Biomedical subjects
Publications and source records attributed to J S Wheeler.
Metastatic tumors to the penis are becoming more common as patients with cancer are living longer. Four cases of metastatic transitional cell carcinoma to the penis are presented to emphasize the pathophysiology and management of this condition.
Naloxone has been reported to facilitate detrusor activity by blocking the inhibitory action of the enkephalins. We tested the urodynamic effects of intravenous naloxone (0.4 to 0.8 mg.) in 15 patients with spinal cord injury via rapid fill carbon dioxide cystometry and perineal electromyography. Fourteen patients had suprasacral lesions (3 complete), while 1 had an incomplete lower cord lesion. The average interval from injury was 4.2 months. Most of the patients were managed with intermittent catheterization and most had chronic bacteriuria. Initially, 10 patients had detrusor areflexia and 5 had detrusor hyperreflexia (2 with dyssynergia). Of the 15 patients 14 had no neuropathic condition as noted on baseline electromyography. After naloxone injection no significant cystometrographic changes occurred but 11 patients (73 per cent) had decreased electromyographic activity. The vesicourethral pattern of the 2 patients with dyssynergia did not change after naloxone, even though the electromyographic response decreased in both. The patients showed no other effects of the naloxone administration. Contrary to other studies, naloxone seemed to diminish pelvic floor (electromyographic) activity but it did not change bladder (cystometrographic) function during bladder rehabilitation of spinal cord injury patients.
Prostatic carcinoma in the third decade of life is a rare occurrence. We describe a 25-year-old man with prostatic cancer, as well as discuss the literature and the natural history of the disease in the young adult.
Neurosyphilis today is a rare problem. We describe a man who presented with organic brain syndrome, psychosis and incontinence, and diagnosis was neurosyphilis with resultant bladder dysfunction. Urodynamic studies defined the voiding dysfunction as detrusor areflexia with a positive bethanechol test. This case reminds us of the necessity of obtaining a test for venereal disease to rule out neurosyphilis in patients with idiopathic voiding dysfunction.
We evaluated 23 male spinal cord injury patients who underwent percutaneous nephrolithotomy for the success rate of stone removal and the incidence of operative complications. There were 18 quadriplegic and 5 paraplegic patients, and 5 had bilateral procedures. Of the kidneys 7 had staghorn calculi, 8 had pelvic and caliceal combinations, 6 had large multiple caliceal stones, 4 had large (more than 2.5 cm.) pelvic stones and 3 had pelvic stones less than 2.5 cm. Placement of a nephrostomy tube and stone extraction were performed as a single procedure with the use of general anesthesia in all but 4 patients. Our results showed that 19 of 21 compliant patients (90.4 per cent) were free of stone, with an average of 2.04 procedures per patient. A total of 47 procedures was performed, with an average operative time of 1 hour 45 minutes. Major complications were associated with 4 of the 47 procedures (8.5 per cent), and consisted of a respiratory arrest, 2 perirenal abscesses and a hydrothorax. Minor complications included fever (more than 101.5F) in 64.3 per cent and retained stones in 14.3 per cent of the kidneys operated upon, dislodged nephrostomy tubes in 12.6 per cent of the procedures (21.4 per cent of the kidneys operated upon), and anemia requiring transfusion in 17.0 per cent (8 of 47) of the procedures (27.8 per cent of the kidneys operated upon). The presence of infected stones, prior operative procedures and medical complexity of these patients make complications more frequent. Nevertheless, percutaneous nephrolithotomy is a safe and effective procedure for the spinal cord injury population.
The immunocompromised patient after organ transplantation is susceptible to unusual and life-threatening infections. We report a case of epididymitis that evolved into testicular nocardiosis after cardiac transplantation. An awareness of the potential for these infections and early diagnosis may prevent extensive morbidity in the post-transplantation patient.
The neurological syndrome described by Shy and Drager includes urinary symptoms of incontinence and retention. We present the urodynamic evaluation of 2 patients with this syndrome, which demonstrated different sources for the symptoms and led to 2 separate effective treatments.
We report a case of a nephro-duodenal fistula complicating percutaneous nephrolithotomy that was managed conservatively. The patient was discharged from the hospital 14 days postoperatively, free of stone and doing well. The etiology and treatment of this problem are discussed.
Six patients with Huntington's chorea (5 females, 1 male) underwent neuro-urological evaluation because of urological complaints, usually incontinence. Four patients had detrusor hyperreflexia with a normal sphincter and two patients had a normal study, suggesting that their incontinence might be non-organic. A characteristic urodynamic pattern, not previously described, was observed, consisting of choreiform contractions of the abdominal perineal floor muscles during filling with selective suppression of choreiform contractions in the perineum during detrusor contraction.
