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Biomedical subjects

J G Blaivas

Publications and source records attributed to J G Blaivas.

135 records · Page 8Linked to original sources

Idiopathic pelviureteric varices.

Pelviureteric varices are well-documented sequelae of renal vein thrombosis, but there have been only 10 prior reports of idiopathic renal vein varicosities. Herein we report 3 more cases and review the literature. Two thirds of the patients presented with hematuria; one-fourth had flank pain, and one-third had saphenous vein varicosities. Pyelographic findings include scalloped deformities of the upper ureter and pelvis with displacement and intraluminal filling defects. The diagnosis may be suspected from the excretory urogram, but venography is definitive. Excision and ligation of the varicose veins were curative in all but 3 patients who required nephrectomy for life-threatening hemorrhage.

Adult↗

Primary renal artery dissecting aneurysm: a review.

Primary dissecting aneurysms of the renal artery are exceedingly rare. Our recent encounter with a patient with this condition prompted a review of the literature. The diagnostic and therapeutic problems in 30 patients were analyzed and guide lines for proper management were discussed. The triad of flank pain, hematuria and hypertension of acute onset in the absence of urinary obstruction should suggest this rare condition.

Adult↗

A new approach to electromyography of the external urethral sphincter.

Detailed electromyographic investigation of the external urethral sphincter was done as part of a urodynamic evaluation of 119 patients. The sphincter was located by inserting electrodes alongside the urethra. The electromyogram was viewed on an oscilloscope and recorded on paper. Normal and abnormal sphincter electromyograms were defined and the role of sphincter electromyography in urodynamic studies was discussed. It was observed that electromyographic activity does not always correlate with urethral resistance but must be interpreted in conjunction with other urodynamic parameters, such as urethral pressures, urinary flow rates and voiding cystourethrography. In addition, sphincter electromyography provides valuable information to define the various neural pathways involved in micturition and continence.

Electromyography↗

Changing concepts in the urodynamic evaluation of children.

Urodynamic evaluation was performed in 46 children with myelodysplasia, spinal cord injury, enuresis, postoperative incontinece, sacral agenesis and recurrent urinary tract infection. The basic study consisted of voiding cystourethrography followed by the simultaneous recording of intra-abdominal and intravesical pressure with external urethral sphincter electromyography. Urethral pressure profile, urinary flow rate and anal sphincter electromyography were performed selectively. There was no correlation between the clinical neurological level and the cystometric pattern in patients with spinal cord lesions. Bladder-external sphincter dyssynergia was associated with a high post-void residual urine in children with hypertonic bladders, while in children with hypotonic bladders dyssynergia did not affect the post-void residual. Since, urinary symptoms bore little relationship to urodynamic findings in our study we recommend complete evaluation of children who have persistent disturbances of micturition.

Adolescent↗

Paraurethral cysts in female neonate.

Paraurethral cysts in the female neonate are uncommon lesions. All reported cases have either ruptured spontaneously or responded to simple marsupialization. However, complete urologic evaluation is mandatory because they simulate ectopic ureteroceles in appearance. Herein is reported our experience with 5 patients. The etiology, embryogenesis, natural history, differential diagnosis, and treatment are discussed.

Cysts↗

Chemolysis of residual stone fragments after extensive surgery for staghorn calculi.

Chemical dissolution of residual stone fragments was attempted in twelve instances via nephrostomy tube irrigation. Appropriate solutions containing either hemiacidrin or sodium bicarbonate were used for struvite and uric acid stones, respectively. Precautions were taken to prevent and recognize outflow obstruction and urinary infection. Seventy-five per cent of the stones so treated were completely dissolved, and there were no major complications. The incidence of retained stones, natural history, and indications for chemical dissolution are reviewed.

Adult↗

Diabetic cystopathy.

Diabetic cystopathy refers to the spectrum of voiding dysfunction in patients with diabetes mellitus. Diabetic cystopathy is marked by insidious onset and progression with minimal symptomology. The most common urodynamic findings are impairment of bladder sensation, increased post-void residual volume, decreased detrusor contractility that may progress to detrusor areflexia and diminished urinary flow. Treatment of diabetic cystopathy may be complicated by frequently occurring coexisting urologic conditions. The most common of these is bladder outlet obstruction. Therefore, treatment of diabetic cystopathy should be tailored to the symptom complex and clinical condition of the patient. Asymptomatic patients with manifestations of diabetic cystopathy may be treated with timed voiding. In contrast, the sine qua non for therapy in symptomatic patients is clean intermittent catheterization. While other modalities such as pharmacologic and surgical intervention have been described, none have been consistently effective.

Diabetes Complications↗