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J N Kabalin

Publications and source records attributed to J N Kabalin.

At least 55 records · Page 3Linked to original sources
PubMed1995

Costs of minimally invasive laser surgery compared with transurethral electrocautery resection of the prostate.

We reviewed hospital charges for patients undergoing uncomplicated endoscopic surgical resection for symptomatic bladder outlet obstruction due to benign prostatic hyperplasia over a 1-year period at a single institution. Of 115 patients, 67 underwent transurethral electrocautery resection of the prostate, and 48 underwent endoscopic neodymium:yttrium-aluminum-garnet laser ablation of the prostate under direct vision. Analysis showed a cost differential between these 2 surgical treatments in excess of $2,000, favoring laser prostatectomy (P < .0001) over transurethral electrocautery resection. The single greatest difference between the treatments was the ability to manage all patients receiving laser treatment as outpatients, whereas the mean and median hospital stay after transurethral electrocautery resection was 3.0 days. Taking additional cost variables into account and decreasing the cost of laser delivery systems would further increase this cost differential in favor of laser therapy. The diminished postoperative morbidity associated with laser treatment also promises lower total costs over the long term.

Electrocoagulation↗
PubMed1994

Dosimetry studies utilizing the Urolase right angle firing neodymium:YAG laser fiber.

Neodymium:YAG laser application was performed with the Urolase right angle laser fiber in a potato model and then in vivo in 29 canine prostates in an attempt to define dosimetry and optimal treatment parameters required to maximize tissue ablation and treatment efficacy. Depth and volume of prostatic tissue ablation for single, continuous laser applications with the Urolase fiber were measured at variable power settings from 20 to 60 watts, while holding total energy delivery constant. Peak tissue ablation was observed at 40 watts--up to a maximum of 21 mm tissue penetration in the canine model with a mode of 15 mm. The mean depth of tissue destruction at 40 watts power setting was 15.7 mm, with a mean volume of tissue ablation of 5.5 cc. The mean depth of tissue penetration at 40 watts was more than 30% greater than that observed at 60 watts, and the mean volume of tissue ablation was more than 60% greater than that observed at 60 watts. Holding the power setting constant at 40 watts, the extent of tissue ablation was measured for variable treatment times from 60 to 120 seconds. As treatment time was increased from 60 to 90 seconds, tissue ablation increased significantly. However, beyond 90 seconds of continuous laser application at 40 watts, a plateau in tissue effects was observed, with no real increase in tissue ablation between 90 and 120 seconds. Interruption or discontinuous laser application produced tissue effects which were significantly less than those observed for a single continuous 90 second laser treatment.

Animals↗
PubMed1994

Characterization of tissue effects produced by the Prolase II lateral-firing neodymium:YAG laser fiber in the canine prostate.

The immediate and long term-effects of neodymium:YAG laser treatment with the ProLase II lateral-firing laser fiber in the canine prostate were evaluated. Fourteen male dogs, aged 3 years and older with established benign prostatic hyperplasia, underwent endoscopic ablation of the prostate using the ProLase II fiber. Subjects were treated at laser power settings of 60 watts (6 dogs), 75 watts (4 dogs), or 90 watts (3 dogs), with a mean total energy delivery of 15,000 joules. One dog underwent a sham procedure and served as a normal control. Prostates were examined grossly and histologically at 48 hours, 2 weeks, 4 weeks, or 8 weeks post-treatment. The cross-sectional diameter and volume of tissue ablation were measured in each prostate. Histological studies of the extent of thermal injury to the prostatic tissue and the course of healing of the prostatic urethra were performed. The mean cross-sectional diameter of tissue ablation was 28.6 +/- 4.7 mm and mean volume of tissue ablation was 8.2 +/- 5.1 cc. No statistically significant difference in diameter or volume of tissue ablation was noted between varying power settings. Histological studies showed extensive tissue necrosis with hemorrhage and an acute inflammatory cell infiltrate at 48 hours. By 8 weeks, total resolution of both necrosis and inflammatory changes with complete re-epithelialization of the prostatic urethra was observed.

Aluminum Silicates↗
PubMed1994

Corporeal fibrosis as a result of priapism prohibiting function of self-contained inflatable penile prosthesis.

Corporeal fibrosis and erectile impotence are known sequelae of priapism. Fibrosis following priapism may make subsequent placement of a penile prosthesis, especially inflatable devices, difficult or impossible. A case is described in which a self-contained inflatable prosthesis (Dynaflex) was successfully placed to treat impotence resulting from idiopathic priapism. However, fibrosis of the distal tunica albuginea of the corpora cavernosa rendered them noncompressible, and thus precluded inflation of the device with its distally placed pump mechanism. This anatomic problem is added to the list of potential contraindications to placement of self-contained inflatable penile prostheses, and the advisability of having patients who desire such a prosthesis also choose a secondary prosthesis type is emphasized.

