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Biomedical subjects

J M Teichman

Publications and source records attributed to J M Teichman.

At least 55 records · Page 3Linked to original sources
PubMed1997

The malone antegrade continence enema combined with urinary diversion in adult neurogenic patients: early results.

OBJECTIVES: Patients with neurogenic voiding dysfunction often have coexisting neurogenic bowel problems. Impaired bowel evacuation is a cause of major morbidity and impaired lifestyle for these patients. The Malone antegrade continence enema (ACE) performed synchronously with a urinary continence procedure has been successful in pediatric patients. We report early experience combining the ACE with a urinary continence procedure in adult neurogenic patients. METHODS: Adult patients with neurogenic voiding dysfunction and impaired bowel evacuation refractory to conservative management underwent a urinary continence procedure synchronously with an ACE. RESULTS: Two patients have undergone the procedure. One patient chose a continent catheterizable supravesical bladder augmentation, whereas the other patient chose an ileal conduit. Both patients had a separate appendiceal stoma for their ACE. Both patients are continent of stool at their appendiceal stoma and per rectum. Both patients have stabilized their urinary tracts. Complications were minimal. CONCLUSIONS: The ACE may benefit adult patients with impaired bowel evacuation and may be combined with a urinary continence procedure. Further study of the ACE is warranted.

Adult↗
PubMed1997

Holmium:yttrium-aluminum-garnet laser cystolithotripsy of large bladder calculi.

OBJECTIVES: Patients with large bladder calculi (4 cm or larger) have traditionally been managed with open cystolithotomy. Endoscopic management with cystolitholapaxy or electrohydraulic lithotripsy risks complications. In an effort to spare patients the morbidity of open cystolithotomy, the results of holmium:yttrium-aluminum-garnet (YAG) laser cystolithotripsy for bladder calculi 4 cm or larger were reviewed. METHODS: Consecutive patients with bladder calculi of 4 cm or larger were managed with holmium:YAG laser cystolithotripsy. Laser energy was delivered using either the 365-micron end-firing fiber or the 550-micron side-firing fiber. RESULTS: Fourteen consecutive patients were managed with holmium:YAG cystolithotripsy. All patients were rendered stone free, regardless of stone composition or size. Median anesthesia time was 57 minutes. Twelve of 14 patients were discharged by the first postoperative day. The procedure times normalized for stone size (mean +/- standard deviation) for the end-firing versus the side-firing fibers were 13 +/- 6 min/cm versus 6 +/- 1 min/cm, respectively; P = 0.04. CONCLUSIONS: Holmium:YAG laser cystolithotripsy of large bladder calculi is effective, technically facile, and safe. The 550-micron side-firing fiber may be better suited for large bladder calculi compared with the 365-micron end-firing fiber. Holmium:YAG cystolithotripsy may obviate open cystolithotomy in selected patients.

Adult↗
PubMed1997

Holmium: YAG laser damage to ureteral guidewire.

The holmium:yttrium-aluminum-garnet (holmium:YAG) laser effectively fragments urinary calculi of all compositions. Complications have been minimal and mostly attributable to the ureteroscopy as opposed to the laser. We report a case in which the polytetrafluoroethylene (PTFE) coating of a ureteral guidewire was broken with the holmium:YAG laser and remained in the collecting system after the guidewire was removed postoperatively. The patient required cystoscopy to remove the guidewire coating.

Adult↗
PubMed1997

Holmium:YAG laser-induced damage to guidewires: experimental study.

The holmium:YAG laser fragments stones of all compositions effectively. However, damage to ureteral guidewires by the laser has been described, including in one of our own patients, in whom such damage resulted in morbidity. The purpose of this study was to characterize the interaction of Ho:YAG energy with guidewires in vitro. Seven ureteral guidewires were tested in a waterbath. The 365-microm Ho:YAG laser fiber was placed at defined distances (0, 1, 2, 4, and 5 mm) from the guidewire. All guidewires were tested at angles of 0 degrees, 45 degrees, and 70 degrees from normal incidence. The minimum energy setting that resulted in structural damage to the guidewires was detected by endoscopic video monitoring. All guidewires were susceptible to Ho:YAG laser damage at modest energy settings. The energy required to produce visual damage varied inversely with the square of the distance of the laser fiber from the guidewire. At a distance of 5 mm, none of the guidewires was damaged, even at energy settings of 2.8 J (the maximum output from the laser). The energy required to induce guidewire damage varied with the inverse of the cosine of the incident angle. The results demonstrate that no guidewire is immune from Ho:YAG laser damage when the fiber and guidewire are in contact. Caution must be exercised when operating the Ho:YAG laser near a guidewire, and guidewire integrity should be assured by the surgeon. Generally, the energy required to induce guidewire damage exceeded lithotripsy levels at distances >1 mm and with higher incident angles, implying a reasonable margin of safety during ureteroscopy. The pattern of energy thresholds required to induce damage with respect to distance and incident angle suggests that the mechanism of Ho:YAG lithotripsy is thermal.

