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Biomedical subjects

L S Baskin

Publications and source records attributed to L S Baskin.

At least 55 records · Page 3Linked to original sources
PubMed1999

Fetal genital anatomy reconstructive implications.

PURPOSE: Genital anomalies are not typically diagnosed and/or treated in utero. Recent reports have focused on the prenatal treatment of congenital adrenal hyperplasia. The normal male and female genitalia anatomy is reviewed with an emphasis on reconstructive implications. MATERIALS AND METHODS: Normal fetal genital anatomy was analyzed by serial immunohistochemical staining and 3-dimensional computer reconstruction. RESULTS: The neuroanatomy was analogous in male and female patients, revealing an extensive network of nerves not only at the 11 and 1 o'clock position, but completely surrounding the ventral aspect of erectile bodies. The 12 o'clock position was notable for a lack of nerves which has implications in the design of penile straightening procedures. Ultrastructure of the female corporeal bodies is similar to the male counterpart. Evaluation of a fetal specimen with hypospadias revealed a similar anatomy to the normal penis except at the area of deficient urethral spongiosum. CONCLUSIONS: Attention to anatomical detail will improve surgical techniques for reconstruction in patients with penile curvature and masculinization of the external genitalia.

Female↗
PubMed1998

Length of stay for specialized pediatric urologic care.

BACKGROUND: Pediatric urologic specialists have been excluded from many recent managed care contracts because they are believed to be more expensive and of no better quality than general urologists in managing common urologic problems in children. We believed this to be inaccurate. OBJECTIVES: To compare the length of stay at the University of California, San Francisco Medical Center for 2 common pediatric urologic operative procedures with data from other northern California hospitals and to document our results and patient satisfaction. DESIGN: Retrospective analysis of HCIA statewide database (HCIA Inc, Orange, Conn). SETTING: Northern California, 1995. SUBJECTS: Children younger than 12 years undergoing surgery for repair of an obstruction of the ureteropelvic junction or vesicoureteral reflux. MAIN OUTCOME MEASURE: Length of stay. RESULTS: The length of stay in our hospital was similar to that observed in other hospitals in which other full-time pediatric urologic specialists practiced and was significantly less than that observed in other northern California hospitals, even when adjusted for risk. In fact, a savings of 279 hospital days would have been realized if all patients had the same length of stay as that achieved at University of California, San Francisco Medical Center. In the 38 patients operated on at our center, there was uniform surgical success. Of the parents, 92% (11/ 12) were satisfied with their child's care and 92% (11/ 12) believed they received enough information to know what to expect and how to care for their child at home. There were no data available evaluating quality from other northern California hospitals for comparison. CONCLUSIONS: Our finding that actual and risk-adjusted length of stay were shorter when patients were treated by full-time pediatric urologists, while excellent quality was maintained, suggests that these specialists achieve their results with more efficiency and lower resource utilization than do general urologists. The implication of these results is that exclusive contracting that prevents patients from receiving care from full-time specialists results in overuse of valuable resources and possibly reduced quality. If our results are generalizable, they have important implications for health care reform in the United States.

Academic Medical Centers↗
PubMed1998

Gastrocystoplasty: is there a consensus?

The problems encountered with ileal and colocystoplasty have led to the use of the stomach for bladder augmentation, termed gastrocystoplasty. The advantages of gastrocystoplasty over intestinal segment augmentation include reduced chloride reabsorption, decreased mucus production, decreased urinary infection in the presence of acid urine, extremely low incidence of stones, and avoidance of complications from short bowel syndrome. The gastric patch provides comparable improvements in bladder volume, pressure, and continence. The thick muscular wall of the stomach facilitates ureteric reimplantation as compared with the small intestine, but the rate of stenosis and reflux may not be superior. The disadvantages of the gastric patch include complications of severe systemic alkalosis, which is usually manifest in dehydrated, renal compromised patients, and the hematuria-dysuria syndrome (HDS), which is more prevalent in patients with renal insufficiency, normal pelvic sensation, and urinary incontinence. The postoperative complication rate of gastrocystoplasty is comparable with that of other augmentation procedures and similarly warrants proper selection and close follow-up of patients. In this report we review the literature and present the results, including a discussion of the technique and the pathophysiology of its complications.

Bacteriuria↗
PubMed1998

The correction of congenital penile curvature in young men.

