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Biomedical subjects

G Ralph

Publications and source records attributed to G Ralph.

At least 55 records · Page 3Linked to original sources
PubMed1990

[Urodynamic results of Burch colposuspension].

Between 1984 and 1987 31 patients underwent a colposuspension according to Burch for stress urinary incontinence. Seventeen women were available for clinical and urodynamic follow-up after an average of 17.6 months. Clinically, 2 women had postoperative stress-urge incontinence and 2 had stress incontinence only. 13 (77%) patients were continent while straining, 9 (53%) patients complained of urge and voiding disorders, 7 reported post micturition dribble, 2 patients lost urine during intercourse. Urodynamically, 14 (82%) patients were continent during straining, 3 showed mild stress incontinence. The functional urethra length and urethral closure pressure at rest were unchanged. The urethral pressure under stress, depression quotient, and transmission factor increased significantly. The average uroflow sank from 16.8 ml/s to 7.8 ml/s, reflecting the subjective voiding disorders. Bladder compliance was unchanged. We saw no autonomous detrusor contractions and thus no correlation with subjective urge complaints.

Adult↗
PubMed1989

[Urodynamic results following surgery of incontinence].

184 women who underwent surgery because of stress incontinence during the years 1982-1986 were examined both before and after surgery. The interval between operation and post operational control was from 12 to 60 months. After colporrhaphy anterior and colcoperineoplasty 69% of the women were continent; 14% showed a stress incontinence of first degree, 17% a stress incontinence of second degree. After Marshall-Marchetti 75% of the patients were continent; 16% were stress incontinent to degree I. The best result was achieved by lifting the neck of the bladder (Stamey-method): 82% of the women were continent, 18% stress incontinent. The urethral closure pressure at rest went down significantly after colporrhaphia anterior; it rose slightly after Marshall-Marchetti and the endoscopic lifting of the bladder neck (Stamey-method). All postoperatively continent women showed an improval of pressure transmission, the best result having been achieved after the endoscopic lifting of the bladder neck (Stamey-method). Contrary to colporrhaphia anterior and colpoperineoplasty the miction was impaired after abdominal operational methods. The results will be shown and discussed.

Female↗
PubMed1988

Urodynamics following radical abdominal hysterectomy for cervical cancer.

We performed urologic evaluations and urodynamic studies on 40 patients before and 2 weeks, 6 months and 1 year after radical abdominal hysterectomy for cervical cancer. Preoperative findings were mostly within normal limits. Fourteen days after surgery, all patients had small, spastic bladders and 68% had residual urine. Bladder sensation was impaired in all patients at 2 weeks and in 63% after 1 year. The average bladder capacity was 400 ml before surgery, 180 ml at 2 weeks, 350 ml at 6 months, and 460 ml at 1 year. One year postoperatively, no patient had residual urine, but 17.5% had asymptomatic bacteriuria, 17.5% had bladder trabeculation, 62.5% had abnormal compliance, and 85% used abdominal straining to void. Three patients developed overflow incontinence and 8 women developed urodynamic stress incontinence. Most patients were tolerant of the observed dysfunction.

Female↗
PubMed1988

Operative anatomy and technique of radical parametrial resection in the surgical treatment of cervical cancer.

Wertheim's radical operation aimed, by removing the parametrial tissue far from the tumour, to achieve margins free of disease. The paratissues contain the lymphatic channels draining the cervix. They run to the pelvic wall and are interspersed by lymph nodes scattered throughout the parametrium. If lymphadenectomy is to be curative then the entire parametrium must be removed. To this end the resection of the cardinal ligament was pushed to its limit by dissection directly at the pelvic wall. The surgical technique is guided by the anatomy of the pelvic fascia. The gaine hypogastrique lies just beneath the peritoneum and facilitates the opening of the paravesical space. The following are discussed: the condensations of the pelvic fascia; the composition of the cardinal ligament; the division into a venous, an arterial, and a neurovegetative root; and the anatomy of the connective tissue planes. The order in which the surgical steps are carried out is important. The paraspaces are opened first. The ureter is identified, and lymphadenectomy is performed. The rectum is dissected off the vagina, and the uterosacral ligaments are identified and removed. Only then is the vesico-uterine fold opened. The bladder is dissected off the vagina, and the anterior parametrium is clamped and divided. Now the cardinal ligament is completely exposed. The bladder, rectum and ureter have been mobilized so that the parametrium can be divided sharply directly at the pelvic wall, clipping the vessels step-by-step. The paracolpium is clamped and divided according to the proposed vaginal cuff. Thus, the entire lymphatic drainage can be removed. The value of this extension of radical abdominal hysterectomy lies especially in the treatment of large, voluminous tumours.

