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Biomedical subjects

Howard B Goldman

Publications and source records attributed to Howard B Goldman.

11 recordsLinked to original sources
PubMed2006

The bladder epithelium and overactive bladder: what we know.

Although the urothelium has been traditionally thought of as a passive barrier between urine and detrusor muscle, new studies have shown that the urothelium is a highly specialized structure involved in antigen presentation, micturition reflex, metabolic secretion, inflammatory regulation, and sensory afferent functioning. Data from several laboratories have shown that the urothelium can respond to thermal, mechanical, and chemical stimuli. The earlier findings (activation of urothelial transient receptor potential channel vanilloid 1 producing the second messenger nitric oxide, which in turn triggers suburothelial sensory nerves) demonstrate how the urothelium acts as a transducer, releasing chemicals that target adjacent bladder cells and sensory neurons. We now know that bladder urothelium acts also as a transducer whereby afferent neurons, via urothelial mechanoafferent transduction, are involved in the micturition process and the pathogenesis of bladder disorders. This paper highlights the important role that the urothelium has in bladder pathophysiology.

Humans↗
PubMed2005

Large thigh abscess after placement of synthetic transobturator sling.

PURPOSE: To report a unique complication associated with transobturator slings. MATERIALS AND METHODS: The evaluation and treatment of a unique infectious complication of transobturator slings is reviewed. RESULTS: A large thigh abscess associated with a transobturator sling was diagnosed and treated. CONCLUSION: New techniques of sling placement may be associated with unique infectious complications. Slings passing through the obturator foramen and thigh can lead to a significant abscess within the adductor muscles of the thigh.

Abscess↗
PubMed2004

Treatment options for female urinary incontinence.

Contrary to the belief of some patients and physicians, urinary incontinence in women should not be accepted as a natural and inevitable part of aging. Indeed, it is a costly problem, psychologically, physically, and economically, and can have a considerable impact on a woman's quality of life. Accurate diagnosis of the type of incontinence is important to implement appropriate and successful treatment. In general, a focused medical and symptom-oriented history and physical examination is all that is needed to establish the correct diagnosis. UI, SUI, and mixed incontinence are the most common types seen in women. Most patients with urge incontinence respond to behavioral treatments, PFEs, medication, or some combination thereof. Recalcitrant cases should be referred to a specialist. Patients with SUI may respond to PFEs, but many require surgical intervention for a satisfactory outcome. The successful treatment of urinary incontinence in a woman can lead to a substantial improvement in her overall quality of life, and for the physician, can be as professionally rewarding as the successful management of various other chronic disease states.

Female↗
PubMed2003

Simple sling incision for the treatment of iatrogenic urethral obstruction.

OBJECTIVES: To review a single-institution experience with sling incision to treat urethral obstruction resulting from pubovaginal sling placement. Urethrolysis involving full mobilization of the urethra has traditionally been used to treat urethral obstruction resulting from a pubovaginal sling. Recently, sling incision has been reported to be a technically simpler, less potentially morbid technique to relieve such obstruction. METHODS: The charts of 14 women with iatrogenic urethral obstruction from pubovaginal slings who were treated with simple sling incision were reviewed. Presenting symptoms and physical findings and outcomes (primarily resolution of obstructive and irritative symptoms, change in postvoid residual volume, and change in continence status) were evaluated. RESULTS: Eleven patients had a biologic sling and three a mid-urethral polypropylene mesh sling. All patients had either obstructive or irritative findings or retention and 10 of 14 had an elevated postvoid residual volume. The average follow-up was 12 months. Overall, 13 (93%) of 14 had complete or significant improvement of presenting complaints, and 1 (7%) eventually required formal urethrolysis. Of the 13 with resolution of presenting complaints, 3 had residual irritative symptoms. Although 3 (21%) of 14 had some element of recurrent stress urinary incontinence, only 1 (7%) required treatment. CONCLUSIONS: Simple sling incision is an effective, technically simple, and safe treatment for women with iatrogenic urethral obstruction after placement of a pubovaginal sling. Its results are comparable to those of formal urethrolysis, and it may be considered as first-line treatment for iatrogenic obstruction after a sling procedure.

Equipment Failure↗
PubMed2002

Does the size of the surgical margin in partial nephrectomy for renal cell cancer really matter?

PURPOSE: Although many groups recommend a surgical margin of 1 to 2 cm., to our knowledge the amount of normal renal parenchyma that must be excised during partial nephrectomy for stages T1-2N0M0 renal cell carcinoma to ensure a safe margin has never been critically evaluated. We investigated whether the size of the surgical margin has any effect on recurrence. MATERIALS AND METHODS: All partial nephrectomies performed for localized renal cell carcinoma at our institution from 1988 to 1999 were retrospectively analyzed via a review of hospital records, pathology reports and histological slides. Parenchymal margin status was assessed and quantified by microscopy. Followup data were obtained via patient chart review and telephone interview. Average negative margin size and postoperative followup were determined, and renal cell carcinoma recurrence was assessed. RESULTS: A total of 44 partial nephrectomies were performed with a mean followup of 49 months (range 8 to 153). Mean tumor size was 3.22 cm. (range 1.3 to 10). Surgical margins were negative for malignancy in 41 cases and positive in 3. All patients with negative margins were without local recurrence at followup except 1 with a recurrent mass adjacent to the kidney at a site distant from the original lesion. Mean and median size of the negative margins was 0.25 and 0.2 cm., respectively (range 0.05 to 0.7). In the 3 cases with positive margins there was no evidence of disease at 39 and 62 months of followup in 2, while multiple local and metastatic recurrences developed in 1. CONCLUSIONS: No patient with negative parenchymal margins after nephron sparing surgery for stages T1-2N0M0 renal cell carcinoma had local recurrence at the resection site at a mean followup of 49 months. Margin size was irrelevant. Only a minimal margin of normal renal parenchyma of less than 5 mm. must be removed during partial nephrectomy for localized renal cell carcinoma.

Adult↗
PubMed2002

Removal of transurethral catheter during urodynamics may unmask stress urinary incontinence.

PURPOSE: The measurement of Valsalva leak point pressure may have an important role in the treatment algorithm of women with stress urinary incontinence. However, some patients with stress urinary incontinence may not have leakage during standard urodynamic studies and, thus, the Valsalva leak point pressure cannot be determined. We hypothesized that the transurethral catheter may inhibit leakage during urodynamics. MATERIALS AND METHODS: We evaluated 21 consecutive women presenting with complaints of stress urinary incontinence who failed to have leakage on urodynamic studies. Bedside cystometry was performed, followed by urodynamics using a 6Fr transurethral catheter. When stress urinary incontinence was not noted, the catheter was removed and the Valsalva leak point pressure was measured using the intraabdominal pressure catheter. RESULTS: No woman had leakage on urodynamic studies with the catheter in place, although 11 of 21 had leakage after the catheter was removed and 15 had leakage on bedside cystometry. All 11 patients with leakage at catheter removal showed leakage on bedside stress testing. Mean Valsalva leak point pressure in those with leakage was 67 cm. water. CONCLUSIONS: Patients with a history of stress urinary incontinence and those with a positive bedside stress test who do not have leakage during a Valsalva maneuver on urodynamic studies should repeat the Valsalva maneuver with the catheter out. This technique may unmask stress urinary incontinence and allow the measurement of Valsalva leak point pressure.

Female↗