Biomedical subjects

L Partoll

Publications and source records attributed to L Partoll.

4 recordsLinked to original sources

PubMed2000

Suprapubic bladder drainage after extraperitoneal cystotomy.

OBJECTIVE: To observe the effects of cessation of continuous bladder drainage after short-term catheterization in women who had extraperitoneal cystotomies. METHODS: The study population included 84 women, 78 of whom had retropubic urethropexies and six of whom had retropubic paravaginal repairs. Intentional cystotomy was done intraoperatively to assure ureteral patency, bladder integrity, and no inadvertent suture penetration into the bladder. All cystotomies were closed in two layers with 3-0 chromic suture. Suprapubic catheters were placed intraoperatively in all cases. In all women except four with gross hematuria, continuous bladder drainage was stopped and voiding trials were started within 24 hours after surgery. Suprapubic catheters were removed when women spontaneously voided 80% of total bladder volume. RESULTS: Suprapubic catheters were discontinued on average 4.1 days after surgery (range 2.7-14.1 days). Average bladder volume at initial clamping of the suprapubic catheter was 382 mL (range 224-510 mL). At this volume the integrity of the cystotomy should have been challenged appropriately. The women were observed for a minimum of 3 months with no immediate or long-term complications. CONCLUSION: Extraperitoneal cystotomy in a nondependent portion of the bladder does not require continuous bladder drainage for more than 24 hours. This information should allow pelvic surgeons to be more liberal with intraoperative cystotomies if bladder integrity or ureteral patency needs to be confirmed.

Cystostomy↗

PubMed1997

Sacrospinous ligament fixation with transvaginal needle suspension for advanced pelvic organ prolapse and stress incontinence.

OBJECTIVE: To assess the results of sacrospinous ligament fixation with transvaginal needle suspension for the correction of advanced pelvic organ prolapse and stress incontinence. METHODS: Ninety-six women who had pelvic organ prolapse to or beyond the hymen with or without stress incontinence were surgically managed over 3.5 years. Objective follow-up was available on 75 women. The subject group comprised 54 of these women who had stress incontinence and underwent sacrospinous ligament fixation with transvaginal needle suspension. The remaining 21 women who did not have stress incontinence underwent sacrospinous ligament fixation and served as controls. Appropriate vaginal repairs were performed as needed in both groups. RESULTS: The mean duration of follow-up was 24 months (range 7-72) for the subjects compared with 24.3 months (range 3-53) for the controls. Eighteen subjects (33%) developed recurrent prolapse to or beyond the hymen. Additionally, five (9%) subjects developed recurrent stress incontinence and nine (17%) complained of urge incontinence. Four (19%) controls developed recurrent prolapse, two of whom also have urge incontinence. There was no statistical difference in the mean duration of follow-up or the incidence of recurrent prolapse between subjects and controls. CONCLUSION: Despite the absence of statistical significance, we believe that the 33% recurrent prolapse rate associated with sacrospinous ligament fixation and transvaginal needle suspension is clinically important.

Aged↗

PubMed1997

Factors affecting detrusor contraction strength during voiding in women.

OBJECTIVE: To compare voiding mechanisms in continent and stress incontinent women and to assess the effects of aging, childbirth, menopausal status, and anterior vaginal wall relaxation on detrusor contraction strength during voiding. METHODS: Thirty-eight asymptomatic female volunteers underwent a thorough evaluation including multichannel urodynamic testing and instrumented pressure-flow voiding studies. The voiding mechanisms and detrusor contraction strengths, available in 30 women, were compared with those of 70 women evaluated previously with objective evidence of genuine stress urinary incontinence. The effect of age, parity, bladder neck mobility, and anterior vaginal wall relaxation on maximum detrusor pressure was assessed using chi2 and linear regression analyses. Detrusor pressures in premenopausal and postmenopausal women and continent and stress incontinent women were also compared. RESULTS: Four types of voiding mechanisms were identified. All 30 of the continent women voided with a detrusor contraction, compared with 59 (84%) of genuine stress incontinent subjects. The mean +/- standard deviation [SD]) detrusor contraction was significantly stronger in continent women than incontinent women (20.3 +/- 14.2 cm H2O compared with 12.3 +/- 11.0 cm H2O; P < .01). In continent and incontinent subjects, maximum detrusor pressure did not correlate significantly with increasing age, parity, bladder neck mobility, or degree of anterior vaginal wall relaxation. Premenopausal women had significantly higher mean (+/- SD) maximum detrusor pressures than postmenopausal women (16.3 +/- 13.0 cm H2O compared with 11.5 +/- 11.0 cm H2O; P < .01). CONCLUSION: Women with genuine stress urinary incontinence may be more likely to void with a weak or absent detrusor contraction than continent women. Menopausal status was the only factor identified that significantly affected maximum detrusor pressure during voiding.

Adult↗

PubMed1996

Efficacy of nonsurgical therapy for urinary incontinence.

OBJECTIVE: to assess the efficacy of aggressive nonsurgical therapy for urinary incontinence in women and to determine if it is advantageous to perform invasive urodynamic testing prior to initiating treatment. STUDY DESIGN: We subjectively assessed 202 incontinent women three months to four years following nonsurgical therapy for urinary incontinence. Therapy in all patients included behavioral modification in the form of timed voiding and pelvic floor exercises. Depending on the suspected diagnosis and menopausal state, patients were also treated with various combinations of pharmacologic agents and estrogen replacement therapy. Based on initial evaluation, patient preference and referring physician preference, 100 women were started on therapy after a minimal evaluation, while 102 women were treated based on invasive urodynamic testing. A subjective assessment of treatment outcome was made via a telephone interview in which patients were asked standardized questions. RESULTS: One hundred nineteen cases (59%) were subjectively improved or cured with nonsurgical therapy. Performing urodynamic testing prior to initiating therapy did not increase the overall success rate: 69 of 100 patients (69%) treated on the basis of history, physical examination and a minimal office evaluation were improved or cured, while only 50 of 102 patients (49%) having electronic multichannel urodynamic testing were improved or cured. CONCLUSION: All women with urinary incontinence should be initially offered nonsurgical therapy since a large percentage will obtain satisfactory results. It is not beneficial or cost-effective to perform electronic urodynamic testing prior to initiating therapy.

Behavior↗