Broad Ligament↗
PubMed1988

Urological complications after radical abdominal hysterectomy for cervical cancer.

Radical abdominal hysterectomy for cervical cancer is naturally associated with a number of urological complications. In a review of 320 hospital records we found a 6.6% incidence of intraoperative injury to the bladder or ureters; in all cases the tumour had encroached on the organ. The incidence of postoperative fistula formation was 4.4%. Postoperative urodynamic studies of 116 patients after radical hysterectomy, with or without adjuvant radiotherapy, quantified lower urinary tract dysfunction. A prospective study of 40 patients showed that 20% developed urinary stress-incontinence after surgery. Patients who had had surgery only showed an improvement in most urodynamic parameters over the years, while patients who had also had radiotherapy did not. Seventy-eight per cent of the patients after surgery only were satisfied with their condition and, years later, reported no complaints. They may just have become used to them, but half the patients who had also had radiotherapy reported complaints, mainly impaired bladder sensation, frequency and nocturia. Urinary tract dysfunction after radical hysterectomy is inevitable, but meticulous peri-operative management, regular follow-up examinations and psychological support can keep it to a minimum and help the patient to cope.

Adult↗
PubMed1988

[Sexuality following radical operations].

In a retrospective study to evaluate the sexuality of patients after radical surgery for cervical cancer, we interviewed with a standardized questionnaire 87 women who had undergone radical abdominal (N = 76) or radical vaginal (N = 11) hysterectomy between 1971 and 1985. Apart from employment and partnership, we assessed sexual behaviour as reflected by frequency of coitus, libido, and orgasm. The patients were questioned about each aspect preoperatively before knowing the diagnosis, post-operatively after the immediate effects of surgery had passed, and at the time of the interview. 6.6% of the women could be considered invalids. There was a clear decrease in frequency of coitus and an anxiety-related decrease of libido. However, the number of patients without sexual activity was not statistically different from that in an age-matched group of women who did not undergo surgery. 4.5% of partnerships broke up as an immediate consequence of the surgery. Only 20% of the patients felt they had been adequately informed of possible sexual consequences of treatment by the surgeon.

Adult↗
PubMed1988

[Disorders of bladder emptying following abdominal radical operation of cervix cancer].

Radical abdominal hysterectomy causes functional disorders of the lower urinary tract. We prospectively evaluated urinary dysfunction in 72 women before 2 weeks, 6 months and 1 year after surgery. The results were compared to those of 10 women who underwent simple abdominal hysterectomy. After radical abdominal hysterectomy 63% of our patients had impaired or absent bladder sensibility at 6 months. Bladder compliance was abnormal in 79% patients at 14 days and in 60% after 6 months and 1 year. Preoperative urethral stress profiles were performed in 58 patients. 69% of the stress profiles showed continence, 31% stress incontinence. 11 initially continent women (22%) developed stress incontinence. We attribute post-operative stress incontinence to surgical trauma, edema, haematoma, scartissue that restricts mobility of the bladder neck.

Adult↗
PubMed1987

[Labor induction at term: amniotomy versus intravaginal administration of prostaglandin E2 tablets].

This study compares the conventional method for induction of labour, amniotomy (A) with or without oxytocin infusion, with induction by means of intravaginal prostaglandin (PG)-E2 tablets. We reviewed the records of 266 women (A group: 155 women, PG group: 111 women), who had no risk factors at the time of induction. Both methods were effective. However, induction by PGE2 tablets presented less risk and was more comfortable than early amniotomy. We conclude that A should no longer be the method of choice for the induction of labour at term; the application of intravaginal PGE2 tablets is an efficacious, easy, and low-risk alternative.

Administration, Intravaginal↗
PubMed1987

[Labor induction by intravaginal administration of prostaglandin E2 tablets].

