Biomedical subjects

Jeffrey R Dell

Publications and source records attributed to Jeffrey R Dell.

5 recordsLinked to original sources

PubMed2006

Multimodal therapy for painful bladder syndrome/interstitial cystitis.

Most patients who suffer from PBS/IC can now be simply and effectively treated. The first step to successful management is accurate and timely diagnosis, which has become easier with available and validated screening and diagnostic tools such as PUF and PST. Once PBS/IC is correctly diagnosed, prompt treatment should address the main components of the disease, a dysfunctional urothelium, mast cell activation and neural upregulation. Multimodal treatment that has shown benefit includes oral PPS plus an antihistamine, such as hydroxyzine, and a TCA, such as amitriptyline. Behavioral interventions and intravesical instillation therapy are adjunctive measures that will promote symptom relief. Intravesical "rescue" solutions using lidocaine and heparin or PPS (dissolved in water or in the instillation solution [off-label use of PPS]) can provide immediate relief while patients develop a response to oral PPS. Patient education and support are critical in managing this complex but treatable disorder.

Administration, Intravesical↗

PubMed2004

TVT erosion secondary to a twist in tape.

Mesh erosions through vaginal mucosa as well as the urethra following TVT procedures have been reported but are rare. We report a case of a 50-year-old woman who was found to have mesh erosion through vaginal mucosa 8 weeks after her TVT procedure, apparently secondary to a twist in the tape. Excision of approximately 5 mm of tape encompassing the twist was accomplished without difficulty, and allowed for complete healing of the vaginal mucosa and resolution of the patient's pain and irritative voiding symptoms.

Device Removal↗

PubMed2004

PelviSoft BioMesh augmentation of rectocele repair: the initial clinical experience in 35 patients.

Graft materials have been utilized in the repair of posterior vaginal wall defects to enhance anatomical and functional results, and to improve long-term outcomes. We report on our initial series of 35 patients treated with porcine dermal acellular collagen matrix BioMesh (PelviSoft BioMesh, CR Bard, Cranston, R.I., USA), which has alleviated problems with early postoperative vaginal mucosal dehiscence and delayed healing experienced with the use of other graft materials in the posterior vaginal wall.

Adult↗

PubMed2004

Multimodal therapy for interstitial cystitis.

Gynecologists have been challenged by the diversity in treatment approaches and the historical absence of effective therapy for interstitial cystisis (IC). Until recently, the only Food and Drug Administration (FDA)-approved treatment was bladder instillation with dimethyl sulfoxide, a moderately effective and safe, albeit invasive, process. The approval in 1996 of pentosan polysulfate sodium (PPS) provided IC patients with an effective and safe oral regimen that specifically targets and repairs the damaged urothelium. Intravesical administration of heparin sulfate or PPS, while not FDA indicated, has also been shown to provide symptom relief. Patients with moderate to severe disease may require a multimodal therapeutic approach utilizing PPS as the foundation. Oral PPS can be combined with antihistamines, analgesics, antispasmodics or antidepressants to provide enhanced pain and symptom relief. Patients with severe disease or flares may benefit from instillation of an anesthetic therapeutic relief solution composed of heparin or PPS combined with sodium bicarbonate and lidocaine. Nonpharmacologic approaches, such as bladder training, biofeedback and dietary changes, can provide supplemental relief. Acute and chronic pain associated with IC can now be effectively managed using a multimodal approach with PPS as the basis.

Administration, Intravesical↗

PubMedDate not supplied

Chronic pelvic pain of bladder origin: a focus on interstitial cystitis.

Chronic pelvic pain afflicts some 9,000,000 women in the United States. Of these, perhaps 10%-although the true number of those affected is actually much greater-are found to have interstitial cystitis (IC), that is, pain of bladder origin. The etiology is multifactorial, but a fairly good marker is dysfunction of the glycosaminoglycan/mucus/mucin layer of the bladder as detected by a potassium (KCl) sensitivity test. A cascade starting with Substance P seems to be involved in generating inflammation, and even ulceration, which is the focus of pain. This article describes means of diagnosis, including the KCl test and cystoscopy, and both U.S. FDA-approved and extended-use medical treatment options which are always to be attempted before the final step of surgery.

Cystitis, Interstitial↗