PubMed Health⌕ Search

Biomedical subjects

J M Cummings

Publications and source records attributed to J M Cummings.

At least 19 recordsLinked to original sources
PubMed2006

Endoscopic management of ureteral complications following renal transplantation.

Management of ureteral complications after kidney transplantation can be done with a surgical, percutaneous, or endoscopic approach. The aim of this study was to determine the success rate of the endoscopic retrograde approach for the management of these complications following renal transplantation. We reviewed the records of 25 patients who underwent endoscopic management of ureteral complications after renal transplant between 1995 and 2005. Variables examined included timing of event following transplant, type of ureteral complication, equipment implemented in the procedure, operating time, success in stent placement, and complications. Initial approach was via rigid cystoscopy followed by flexible cystoscopy if needed. Initial attempts to intubate the ureteral orifice were by a flexible-tipped guide wire, and occasionally an angiocatheter guide was used for ultimate wire placement. Stents were positioned with fluoroscopic and direct visual guidance. Of 25 patients evaluated, five had a ureteral anastomotic leak with a mean time of presentation of 16.8 days. The remaining 20 patients suffered from ureteral obstruction revealed by hydronephrosis on a renal ultrasound prompted by a rising creatinine. Mean time of onset was 48 months. Although each was initially approached with rigid cystoscopy, 12 were converted to flexible cystoscopy for easier access to the ureteral orifice. Twenty of the 25 patients had successful stent placement with three failures in the ureteral obstruction group and two failures in the leakage group. Average operative time was 42 minutes. No intraoperative complications were experienced. Resolution of hydronephrosis in those with preoperative obstruction was noted and all stented urinary leaks resolved.

Anastomosis, Surgical↗
PubMed2000

Urinary stress incontinence among obese women: review of pathophysiology therapy.

Obesity is a common condition among women in developed countries and has a major impact on stress urinary incontinence. Women suffering from obesity manifest increased intra-abdominal pressures, which adversely stress the pelvic floor and may contribute to the development of urinary incontinence. In addition, obesity may affect the neuromuscular function of the genitourinary tract, thereby also contributing to incontinence. Accordingly, thorough evaluation of obese women must be performed prior to the institution of treatment. Weight loss may relieve urinary incontinence, but definitive therapy via operative procedures is effective even in obese patients and should be recommended with confidence.

Female↗
PubMed2000

Scrotal dog bites.

PURPOSE: Dog bites to the scrotum are rare but they potentially result in morbidity if improperly managed. MATERIALS AND METHODS: Between 1991 and 1999 we treated 4 men and 3 boys with dog bites to the scrotum. All 7 patients presented to the emergency department shortly after the injury. Of the 4 adults 3 were ingesting alcohol and 2 were obviously intoxicated, and 1 had a T4 spinal cord injury and was bitten during sleep. Of the children 2 were apparently bitten without provocation, while a 5-year-old boy was bitten when the family dog was disturbed while eating. RESULTS: All wounds were explored, irrigated and débrided. There was no involvement of the testes or spermatic cord. Each wound was closed primarily and 5 healed without sequelae. The spinal cord injured man had partial dehiscence of the incision and in another man superficial hematoma required drainage. Each patient received antibiotics and tetanus prophylaxis but none required rabies inoculation. CONCLUSIONS: Although there are reports of devastating scrotal injuries from dog bites, most such wounds may be treated by careful inspection for intrascrotal injuries followed by débridement and closure. Antimicrobial prophylaxis should be administered, as for any bite wound.

Adult↗
PubMed2000

Prediction of spontaneous ureteral calculous passage by an artificial neural network.

PURPOSE: Although a consensus exists that small stones presenting in the distal ureter have a good probability of spontaneous passage, it is difficult to predict in individuals whether a particular ureteral stone would pass or require intervention. If an accurate judgment were made at presentation on the likelihood of stone passage, patients would receive immediate intervention for the stone or be notified of a more appropriate time at which to expect passage. We used an artificial neural network to evaluate data in patients with ureteral calculi to predict whether a stone would pass spontaneously or require intervention. MATERIALS AND METHODS: Data were collected from the records of 181 patients presenting with colic due to a ureteral calculus. Patient input factors included age, sex, race, marital status, insurance, stone side, level and size, hydronephrosis and obstruction grades, duration of symptoms before presentation, serum creatinine, history of stone passage or intervention and nausea, vomiting or fever. Outcomes evaluated were stone passage or intervention. Data were entered into a neural network created using commercially available computer software. RESULTS: A set of 125 patients from the database was used for training the network. The network correctly predicted outcome in 38 of the remaining 55 patients (76%) used for testing. In the 25 cases in which stones passed spontaneously sensitivity was 100%. Duration of symptoms before presentation was the most influential factor in network ability to predict accurately stone passage, followed by hydronephrosis grade. CONCLUSIONS: An artificial neural network may be used to predict accurately the probability of spontaneous ureteral stone passage. Using such a model at presentation may help to determine whether a patient should receive early intervention for a stone or expect a lengthy interval before stone passage.

