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Karl J Kreder

Publications and source records attributed to Karl J Kreder.

At least 19 recordsLinked to original sources
PubMed2005

Conservative strategies for the treatment of stress urinary incontinence.

The conservative treatment of stress urinary incontinence for women has many facets. Each intervention may have value and patients may benefit from simple, reversible recommendations and techniques versus invasive surgery. Starting with a thorough history, lifestyle modifications may lead to decreased incontinence. Depending on the patient's goals and clinical situation, they may benefit from a pessary or anti-incontinence device. Finally, the use of pelvic floor muscle exercises has been shown to benefit a significant number of patients. Regardless of the degree of stress urinary incontinence, conservative strategies should be considered a fundamental part of the treatment plan.

Behavior Therapy↗
PubMed2005

Two-surgeon versus single-surgeon radical cystectomy and urinary diversion: impact on patient outcomes and costs.

OBJECTIVES: To examine the difference in charges and outcomes between patients who underwent radical cystectomy and urinary diversion by a team of two surgeons versus a single surgeon. METHODS: A total of 63 patients with bladder cancer who underwent the procedures were retrospectively analyzed. Two surgeons sequentially performed the cystectomy and ileal conduit (IC, n = 17) or neobladder (NBL, n = 18) or a single surgeon performed both the cystectomy and IC (n = 21) or NBL (n = 7). Procedure-related charges, hospital charges, operating room time, length of stay, and complications were compared between the two groups. RESULTS: For the IC patients, the two-surgeon team had 60% greater mean surgeon charges (P <0.0001), 23% lower mean anesthesia charges (P <0.0001), 121 minutes shorter operating room time (P = 0.001), and 30% lower operating room charges (P = 0.001). For the NBL patients, the two-surgeon team had 32% greater surgeon charges (P <0.0001), 22% lower anesthesia charges (P = 0.003), 149 minutes shorter operating room time (P <0.0001), and 41% less operating room charges (P <0.0001). No differences were found in total hospital charges. The NBL patients who underwent surgery by two surgeons had a longer length of stay (P = 0.008). No differences were found in complications between the groups. CONCLUSIONS: For IC patients, our data showed no differences in the average overall charges, whether a two-surgeon team or a single surgeon performed the procedure. Additional reductions in hospital charges could offset the greater physician charges in the NBL patients and allow full realization of the benefit from the shorter operative time with the two-surgeon team.

Aged↗
PubMed2005

Association between valsalva and cough leak point pressures and pelvic organ prolapse quantification in women with stress incontinence.

PURPOSE: Women with urodynamically documented stress urinary incontinence (SUI) and urethral hypermobility may have a higher pelvic organ prolapse quantification (POP-Q) stage according to anterior POP-Q measurements. In this study we determined if POP-Q system anterior components representing the urethrovesical junction (anterior wall point Aa/Ba) and/or POP-Q stage has a relationship with leak point pressure testing. MATERIALS AND METHODS: Of the 1,511 women who underwent video fluoro-urodynamics during 1997 to 2003 at our institution 88 with only evidence of SUI with negative Valsalva leak point pressure and positive cough leak point pressure (CLPP) were selected. RESULTS: Average patient age was 58.6 years (range 32 to 89). Of the 88 women 82 had complete POP-Q examinations available, which revealed stages 0 to III in 21 (25.61%), 20 (24.39%), 40 (48.78%) and 1 (1.22%), respectively. The association between POP-Q stage/components and positive CLPP showed no significant difference in mean positive CLPP among POP-Q stages (p = 0.178) or components (p = 0.42 to 0.97). The test for linear trend was not significant (p = 0.636) for POP-Q stages/components (p = 0.40 to 0.93). No significant difference in volume at which positive CLPP occurred was observed among POP-Q stages (p = 0.283) or components (p = 0.13 to 0.75). The proportion of patients with leakage at 200 cc did not differ significantly among POP-Q stages (p = 0.119) or components (p = 0.15 to 0.60). CONCLUSIONS: Analysis of women with urodynamic evidence of SUI with negative Valsalva leak point pressure and positive CLPP did not show any significant association with components of the POP-Q system or with POP-Q stages. Findings support that POP-Q measurements should not be interpreted as indicators of urethral hypermobility when evaluating women with SUI.

Adult↗
PubMed2005

An update on slings.

