Biomedical subjects
Publications and source records attributed to J D Giesy.
Equipping ureteral instruments with the guide-eye feature has expanded the instrumentation options available to urologists. The guide-eye facilitates repetitive instrument access, allows coordinated instrument combinations, and enhances sequential placement of a series of instruments. We believe this concept increases the safety and efficacy of our present instruments and clearly encourages innovative designs for the future.
Voiding problems are prevalent in women. Cost-effective evaluation can be performed on the basis of a voiding calendar and simple office urodynamic studies. The numerous treatment options include pelvic support exercises, drug therapy, bladder irrigation, hydraulic distention, intermittent self-catheterization, and various surgical procedures.
New coaxial balloon dilators with standard urologic tip configurations have been designed for use in urethral strictures. Balloon dilatation provides several advantages over conventional dilatation of strictures including improved access and decreased mucosal trauma due to a low silhouette, adjustability of diameter and rigidity, decreased instrumentation, and facilitation of intermittent self-dilation by the patient. The instruments were evaluated in 51 strictures (41 patients) as both a dilator and a calibrator. All catheters were located across the stricture easily (although two required filiform attachments). All clinical goals were achieved, and no complications were identified. Two patients were started on a program of intermittent self-dilation after internal urethrotomy with good results. It is our initial clinical impression that slow, gradual dilation of strictures is superior to rapid, abrupt dilation. This can only be practically achieved with balloon dilators.
Applying the basic principles, therapy guides to our hypothetical cases can be constructed. The 60 year old man with postoperative abdominal perineal resection with hypertension and parkinsonism may well need a transurethral resection of the prostate; however, other options include decreasing his anticholinergic-type medications, such as antiparkinsonism medications, changing his hypertensive therapy from beta blockers such as propranolol and metoprolol to alpha blockers such as methyldopa and prazosin. Bethanacol would seldom be helpful alone, but with an alpha blocker could help if not contraindicated by the presence of vascular disease. The second example, a 45 year old woman with stress incontinence, may be assisted with improved storage by an anticholinergic agent, an alpha enhancer, a mucosal enhancer, and if pertinent, switching hypertensive therapy from an alpha blocker to a beta blocker. The last example, a T10 paraplegic with a spastic, hyperreflexic bladder, can have improved storage with anticholinergics, decreased sphincter tone with alpha blockers, as well as decreased sphincter tone with alpha blockers, as well as decreased spasms through suppression of hyperactive spinal cord activity with baclofen.
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During a 25-month period, beginning in May 1977, 19 patients had Rosen incontinence devices implanted. During the 9 to 34 months of followup 26 additional operations were required for urethral compression balloon leakage, urethral compression balloon aneurysm, tubing kinks, reservoir malfunction and urethral erosion. Currently, 7 devices are in place, 6 of which are functioning and 3 of which have aneurysms of the urethral compression balloon. The 6-month failure rate of the first device was 44 per cent. During the 247 months that the devices were in place the patients were dry for 89 months, and required pad protection for 118 months and condom or an external urethral clamp for 40 months.
A young man who presented initially with a ureteral stone was found to have toluene-induced renal tubular acidosis. Persistent toluene sniffing resulted in recurrent calculi and life-threatening hypokalemic paralysis. The pathophysiology, classification and treatment of renal tubular acidosis are discussed.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.