Equipment Design↗
PubMed1997

Terminal nerve distribution to the urethra and bladder neck: considerations in the management of stress urinary incontinence.

PURPOSE: Recent reports have suggested an increased incidence of intrinsic sphincter dysfunction, most of which seems to appear following the failure of a previous, usually vaginal, surgical repair. Our studies attempt to define more precisely the neuroanatomical relationships that exist in the region of the bladder neck and proximal urethra, and between the urethra and anterior vaginal wall. MATERIALS AND METHODS: We dissected the pelves of adult female cadavers and step sectioned them at 4 mm. intervals. Several staining methods were used on each section to identify and document the position of the nerves and vascular structures between the vaginal wall and urethra. RESULTS: A rich plexus of blood vessels and nerves with ganglia is located between the vaginal wall, and the proximal urethra and bladder neck. The greatest concentrations of nerves are in the 4 o'clock and 8 o'clock positions but nerve fibers are identified throughout the loose areolar tissue planes through which vaginal surgery for stress urinary incontinence is often performed. CONCLUSIONS: When performing surgical procedures for the correction of stress urinary incontinence, the possibility that denervation and devascularization of the terminal urethra and bladder neck secondary to surgical dissection could contribute to the subsequent development of intrinsic sphincter dysfunction should be considered.

Adult↗
PubMed1997

The utility of the Malone antegrade continence enema for urologists.

Urologists often manage patients with neurogenic voiding dysfunction. These patients often have neuropathic bowel dysfunction. The malone antegrade continence enema (ACE) performed synchronously with a urinary continence procedure has been successful in pediatric patients. We report preliminary experience combining the ACE with a urinary continence procedure in two adult neurogenic patients. The ACE procedure is technically easy. Both patients had a separate urinary stoma and an appendicocecostomy for their ACE. Both patients are continent of stool at their appendicocecostomy and per rectum. Both patients have stabilized their urinary tracts. Complications were minimal. The ACE may benefit adult patients with impaired bowel evacuation and may be combined with a urinary continence procedure. Urologists can easily perform the ACE.

Adult↗
PubMed1997

Modified urodynamics for interstitial cystitis.

Interstitial cystitis (IC) is a poorly understood syndrome. Patients with pelvic pain, urgency, frequency, and/or dysuria may pose a diagnostic dilemma. They may have bladder-related symptoms or they may have nonbladder related symptoms. It is beneficial for the urologist to distinguish between these patients. This study outlined a modified urodynamics test to discriminate between bladder-related and nonbladder-related patients. Consecutive IC patients (bladder-related and nonbladder-related patients) and stress incontinent controls underwent modified urodynamics. Testing consisted of an epithelial leak test, a filling cystometrogram, bladder emptying and instilling lidocaine intravesically, and repeat cystometrogram after bladder emptying. The epithelial leak test and lidocaine test predict reliably if a patient has bladder-related or nonbladder-related symptoms. Modified urodynamics permits a logical stratification of IC patients, and may predict treatment response.

Adult↗
PubMed1997

Comparison of lighted ureteral catheter luminance for laparoscopy.

Urologists may be asked to place a lighted ureteral catheter for laparoscopic surgeons. Presumably, the lighted ureteral catheter with the greatest luminance will provide the best visual roadmap to the ureter during laparoscopy. The purpose of this article was to compare the luminance of three lighted ureteral catheters and characterize technical characteristics so that urologists could select the lighted ureteral catheter most appropriate for laparoscopy. Four lighted ureteral catheters were evaluated: Cook 5F single lumen, Cook 5F double lumen, Cook 7F, and Rüsch 5F. Each catheter was attached to a standard fiber-optic light source at maximum output. Each catheter was placed in a porcine ureter. Luminance was measured with a photometer in a dark room. Luminance was characterized at catheter locations corresponding to the proximal, middle, and distal ureter. The luminance measured in foot-Lamberts (fL) in the middle ureter for each catheter was as follows: Cook 5F single lumen 98+/-47, Cook 5F double lumen 42+/-14, Cook 7F 98+/-11, Rüsch 5F 58+/-45 (p=.01). The luminance (fL) in the distal ureter for each catheter was: Cook 5F single lumen 129+/-40, Cook 5F double lumen 110+/-108, Cook 7F 22+/-2, Rüsch 5F 49+/-30 (p=.02). The luminance was not significantly different among the catheters when measured in the proximal ureter. The Cook 5F single-lumen ureteral catheter overall has the greatest luminance. This catheter should be easiest to identify at laparoscopy.