PURPOSE OF REVIEW: The aim of this article is to review the year's literature on the treatment of female incontinence with suburethral slings. RECENT FINDINGS: The use of slings to treat female stress urinary incontinence has had resurgence with new surgical techniques. The tension-free vaginal tape created in 1996 was the basis of most of the studies performed over the past year. The device was compared with more traditional surgical techniques as well as new techniques such as the trans-obturator tape. In addition the tension-free vaginal tape was examined in women with pelvic organ prolapse and older in age. The complications of the device are well known and several studies recounted these with an attempt to predict patients who will have success. Modifications to surgical technique are described to improve patient results as well as further analysis of outcomes with post-surgical urodynamic-based studies. SUMMARY: The majority of papers center on the tension-free vaginal tape and comparing other methods of incontinence surgery with the tape's success. With 7-year data, the device has secured its place in the treatment of female stress incontinence. Newer methods are being explored and are now compared with the tension-free vaginal tape's outcomes.

Female↗
PubMed2005

Associated pelvic organ prolapse in women with stress urinary incontinence: when to operate?

PURPOSE OF REVIEW: This review discusses recently published data concerning the indications for pelvic organ prolapse (POP) surgery in women who present with stress urinary incontinence (SUI). RECENT FINDINGS: POP can functionally mask SUI. Surgery for POP may unmask occult SUI in many women. Clinically continent women undergoing POP surgery are at risk for developing symptomatic SUI postoperatively. Preoperative identification of occult (and overt) SUI will facilitate the use of an appropriate prophylactic anti-incontinence procedure at the time of prolapse repair. Numerous studies on the preoperative prediction of SUI following repair of POP have been conducted in an effort to determine whether concomitant prophylactic measures should be taken at the time of POP repair to prevent the postoperative unmasking of SUI in women who do not have SUI preoperatively (with or without prolapse reduction). Although the literary evidence available is not sufficient for POP with occult SUI, there is some information available to guide clinicians in deciding when to perform concurrent POP surgery in women who are undergoing primary surgery for SUI. SUMMARY: The intended goal of surgical correction of SUI and POP is durable restoration of normal anatomy and function, with symptomatic relief and avoidance of morbidity. Recommendations regarding when to surgically intervene for POP in women who present with SUI are based on the available literature although contemporary studies are few and include small numbers of patients with no controls. Long-term, randomized, controlled prospective studies of large numbers of patients are indicated.

Age Distribution↗
PubMed2004

Abdominal sacral colpopexy using autologous fascia lata.

PURPOSE: Numerous techniques and materials have traditionally been used to correct vaginal vault prolapse, including cadaveric fascia, synthetic materials and autologous rectus fascia. We report our experience with autologous fascia lata used for abdominal sacral colpopexy. MATERIALS AND METHODS: A retrospective review identified all women who underwent abdominal sacral colpopexy using autologous fascia lata for vaginal vault prolapse with at least 18 months of followup. Preoperative and postoperative pelvic organ prolapse quantification (POP-Q) scores, relevant clinical and operative parameters, treatment efficacy, harvest site morbidity and patient satisfaction were assessed. RESULTS: Ten women underwent this procedure between 1999 and 2001. Mean patient age was 68.3 years (range 55 to 82). Followup was 19 to 42 months (mean +/- SD 30.5 +/- 7.78). Preoperatively POP-Q stages were II to IV in 3, 5 and 2 cases, respectively. Postoperative POP-Q scores improved to and remained at stage II or lower in all 10 patients. Mean operative time was 182 +/- 40.94 minutes (range 136 to 265). Mean blood loss was 107.5 +/- 50.07 cc (range 50 to 200). There was no morbidity associated with fascia lata harvest. Eight of the 9 women alive at review completed and returned the survey. When asked if they could return to how they were before surgery, would they still have the same procedure done and would they recommend the procedure to a friend, all respondents answered yes to each question. CONCLUSIONS: Autologous fascia lata compares favorably in efficacy to that reported for other materials in the contemporary literature and it is not associated with any significant morbidity.

Aged↗
PubMed2004

Efficacy and morbidity of autologous fascia lata sling cystourethropexy.

