not a panacea but it is a valuable adjunct in the treatment of complex urethral strictures, offering comparable results to and benefits over scrotal inlay procedures. In a significant percentage of cases it is a multistage rather than a 2-stage procedure.

Adolescent↗
PubMed1997

Favorable outcome of pubovaginal slings for geriatric women with stress incontinence.

PURPOSE: Traditionally pubovaginal slings have been associated with a greater risk of immediate morbidity and prolonged voiding dysfunction compared to other stress incontinence repairs. Because elderly patients already have inherently greater perioperative risk and prevalence of innate voiding dysfunction, there is some reluctance to construct slings in this age group. We examined the outcome of pubovaginal sling in elderly women versus younger controls to determine whether this concern is justified. MATERIALS AND METHODS: We retrospectively analyzed the outcome of 19 geriatric women older than 70 years who underwent a pubovaginal sling procedure between 1992 and 1995, and compared the findings to those of 77 younger control women with a mean followup of 22 months. All women had video urodynamically proved stress incontinence due to intrinsic sphincter deficiency and many had coexistent bladder instability symptoms. Women with neurogenic causes for incontinence were excluded from the study. RESULTS: Stress incontinence resolved in 100% of geriatric and 97% of control women. Preoperative instability symptoms, including urge incontinence, improved in more than 50% of patients in both groups. De novo instability symptoms arose in 10% of women in each group but were generally controlled with anticholinergics. Efficient voiding resumed within a mean of 16 days in both groups. CONCLUSIONS: The morbidity and success rates of pubovaginal sling surgery in the elderly compare favorably to those in younger women. Advanced age alone would not dissuade us from constructing a pubovaginal sling when indicated.

Adult↗
PubMed1996

Kock versus right colon continent urinary diversion: comparison of outcome and reoperation rate.

OBJECTIVES: To compare one surgeon's sequential experience with two types of continent cutaneous diversion; namely, the Kock pouch (KP) and the right colon pouch (RCP). METHODS: Outcomes for the final 30 KP patients seen during the period 1989 to 1992 and the initial 30 RCP patients seen between 1992 and 1995 were analyzed retrospectively. Patients differed in median age (KP 52.5, RCP 63.5 years), in number in whom malignancy was the reason for diversion (KP 18, RCP 25), and median follow-up period (KP 50, RCP 16 months). RESULTS: No intraoperative complications or perioperative deaths occurred. Immediate postoperative complications were mild and self-limited in both groups, with the exception of 1 RCP patient who developed life-threatening hemorrhage from a ruptured splenic artery aneurysm. KP patients had a statistically higher (P < 0.05) surgical revision requirement (16 patients, 26 revisions) than RCP patients (4 patients, 4 revisions). The majority of KP revisions were for efferent limb problems. Of the 14 KP patients not requiring revision, 4 have mild incontinence not warranting surgery. Three renal units showed new mild hydronephrosis (2 KP, 1 RCP) and are being observed. Prolonged diarrhea was present in 1 patient in each group, and vitamin B12 supplementation was required in 1 KP and 2 RCP patients. CONCLUSIONS: The markedly higher rate of surgical revision with the Kock pouch has led to our change in practice in favor of the right colon pouch for continent cutaneous urinary diversion.

Colon↗
PubMed1996

Bladder outlet obstruction in women.

While voiding dysfunction is relatively common in women, true bladder outlet obstruction is a rare condition and may be present in a misleading manner. To make an accurate diagnosis and tailor appropriate treatment, urodynamic investigation is required. However, even sophisticated urodynamic studies have limitations in predicting obstruction as a complication of anti-incontinence surgery and response to ureterolysis.

Female↗
PubMed1996

Endoscopic management of the obliterated anastomosis following radical prostatectomy.

PURPOSE: We evaluated an endoscopic technique to treat the challenging problem of an obliterated anastomosis following radical prostatectomy. MATERIALS AND METHODS: Four men with a mean 2.25 cm. obliterative defect underwent visual internal urethrotomy along a sternal guide wire passed under direct antegrade and retrograde vision. Men then performed self-dilation according to an increasing interval protocol. RESULTS: All 4 men maintained anastomotic patency for a mean followup of 12.5 months and 1 no longer requires self-calibration. There were no complications of this procedure. CONCLUSIONS: Endoscopic management coupled with self-dilation offers a safe, minimally invasive option for difficult, long obliterative anastomotic defects following radical prostatectomy.

Aged↗
PubMed1995

Impotence following pelvic fracture urethral injury: incidence, aetiology and management.

OBJECTIVE: To evaluate the potency status of patients undergoing delayed perineal repair following a pelvic fracture urethral injury to determine the incidence and aetiology of impotence. PATIENTS AND METHODS: Long-term potency (> 6 months post-operatively) was subjectively evaluated in 92 patients and correlated with their pre-operative and intra-operative findings. The management of their impotence was aso reviewed. Thirty original pelvic radiographs were assessed independently to determine if the pattern of bony injury was associated with the development of impotence. RESULTS: Fifty-seven patients (62%) remained impotent in the long term with a median follow-up of 48 months (range 12-128) and the operation did not render any potent patient impotent. Self-injection with vasoactive agents was successful in 24 of 27 (89%), suggesting a neurogenic aetiology in the majority. Bilateral pubic rami fracture was also associated with a high incidence of impotence. CONCLUSION: Disruption of the cavernosal nerves lateral to the prostatomembranous urethra behind the symphysis pubis is the most likely cause of impotence in this injury.

