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Biomedical subjects

G M Ghoniem

Publications and source records attributed to G M Ghoniem.

At least 19 recordsLinked to original sources
PubMed2002

Grades of intrinsic sphincteric deficiency (ISD) associated with female stress urinary incontinence.

Intrinsic urethral sphincter deficiency (ISD) is a clinical entity that should be suspected in women with stress urinary incontinence. If it is not diagnosed prior to surgery, it poses a significant risk factor for repair failure. We propose a classification of ISD based on videofluorourodynamic (VFUD) and abdominal leak-point pressures. One hundred female patients with stress urinary incontinence due to ISD were included in this study. History and physical examination were performed on all patients. Each patient underwent a standard VFUD study with abdominal leak-point pressure (ALPP) measurement. ISD is classified into subtypes according to VFUDS and ALPP. The findings were then correlated with the clinical presentation, etiology and proposed management. Three types of ISD/SUI were identified. ISD-A, subtle/urodynamic, was present in 32 patients (32%). It is most difficult to diagnose because radiologically the bladder neck is not open at rest, and it is only diagnosed by VFUD. The abdominal leak-point pressure was less than 12 cmH2O. ISD-B was present in 45 patients (45%). This is characterized by a beak-shaped open bladder neck at rest. The abdominal leak-point pressure was less than 90 cmH2O. ISD-C was present in 14 patients (14%). It is characterized by an open, fixed non-functioning urethra (pipe-stem) with high position of the bladder neck. The abdominal leak-point pressure was less than 70 cmH2O. All the three subtypes had proximal urethral closure pressure (PCUP) less than 10 cmH2O. Based on these data, the treatment options may vary from one subtype to another. For ISD-A, initial treatment was medical, with collagen injection being used for the failed cases. For ISD-B a modified pubovaginal sling was used, as it corrects the ISD and the urethral hypermobility at the same time. For ISD-C, urethrolysis and takedown of the previous suspension was required before using a sling. Collagen injections were used in selected cases. This classification identifies different subgroups of ISD, which is important in the diagnosis and management of this condition.

Algorithms↗
PubMed2002

Pelvic floor dysfunction management practice patterns: a survey of members of the International Urogynecological Association.

The authors report results of a survey of the practice patterns of International Urogynecological Association (IUGA) members in the management of urinary incontinence and pelvic organ prolapse. A questionnaire regarding current urogynecological clinical practice was developed by the Research and Development Committee of IUGA and mailed to all members of IUGA. Age, specialty, and geographic location factors were used for response comparisons. One hundred and fifty-two surveys (30%) were returned, 35% from North America, 51% from Europe/Australia/New Zealand, and 14% from elsewhere. The average age of respondents was 47.2 years (SD = 9.5), 89% were gynecologists and 11% were urologists. Overall, the procedures of choice for stress incontinence (SUI) were tension-free vaginal tape (TVT; 48.8%) and Burch colposuspension (44%). There were significant geographic variations noted. For SUI with low-pressure urethra/intrinsic sphincteric deficiency, TVT was used by 44.6% and suburethral sling by 32.3%. Various materials are used for suburethral slings, including autologous fascia (46.5%), Marlex mesh (27.8%) and cadaveric fascia lata (11.6%). Bulking agent injection therapy is used for ISD by 75% of respondents. Traditional reconstructive procedures are performed by the majority of respondents, including sacrospinous fixation (78%), abdominal sacrocolpopexy (77%), paravaginal repair (65%) and vaginal enterocele repair (93%); 6.5% use defecography in evaluating rectoceles and 44% use the POP-Q. Seventy-two per cent use urodynamic evaluation routinely in prolapse cases with no manifest SUI. Most IUGA members perform commonly accepted procedures for surgical therapy of urinary incontinence and genital prolapse. IUGA members do not frequently use anorectal physiology and fluoroscopic investigations to evaluate rectoceles prior to repair.

Adult↗
PubMed2001

Nonautologous sling materials.

This article provides a comprehensive and updated review of the current nonautologous sling materials available for treatment of stress urinary incontinence. The various materials are described, relevant clinical studies are discussed, and newer materials are outlined. Complications arising from use of different materials also are described.

Biocompatible Materials↗
PubMed2001

Male perineal sling.

PURPOSE: Postprostatectomy incontinence remains a significant problem for both patients and their urologists. Treatment options include placement of an artificial urinary sphincter or collagen injections. Many patients with only minimal or moderate stress incontinence after prostatectomy shy away from AUS placement and do not benefit from collagen injections. We evaluate the placement of the male perineal sling as an option in the treatment of post-prostatectomy stress urinary incontinence. METHODS AND MATERIALS: Ten patients had placement of a male perineal sling with cadaveric fascia lata. Their pre- and postoperative symptoms, including quality of life scores, were evaluated with a standard validated incontinence questionnaire. RESULTS: Preliminary results show that 70% of patients were dry, 10% showed improvement, and 20% were dry but had sudden return of their symptoms. The last two patients had pelvic x-rays which revealed migration of the bone anchors out of the pubic rami. All patients had improvement in their quality of life. Mean operative time was 30 minutes, and no operative complications were encountered. CONCLUSIONS: The male perineal sling is a quick and simple procedure in the treatment of post-prostatectomy stress urinary incontinence.

