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Biomedical subjects

J A Savastano

Publications and source records attributed to J A Savastano.

9 recordsLinked to original sources
PubMed1987

Experience with pubovaginal slings for urinary incontinence at the University of Michigan.

In July 1983 pubovaginal slings were used first at our university to treat incontinence in female patients with poor urethral function. From then until July 1, 1986, 82 such procedures were performed on a diverse group of patients, including a male patient. Initial success occurred postoperatively in 67 patients, with 15 failures. Of these failures 7 were related to urethral dysfunction. Another sling procedure was done in 2 patients and they are continent, while 3 were treated with medication: 2 became dry and 1 remains wet. A total of 8 patients suffered detrusor-related incontinence postoperatively (2 required augmentation cystoplasty for poor bladder compliance). To date 78 patients (95 per cent) are continent. Of the patients 2 required periodic intermittent catheterization for more than a year postoperatively and 12 are managed by chronic intermittent self-catheterization on a planned basis for neurogenic vesical dysfunction.

Adolescent↗
PubMed1987

Urodynamic evaluation of ileal conduit function.

Bilateral hydroureteronephrosis following ileal conduit urinary diversion is not uncommon. It may be owing to ureteroileal stenosis, stomal stenosis or a poorly compliant ileal conduit. The standard evaluation of stoma size, conduit residual urine and a loopogram often fail to allow determination of the cause of ureteral dilatation. In addition to these standard tests, we have used conduit urodynamics to study conduit function with a triple lumen urodynamic catheter to measure simultaneously conduit pressure proximal and distal to the fascia during filling under fluoroscopy. In 4 control patients with normal upper tracts who were studied with this technique conduit leak point pressures ranged from 5 to 20 cm. water pressure. Six patients with bilateral hydroureteronephrosis were studied to evaluate conduit function. We found abnormalities in 5 patients, including functional stomal stenosis in 2, an atonic loop in 1, segmental obstruction in 1 and a high pressure noncompliant distal segment in 1.

Aged↗
PubMed1984

Urodynamic findings and clinical status following vesical denervation procedures for control of incontinence.

We compared the results of intrathecal chemical rhizotomy performed in 3 patients, complete sacral rhizotomy in 3 and dorsal root ganglionectomy in 3. Dorsal root ganglionectomy (S2 to S4) obviated reflex bladder contractility and autonomic dysreflexia, and did not induce detrusor hypertonia. Chemical rhizotomy failed to abolish reflex activity or autonomic dysreflexia and was unsatisfactory. Complete intradural sacral rhizotomy obviated reflex activity and autonomic dysreflexia but induced detrusor hypertonicity and incontinence.

Adult↗
PubMed1984

Urodynamic studies in enuresis and the nonneurogenic neurogenic bladder.

We studied urodynamically 55 patients with enuresis. The severity of urinary incontinence ranged from occasional nocturnal episodes to daytime and nighttime wetting associated with radiographic abnormalities of the bladder and upper urinary tract. Despite differences in symptoms, urodynamic findings of poor cerebral appreciation of the degree of bladder filling and sudden unanticipated detrusor contractility were common in 50 of the 55 patients. Volitional detrusor sphincter discoordination also was common and appeared to be related to uncontrolled bladder contractility rather than a primary problem.

Adolescent↗
PubMed1983

Bladder and ureteral pressure relationships in nonhuman primates.

Bladder pressures during filling are precisely paralleled by ureteral resistance to perfusion. The pressure relationships are identical in normal, spinal and decentralized nonhuman primates, none of which had vesicoureteral reflux. Intravesical and thus intraureteral pressures are higher in animals with neurological lesions, particularly decentralization.

Animals↗
PubMed1983

Long-term followup of spinal cord injury patients managed by intermittent catheterization.

Intermittent catheterization was used for permanent management in 41 patients with neurogenic vesical dysfunction. Patients with reflex and areflexic vesical dysfunction were managed satisfactorily by the technique. Positive urine cultures were relatively infrequent, febrile urinary tract infections were rare and upper urinary tract function was stable.

Adolescent↗