Adolescent↗
PubMed1995

Detrusor instability.

Detrusor instability is a common cause of urgency and urge incontinence in neurologically normal patients. It is defined as an involuntary phasic detrusor contraction of any pressure associated with symptoms of urge or leakage while the patient is attempting to inhibit micturition. The etiology is unknown but it has been associated with congenital causes, aging, stress incontinence, and bladder outlet obstruction. Diagnosis relies on a urologic history and physical examination, a voiding diary, and a urodynamic evaluation. Treatment is primarily pharmacologic and behavioral, with surgical options being reserved for selected patients.

Humans↗
PubMed1994

Performance of four computer-based diagnostic systems.

BACKGROUND: Computer-based diagnostic systems are available commercially, but there has been limited evaluation of their performance. We assessed the diagnostic capabilities of four internal medicine diagnostic systems: Dxplain, Iliad, Meditel, and QMR. METHODS: Ten expert clinicians created a set of 105 diagnostically challenging clinical case summaries involving actual patients. Clinical data were entered into each program with the vocabulary provided by the program's developer. Each of the systems produced a ranked list of possible diagnoses for each patient, as did the group of experts. We calculated scores on several performance measures for each computer program. RESULTS: No single computer program scored better than the others on all performance measures. Among all cases and all programs, the proportion of correct diagnoses ranged from 0.52 to 0.71, and the mean proportion of relevant diagnoses ranged from 0.19 to 0.37. On average, less than half the diagnoses on the experts' original list of reasonable diagnoses were suggested by any of the programs. However, each program suggested an average of approximately two additional diagnoses per case that the experts found relevant but had not originally considered. CONCLUSIONS: The results provide a profile of the strengths and limitations of these computer programs. The programs should be used by physicians who can identify and use the relevant information and ignore the irrelevant information that can be produced.

Analysis of Variance↗
PubMed1994

Synchronous management of anastomotic contracture and stress urinary incontinence following radical prostatectomy.

Of 77 patients presenting for artificial urinary sphincter implantation due to incontinence following radical prostatectomy 26 had a significant associated urethrovesical anastomotic contracture. Synchronous endoscopic contracture incision with electrocautery and implantation of an artificial urinary sphincter (AMS800) were performed in all cases. A total of 25 patients void with a good subjective flow, with an average followup of 32 months. In 1 patient symptomatic stenosis recurred 6 months after incision and reincision was successful at the time of sphincter revision. No infection or erosion developed and 24 patients are socially continent (0 to 1 thin pad per day). During this time 5 patients underwent 8 revisions of the artificial sphincter. Synchronous contracture incision with electrocautery and artificial urinary sphincter implantation are safe and provide satisfying results in patients with complex post-prostatectomy incontinence.

Anastomosis, Surgical↗
PubMed1993

Urological dysfunction in patients with diastematomyelia.

Little information exists concerning voiding dysfunction associated with diastematomyelia (splitting of the spinal cord). We present 27 patients 4 days to 62 years old (mean 13 years) who underwent neurosurgical intervention for treatment of this disorder. Of these patients 14 had urological evaluation, with 11 having undergone video urodynamics. Nine patients had minimal urological manifestations. No patient had a urodynamically proved hostile bladder nor evidence of upper urinary tract deterioration. In our experience, patients with a spinal cord fixation syndrome resulting from diastematomyelia not associated with a meningomyelocele appear to have a relatively benign course in terms of the urological manifestations. However, due to the lack of reports concerning the urological findings in this occult dysraphic state, we still suggest upper and lower urinary tract evaluation and followup.

Adolescent↗
PubMed1992

Management of type III stress urinary incontinence using artificial urinary sphincter.

Type III stress urinary incontinence due to severe intrinsic urethral weakness without significant urethrovesical descensus may be treated by periurethral injection, sling cystourethropexy, bladder neck reconstruction, or artificial urinary sphincter implantation. The rationale for procedure selection depends on a number of patient factors and the surgeon's experience. We herein report on 25 women who were identified as having such incontinence by evaluation which included videourodynamic study and lateral voiding cystography and who were managed by the implantation of an artificial urinary sphincter. The etiology of the severe intrinsic urethral weakness in most patients was multiple prior failed cystourethropexies. Postoperatively, 1 patient died of a cerebral vascular accident. The remaining 24 women had significantly improved continence and were completely satisfied at latest follow-up. No revisions have been required for patients receiving an artificial sphincter after 1983. No sphincter erosions or infections have occurred. Our experience and review of the literature shows that the artificial sphincter provides an excellent first option for women with type III urinary stress incontinence due to intrinsic urethral weakness of various etiologies.

Adult↗
PubMed1992

Anomalies associated with myelodysplasia.

The records of 181 patients with myelodysplasia were reviewed. The prevalence of associated genitourinary anomalies as well as cardiac, facial, anal, and tethered cord were determined. The prevalence of congenital malformations associated with myelodysplasia were less in this series than in previous reports.

Abnormalities, Multiple↗