External urinary devices: use and abuse.
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Adult↗
Biomedical subjects
J W Morrow
Publications and source records attributed to J W Morrow.
Phenoxybenzamine in neurogenic bladder dysfunction after spinal cord injury. I. Voiding dysfunction.
Phenoxybenzamine is a welcomed adjunct in the pharmacologic management of patients with neurogenic bladder dysfunction resulting from spinal cord trauma. Side effects are infrequent. Bladder balance was predictably and effectively achieved and maintained in patients with 1) lower motor neuron lesions, 2) upper motor neuron lesions and coexisting autonomic dysreflexia and 3) intact sympathetic innervation and upper motor neuron bladders. The response was unpredictable in patients with upper motor neuron lesions without coexisting dysreflexia.
Adrenergic Fibers↗
Phenoxybenzamine in neurogenic bladder dysfunction after spinal cord injury. II. Autonomic dysreflexia.
Phenoxybenzamine blockade of the alpha receptor site can abolish the vascular and internal sphincter responses in patients with chronic recurrent autonomic dysreflexia associated with bladder filling or contraction. The life-threatening hypertensive response is suppressed by this medication. Therefore, the drug is a beneficial adjunct in the pharmacologic management of autonomic dysreflexia. When the drug is used patients can be maintained free of a catheter. The drug had no serious side effects at the dose regimen used. One particularly significant advantage is its long duration of action--patients occasionally can skip doses of medication and not suffer acute symptoms.
Autonomic Nervous System↗
Erections and sexual function in post-sphincterotomy bladder neck patients.
A study of 131 patients who underwent sphincterotomy and bladder neck incision was done to determine changes in postoperative erectile and sexual function. A complete, permanent loss of erectile function was noted in 8.2 per cent of the patients and diminished erectile function was noted in 16.8 per cent. Unchanged or improved erections were noted in 74.8 per cent of the patients, while a complete loss of ability to engage in vaginal sexual intercourse, which had been present preoperatively, was sustained by 3.9 per cent of patients with diminished erections suffered no impairment of their preoperative sexual ability. Unaltered, improved or induced sexual function was present in 96.1 per cent of the patients postoperatively.
Adult↗
Use of the iced cystogram to differentiate bladder neck and external sphincter obstruction.
An iced cystogram was done on 31 patients with neurogenic bladder and voiding dysfunction. We observed 5 distinguishable patterns upon which therapeutic measures to improve balance could be based. We found the iced cystogram to be a simple, inexpensive yet reliable technique to assess detrusor sphincter imbalance. With the information obtained from this study the therapeutic options were delineated more clearly and the results of the treatment were made more predictable.
Contrast Media↗
Pseudomonas colonization in patients with spinal cord injury.
Pseudomonas has been an important cause of urinary tract infection in patients with spinal cord injuries. To determine the possible reservoirs of Pseudomonas, colonization with Pseudomonas was studied in 52 inpatients and 28 outpatients with spinal cord injuries. Body sites, the environment, and hospital staff were cultured. There was a high prevalence of colonization of the urethra, perineum, and rectum. Pseudomonas was isolated from one or more of these sites in 85% of male inpatients and in 71% of male outpatients. Significant bacteriuria with Pseudomonas was found in 37% of inpatients and 13% of male outpatients. Urethral colonization in men was significantly associated with the use of the external urethral catheter. Culturing the patient's perineum was a sensitive indicator of patient colonization. The urinary drainage bag was another frequent reservoir of Pseudomonas. More than one-half of these patients did not have significant bacteriuria and presumably the drainage bag was colonized from the urethra or perineum. The rates of urethral, perineal, and rectal carriage were higher than those described previously. These rates may be accounted for by the use of the external urethral catheters. Other factors, such as rectal manipulation, and fecal incontinence may be important in these groups of patients.
Bacteriuria↗
Bladder rehabilitation in patients with old spinal cord injuries with bladder neck incision and external sphincterotomy.
Seventy-five patients with neurogenic bladders underwent bladder neck incision and/or external sphincterotomy to establish effective vesical emptying and reverse progressive hydronephrosis. A second operation to achieve these goals was necessary in 11 cases. The over-all success rate of these procedures in improving urinary tract stability was 94 per cent. Complications were infrequent, with hemorrhage and impaired penile erection being the principal problems. Eradication of established urinary tract infections was poor. However, infection-related morbidity was improved.
Adolescent↗
Quantitative urine culture by reagent strip incubation.
The filter paper culture-tetrazolium test ressults have been compared with routine hospital streak plate cultures in 400 random urine specimens. Pseudomonas cultures tended to impart a color change to the test pads which rendered interpretation difficult. While a consistently accurate quantitative interpretation of these cultures did emerge during the course of the trial studies, some degree of observer accommodation and bias, in terms of the manufacturer's instructions and description, was necessary to achieve an appropriate reading. When the hospital laboratory results and culture strip test results are compared in terms of colony counts greater than 10-4 bacteria per milliliter and less than 10-4 bacteria per milliliter, the method was found to be 93% sensitive for the total count and 83% sensitive for the gram-negative count with a specificity correlation of 96% for the total and gram-negative counts, respectively.
Bacteria↗
The use of pedicled omentum in the repair of large vesicovaginal fistulas. Experimental work in dogs.
Large vesicovaginal fistulas involving most of the trigone were created in eight dogs. Three weeks postoperatively, pedicled omentum was insinuated between the open bladder and vaginal defects. Bladder continuity was present at 2 weeks and epithelization was complete at 3 weeks postoperatively. There was little morbidity and no mortality.
Animals↗