PURPOSE: Sling cystourethropexy for intrinsic sphincter deficiency has more recently been accepted as effective surgical treatment for all types of stress urinary incontinence. We report our experience using autologous fascia lata for sling cystourethropexy, regarding treatment efficacy, harvest site morbidity and patient satisfaction. MATERIALS AND METHODS: A retrospective data base review identified all women who underwent sling cystourethropexy using autologous fascia lata for stress urinary incontinence. A followup survey study using questionnaires (Black and Urogenic Distress Inventory-6) combined with questions regarding pad use, satisfaction and leg morbidity was done. RESULTS: A total of 100 women who could be contacted and who had undergone autologous fascia lata sling cystourethropexy performed by a single surgeon between 1993 and 2002 were surveyed. Mean patient followup was 4.4 years (range 0.8 to 9.3). Of the women 85% stated that they were dry or improved and 93% were pain-free at the harvest site by 7 days. There was no harvest site infection and no lower extremity thrombotic complication. Of the patients 83% indicated that the procedure had a positive effect on their life with only 4% stating that it had a negative effect, while 77% were satisfied with the procedure, 82% would recommend the procedure to a friend with incontinence and 83% would undergo the procedure if making the decision again. CONCLUSIONS: Autologous fascia lata sling cystourethropexy is associated with high patient satisfaction and treatment efficacy comparable to that of other sling cystourethropexy materials, as determined by questionnaire. Harvest site morbidity is low. Sling cystourethropexy using autologous fascia lata should be considered as a primary surgical approach in women with stress urinary incontinence.

Fascia Lata↗
PubMed2004

Autonomic response to stress in interstitial cystitis.

PURPOSE: Previous studies have documented elevations in indices of sympathetic activity in cats and humans with interstitial cystitis (IC). To examine potential autonomic dysregulation in IC we examined the effects of a laboratory mental stress challenge on blood pressure and heart rate (HR) in patients with IC and healthy controls. MATERIALS AND METHODS: A total of 14 female patients with IC and 14 age matched controls participated in a laboratory session, including a 25-minute mental stress challenge. Systolic blood pressure (SBP), diastolic blood pressure (DBP) and HR were measured at intervals before, during and following the stressor. The level of chronic stress, symptom severity and pain at voiding were assessed. RESULTS: Mean age was 49 years (range 32 to 66). The resting HR of patients with IC (82.02 bpm) was significantly higher than that of controls (63.31 bpm, p = 0.0001). There was also suggested evidence of elevated resting DBP in patients with IC (p = 0.07) but no significant difference in mean resting SBP. Autonomic arousal elicited by the laboratory stressor did not differ between the groups and subjects in each group perceived the task as equally stressful. Patients with IC had significantly elevated HR at each time point compared with controls (p <0.0001) with an average mean difference +/- SD between the groups of 19.5 +/- 4.0 (main effect for group p <0.0001). Although consistent increases in SBP and DBP were observed in patients after baseline, these differences were not significant. CONCLUSIONS: Patients with IC had an increased HR at baseline and throughout a laboratory mental stress challenge compared to healthy age matched women. No differences in HR or blood pressure reactivity were observed between the 2 groups.

Adult↗
PubMed2004

Voiding frequency in a sample of asymptomatic American men.

PURPOSE: There are sparse published data concerning the urinary habits of asymptomatic American men. We studied those urinary habits, as revealed by a 24-hour voiding diary. MATERIALS AND METHODS: Men without lower urinary tract symptoms completed the International Prostate Symptom Score (I-PSS) and a 24-hour voiding diary. Demographic and diary data were analyzed using multivariate linear and logistic regression. RESULTS: A total of 284 asymptomatic males 18 to 66 years old returned interpretable diaries. Subjects voided a median of 7 times in 24 hours (range 2 to 21) with 95% voiding fewer than 12 times daily. Median 24-hour urine volume was 1,650 ml (range 290 to 6,840). Median fluid intake was 2,747 ml (range 500 to 10,520). Of the men 82 (29%) reported at least 1 nocturic episode. The 24-hour frequency was related to total urine volume (beta = 1.2, p <0.001) and total fluid intake (beta = 0.1, p <0.001), inversely related to mean voided volume (beta = -1.1, p <0.001) and lower in white men (beta = 0.1, p <0.02) but independent of age and body mass index. The probability of nocturia was highly related to the nighttime diuresis rate (beta = 15, p <0.001), inversely related to mean voided volume (beta = 1, p = 0.001) and less likely in white men. Median I-PSS was 2 (range 0 to 22). I-PSS increased with age, body mass index and total urinary frequency, and it was lower in white men. CONCLUSIONS: This study suggests that the threshold of 8 to define abnormal urinary frequency may not be correct since more than a third of our sample of asymptomatic men voided more than 8 times daily. It is probably inadvisable to apply a single set of normative values to all American men because of significant variability in regional climates and populations.

Adolescent↗
PubMed2003

The long-term effect of doxazosin, finasteride, and combination therapy on the clinical progression of benign prostatic hyperplasia.

