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Biomedical subjects

K W Kaye

Publications and source records attributed to K W Kaye.

At least 19 recordsLinked to original sources
PubMed1998

Innervation of the striated muscle of the membranous urethra of the male dog.

PURPOSE: To identify the functional innervation of the striated muscle layer of the post-prostatic urethra of male dogs. MATERIALS AND METHODS: Detailed anatomic dissection of the pelvic and pudendal nerves was carried out. The pressure and contractile responses to stimulation of these nerves were recorded in vivo and in vitro. RESULTS: Small branches of the pelvic nerve entered the membranous urethra but passed through the striated muscle to the inner smooth muscle layer. Stimulation of the nerve with 1 msec pulses at 10 Hz produced a slow contraction of the urethra which was unaffected by d-tubocurarine. Pudendal nerve branches entered the striated layer from the caudal end. Stimulation produced a rapid, visible contraction that was abolished by d-tubocurarine. Field stimulation of isolated strips of striated muscle resulted only in rapid, d-tubocurarine sensitive contractions. CONCLUSIONS: The striated muscle of the membranous urethra is innervated exclusively by the pudendal nerve.

Animals↗
PubMed1998

Prostate specific origin of dipeptidylpeptidase IV (CD-26) in human seminal plasma.

PURPOSE: A number of peptidases which can metabolize certain bioactive peptides and growth factors have been identified in seminal plasma. Our goal in this study was to determine molecular properties and the tissue source(s) for one of these peptidases, dipeptidylpeptidase IV (DPP IV), in human seminal plasma. MATERIALS AND METHODS: We measured the activities of DPP IV with the dipeptide glycylprolyl-p-nitroanalide and its molecular forms using immunoblotting of seminal plasmas of men who were vasectomized or with different sperm concentrations, and in prostatic and seminal vesicle secretions of men undergoing prostatic surgery. RESULTS: DPP IV in seminal plasma of vasectomized men was a membrane associated dimer comprised of subunits of approximately 110 kDa. Its activity did not differ in seminal plasmas of vasectomized, azoospermic, oligozoospermic and normozoospermic men indicating no correlation with the concentration of sperm originally present in the semen. The DPP IV antigen (CD -26) and enzymic activity were present in prostatic secretion, but absent from that of the seminal vesicles. These data indicate that the prostate gland is the primary source of DPP IV activity in seminal plasma. There was little variation in its activities in repeat seminal plasma samples from the same individual, and there was no change in its activity with age to 50 years. CONCLUSIONS: DPP IV in seminal plasma was derived from the prostate gland and it may be useful as a bioindicator of prostate function and/or disease with age in men.

Dipeptidyl Peptidase 4↗
PubMed1997

Urinary continence after radical retropubic prostatectomy. Analysis and synthesis of contributing factors: a unified concept.

OBJECTIVE: To assess the effects of three types of apical dissection on urinary continence after radical retropubic prostatectomy and to evaluate possible contributing factors, e.g. preservation of the bladder neck and preprostatic sphincter, age, anastomotic strictures, previous transurethral resection and nerve-sparing surgery. PATIENTS AND METHODS: Having undergone one of three types of apical dissection, 280 patients were evaluated: in Group 1 (sphincter-damaging) 134 patients underwent the original technique of ligating and transecting the venous complex; in Group 2 (sphincter-repairing), 76 patients had the venous complex with part of striated sphincter incorporated within anastomotic suture(s); and in Group 3 (sphincter-preserving), 70 patients had the venous complex alone ligated using the 'bunching' technique of Myers. The outcome was analysed for the number becoming continent and the time to continence. RESULTS: Continence was achieved in 93% overall, with 90%, 93% and 99% achieving continence in Groups 1, 2 and 3, respectively. The mean time to continence was 68 days overall, taking 100, 52 and 30 days for the respective groups. Twenty patients (7%) did not achieve full continence; 15 had minor incontinence and five severe, with none of the latter being in Group 3. The group (preservation of external sphincter), age and freedom from development of anastomotic strictures were the most important factors both in regaining continence and decreasing the time to continence. CONCLUSIONS: Preservation of as much as possible of the normal anatomy of the sphincter mechanisms and their nerve supplies results in an excellent return to continence after radical retropubic prostatectomy.