Analysis of Variance↗
PubMed1996

T-cell lymphocytic lymphoma involving the prostate presenting as elevated PSA in paraplegia: case report.

The vast majority of cancers that involve the prostate are adenocarcinomas of the duct-acinar secretory epithelium. Other cancers, primarily leukemia and lymphoma, can involve the prostate and lead to an abnormal digital examination or elevated serum prostate specific antigen (PSA). The case discussed is that of a 62 year-old male with T12 complete paraplegia who presented with a persistently elevated PSA and was subsequently diagnosed with T-cell lymphoma involving the prostate. Although rare, leukemia and lymphoma involving the prostate should be included in the differential diagnosis of patients being evaluated for adenocarcinoma of the prostate.

Adenocarcinoma↗
PubMed1996

Cystoscopic holmium lithotripsy of large bladder calculi.

Patients with large bladder stones are often difficult to treat endoscopically with the current modalities available to the practicing urologist. We present the results of cystolithotripsy of bladder stones larger than 4 cm with the holmium: Yag (Ho:Yag) laser. In our three patients, all patients were rendered stone free without complication using the Ho:Yag laser, with an average anesthesia time of 50 min. Minimal tissue trauma or stone movement were observed. All stones were easily fragmented, even one stone that had previously been refractory to electrohydraulic lithotripsy. Our conclusion is that the Ho:Yag laser is a safe and effective treatment for patients with large bladder stones. Its use may make it possible to eradicate stones endoscopically that otherwise would require open surgery.

Cystoscopy↗
PubMed1995

Laparoscopic pelvic lymph node dissection, laparoscopically assisted seminal vesicle mobilization, and total perineal prostatectomy versus radical retropubic prostatectomy for prostate cancer.

OBJECTIVES: The outcomes of patients with prostate cancer who were candidates for radical prostatectomy were compared with patients who underwent either: (1) radical retropubic prostatectomy (RRP); or (2) laparoscopic pelvic lymph node dissection, laparoscopically assisted seminal vesicle mobilization, and total perineal prostatectomy (LN-SV-TPP). METHODS: The staging, surgical, and early postoperative characteristics of 10 consecutive patients treated by RRP were compared with 12 consecutive patients who underwent LN-SV-TPP. RESULTS: Patients who underwent LN-SV-TPP versus RRP had respective median blood loss of 450 versus 1250 cc (P = 0.001), median anesthesia time of 330 versus 287.5 minutes (P = 0.05), median surgical time of 237.5 versus 237.5 minutes (P = 0.6), median units transfused of 0 versus 1 (P = 0.05), median time to ambulation of 1 versus 2 days (P = 0.002), median time to oral intake of 1 versus 3.5 days (P < 0.001), median hospital stay of 3 versus 6 days (P < 0.001), and median morphine requirements of 44 versus 119 mg (P < 0.001). CONCLUSIONS: LN-SV-TPP is less morbid than RRP concerning blood loss, blood transfusions, pain, and postoperative recovery. Compared with LN-SV-TPP, RRP is faster and is particularly indicated for ease of performing a nerve-sparing radical prostatectomy.

Aged↗
PubMed1995

Long-term renal fate and prognosis after staghorn calculus management.

We analyzed retrospectively 177 consecutive staghorn calculus patients to determine risk factors for ultimate renal deterioration and renal cause specific death. Mean followup was 7.7 years. Overall rate of renal deterioration was 28%. Renal deterioration was associated more frequently among patients with solitary versus nonsolitary kidneys (77% versus 21%, p < 0.001), previous versus initial stones (39% versus 14%, p = 0.03), recurrent versus nonrecurrent calculi (39% versus 22%, p = 0.07), hypertension versus normotension (50% versus 22%, p = 0.006), complete versus partial staghorn calculi (34% versus 13%, p = 0.02), diversion versus no diversion (58% versus 19%, p < 0.001) and neurogenic bladder versus normal voiding (47% versus 21%, p = 0.006), as well as those who refused treatment versus treated patients (100% versus 28%, p < 0.001). No patient with complete clearance of fragments died of renal related causes compared to 3% of those without clearance of fragments and 67% of those who refused treatment (p < 0.001). Our study suggests that long-term renal preservation in the staghorn calculus patient may depend on normal blood pressure, staghorn size, absence of diversion or voiding dysfunction, and complete stone eradication.