BACKGROUND: Benign prostatic hyperplasia is commonly treated with alpha-adrenergic-receptor antagonists (alpha-blockers) or 5alpha-reductase inhibitors. The long-term effect of these drugs, singly or combined, on the risk of clinical progression is unknown. METHODS: We conducted a long-term, double-blind trial (mean follow-up, 4.5 years) involving 3047 men to compare the effects of placebo, doxazosin, finasteride, and combination therapy on measures of the clinical progression of benign prostatic hyperplasia. RESULTS: The risk of overall clinical progression--defined as an increase above base line of at least 4 points in the American Urological Association symptom score, acute urinary retention, urinary incontinence, renal insufficiency, or recurrent urinary tract infection--was significantly reduced by doxazosin (39 percent risk reduction, P<0.001) and finasteride (34 percent risk reduction, P=0.002), as compared with placebo. The reduction in risk associated with combination therapy (66 percent for the comparison with placebo, P<0.001) was significantly greater than that associated with doxazosin (P<0.001) or finasteride (P<0.001) alone. The risks of acute urinary retention and the need for invasive therapy were significantly reduced by combination therapy (P<0.001) and finasteride (P<0.001) but not by doxazosin. Doxazosin (P<0.001), finasteride (P=0.001), and combination therapy (P<0.001) each resulted in significant improvement in symptom scores, with combination therapy being superior to both doxazosin (P=0.006) and finasteride (P<0.001) alone. CONCLUSIONS: Long-term combination therapy with doxazosin and finasteride was safe and reduced the risk of overall clinical progression of benign prostatic hyperplasia significantly more than did treatment with either drug alone. Combination therapy and finasteride alone reduced the long-term risk of acute urinary retention and the need for invasive therapy.

5-alpha Reductase Inhibitors↗
PubMed2003

Coping strategies in patients with interstitial cystitis: relationships with quality of life and depression.

PURPOSE: Previous research has demonstrated that interstitial cystitis patients experience depressive symptoms and decrements to quality of life. However, to our knowledge the extent to which patients may be able to influence quality of life and depressive symptoms through coping strategies has not been investigated in this population. In a number of other chronic conditions specific coping strategies have been associated with the degree of impairment beyond disease severity. Therefore, the association of coping strategies with depressive symptoms, quality of life and self-reports of pain was assessed in patients with interstitial cystitis. MATERIALS AND METHODS: A total of 64 females with interstitial cystitis were recruited from a urology clinic at a tertiary medical center. Questionnaires assessing depression, quality of life, coping and symptom severity were completed and returned at a clinic appointment. Depression was also measured through a standardized semi-structured interview (Hamilton Rating Scale for Depression). All analyses controlled for age. RESULTS: Patients coping by greater catastrophizing reported greater impairments in various domains, including depressive symptoms, general mental health, social functioning, vitality and pain. Greater venting was associated with greater depressive symptoms and poorer mental health. Seeking instrumental social support was associated with fewer depressive symptoms. CONCLUSIONS: These findings suggest that maladaptive coping strategies are associated with higher levels of depressive symptoms and quality of life decrements in patients with this condition. Psychosocial interventions aimed at increasing adaptive coping may positively impact the female experience with interstitial cystitis.

Adaptation, Psychological↗
PubMed2002

Dynamic magnetic resonance imaging of the female pelvis: the relationship with the Pelvic Organ Prolapse quantification staging system.

PURPOSE: Magnetic resonance imaging (MRI) was performed to determine anatomical correlations with respect to physical examination using the Pelvic Organ Prolapse (POP) staging system. In addition, the standard POP staging system was analyzed to obtain normative data and determine any risk factors for prolapse. MATERIALS AND METHODS: A total of 52 continent women 19 to 67 years old participated in our study. Pelvic MRI was performed at 1.5 Tesla. The vagina, bladder and rectum were opacified. Subjects performed pelvic floor contraction, relaxation and straining maneuvers for T1-weighted imaging. One-way analysis of variance, Fisher's exact test and multinomial logistic regression were used to analyze the data. RESULTS: POP stage is quantified from 0 to IV. Stage was 0 to II in 56%, 27% and 17% of cases. POP stage was not significantly influenced by the number of cesarean sections (p = 0.64) or smoking (p = 0.91) but the number of vaginal deliveries significantly correlated with stage. Women with 1 vaginal delivery were at increased risk for a stage I condition (p = 0.018), whereas those with more than 1 were at increased risk for stage II (p = 0.013). On MRI stages 0 versus I or II differed significantly in regard to bladder descent (p = 0.01 and <0.0001, respectively), while stages 0 versus I differed in regard to levator angle (p = 0.007). No significant staging differences were observed in regard to the posterior urethrovesical angle or stages I versus II with respect to all 3 MRI measurements. CONCLUSIONS: MRI appears to detect anatomically measurable changes in POP stage 0 versus other stages in regard to bladder descent and the levator angle and yet it is not sensitive enough to detect differences in stages I and II. It is not unusual for continent women to have a moderate degree of pelvic prolapse and previous vaginal delivery appears to increase this risk.