Between 1982 and 1984, at Graz University Obstetric and Gynaecological Clinic, labour was induced in 307 women (146 primiparae and 161 multiparae) by intravaginal administration of 3 mg prostaglandin (PG) E2 tablets, because birth was overdue or because labour was irregular. No risk factors were present when PG was administered: signs of deficiency or postmaturity, or twisted cord, were ruled out. The following complications were evaluated: birth rate and induction-birth interval in relation to cervical maturity and parity. The number of complications was low. It was unrelated to cervical maturity and only partially to parity. Birth was induced successfully with a single dose of 3 mg PG E2 in over 80% of the primiparae and over 90% of the multiparae. The majority of the primiparae and all the remaining multiparae were successfully delivered with a second dose; no relationship between birth rate and cervical maturity was established. Among the primiparae with a low degree of cervical maturity the child was born within 12 hours in over 50% of the cases, among primiparae with more mature cervices in almost 90%. Among the multiparae, the child was born within 12 hours in 90% of the cases regardless of the state of cervical maturity. It is concluded from these results that with appropriate monitoring of birth, intravaginal administration of PG E2 tablets is an efficient and easily managed method of inducing birth at term, involving little risk.

Administration, Intravaginal↗
PubMed1987

[Functional disorders of the lower urinary tract following radical abdominal and vaginal surgery of cervix cancer].

To establish the prevalence and extent of lower urinary tract dysfunction after radical surgery for cervical cancer, we evaluated 121 patients who underwent surgery between 1978 and 1984. 91 women underwent radical abdominal hysterectomy for disease in stage Ib or IIb; 30 patients underwent radical vaginal hysterectomy for stage Ib disease. Evaluation, at 12-72 months postoperatively, included pelvic examination, urinary history (explored via a specially designed questionnaire), measurement of residual urine, urine culture, and urodynamic studies. All patients underwent urethrocystoscopy and intravenous urography. Results showed 36 patients completely free of complaints, namely, 17 (18.7%) after radical abdominal hysterectomy and 19 (64%) after the vaginal produce. 85 patients (70%) had complaints, most commonly difficult spontaneous micturition (81.4% after abdominal, 17% after vaginal surgery). Other pathologic conditions were identified as follows: stress incontinence in 52.8% of patients after abdominal and 24% after vaginal surgery; impaired bladder sensation in 48.4% after the abdominal procedure but in only 13% after the vaginal; residual urine volume exceeding 10% of maximum bladder capacity in 13.2% after abdominal surgery (range: 40-220 ml) and 24.2% after vaginal surgery (range: 30-200 ml); significant bacteriuria in 21 patients (23%) after abdominal hysterectomy and 3 patients (9%) after vaginal. Urodynamic studies showed that, after abdominal surgery, bladder compliance was normal in 41.8% of patients, high in 39.6%, and low in 18.7%. After vaginal surgery, bladder compliance was normal in 66% of patients and abnormal in 34%.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1985

[Functional disorders of the lower urinary tract following a radical abdominal operation in cervical cancer].

196 women underwent radical abdominal hysterectomy with pelvic lymphadenectomy for cervical cancer of the clinical stages Ib to IIb, at the University Department of Obstetrics and Gynaecology in Graz during 1977 to 1982. 51 patients without recurring cancer and without subsequent radiotherapy were followed up for functional disturbances of the efferent urinary tract. The time interval between surgery and follow-up being 6 to 60 months. Follow-up examination consisted of palpation and, in addition, specific anamnesis based on a specially designed questionnaire, determination of residual urine, control of urine culture, and urodynamic measurement. Furthermore, urethro-cystoscopy and excretion urography were performed in all patients. 21.6% of the patients were completely free from complaints. In contrast, 78.4% of the women reported more or less pronounced signs and symptoms: first of all, delayed spontaneous micturition (78.4% of the cases), and, secondly, stress incontinence (58.8%) and a reduced desire to urinate (47.1%). Enhanced amounts of residual urine were measured in 35.3% of the women, whereas significant bacteriuria occurred in 31.4% of the women. Urodynamic measurement resulted in normal intravesical pressure values in 23 women (45.1%). On the other hand, hypotonic intravesical pressure was seen in 20 patients (39.2%) and hypertonic pressure in 8 women (15.7%). In all patients micturition was disturbed both in respect of urine flow and micturition time. 41 (80.4%) urethro-cystoscopic findings and 41 intravenous pyelography were in the normal range. The complaints reported by the patients were mostly not of special significance for them, since 34 women (66.6%) were greatly satisfied with their condition. The results are described in detail and are discussed.

Adult↗