Adult↗
PubMed1994

Spermatic cord metastasis from transitional cell carcinoma of the bladder.

A case of transitional cell carcinoma of the bladder metastasizing to the spermatic cord is reported. This represents the only clinically recognized site of tumor recurrence in a man treated with radical cystoprostatectomy followed by four cycles of adjuvant cis-platinum/methotrexate/vinblastine (CMV) chemotherapy for Stage D1 disease (local pelvic lymph node involvement). The existing literature concerning metastatic tumors of the spermatic cord is reviewed.

Aged↗
PubMed1994

Treatment of post-prostatectomy stress urinary incontinence with periurethral polytetrafluoroethylene paste injection.

Periurethral injection of polytetrafluoroethylene (Teflon) paste was performed to treat moderate to severe stress urinary incontinence following prostatectomy. A total of 20 procedures was performed in 13 men, of whom 8 had previously undergone radical prostatectomy for prostate cancer and 5 had undergone transurethral electrocautery resection of the prostate for bladder outlet obstruction due to benign prostatic hyperplasia. All patients had significant stress urinary incontinence requiring a minimum of 2 pads wet daily. Between 16 and 20 cc polytetrafluoroethylene paste were injected initially transurethrally into the periurethral tissues in the region of the external sphincter. Of the 13 patients 7 underwent a second injection procedure with an additional 12 to 23 cc paste. Three men (23%) experienced a noticeable improvement in continence status, including 1 of 5 patients after transurethral electrocautery resection and 2 of 8 after radical prostatectomy. However, none of these men became completely dry or was able to eliminate completely the use of pads. Of the 13 patients 10 (77%) experienced no detectable improvement in continence status. Seven patients have now successfully undergone implantation of an artificial urinary sphincter without complication. With a minimum followup of 11 months in all patients and a maximum followup of 3 years, none has experienced any clinically detectable long-term side effects related to the polytetrafluoroethylene injection or evidence of particulate migration.

Aged↗
PubMed1994

Long-term experience with controlled expansion cylinders in the AMS 700CX inflatable penile prosthesis and comparison with earlier versions of the Scott inflatable penile prosthesis.

UNLABELLED: OBJECTIVEs. To determine complication and survival rates of the AMS 700CX penile prosthesis and to compare its reliability with earlier versions of the Scott inflatable penile prosthesis. METHODS: Retrospective chart review and telephone interviews were used. RESULTS: Actual 4-year survival of the AMS 700CX device was 85%, whereas earlier versions of the device had actual 4-year survival of 46% (p < 0.0001). The observed difference in prosthesis reliability could not be accounted for by differences in patient population, surgical technique, or incidence of infections. The most significant factor that contributed to improved prosthesis survival was the lack of cylinder complications (leaks and aneurysms). CONCLUSIONS: The controlled expansion cylinders of the AMS 700CX penile prosthesis are a significant advance in reliable, low-morbidity surgical therapy for impotence.

Actuarial Analysis↗
PubMed1993

Urolase laser prostatectomy in patients on warfarin anticoagulation: a safe treatment alternative for bladder outlet obstruction.

Three patients with symptomatic bladder outlet obstruction due to benign prostatic hyperplasia underwent laser prostatectomy using a Neodymium:YAG source delivered with the Urolase right-angle laser fiber. All patients had significant underlying medical problems, and all were fully anticoagulated with oral warfarin (mean prothrombin time 17 seconds). Two were in urinary retention with indwelling catheters preoperatively. Laser prostatectomy was performed in each case without change in the medical regimen, including continuous warfarin dosing. No complications occurred, and in particular, no early or late bleeding episodes were encountered. All are symptomatically improved and catheter-free on follow-up. Laser prostatectomy provides a new and safe therapeutic option in the management of these high-risk patients.

Aged↗
PubMed1993

Laser prostatectomy performed with a right angle firing neodymium:YAG laser fiber at 40 watts power setting.

A total of 25 patients with symptomatic bladder outlet obstruction due to benign prostatic hyperplasia was entered into a prospective, randomized trial comparing laser prostatectomy performed with the Urolase right angle firing neodymium:YAG laser fiber to standard transurethral electroresection of the prostate. Overall acute perioperative morbidity, including blood loss and fluid absorption, was significantly less for patients undergoing laser prostatectomy. Efficacy of treatment was assessed by standardized American Urological Association symptom scores, patient assessment of symptom improvement, peak urinary flow rates and post-void residual urine volumes, and was equivalent for the 2 treatment groups at 3 and 6 months.