Bioprosthesis↗
PubMed2000

Surgical management of intrinsic sphincter deficiency in women.

The past decade has witnessed significant changes not only in our understanding of intrinsic sphincter deficiency, but also in our surgical approach to this problem. It became evident that the patient's medical condition, expectations, and degree of incontinence should define the approach in order to make the greatest impact on quality of life. The present review describes the current concepts and surgical approaches to intrinsic sphincter deficiency, namely slings, injectables, and artificial sphincters.

Adult↗
PubMed1999

Long-term outcome and quality of life after modified pubovaginal sling for intrinsic sphincteric deficiency.

OBJECTIVES: To evaluate the long-term outcome of the modified pubovaginal sling (MPVS) procedure and its impact on our patients' quality of life (QOL). METHODS: We mailed an outcome questionnaire to 112 female patients who underwent the MPVS procedure for complicated type III stress urinary incontinence (SUI), intrinsic sphincteric deficiency. Eighty-two responses (73.2%) were obtained, with a mean follow-up of 3.4 years (range 0.5 to 8). Forty-four of them have had a follow-up for more than 3 years. RESULTS: Of the patients who responded, 86.3% were satisfied, and 78% of the patients reported significant improvement; 49.3% were dry all the time, 21.9% were occasionally wet, 17.9% were wet with moderate activity, and 10.9% were wet all the time. Social activity improved in 74% of the patients, and sexual activity improved in 39%. No significant difference was noted in continence and satisfaction or QOL. Reviewing the charts of our failures (15 patients, 19.2%) revealed that all of them had urge incontinence with or without SUI. CONCLUSIONS: The questionnaire results revealed a high satisfaction rate and a significant improvement in the QOL of patients with complicated SUI who underwent MPVS. The patients remained satisfied over a long follow-up period. Failures are mostly associated with urge incontinence and severe irritative symptoms.

Adult↗
PubMed1998

Transurethral collagen injection for female stress incontinence.

Periurethral collagen injections have been used to treat female urinary incontinence secondary to intrinsic sphincteric deficiency (ISD). As an alternative, a transurethral submucosal collagen injection was used in 33 consecutive women suffering from stress incontinence secondary to ISD at Tulane University Medical Center. Prior to the procedure, careful clinical examination with a videofluorourodynamic study was performed for each case. The procedure was carried out under local anesthesia assisted with monitored anesthesia care (MAC). The collagen was injected transurethrally by the long collagen needle (C. R. Bard). In the first 11 cases the average cumulative collagen injected per patient was 6.1 ml, whereas in the last 22 cases the average was 3.5 ml. As a result of the injection 16 patients were dry (48.5%) and 11 were improved (33.3%), with an overall success rate of 81.8%. The injection failed in 6 patients (18.1%). The mean follow-up was 18.8 months, with a range of 2-33 months. In the successful group there was a significant decrease in pretreatment frequency, from an average of 8 to 4.9 (P = 0.005) and in nocturia from an average of 2.14 to 0.76 (P = 0.001). Also, there was a significant decrease in the number of pads, from an average of 3.7 to 1.1 (P = 0.001). The stress leak-point pressure showed a significant increase, from an average of 68.1 to 93.5 cm H2O (P = 0.03). There was no relation between grade of incontinence and the success of the injection. Two cases suffered from temporary urinary retention. This study revealed that the transurethral submucosal collagen injection is an effective method for treating cases of intrinsic sphincteric deficiency. The volume of collagen required to produce the seal effect is small and it may decrease the reinjection rate. As experience is gained, the procedure time is typically 15 minutes. This makes it a reliable, cost-effective and well-controlled method. However, it has a learning curve and the cystoscope instruments require minor adaptation for its use.

Adult↗
PubMed1998

Detrusor properties in myelomeningocele patients: in vitro study.

