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Biomedical subjects

H Lipsky

Publications and source records attributed to H Lipsky.

At least 19 recordsLinked to original sources
PubMed1992

[Urethral stricture after TURP and transvesical prostatectomy].

In an attempt to elucidate factors predisposing to the occurrence of urethral stricture after transurethral resection of the prostate, we performed a prospective follow-up of 178 patients over 12-20 months. We took account of 11 factors that we considered important. Urethral strictures developed in 14.04% of the patients. The resection operations were carried out by five different surgeons, who had different rates of stricture. The only one of the 11 factors studied that was found to involve a statistically significant risk was the presence of an indwelling catheter for more than 3 days. No other factor influenced the result. This patient group was compared with a group of 73 patients followed up for 12-60 months following transvesical prostatectomy. In this group only one stricture (1.36% incidence rate) was observed retrospectively. It seems that urethral ischaemia might increase the risk of urethral stricture. Urethral injuries are considerably less frequent with open prostatectomy. Therefore, we recommend transvesical prostatectomy for pronounced prostatic hyperplasias.

Catheters, Indwelling↗
PubMed1992

[Incidental prostatic cancer--"wait and see" or radical prostatectomy?].

In a comparative and retrospective study, outcome was examined in two groups of patients with incidental carcinoma of the prostate (stage T1a). In the 47 patients in the first group the carcinoma was kept under observation for 2-10 years without the administration of any treatment. During the mean follow-up of 5 years, the disease progressed in 11 (23.4%) of these patients, and 4 of them died. The other group was made up of 20 patients who underwent radical prostatectomy. The clinical and pathological staging were quite different in this group than in the other: more advanced stages and higher grades were seen in 10 patients, and the specimens taken from 6 were found not to contain any tumour. After a mean follow-up period of 4.5 years, all these 20 patients are alive with no evidence of disease. The management of patients with T1a tumour is still a problem. Observation only will be followed by progression in 23% of cases, while radical prostatectomy actually constitutes overtreatment in 30%. In conclusion, we prefer to perform prostatectomy in all patients with T1a carcinoma who are young and have a good life expectancy.

Aged↗
PubMed1990

Dietary fiber for reducing blood cholesterol.

Soluble dietary fiber, including psyllium, has been shown to have mild to modest cholesterol lowering properties. Psyllium hydrophilic mucilloid (Metamucil, Procter and Gamble, Cincinnati, OH), a bulk laxative, when used as a dietary supplement in combination with a low fat diet, can lower total serum cholesterol and low-density lipoprotein (LDL) cholesterol, and raise high-density lipoprotein (HDL) cholesterol in hypercholesterolemic patients. The cholesterol lowering effects of psyllium are much less evident than those observed with cholestyramine and the HMG-CoA reductase inhibitors. The mechanism for the cholesterol lowering effect of psyllium is not known. The substance is well tolerated with long-term use.

Cholesterol↗
PubMed1990

Endoscopic treatment of vesicoureteric reflux with bovine collagen.

A submucosal injection with bovine collagen (Zyplast) was performed in 45 female patients with 70 refluxing ureters. 4 ureters showed reflux grade IV, while the others had reflux grade I-III. All patients suffered from recurrent urinary tract infections. In 18 ureters, a second injection was given. As a result of this treatment, reflux was cured in 85.8% of the ureters. Only 13 patients had urinary tract infections during the follow-up period (6-24 months). 5 patients had antireflux surgery and collagen was excised. The histology of the specimen did not show an inflammatory reaction. Collagen injections could gain great importance in the management of vesicoureteral reflux.

Adult↗
PubMed1989

Management of patients with localized prostatic carcinoma.

Three groups of patients with localized prostatic carcinoma are presented. One group of 42 patients was treated with radiation therapy. The second group of 43 patients was subjected to radical prostatectomy. The third group consisted of 42 elderly men with focal, incidental carcinoma who received no therapy. The preliminary results of management and observation are presented. Comparison of the two forms of management shows that radical prostatectomy gives better results than radiation in terms of cure, survival and disease progression. The probability of recurrence or metastases is very high in T3 lesions, despite radical surgery. In the group with incidental untreated carcinoma, a high incidence of progression was seen. It is concluded that these patients are at a certain risk despite old age and focal disease.

Age Factors↗
PubMed1988

[Changes in the treatment of urogenital tuberculosis].

Potent antituberculosis drugs and new endourological measures have changed the concept of management of urogenital tuberculosis. This paper presents a report on 56 patients treated with rifampicin, ethambutol and isoniazid for 1 year. Therapy was started in hospital and continued on an ambulatory basis. Reconstructive surgery was carried out as early as 4-5 weeks after commencement of therapy, whereby only destroyed organs wee removed. Follow up continued at three-monthly intervals for a period of 2-5 years after completion of chemotherapy. All patients were cured.

Adolescent↗
PubMed1987

[Diagnosis and therapy of female incontinence].

The different types of urinary incontinence in the female are defined and described. A meticulous differential diagnosis is a prerequisite for adequate treatment. The pre-treatment examination includes a detailed history, a residual urine, a gynaecological examination, a neurological examination, an intravenous pyelogram, the incontinence test, the Bonney and Bethoux tests, and a urethrocystoscopy. In difficult cases urodynamic tests and X-rays of the bladder and the pelvic organs are added to the workup. Two types of incontinence can be differentiated. We recommend to manage type 1 with an anterior vaginal repair or with colposuspension. Type 2 should be treated with colposuspension and if necessary vaginal repair or levatorplasty. Recurrences should be managed always with colposuspension. It is stressed that after correction of incontinence bladder outlet obstruction can occur.