Adolescent↗
PubMed1999

Role of chronic catheterization in the development of bladder cancer in patients with spinal cord injury.

OBJECTIVES: Patients with spinal cord injury (SCI) and chronic indwelling catheters are known to be at increased risk of bladder malignancy. "Decatheterization" by clean intermittent catheterization, external condom catheterization, or spontaneous voiding is thought to reduce the risk by decreasing the chronic mucosal irritation and rate of infection. We examined two Department of Veterans Affairs (DVA) data bases to test this theory. METHODS: A population-based retrospective analysis of invasive treatments for carcinoma of the bladder in all DVA hospitals was conducted using computerized inpatient files from fiscal years 1988 to 1992. RESULTS: One hundred thirty patients with bladder malignancy were identified from a pool of 33,565 patients with SCI (0.39%). All 130 patients underwent either radical cystectomy (n = 63, 48%) or transurethral resection of bladder tumor (n = 67, 52%). The 30-day perioperative mortality and overall 5-year survival rates were 2 (1.5%) and 49 (38%) of 130, respectively. Of the 130 patients analyzed, 42 (32%) had adequate data available regarding tumor pathologic findings and method of bladder management for analysis. The average age at diagnosis was 57.3 years. The histologic finding was transitional cell carcinoma in 23 (55%), squamous cell carcinoma in 14 (33%), and adenocarcinoma in 4 (10%) of 42. Bladder management was an indwelling urethral catheter in 18 (43%), suprapubic catheter in 8 (19%), clean intermittent catheterization in 8 (19%), and condom catheter in 6 (14%) of 42 patients. Squamous cell carcinoma was more common in patients with indwelling urethral catheters and suprapubic tubes (11 of 26, 42%) than in those using clean intermittent catheterization, condom catheterization, or spontaneous voiding (3 of 16, 19%). CONCLUSIONS: Bladder cancer was diagnosed in approximately 0.39% of this large SCI population during a 5-year period. Most cancers (55%) were transitional cell carcinomas. Squamous cell carcinoma was more common in patients with SCI and indwelling catheters than those without chronic catheterization. These data continue to suggest that avoidance of indwelling catheters, when feasible, is the preferred method of bladder management in patients with SCI.

Adenocarcinoma↗
PubMed1998

Surgical correction of stress incontinence in morbidly obese women.

PURPOSE: Obesity is a contributing factor to the development of stress urinary incontinence in women, in addition to surgical technical factors which may make some urologists reticent to offer operative therapy. We reviewed our series of morbidly obese women who underwent anti-incontinence surgery to determine if they were at higher risk for surgical failure. MATERIALS AND METHODS: The records of our operative series of female stress urinary incontinence were reviewed and 16 women were considered morbidly obese. Transvaginal bladder neck suspension was performed in 4 women and sling procedures in 12, depending on preoperative urodynamic findings. RESULTS: Bladder neck suspension procedures failed in 2 cases, and no sling procedures failed. There was no recurrent or new pelvic floor deficit. The operations were somewhat more difficult to perform due to the body habitus of these patients but there were no intraoperative complications and only 1 minor wound infection postoperatively. CONCLUSIONS: Morbidly obese women with stress urinary incontinence can undergo operations for this disorder with a good chance of success. We recommend complete evaluation including urodynamics to ensure proper classification of stress incontinence. Sling operations may be the procedure of choice for stress incontinence in morbidly obese women.

Female↗
PubMed1998

Schwannoma of the urinary bladder: a case report.

The urinary bladder is an extremely rare site for primary schwannomas. They are most often associated with von Recklinghausen disease. This patient was found to have a schwannoma of the bladder in the absence of evidence of von Recklinghausen disease and was successfully treated with a partial cystectomy. This represents only the third such case in the literature of this entity.

Cystectomy↗
PubMed1997

Leakpoint pressures in female stress urinary incontinence.

Patient selection is critical to achieving good results in the surgical management of stress urinary incontinence. The evaluation of urethral function in these women is of great importance, since the choice of operative technique often depends on the ability of the urethra to generate adequate resistance to the expulsive forces of increased abdominal pressure. The Valsalva leakpoint pressure (VLPP) has been described as an easily performed, reproducible and accurate urodynamic test to assess the patient for the presence of intrinsic sphincter deficiency (ISD). Critical review of the VLPP demonstrates its reproducibility and correlation with other measures of ISD. However, more work needs to be done to identify the truly critical values of VLPP that would help in selecting the most appropriate procedure in surgery for stress incontinence.