PURPOSE: To characterize detrusor properties of myelomeningocele (MMC) bladders which failed conventional therapy. MATERIALS AND METHODS: Bladder strips from five end-stage MMC patients were compared with those from five patients with vesicoureteric reflux. The active and passive properties of the detrusor muscles and the effect of different blocking agents on the transmural nerve stimulation were studied. RESULTS: A significant decrease in contractility (p = 0.003) and increased rigidity (p = 0.019) was found in MMC group. In the control group, atropine blocked 77.7% of the detrusor contractility and tetrodotoxin demonstrated an equal blocking effect. In MMC group, atropine blocked 58.2% and tetrodotoxin blocked 77.4% of the detrusor contractility. CONCLUSION: MMC bladders showed decreased contractility and increased rigidity. In MMC group, the atropine-resistant component which is blocked by tetrodotoxin signifies the possible existence of non-adrenergic, non-cholinergic neurotransmitters (NANC). Further studies are needed to possibly improve the pharmacological therapy of the myelomeningocele detrusor.

Atropine↗
PubMed1998

Bladder neck prop using vaginal wall island for intrinsic sphincteric deficiency in elderly patients: a new technique.

OBJECTIVES: A simple new technique, using a trapezoid island of vaginal wall, is described for elderly female patients undergoing transvaginal pelvic prolapse repair and suffering from stress urinary incontinence secondary to intrinsic sphincteric deficiency. METHODS: Fifteen elderly women underwent bladder neck prop in association with other pelvic prolapse surgery. The mean follow-up period was 20 months. RESULTS: Twelve of 14 patients (85.7%) were dry. One patient was lost to follow-up. CONCLUSIONS: Bladder neck prop provided urethral and bladder neck compression and support. The major advantage of this approach is avoiding extensive dissection and/or abdominal incision in elderly female patients.

Age Factors↗
PubMed1998

Collagen injection for intrinsic sphincteric deficiency in men: a reasonable option in selected patients.

PURPOSE: We evaluate transurethral collagen injection as a minimally invasive option in treating stress urinary incontinence in men and identify the prognostic factors for success or failure. MATERIALS AND METHODS: Transurethral collagen was injected in 35 men with grades III (22) and II (13) incontinence. RESULTS: Of the patients 7 became dry (20%), 11 improved (31.4%) and 17 were considered failures (48.6%). Abdominal leak point pressure increased and the number of pads needed decreased. In the failed group 4 patients had a history of pelvic irradiation, 5 urethral stricture disease and 3 bladder instability before injection. There was 1 case of temporary urinary retention as a complication. CONCLUSIONS: Transurethral collagen injection for male stress urinary incontinence is a reasonable option in select patients.

Aged↗
PubMed1998

Potential role of rel/nuclear factor-kappaB in the pathogenesis of interstitial cystitis.

PURPOSE: Despite assertive investigation in the last 2 decades, interstitial cystitis remains an unresolved problem in clinical urology, and its etiology and the mechanisms involved in its pathogenesis are still a matter of conjecture. Recently nuclear factor (NF)-KB has been implicated in chronic inflammatory diseases, and is thought to be a key regulator of genes involved in response to infection, inflammation and stress. We document the presence, pattern and distribution of NF-kappaB in bladder biopsies from patients with interstitial cystitis. MATERIALS AND METHODS: Bladder biopsies from 7 women clinically diagnosed with interstitial cystitis according to National Institute for Diabetes and Digestive and Kidney Diseases criteria and 5 women diagnosed with urinary incontinence were used for immunohistochemical localization of p65, an NF-kappaB subunit. RESULTS: Our immunohistochemical localization experiments indicate that NF-kappaB was predominantly activated in bladder urothelial cells and cells of the submucosal layer in biopsies from patients with interstitial cystitis compared to controls. While activation was evident by intense nuclear localization of NF-kappaB in all interstitial cystitis specimens, diffuse and faint immunostaining was observed in control samples. The results also indicate that activation of NF-kappaB correlated with disease occurrence. CONCLUSIONS: The fact that NF-kappaB is capable of transactivating pro-inflammatory mediators, which in turn can amplify NF-kappaB activation by a positive regulatory loop, suggests that inflammatory and/or immune responses in interstitial cystitis can be exacerbated possibly by persistent activation of this nuclear factor. We believe that our study provides a novel basis for investigating the role of NF-kappaB activation in the pathophysiology of interstitial cystitis and further opens a frontier for the development of an innovative therapeutic approach to interstitial cystitis.

Biopsy↗
PubMed1998

The evolving role of submucosal injectables for treating internal sphincteric deficiency.

Each of the previously mentioned materials can be used in procedures performed on an outpatient basis using sedation and local anesthesia. Teflon usually requires general anesthesia. None of these materials, however, should be used in acute conditions involving cystitis, urolithiasis, or infection. Table 4 summarizes the postoperative care after a bulking agent injection. There are obvious advantages to using injectable materials for ISD, one of which is that the outpatient procedure is usually done under local anesthesia. It does not have the risks inherent in open surgical procedures like slings or artificial sphincters, and it causes minimal increase of urethral resistance to detrusor-generated micturition force. Such procedures are obviously easier and faster to perform with less cost and rapid recovery followed by a return to regular activity within 48 hours. In conclusion, injection therapy for urinary incontinence is appropriate, but the most effective substance has probably not yet been determined.

