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Biomedical subjects

J G Blaivas

Publications and source records attributed to J G Blaivas.

At least 109 records · Page 6Linked to original sources
PubMed1988

Stress incontinence: classification and surgical approach.

We present a modified classification for stress urinary incontinence based on the nature of vesical neck descent and the integrity of the intrinsic sphinteric mechanism. Surgical treatment was undertaken in 72 patients with this classification. With a minimum followup of 18 months there was a 94 per cent cure rate with respect to stress incontinence. However, in 14 patients significant frequency and urgency developed, which persisted for at least 6 months postoperatively. Of these patients 13 had undergone a pubovaginal sling procedure, 3 of whom had refractory symptoms, including urge incontinence, which resulted in augmentation cystoplasty in 2 and supravesical urinary diversion in 1.

Female↗
PubMed1988

Pathophysiology and differential diagnosis of benign prostatic hypertrophy.

Although the symptoms of benign prostatic hyperplasia are usually attributed to simple mechanical obstruction of the prostatic urethra by an enlarged prostate gland, the pathophysiology of this common urologic disorder actually involves multiple factors. These include abnormalities of detrusor function, neuromuscular abnormalities of the prostatic urethra, and sensory abnormalities of the bladder wall. Detrusor abnormalities include impaired detrusor contractility and involuntary detrusor contractions (detrusor instability or detrusor hyperreflexia). Neuromuscular abnormalities of the prostatic urethra are characterized by alpha-adrenergic overactivity which causes outlet obstruction or by alpha-adrenergic hypoactivity which may result in urinary incontinence. Sensory abnormalities of the bladder wall include hypersensitivity (sensory urgency) or hyposensitivity which can lead to overdistention and urinary retention. The diagnostic evaluation of patients with clinical prostatism must take these factors into account. Of particular importance is the recognition that a decreased urinary flow rate and/or increased postvoid residual urine volume may be caused by either bladder outlet obstruction or impaired detrusor contractility. Routine urodynamic studies do not permit a distinction between these two entities, but video/detrusor pressure/uroflow studies are usually definitive.

Humans↗
PubMed1987

Urodynamic findings in Parkinson's disease.

Neurological evaluation was performed in 24 men and 5 women with Parkinson's disease who had persistent bladder symptoms. Detrusor hyperreflexia was found in 26 (90 per cent) of the patients. Sporadic involuntary electromyography activity of the external sphincter during involuntary detrusor contractions was encountered in 61 per cent but in none did this cause obstruction. Coordinated striated sphincter relaxation during voluntary detrusor contraction was found in 13 patients (45 per cent). Among 22 men who were in the prostatic disease age group only 4 (18 per cent) had definite prostatic obstruction. Moreover, none of 8 men with persistent symptoms after prostatectomy had evidence of bladder outlet obstruction.

Abdomen↗
PubMed1987

Bladder neck obstruction in women.

Bladder neck obstruction in women is rare. The symptoms are confounding and nonspecific. The diagnosis depends on demonstrating poor uroflow, a detrusor contraction of adequate magnitude and duration, and radiographic evidence of obstruction at the vesical neck. We treated successfully 3 women with vesical neck obstruction by transurethral vesical neck incision.

Adult↗
PubMed1986

Urological evaluation in the Shy Drager syndrome.

Nine patients with the Shy-Drager syndrome underwent complete urological and neurological investigation of bladder symptoms. Urodynamic studies revealed detrusor areflexia in 6 patients (67 per cent), detrusor hyperreflexia in 3 (33 per cent), a lower motor neuron lesion involving the periurethral striated muscle in 9 (100 per cent) and an open vesical neck at rest in all 5 patients in whom cystography was performed. These findings support the current view that parasympathetic, pudendal and sympathetic involvement is part of the pathophysiology of the Shy-Drager syndrome.

Aged↗
PubMed1986

Unsuspected proximal urethral obstruction in young and middle-aged men.

Proximal urethral obstruction, a common cause of prostatism in young and middle-aged men, often is misdiagnosed as prostatitis, neurogenic bladder or a psychogenic voiding disorder. Simple urodynamic studies (uroflowmetry and cystometry) do not distinguish a poor flow owing to bladder neck obstruction from that caused by poor detrusor contractility in these patients. Only the simultaneous measurement of detrusor pressure and uroflowmetry can make this distinction. A total of 23 patients with unsuspected proximal urethral obstruction underwent synchronous video-pressure-flow electromyography studies, and were treated and followed for a minimum of 1 year. Treatment by transurethral prostatic resection or bladder neck incision almost always was curative but alpha-adrenoceptor blocking agents have not been effective. All patients who underwent transurethral prostatic resection or bladder neck incision at the 5 and 7 o'clock positions have had retrograde ejaculation but both patients who underwent unilateral bladder neck incision reported antegrade ejaculation.

Adult↗
PubMed1986

Surgical treatment for male geriatric incontinence.

Surgical treatment of urinary incontinence in elderly men is usually reserved for those patients for whom medical therapy has failed. In properly selected patients, however, an operative approach may offer the best chance for cure.

Aged↗
PubMed1985

Pathophysiology of lower urinary tract dysfunction.

Lower urinary tract dysfunction can be considered in terms of two broad categories: problems caused by abnormalities of the filling and storage phase and problems related to the voiding phase. The author prefaces this discussion with a review of normal anatomy and physiology.

Female↗
PubMed1984

Detrusor-external sphincter dyssynergia in men with multiple sclerosis: an ominous urologic condition.

A total of 27 men with multiple sclerosis underwent urodynamic evaluation as part of a prospective study of voiding dysfunction. Of 18 patients with detrusor-external sphincter dyssynergia 9 suffered serious urologic complications, including repeated episodes of urosepsis, vesicoureteral reflux and urolithiasis. None of the 9 patients without dyssynergia suffered any urologic complications. Urologic complications were correlated highly to the presence of detrusor-external sphincter dyssynergia and the severity of multiple sclerosis but not to duration of multiple sclerosis, age of the patient or type of dyssynergia. Although no treatment was without complications it appears that either anticholinergics plus intermittent self-catheterization or condom catheter drainage is superior to an indwelling catheter for initial conservative treatment. External sphincterotomy or urinary diversion may be necessary if conservative therapy fails.

Adult↗
PubMed1983

Critical evaluation of the Credé maneuver: a urodynamic study of 207 patients.

The efficacy of Credé's maneuver to promote voiding was evaluated prospectively in 207 patients with a variety of lower urinary tract disorders. The normal response to Credé's maneuver was a contraction of the external urethral sphincter (the Credé effect), an increase in urethral pressure and maintained closure of the vesical neck. Relaxation of the external urethral sphincter and synchronous opening of the bladder neck during Credé's maneuver were seen in only 4 patients (2 per cent). We conclude that Credé's maneuver is an inefficient method of bladder emptying in the majority of patients and even when voiding is accomplished with Credé's maneuver it usually is grossly inefficient and associated with significant urethral obstruction.

Adolescent↗