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Biomedical subjects

J G Blaivas

Publications and source records attributed to J G Blaivas.

At least 127 records · Page 7Linked to original sources
PubMed1983

Hemiacidrin irrigation in the management of struvite calculi: long-term results.

Renacidin (10 per cent hemiacidrin) irrigation has been used in the management of renal struvite calculi in 25 patients. Of these patients 22 were free of stone after irrigation: 16 after dissolution of residual stone fragments postoperatively, 4 after prophylactic postoperative irrigation and 2 after primary, nonsurgical percutaneous dissolution. Recurrent urinary tract infections owing to the original urease-producing bacteria occurred in 14 per cent of these patients and recurrent nephrolithiasis occurred in 9 per cent during an average followup period of 66 months.

Adult↗
PubMed1983

Characteristics of neural injury after abdominoperineal resection.

A total of 13 men underwent synchronous video/pressure/flow electromyography studies after abdominoperineal resection of the rectum. All patients had diminished pressure in the proximal urethra and an incompetent vesical neck suggestive of sympathetic denervation. Five patients (38 per cent) had cystometric evidence of parasympathetic denervation and 7 (54 per cent) had electromyographic evidence of pudendal denervation. These data suggest that denervation owing to surgical injury is an important cause of persistent symptoms after abdominoperineal resection of the rectum.

Adult↗
PubMed1983

Neurologic implications of the pathologically open bladder neck.

Normally the bladder neck remains closed except during voiding. We reviewed 550 consecutive patients who underwent synchronous video/flow/pressure/electromyography studies to identify whether neurologic factors are involved in the pathogenesis of an abnormally open bladder neck. A total of 33 patients who had not undergone prior bladder neck surgery had an open bladder neck at rest. The prevalence of neurologic lesions in patients with an open bladder neck was significantly greater than in those with a normal bladder neck. However, there was no correlation between any specific lesion and the incidence of an open bladder neck. Patients with myelodysplasia had an inordinately high incidence of open bladder neck. We conclude that abnormalities of bladder neck innervation may result in a pathologically open bladder neck.

Adolescent↗
PubMed1983

A diagnostic dilemma: when urodynamic findings differ from the clinical impression.

We evaluated prospectively 425 consecutive patients with respect to the correlation between the clinical and urodynamic assessment of the symptoms. A disparity between the clinical and urodynamic diagnosis was found in 45 per cent of the patients who were believed to have storage problems, 25 per cent with emptying problems, and 54 per cent with storage and emptying problems on clinical examination. The reasons for these disparities are outlined and a rationale for including urodynamic studies in the evaluation of patients with voiding dysfunction is presented.

Adolescent↗
PubMed1983

Obstructive uropathy--a potentially serious complication of reconstructive vascular surgery.

We treated successfully 3 patients with upper urinary tract obstruction after an aortoiliac reconstructive vascular operation: 2 with ureterolysis and 1 with transureteroureterostomy. A review of the literature reveals that the incidence of this complication of reconstructive vascular surgery is unknown. Obstruction occurred whether the ureter was anterior or posterior to the graft, and usually presented within 1 year postoperatively in 62 per cent of the patients and was silent in 13 per cent. The obstruction was caused by retroperitoneal fibrosis in 90 per cent of the patients, direct surgical injury in 5 per cent and pseudoaneurysm formation in 5 per cent. Prior pelvic irradiation, and extensive and/or repeat vascular surgical procedures may have been contributory. Ureterolysis, the most common form of treatment, resulted in improvement in 85 per cent of the upper tracts, while renal loss occurred in 10 per cent. The ureter should be placed anterior to the graft during aortoiliac graft procedures. A prospective study is needed to ascertain the true incidence of this complication after reconstructive vascular surgery.

Aged↗
PubMed1982

The neurophysiology of micturition: a clinical study of 550 patients.

Detailed urodynamic and neurologic evaluation of 550 patients was reviewed with the intention of shedding light on the understanding of the neurophysiologic pathways involved in micturition. On the basis of our data the following conclusions were made: 1) normal micturition is a brain stem reflex rather than a simple sacral reflex, 2) interruption of this sacral-to-brain stem reflex pathway results in uncoordinated voiding (detrusor-external sphincter dyssynergia), 3) anatomically separate neural centers control the activity of the detrusor muscle and the external urethral sphincter, and 4) although the pudendal and pelvic nuclei are located in the sacral spinal cord they are anatomically separable from one another.

Adolescent↗
PubMed1981

The bulbocavernosus reflex in urology: a prospective study of 299 patients.

Bulbocavernosus reflex was evaluated clinically in 299 patients during a routine urodynamic evaluation and compared to the electromyographic demonstration of the reflex. The findings were correlated with the neurologic status of the patients. There were 127 patients who were normal neurologically, and 98 per cent of the male and 81 per cent of the female patients in this group had a normal bulbocavernosus reflex clinically. All of the male and 92 per cent of the female patients had a bulbocavernosus reflex demonstrated by electromyography. There were 73 patients with neurologic lesions involving the sacral spinal cord. All patients with a complete lesion had absent bulbocavernosus reflexes clinically and on electromyography, while 44 per cent of the patients with incomplete sacral lesions had an intact bulbocavernosus reflex clinically and 78 per cent had reflex demonstrated by electromyography. There were 99 patients with neurologic lesions of the spinal cord above the sacral outflow, and 90 per cent of this group had demonstrable bulbocavernosus reflexes clinically and 93 per cent had the reflex demonstrated by electromyography. It is concluded that the absence of a bulbocavernosus reflex in a male patient is indicative of a neurologic lesion involving the sacral spinal cord and is highly suggestive of such a lesion in a female patient. The presence of a normal bulbocavernosus reflex in either sex does not rule out the possibility of a significant lesion. The electromyographic demonstration of the bulbocavernosus reflex is more sensitive than the clinical one.