Aged↗
PubMed1997

The 'urogenital diaphragm', external urethral sphincter and radical prostatectomy.

BACKGROUND: The present study was performed to determine whether a 'urogenital diaphram' exists, to examine the true nature of the striated external urethral sphincter and to evaluate whether the standard technique for radical prostatectomy damages the external sphincter. METHODS: Fifty radical prostatectomies were performed using optical magnification and the dorsal bunching technique, and the external sphincter was carefully examined. Ten human cadavers and one 5-year-old baboon were dissected with longitudinal (sagittal) and transverse sections being taken through the prostate apex, membranous and bulbar urethrae. During the standard technique for dorsal vein control during radical prostatectomy, the tissue incorporated within the ligature was examined for striated muscle. RESULTS: No 'urogenital diaphragm' could be demonstrated in any human or baboon tissue. The striated external urethral sphincter is a cylinder of muscle surrounding the membranous urethra, extending from the perineal membrane to the prostate and continuing over the prostate as part of the anterior fibromuscular stroma. Striated muscle was present in the ligated material from the dorsal venous complex. CONCLUSIONS: The 'urogenital diaphragm' is a myth. The standard technique of radical prostatectomy significantly damages the external sphincter.

Aged↗
PubMed1995

Percutaneous iodine-125 seed implantation for carcinoma of the prostate.

This study was performed to assess the early results of treating stages T1-T3 adenocarcinoma prostate with either Iodine-125 (125I) implant alone (Group 1), for smaller more well differentiated cancers, or with low dose external beam radiation followed by a 125I boost (XRT + 125I) (Group 2) for larger less well differentiated tumours. Eighty-six patients were followed for between 11 and 60 months with a mean follow up of 26.1. All patients were followed by regular prostate specific antigen (PSA) evaluations, and digital rectal examinations (DRE). Eighty patients had a follow-up biopsy at 1 year. Prostate specific antigen progression-free survival (PSA-PFS) was determined and defined. Complications and potency were also assessed. Early results of 125I prostate seed implantation are very promising especially for selected cases of localized carcinoma.

Adenocarcinoma↗
PubMed1995

Changing trends in urology practice: increasing outpatient surgery.

This study was performed to assess the changes occurring in the field of urology with developments in outpatient surgery during a 5 year period. Using ICD-9-CM code, data for all urology procedures performed in the main operating rooms, day surgery and laser centre operating rooms of a large, general hospital were collected for the years 1987-92. A substitution index (SI) was determined as the ratio of the number of outpatients to the total number of procedures and expressed as a percentage. Changes in the SI reflects the degree to which emphasis has shifted from conventional inpatient to outpatient surgery. It was found that 26% of urology procedures were being performed as outpatients in 1987, and this increased to 42% by 1992. When broken down according to organ, the greatest increase in SI from 1987 to 1992 was for the kidney (57%) and the least, the penis (2%), with ureter, urethra, testes and scrotum all revealing intermediate, but significant, increases (27, 28 and 24% respectively). This paper thus demonstrates that, as in other fields, urology has experienced a marked increase in outpatient surgery. With developments in surgical and anaesthetic techniques, financial pressures, changing physician and patient attitudes and technological advances, further increases in urology outpatient care can be expected.

Ambulatory Surgical Procedures↗
PubMed1995

Detailed preliminary analysis of 125iodine implantation for localized prostate cancer using percutaneous approach.