The endogenous production of prostaglandins and thromboxane A2 by the rabbit urinary bladder was assessed by radioimmunoassay in a relatively intact system and in the absence of substrate. PGE2 and PGI2 (prostacyclin) were the main prostaglandins released whereas PGF2 alpha ratio of 5:1 and a PGI2 to PGF2 alpha ratio of 3:1 were observed. This qualitative pattern was independent of bladder area. In addition, prostaglandin release by the bladder body was significantly greater than by the bladder base at all incubation times. The physiological implications of these experimental observations are discussed.
A total of 7 patients with the Guillain-Barré syndrome and voiding dysfunction, large post-voiding residuals or urinary retention underwent urodynamic evaluation. Of the patients 4 had detrusor areflexia with a positive bethanechol supersensitivity test, including 3 with electromyographic evidence suggestive of neuropathy. This is the expected pattern in the Guillain-Barré syndrome. However, 3 patients had detrusor hyperreflexia with appropriate sphincteric relaxation, which was associated with Babinski's sign in 2. The presence of detrusor hyperreflexia suggests the possibility of Guillain-Barré pathological conditions involving the central nervous system, although the Guillain-Barré syndrome typically is a disease of the peripheral nervous system. Long-term urodynamic studies may help clarify such issues in future patients.
Significant intrapelvic injuries from routine hip surgery are rare but may result in long-term urologic morbidity. Two illustrative cases are presented with attention given to the close anatomic proximity of the intrapelvic structures to the hip joint and their potential for injury after hip surgery. A review of similar cases with their management is presented.
We report a case of detrusor areflexia caused by vincristine neurotoxicity and documented by urodynamic testing. Vincristine commonly induces peripheral neuropathy but rarely causes voiding dysfunction. Neurourological evaluation aided in monitoring and understanding this problem.
The changing clinical course of multiple sclerosis is a hallmark of the disease. The neurourologic findings in this disorder have been well documented in the literature but the occurrence of urodynamic changes with time has been mentioned only briefly. Ten men and 8 women had 2 or more urodynamic evaluations, consisting of cystometrography and perineal floor needle electromyography during 2 months to 6 years (mean 25 months). The initial urodynamic patterns included a normal study in 1 patient, detrusor areflexia in 7 and detrusor hyperreflexia in 10 (5 with vesicosphincter dyssynergia). Re-examinations were done for persistent or new symptoms. The urodynamic pattern changed in 10 patients (55 per cent), including cystometrographic changes in 7, newly developed neuropathic changes on electromyography in 5 and changes in detrusor-sphincter interaction in 9 (with 5 new cases of vesicosphincter dyssynergia). Of the 8 patients who did not demonstrate a urodynamic change 5 had vesicosphincter dyssynergia that persisted on followup. Vesicosphincter dyssynergia was the predominant pattern noted on re-evaluation, acting as a urodynamic indicator of progressive multiple sclerosis. Careful neurourologic assessment should be performed routinely in the followup of multiple sclerosis patients who are unresponsive to treatment or who manifest new symptoms.
A total of 26 patients with symptomatic voiding dysfunction underwent cystometrography concomitant with simultaneous perineal floor and rectus abdominis electromyography. Of the patients 20 had well defined neurological pathological conditions. Cystometrography/perineal electromyography revealed detrusor hyperreflexia with appropriate sphincter relaxation in 8 patients, with vesicosphincter dyssynergia in 10 and with pseudo-dyssynergia in 2. Rectus electromyography in these patients did not reveal electromyographic activity during the filling and expulsion phases of the cystometrogram. However, the 6 neurologically normal patients were noted to have detrusor areflexia with nonrelaxation of the sphincter on urodynamic examination. These patients characteristically attempted to void by abdominal straining, resulting in a concomitant increase in rectus and perineal electromyography activity. We conclude that the addition of rectus electromyography to the standard urodynamic methodology can improve significantly the recognition of intravesical pressure elevation owing to voluntary contraction of the abdominal musculature.
Testicular tumors in patients who have had the lymphatics disrupted by prior scrotal or inguinal surgery can metastasize primarily to the ipsilateral inguinal nodes in addition to the usual retroperitoneal pattern. Whether routine inguinal node dissection along with retroperitoneal node dissection is warranted in patients with testicular tumors and prior scrotal surgery is controversial due to the small numbers of such cases reported in the literature. We report on 2 patients who had undergone previous orchiopexy and who presented with inguinal and testicular masses. Both patients underwent retroperitoneal lymph node dissection and inguinal node dissection with hemiscrotectomy and metastatic tumor was in each lymphatic area. Ipsilateral inguinal along with bilateral retroperitoneal node dissection should be considered in the primary therapy of any patient with a nonseminomatous testicular tumor who has had prior scrotal and certain inguinal procedures.
A modification of the Young procedure for total perineal prostatectomy is described herein. The modification consists of an anterior and posterior paraurethral mattress suture that approximates the distal urethra and the bladder neck without constricting or interfering with the function of the sphincter muscle. None of the 55 patients with early prostatic carcinoma who have undergone this procedure has had incontinence.
Explore the source record for details and available documents.