Female↗
PubMed1987

[Initial experiences with the Camey bladder].

The construction of a new continent reservoir after cystectomy has been a major attempt of urological surgery during recent years. We have employed an ileal conduit which was anastomosed to the urethra according to Camey in 10 patients. Two patients died postoperatively because of complications. Eight left the hospital with a sufficiently working new bladder. Capacity, flow, bladder emptying and continence were satisfactory. The results are presented in detail. Most patients were incontinent to some degree during the night. This was handled by micturition, pads and condom urinals. All patients were content with the result. The longest follow up time is 2 years.

Follow-Up Studies↗
PubMed1986

The use of split-skin mesh graft in the management of urethral strictures.

In the last 3 years 268 patients with urethral strictures have attended this unit. We treat most strictures by urethrotomy and consider an open operation only after two recurrences or in patients whose strictures are considered unsuitable for urethrotomy. Open operations have been performed on 42 patients. Although several types of operation have been used, most comprised an end-to-end anastomosis or Blandy's scrotal flaps. In the last few years a split-skin mesh graft has been used to replace the posterior urethra and the advantage of this technique is that the new urethra is soft and hairless. We present our experience with this method and our overall results.

Forearm↗
PubMed1985

A combined antireflux procedure.

The described operation is a combination of the Politano-Leadbetter procedure with advancement of the orifice. This operation was successfully performed in 26 children (37 renal units). This method is compared to others.

Child↗
PubMed1984

Dilatation of the urinary tract during pregnancy and its management.

Dilatation of the upper urinary tract in pregnancy is caused by an obstruction at the pelvic brim, of varying degree. In some women this obstruction occurs acutely, resulting in renal colics. Our experience with this condition in 17 patients is reported. In 7 patients relief of the obstruction was necessary. The method of choice was drainage with pig-tail stents. The indications for such treatment are discussed.

Adult↗
PubMed1983

[Diagnosis and treatment of functional bladder neck obstruction].

The experience with 32 patients with functional bladder neck obstruction is presented and this condition is discussed. This disease occurred mainly in males from the age of 6 months to 50 years. There was only one female patient. The most important investigations were the micturating cystogram, the flow-rate and the measurement of the residual urine. The bladder neck incision, as proposed by Turner-Warwick, relieved symptoms and obstruction in all patients efficiently.

Adolescent↗
PubMed1982

[Indications for urodynamic studies before and after adenomectomy].

Preoperative urodynamic examinations are an important supplement to our diagnostic repertoire in cases of adenoma of the vesical cervix. Flow measurement should always be carried out. In routine practice further urodynamic examinations are only indicated in uncertain cases. Exact preoperative diagnosis will greatly improve the results of adenectomy. Persistent dysuria or incontinence are always an indication for post operative urodynamic examinations. Here efficient therapy is made possible by exact diagnosis.

Humans↗
PubMed1979

[Urodynamic assessment of enuretic children (author's transl)].

Urodynamic assessment was carried out in 33 children with persistent enuresis in spite of previous therapy. According to these investigations it was possible to divide our patients into several groups. One group of children displayed a normal urodynamic pattern. Another group showed neurogenic non-inhibited detrusor contractions on cystometry. Obstruction was noted in a third group of patients by means of urodynamic parameters. A small group of children was urodynamically normal, but suffered from recurrent urinary infections. The therapeutic results and the aetiology of enuresis is discussed.

Adolescent↗
PubMed1978

[The differential diagnosis of female urinary incontinence (author's transl)].

The different types of urinary incontinence in the female are defined and described. A meticulous differential diagnosis is a prerequisite for adequate treatment. The pre-treatment examination includes a detailed history, a residual urine, a gynaecological examination, a neurological examination, an intraveinous pyelogram, the incontinence test, the Bonney and the Bethoux tests, and a urethro-cystoscopy. In difficult cases urodynamic tests and X-rays of the bladder and the pelvic organs are added to the workup. Among 54 patients with urinary incontinence, 31 had stress incontinence and 23 had incontinence of another cause such as detrusor instability or a urethral syndrome.

Cystoscopy↗
PubMed1977

Prostatectomy with a no-catheter technique.

A method of no-catheter prostatectomy is described and the results of 350 operations are presented. It has been demonstrated that this method of prostatectomy can be done aseptically.

Humans↗
PubMed1977

Direct vision urethrotomy in the management of urethral strictures.

A series of 32 patients underwent direct vision urethrotomy. The technique is simple and the stay in hospital short. Intra- and postoperative complications are rare. Postoperatively, a silicon catheter is left for approximately 7 days, then hydraulic self-dilatation is performed by the patient for 6 months. 25 patients in this series (83%) voided satisfactorily after the procedure and needed no further treatment. Unsatisfactory results were obtained in patients with long strictures, in traumatic strictures with large scarred areas and in patients who failed to carry out regular hydraulic self-dilatation. We advise direct-vision urethrotomy as a treatment of choice for urethral strictures which do not exceed a length of 3 cm.

Adolescent↗