Adult↗
PubMed2002

Diurnal cortisol variations and symptoms in patients with interstitial cystitis.

PURPOSE: Little attention has focused on systemic factors that may allow a state of chronic bladder inflammation to be established and maintained in interstitial cystitis cases. Abnormalities of the hypothalamic-pituitary-adrenal feedback system result in poorer regulation of the inflammatory response and are present in many chronic inflammatory and pain conditions, of which some have high co-morbidity with interstitial cystitis. MATERIALS AND METHODS: A total of 48 patients with interstitial cystitis and 35 healthy, age matched controls collected 24-hour urine samples and 3 days of salivary samples at 7 to 8 a.m., 4 to 5 p.m. and 8 to 9 p.m. for cortisol analysis. In addition, they completed a concurrent symptom questionnaire. Prospective symptom diaries also were completed in the month before sampling. RESULTS: Mean urinary or salivary cortisol did not differ in patients and controls. However, patients with interstitial cystitis and higher morning cortisol had significantly less pain and urgency, while those with higher urinary free cortisol reported less overall symptomatology (p <0.05). Relationships with morning cortisol were also observed when controlling for co-morbid conditions known to be affected by the hypothalamic-pituitary-adrenal axis, such as fibromyalgia, chronic fatigue and rheumatoid arthritis. Patients with morning cortisol less than 12.5 nmol./l. were 12.8 times more likely to report high urinary urgency than those with values above this cutoff. CONCLUSIONS: These findings imply that regulation of the hypothalamic-pituitary-adrenal axis may be associated with interstitial cystitis symptomatology and there may be different diurnal hypothalamic-pituitary-adrenal patterns in patients with interstitial cystitis who do and do not have co-morbid conditions. These findings may have treatment implications for patients with interstitial cystitis who have early morning cortisol deficiencies.

Adult↗
PubMed2002

Depressive symptoms and quality of life in patients with interstitial cystitis.

PURPOSE: Previous research suggests that patients with interstitial cystitis have poorer quality of life and higher levels of depressive symptoms. However, most studies to date have been limited by the lack of standard measures to describe the experience of living with interstitial cystitis. In addition, to our knowledge no study has used a structured interview to assess depressive symptomatology. We investigated the extent of depressive symptoms and impaired quality of life in a sample of female patients with interstitial cystitis compared with healthy controls. Relationships among physician rated symptom severity, quality of life and depressive symptoms were also examined. MATERIALS AND METHODS: At a clinic visit 65 female patients previously diagnosed with interstitial cystitis and 40 age matched, healthy controls completed questionnaires on depressive symptoms (Beck Depression Inventory) and quality of life (Medical Outcomes Study 36-Item Short Form), and a structured interview on depressive symptoms (Hamilton Rating Scale for Depression) with trained interviewers. RESULTS: Patients reported compromised quality of life compared with healthy controls across various domains, including physical functioning, ability to function in one's normal role and vitality. They also had more severe depressive symptoms on the 2 depression measures. In patients, greater interstitial cystitis severity was associated with greater compromise in physical and social functioning, and mental health but not in other quality of life domains or depressive symptoms. CONCLUSIONS: A diagnosis of interstitial cystitis is related to poorer functioning in various life domains. Decrements increase with disease severity.

Adult↗
PubMed2002

Combined urinary and fecal diversion using a no bowel anastomosis technique.

PURPOSE: We present the experience at our institution with combined fecal and urinary diversion using 3 variations of a no anastomosis technique that avoids bowel anastomosis. MATERIALS AND METHODS: The charts of 10 female and 2 male patients who underwent the no bowel anastomosis technique were identified and reviewed. Information on the etiology of urination and defecation abnormalities, surgical resolution, complications, hospital stay and other pertinent aspects of management were retrospectively reviewed. RESULTS: Mean patient age was 64 years (range 36 to 83). Of the 12 patients 7 had a history of cancer treated with external beam radiotherapy, while 4 had neurological disorders with combined fecal and urinary incontinence or a history of colostomy. Mean hospital stay was 14.6 days (range 6 to 31) and mean followup was 26.6 months (range 14 to 52). There were no postoperative deaths, although a nonQ wave myocardial infarction occurred in 1 patient. CONCLUSIONS: The no anastomosis technique of combined diversion is recommended in patients with preexisting or planned diversion of the fecal stream. Avoidance of bowel anastomosis makes this technique especially advantageous in those with a history of radiotherapy.

Adult↗