Female↗
PubMed1997

Development of a malignant peripheral nerve sheath tumor following treatment for testicular seminoma.

A novel case is reported in which an S2 nerve root malignant peripheral nerve sheath tumor was diagnosed approximately 8 years after treatment for Stage I testicular seminoma. This patient underwent right orchiectomy and subsequent irradiation therapy to the periaortic region, including the sacrum. Postoperative radiation therapy likely played a role in the development of this second malignancy.

Adult↗
PubMed1997

Leak point pressures in women with urinary stress incontinence: correlation with patient history.

PURPOSE: We examined the relationship between historical factors in women with urinary stress incontinence and the Valsalva leak point pressure. MATERIALS AND METHODS: Valsalva leak point pressure measurements in 57 women with urinary stress incontinence were compared to findings in the history. RESULTS: Valsalva leak point pressure was low in 83% of women with severe leakage and previous surgery. Interestingly, 47% of patients without predisposing factors had low Valsalva leak point pressures. CONCLUSIONS: Women with severe leakage and previous bladder neck surgery are likely to have urethral dysfunction as demonstrated by Valsalva leak point pressure testing. A significant incidence of low Valsalva leak point pressures in patients without predisposing factors could account for many failures of routine suspension procedures.

Adult↗
PubMed1996

Radical perineal prostatectomy without pelvic lymphadenectomy: selection criteria and early results.

PURPOSE: We evaluated the surgical efficacy of radical perineal prostatectomy and determined preoperative parameters to identify patients at low risk for nodal metastasis. MATERIALS AND METHODS: Of 155 men evaluated for radical perineal prostatectomy, 74 were assigned to a low risk category (prostate specific antigen less than 10 ng./ml., Gleason score less than 7). Of the patients 40 underwent laparoscopic lymph node dissection and 34 did not. This group was compared to 81 patients who underwent surgical staging and did not fit the low risk criteria. RESULTS: None of 74 patients in the low risk group had nodal metastasis, while metastasis was present in 5 of 81 (6.1%) who did not meet such parameters. Organ-confined disease was present in 71.6% of men with low risk criteria, which was a significantly different rate than the 51.9% found in the other 81 men. CONCLUSIONS: Radical perineal prostatectomy confers adequate cancer control and can be performed without pelvic node dissection in select patients.

Aged↗
PubMed1996

Transurethral collagen injections in the therapy of post-radical prostatectomy stress incontinence.

PURPOSE: We report on our initial results with glutaraldehyde cross-linked collagen used as an injectable bulking agent for the therapy of post-radical prostatectomy stress incontinence. MATERIALS AND METHODS: A total of 19 men underwent collagen injection for treatment of post-radical prostatectomy stress incontinence. RESULTS: Of the 19 patients treated 11 had either a good (4) or improved (7) result, for an overall satisfaction rate of 58% with a followup of 3 to 15 months (mean 10.4). Failure correlated with presence of bladder neck contracture or scarring and severity of incontinence. CONCLUSIONS: Injection of collagen for stress incontinence after radical prostatectomy has an acceptable short-term success rate, particularly in men with milder incontinence and lack of bladder neck scarring.

Collagen↗
PubMed1995

Laser prostatectomy: initial experience and urodynamic follow-up.

OBJECTIVES: An evolving technology for the treatment of bladder outlet obstruction due to benign prostatic hyperplasia (BPH) is the use of the side-firing neodymium: yttrium-aluminum-garnet (Nd:YAG) laser to achieve prostatic tissue ablation. The purpose of this study was to determine the short-term efficacy of this procedure in both an objective and subjective manner. METHODS: We examined this technique by carefully evaluating our first 25 men undergoing the procedure. Each patient was subjected to careful symptom score analysis using the American Urological Association symptom index and multichannel urodynamics, including pressure-flow studies both preoperatively and at 3 months postoperatively. RESULTS: At the 3-month follow-up, symptom scores improved from a preoperative mean of 11.4 to 7.2 and the mean maximum flow rate improved from 6.1 to 14.5 cc/s. These are both significant at P < 0.001. Statistically similar improvement was seen in detrusor pressure at opening and at maximum flow. Eighty percent of the men studied had at least a 50% reduction in symptom score and a 50% improvement in flow rate. CONCLUSIONS: We conclude that laser prostatectomy is a promising minimally invasive treatment for bladder outlet obstruction secondary to BPH and deserves further evaluation at longer terms of follow-up.

Follow-Up Studies↗