Female↗
PubMed1995

Laparoscopic marsupialization of the painful polycystic kidney.

Autosomal dominant polycystic kidney disease patients may present with intractable cyst pain. Common practice has been to attempt percutaneous drainage of the affected cyst and, if unsuccessful, to offer open surgical decortication. We report laparoscopic renal cyst marsupialization for painful autosomal dominant polycystic kidney disease among 6 patients who failed prior percutaneous drainage. Mean surgical and anesthesia times were 3 hours and 3 hours 35 minutes, respectively. Mean blood loss was 140 cc. Median intervals to ambulation, oral intake and hospital discharge were 1.5, 1.5 and 3 days, respectively. All 6 patients reported pain relief with followup of 6 to 40 months. These results suggest that laparoscopic marsupialization of painful autosomal dominant polycystic kidney disease is technically feasible and safe, and the laparoscopic approach may offer a palliative option for patients in whom prior percutaneous management failed.

Blood Loss, Surgical↗
PubMed1995

Laparoscopic Burch colposuspension.

The technique of laparoscopic, transperitoneal Burch colposuspension is described. The short-term results indicate that this technique may offer the urologist a laparoscopic approach for the surgical management of stress urinary incontinence.

Blood Loss, Surgical↗
PubMed1994

An alternative approach to myelodysplasia management: aggressive observation and prompt intervention.

We have adopted an approach to the management of myelodysplasia patients which is contrary to that most commonly supported by the existing literature. We screen patients shortly after birth with ultrasound, urine culture and serum creatinine, and then follow patients at 3 to 6-month intervals with similar studies. Cystography and urodynamics are done only as required clinically or by a change in the sonogram. Clean intermittent catheterization is indicated for continence or medical reasons. With this approach of aggressive observation and prompt intervention, we observed a rate of renal deterioration (diminished function on renal scan or parenchymal loss on imaging studies) of 5%. Renal deterioration was associated statistically with urinary tract infections and reflux. Patients started on clean intermittent catheterization for medical indications had greater risk for renal deterioration than those started on it for continence. Renal deterioration occurred with equal frequency between patients with abnormal and normal urodynamic studies, that is urodynamics did not predict renal deterioration. Our data show a rate of renal deterioration similar to other reports. We believe that aggressive observation with prompt intervention for problems once identified represents a reasonable alternative to managing patients with myelodysplasia.

Adolescent↗
PubMed1994

Protamine sulfate and vancomycin are synergistic against Staphylococcus epidermidis prosthesis infection in vivo.

We have previously demonstrated that the quaternary amine, protamine sulfate (PS), is bactericidal against Staphylococcus epidermidis. In an attempt to decrease genitourinary prosthesis infection rates, we examined the ability of PS as a wound irrigant to inhibit Staphylococcus epidermidis viability. Eighty-seven Sprague-Dawley rats were studied by implanting a sterile silicone pellet in their dorsum. The pellet was inoculated with Staphylococcus epidermidis and the rats were divided into four groups based on the wound irrigant employed after inoculation: (1) control (sterile water) (2) vancomycin; (3) PS; (4) vancomycin + PS. All rats received perioperative and daily intramuscular vancomycin, and the pellets were explanted on postoperative day 28 and cultured. The infection rates were: (1) control 77%, (2) vancomycin 50%, (3) protamine sulfate 67%, and (4) protamine sulfate and vancomycin 19%. The differences between (2) vancomycin versus (4) vancomycin + PS and (3) PS versus (4) vancomycin + PS were significant (p = 0.05 and p < 0.005). The data suggest that PS potentiates vancomycin as a wound irrigant in prosthesis implantation.

Animals↗
PubMed1994

Mucinous adenocarcinoma of the prostate and hormone sensitivity.

We report a case of mucinous adenocarcinoma of the prostate treated successfully with androgen ablation followed by laparoscopic lymphadenectomy and total perineal prostatectomy. This case demonstrates that mucinous adenocarcinoma of the prostate may be hormonally sensitive.

Adenocarcinoma, Mucinous↗