Aged↗
PubMed1993

Incidence and management of autonomic dysreflexia and other intraoperative problems encountered in spinal cord injury patients undergoing extracorporeal shock wave lithotripsy without anesthesia on a second generation lithotriptor.

Spinal cord injury patients are at increased risk for urolithiasis and many will require treatment, most commonly with extracorporeal shock wave lithotripsy. New, second generation lithotripsy devices allow treatment without tub immersion, and without general or regional anesthesia for most patients. Spinal cord injury patients, with loss of sensation below the level of injury, would seem to be ideal candidates for such treatment. We present our experience with 20 consecutive spinal cord injury patients treated without anesthesia on the Medstone STS second generation lithotriptor. All patients were awake and experienced no direct sensation from the shock waves. All but 1 patient (T12 level), however, experienced autonomic dysreflexia, with significant elevations in systolic blood pressure (mean increase 44 mm. Hg, maximum 74) and diastolic blood pressure (mean increase 24 mm. Hg, maximum 61), with reflex bradycardia (mean decrease -22 beats per minute). Autonomic dysreflexia was successfully treated in this setting with short-acting sublingual nifedipine. Associated bradycardia was treated with atropine in 6 patients. Preoperative bowel preparation proved to be useful in spinal cord injury patients to maximize stone imaging and may decrease autonomic dysreflexia if this is caused by shock waves impacting on the distended bowel. Other problems included uncontrolled skeletal muscle spasms elicited by shock waves, which proved to be troublesome in maintaining patient position and stone localization. Muscle spasms were decreased with benzodiazepines. Care was also observed in spinal cord injury patients to pad all pressure points on the hard, dry treatment surfaces associated with second generation lithotriptors and, thus, prevent skin breakdown.

Adult↗
PubMed1992

Inflammatory pseudotumor of the bladder.

Inflammatory pseudotumor of the bladder is an unusual benign lesion arising from the bladder submucosa. We present 2 cases and describe the clinical presentation, and radiographic and histological findings. This benign lesion must be differentiated histologically from several malignant lesions of the bladder. Complete surgical excision, either by transurethral resection or partial cystectomy, appears to be curative.

Adult↗
PubMed1992

Intravesical migration of intrauterine device.

Intrauterine devices have been plagued by many early and late complications, including uterine perforation and migration into adjacent structures. To our knowledge only 18 cases have been reported in the literature of migration of an intrauterine device into the bladder. We report on a 38-year-old woman in whom an intrauterine device eroded from the uterus 3 years after placement. The device remained asymptomatic in the pelvis for an additional 13 years before the patient presented with urinary symptoms. The literature is reviewed.

Adult↗
PubMed1992

Use of penile prostheses to maintain external condom catheter drainage in spinal cord injury patients.

This is a retrospective analysis of 79 spinal cord injury patients who have had penile implants from one to 14 years. The primary indication for implants was the loss of condom catheter with a small retractile penis. Mean period after injury to when the implants were placed was 8.24 years (range 1-21 years). Mean total length of time the implants have been followed was 7.08 years (1-14 years). Sixty patients responded to our detailed questionnaire and they have been subjected to further analysis: prior to the implant 46 patients (77%) frequently lost their condoms. Fourteen of the patients (23%) had indwelling catheters, and 3 (5%) had a suprapubic cystostomy since they could not retain an external condom for urinary drainage because of retraction of a small penis. Post implant, 81% of patients had no accidents involving condom loss, while 19% still lost condoms. All indwelling catheters could be removed except for one patient who continued with a suprapubic catheter following transurethral sphincterotomy (TURS) and a penile implant. Sixty-eight percent used the implant for sex and felt their wives were satisfied. Patient satisfaction survey showed a markedly increased self esteem, increased mobility without fear of condom loss, and an improved sex life. Overall, the long term prosthesis failure rate was 8%. The specific infection complication rate was less than 2%. The Flexirod semirigid, hinged prosthesis proved ideal in meeting the requirements for these patients.

Adult↗
PubMed1992

Prostate specific antigen: clinical use in the diagnosis and management of prostate cancer.

Prostate specific antigen (PSA) has replaced prostatic acid phosphatase as the preeminent clinical tumor marker in the management of patients with prostate cancer. Serum PSA levels have been shown to be proportional to clinical and pathologic stage of prostate cancer and in particular to correlate closely with prostate cancer volume. Serum levels of PSA thus serve as a useful adjunct in the initial clinical staging of men with prostate cancer. Serum PSA values provide a unique and valuable tool in monitoring prostate cancer progression over time and its response to surgical, radiation, and/or hormonal therapies. Unfortunately, its lack of specificity for prostate cancer leaves many questions unanswered as to the efficacy and advisability of using PSA as a screening test for this cancer.

Aged↗