Recent developments have permitted accurate seed placement and dosimetry for interstitial brachytherapy of selected patients with localized prostate cancer. We present our experience with 76 patients divided into 2 groups. Group 1 included 45 patients with smaller, more well differentiated tumors, usually less than 2 cm. in diameter on digital rectal examination or transrectal ultrasound and a Gleason score of less than 7 who were treated with 125iodine alone. Group 2 consisted of 31 patients with localized tumors greater than 2 cm. in diameter and/or a Gleason sum equal to or greater than 7 who were treated with low dose external beam radiation followed by 125iodine boost 4 weeks later. Complete clinical progression-free survival, including prostate specific antigen, digital rectal examination and biopsy, was 51% for group 1 and 63.3% for group 2, with a mean followup of 26.3 months. Prostate specific antigen progression-free survival was 97.7% for group 1 and 94.7% for group 2. These results appear to be superior to external beam radiation only although longer followup is needed to substantiate these favorable early results. The procedures were well tolerated with good potency sparing. They were performed on an outpatient or short stay basis and provided a good alternative to external beam radiation only or hormonal treatment for select patients with localized prostate cancer who may not be candidates for radical prostatectomy.

Aged↗
PubMed1993

Prostate biopsy indices: toward efficient use of transrectal ultrasound.

With increasing use of transrectal ultrasonography (TRUS) it becomes important to establish guidelines for its appropriate utilization. Three hundred and twenty-two patients with either an abnormal digital rectal examination (DRE) or prostate-specific antigen (PSA), or both, were evaluated further for cancer by means of prostatic ultrasonography. Two hundred and twenty-five (70%) of these underwent ultrasound-guided biopsy, cancer was detected in 74 (23%), and 33 percent of all biopsy specimens were positive. Thus, the indices of biopsy: TRUS (Bx:T), cancer: TRUS (Ca:T), and cancer: biopsy (Ca:Bx) were 70 percent, 23 percent, and 33 percent, respectively. Comparing these indices with other earlier series (TRUS used less selectively) and with more recent series (TRUS used more selectively), suggest that ratios in the range of biopsy: TRUS of 70 percent to 75 percent, cancer: TRUS of 25 percent to 30 percent, and cancer: biopsy of 30 percent to 40 percent may be expected with appropriate use of this imaging modality.

Biopsy↗
PubMed1993

Transurethral ultrasound-guided laser-induced prostatectomy: National Human Cooperative Study results.

Between November 1990 and March 1992, 150 patients at 10 United States institutions were treated with transurethral ultrasound-guided laser-induced prostatectomy (TULIP) for the relief of bladder outlet obstruction secondary to benign prostatic hypertrophy. The TULIP system incorporates ultrasound visualization with a 90-degree angle, side-firing laser to effect coagulation necrosis of prostate tissue. The overall preoperative prostate volume in this TULIP study was 40 cc and all types of prostatic enlargement, including median lobe obstruction, were treated. There were no intraoperative complications, with no hemorrhage or post-transurethral resection syndrome, and no blood transfusions were required. Hospital stay averaged 1.7 days and 83% of the patients went home after a 1-night stay. We evaluated 63 patients at 6 months after the TULIP procedure. Mean symptom scores decreased from 18.8 to 6.1, for a 68% improvement. The mean peak flow increased from 6.7 ml. per second preoperatively to 11.9 ml. per second, for a 78% improvement. Overall, 87% of the patients exhibited at least 50% improvement in either the symptom score or peak flow parameter, while 49% of the patients demonstrated at least a 50% improvement in both parameters.

Equipment Design↗
PubMed1990

Ultrasonographic anatomy of normal prostate gland: reconstruction by computer graphics.

Computer graphic reconstructions of the prostate were made in both the transverse (axial) and longitudinal (sagittal) planes at different levels on the basis of the normal anatomic model of McNeal. Additional images then were created to give a picture of what the ultrasonogram should look like at each level, and these were compared with actual ultrasonograms of the normal prostate. A precise yet simple terminology is suggested for prostate ultrasonographic descriptions.

Adult↗
PubMed1990

Surgery using local anesthesia in the elderly.

Many procedures can now safely be performed in the elderly using local anesthesia. Patients benefit physically, psychologically, and financially. With care, the techniques are easy to learn and simple to perform. Surgeons and the health care system in general benefit by permitting more outpatient surgery. The use of local anesthesia whenever possible and especially in the elderly is to be highly encouraged.

Aged↗