Adolescent↗
PubMed1981

Detrusor-external sphincter dyssynergia.

Detrusor-external sphincter dyssynergia is characterized by involuntary contractions of the external urethral sphincter during detrusor contractions. A review of 550 consecutive patients who underwent urodynamic evaluation revealed that this condition was found only in patients who had involuntary detrusor contractions owing to well defined neurologic lesions of the suprasacral spinal cord. All patients with supracervical neurologic lesions had synergistic voiding patterns. We conclude that bladder-external sphincter dyssynergia is a neurologic condition owing to interruption of the spinal pathways connecting the pontine mesencephalic and the sacral micturition centers. In the absence of such a neurologic lesion one should be extremely cautious in making this diagnosis.

Adolescent↗
PubMed1981

Detrusor-external sphincter dyssynergia: a detailed electromyographic study.

We reviewed 54 cases of detrusor-external sphincter dyssynergia following complete urodynamic evaluations. All patients had well defined neurologic lesions of the suprasacral spinal cord. On the basis of urodynamic findings 3 types of dyssynergia were encountered: type 1 (30 per cent) was characterized by a crescendo increase in electromyographic activity that reached a maximum at the peak of the detrusor contraction, type 2 (15 per cent) consisted of clonic sphincter contractions interspersed throughout the detrusor contraction and type 3 (55 per cent) was characterized by a sustained sphincter contraction that coincided with the detrusor contraction. There was no correlation between the clinical neurologic level and the type of dyssynergia.

Action Potentials↗
PubMed1980

Comprehensive laboratory evaluation of impotent men.

A thorough diagnostic evaluation was done on 27 impotent men. In addition to a detailed history and physical examination each patient underwent a psychiatric interview, Doppler penile blood pressure determination and measurement of the bulbocavernosus reflex latency time. Abnormalities in penile blood pressure were detected in 67 per cent of the patients, neurologic abnormalities were found in 41 per cent and psychiatric disorders were noted in 35 per cent. Of the 27 patients 48 per cent had a combination of neurologic, psychiatric and vascular abnormalities. A definite cause-and-effect relationship between these abnormalities and impotence has not been established.

Doppler Effect↗
PubMed1980

Cystometric response to propantheline in detrusor hyperreflexia: therapeutic implications.

We studied 42 patients with urinary incontinence who demonstrated uninhibited detrusor contractions during cystometry. Each patient underwent urodynamic evaluation before and after the parenteral administration of propantheline bromide. Of these 42 patients 33 (79 per cent) had a positive response to propantheline: total abolition of uninhibited bladder contractions or 200 per cent increase in bladder capacity. Of these 33 patients 26 were treated with the oral drug and all but 1 had complete clinical response. Urinary retention occurred in half of the patients. These patients were managed with intermittent self-catheterization in addition to oral propantheline. None of the patients who failed to respond to the parenteral medication had a favorable response to the orally administered drug.

Administration, Oral↗
PubMed1980

Failure of bethanechol denervation supersensitivity as a diagnostic aid.

A total of 33 patients who demonstrated detrusor areflexia during cystometry underwent the bethanechol denervation supersensitivity test. In each instance the presence or absence of a neurologic lesion was documented carefully by complete neurologic evaluation. Of the 21 patients with a neurogenic bladder there was a falsely negative rate of 24 per cent. Of the 12 patients without a neurogenic bladder the falsely positive rate was 50 per cent. It is concluded that a positive bethanechol test is not by itself indicative of neurogenic bladder nor does a negative test exclude this diagnosis.

Adult↗
PubMed1980

Management of bladder dysfunction in multiple sclerosis.

Sixty-seven consecutive patients participated in a prospective urodynamic study of the diagnosis and treatment of urinary bladder symptoms in multiple sclerosis. The etiology of symptoms was classified as either failure to store urine (30%), failure to empty the bladder (18%), or a combination of the two (50%). Treatment was individualized on the basis of the underlying pathophysiology and consisted of intermittent self-catheterization (21%), none (20%), surgical (12%), drugs (9%), voiding maneuvers (6%), and external condom drainage (6%). In 18 patients (27%), lesser forms of treatment were unsuccessful, and indwelling vesical catheters were required. Symptoms correlated poorly with urodynamic findings, and treatment based on symptoms alone would have been ineffective in over half the patients.

Adult↗
PubMed1979

Vesicourethral dysfunction in multiple sclerosis.

Urodynamic evaluation was done 45 times on 41 consecutive patients with multiple sclerosis. Bladder symptoms correlated poorly with any single urodynamic finding and, accordingly, a comprehensive evaluation was necessary to define the underlying pathophysiology. Only 63 per cent of the patients with symptoms of urgency, frequency and urge incontinence actually were found to have uninhibited bladder contractions, while 73 per cent of the patients with obstructive symptoms had detrusor areflexia. Six patients (15 per cent) had a marked change in urodynamic findings upon repeat examination either because of a change in symptomatology or poor response to treatment. An additional 6 patients had vesicoureteral reflux. Bladder symptoms in multiple sclerosis patients should serve more to alert the clinician to the need for urodynamic testing than to mandate specific treatment.

Adult↗