Collagen↗
PubMed1997

Alternatives for the pharmacologic management of urge and stress urinary incontinence in the elderly.

Urinary incontinence in the elderly is a common but typically remediable condition that is frequently managed by pharmacotherapy. However, because of age-related changes, the response to a specific dosage of a certain drug administered to an elderly person may be quite different than the response experienced by a younger individual. This article will review general principles of pharmacotherapy in the elderly patient and pharmacologic alternatives for the management of urge and stress urinary incontinence.

Adrenergic alpha-Agonists↗
PubMed1997

Human vasal changes after vasectomy: in vitro studies.

UNLABELLED: Failure to impregnate, after successful vasovasostomy, has been attributed to immunologic, testicular, and epididymal factors. OBJECTIVES: To study the effect of vasectomy on human vas innervation and vesicoelastic properties. METHODS: Vas rings were obtained from 8 healthy males during vasectomy as controls and compared to those of 3 vasovasostomy patients. The active and passive properties were determined and the cumulative blocking effects of phenoxybenzamine, propranolol, atropine and tetrodotoxin were studied. RESULTS: There was significantly higher rigidity in the vasovasostomy group as compared to the control group but there were similar active forces between the two groups up to 100-120% of stretch. In the control group, phenoxybenzamine blocked 33.3%, propranolol blocked 15.8%, and atropine blocked 36.5% but tetrodotoxin had no further effect. In the vasovasostomy group, phenoxybenzamine blocked 33.3% (similar to control), propranolol blocked 2%, atropine blocked 11.7% and tetrodotoxin blocked 37.1%. CONCLUSIONS: In vasovasostomy group there was increased rigidity without reduction of the active force. There were also decreased cholinergic and possible existence of nonadrenergic noncholinergic neurotransmitters.

Adrenergic alpha-Antagonists↗
PubMed1997

A telemetric multichannel computer-based system for monitoring urodynamic parameters in awake rhesus monkeys.

For comprehensive telemetric monitoring of bladder function in monkeys, transducers were implanted in the bladder wall and abdominal cavity. The EMG lead was buried in the external sphincter. All wires terminated in a subcutaneous transmitter. Conventional urodynamics were performed for comparison. Excellent reproducibility with conventional urodynamics was found. Implantation caused detrusor instability, which subsided in 6 to 8 weeks. Real-time computer-based multichannel telemetric studies of voiding are feasible and reliable. Telemetric studies monitor for long periods without stress or anesthesia and provide an excellent model for lower urinary tract studies.

Animals↗
PubMed1996

Conventional, continuous, and telemetric monitoring of urodynamic parameters in non-human primates: a comparative study.

A comparison between three different techniques for monitoring urodynamic parameters in non-human primates was conducted in six adult female rhesus monkeys. This study was divided into two phases. In phase I, the animals were studied by conventional and continuous methods. During the study, uroflow and micturition pattern were obtained while the animals housed in a specially designed metabolic cage. Pressure transducers and EMG electrodes were surgically implanted. Then the animals were trained for 6 weeks to sit in a specially designed chair. Upon completion of the training period, continuous monitoring of the urodynamic parameters could be carried out for periods up to 14 hours. In phase II, the animals were studied with the conventional and telemetric methods. The same type of pressure transducers and EMG electrodes were implanted but they terminated in a radio transmitter powered by a long-life battery and controlled by a radio-operated switch. Conventional studies under ketamine sedation significantly increased bladder capacity, as well as the pressure at capacity (P < 0.05). Continuous monitoring was feasible, physiological, and more sensitive than the conventional techniques. Telemetric studies are superior to continuous monitoring, since the animal is not tethered to wires and provide data over a longer period of time. It is concluded that telemetric monitoring provides significantly different parameters, which could help in diagnosis and management of different voiding dysfunctions. In normal non-human primates, lower bladder capacity, higher maximum voiding pressure, higher bladder compliance, and higher incidence of detrusor instability without urethral relaxation were found. Telemetric urodynamic data on different pathological processes are currently unavailable and further work is needed in this area.

Animals↗
PubMed1996

Persistence of injectable collagen in human urethra: case report.

A polypoid lesion was found near the bladder neck during cystoscopy in a woman with urinary incontinence who had undergone periurethral collagen (Contigen) injections 3 years before. She had previously received radiation therapy in addition to a radical vulvectomy for vaginal cancer. On transurethral resection of the lesion, particles of unresorbed collagen material extruded from the capsulated suburothelial space. Histologic evaluation verified the material as the foreign collagen. The persistence of glutaraldehyde cross-linked collagen in our patient was much longer than previously reported and may have been due to effects of previous radiation treatment.

Aged↗