OBJECTIVE: To determine the long-term outcome of multiple parallel plication (MPP) used for correcting congenital penile curvature (with normal urethra and corpus spongiosum), a technique which takes account of the greater force of erection in young men (mean arterial pressure approximately 100 mmHg) than in neonates (approximately 60 mmHg). PATIENTS AND METHODS: All young men who underwent surgical correction of congenital penile curvature using the multiple parallel plication technique between 1992 and 1995 were reviewed, from their charts and by a telephone survey. RESULTS: Ten patients (mean age 22.3 years, SD 4, range 17-29) were identified, all of whom had been followed for more than one year (mean 2.8, SD 1.3, range 1.2-4.8). All 10 patients reported a preoperative curvature of 60-90 degrees; postoperatively, eight of the 10 patients had a successful outcome, based on self-documentation of a straighter penis (eight) and/or satisfactory intercourse (four). Two of these eight requested follow-up plications to correct a residual curvature of 15 degrees. All patients reported feeling the sutures as a small bump on the dorsal aspect of the penis. In one patient this was considered bothersome, but it did not interfere with intercourse. In one patient the curvature recurred 5 weeks after surgery, following intercourse. Another patient was lost to follow-up and could not be evaluated. CONCLUSION: The MPP technique has the following advantages; it entails no dissection of the neurovascular bundle or corpus spongiosum of the tunica, avoiding complications (such as impotence and urethral injury) that may occur with manipulation of these structures; it can be performed under local anaesthesia and can be completed within 30 min; suture cut-through is unlikely because the dorsum (12 o'clock position) of the tunica albuginea is the thickest and hence strongest area of the corporal body; and the straightness of the penis can be determined easily because erection is sustained throughout the procedure. The disadvantages of the MPP technique are; several small bumps from the nonabsorbable sutures may be palpable, and the patient needs to be informed of this preoperatively: aspiration and phenylephrine injection may be required to prevent priapism.

Adolescent↗
PubMed1998

Neuroanatomical changes in the rat bladder after bladder outlet obstruction.

OBJECTIVE: To investigate the histological changes in bladder innervation in response to partial bladder outlet obstruction in a rat model. MATERIALS AND METHODS: Forty-eight adult female rats had their bladder outlet partially obstructed by ligating the proximal urethra over a 20 G angiocatheter; 18 shamoperated rats served as controls. Animals were killed after 1, 2 and 4 weeks, and their bladders evaluated using computerized morphometry. Immunohistochemical staining for neuronal protein gene-product 9.5 (PGP, a general neuronal marker) and enzyme histochemical staining of acetylcholinesterase, adrenergic fibres and nitric oxide synthase were performed. RESULTS: Bladder wall changes after obstruction consisted of a six- to sevenfold increase in bladder volume and weight. Smooth muscle hypertrophy was evident equally at all sample times. Cystometry showed functional alterations in bladder capacity and voided pressures; obstructed animals had markedly increased bladder capacities and higher voiding pressures (obstructed, 80-100 cmH2O; normal, 30-40 cmH2O). Neuronal changes in the obstructed bladder were most dramatic within the cholinergic and adrenergic neurotransmitter systems within and surrounding the smooth muscle bundles, where there was less staining than in control animals. PGP immunoreactivity increased slightly. The L-arginine-nitric oxide pathway appeared unperturbed after obstruction. CONCLUSIONS: These histological findings suggest that neuropathic changes in the bladder after outlet obstruction, including detrusor instability, are mainly the result of anatomical perturbations in the cholinergic and adrenergic pathways.

Animals↗
PubMed1998

Mesenchymal-epithelial interactions in bladder smooth muscle development: epithelial specificity.

PURPOSE: We previously showed that mesenchymal-epithelial interactions are necessary for the development of bladder smooth muscle. Specifically without bladder epithelium embryonic bladder mesenchyme does not differentiate into smooth muscle. We determine whether this process is specific to bladder epithelium or whether epithelial cells from other organ systems induce bladder mesenchyme to differentiate into smooth muscle, as well as whether epithelial age is an important variable. MATERIALS AND METHODS: We recombined 14-day bladder mesenchyme before smooth muscle differentiation with rat epithelium from 14-day, 19-day, newborn and adult bladder, ureter, colon, ileum, stomach, cornea and epidermis. In addition, bladder epithelium was recombined with 14-day embryonic small intestinal, 14-day embryonic gastric and newborn seminal vesicle mesenchyme. All tissue recombinants were grafted under the renal capsule of an adult rat syngeneic host for 3 weeks. RESULTS: Immunohistochemical analysis with antibodies directed against smooth muscle alpha-actin revealed that all epithelial types studied induced bladder mesenchyme to differentiate into smooth muscle, although to different degrees. Induction of smooth muscle was independent of urothelial age. In addition, bladder epithelium induced intestinal, gastric and seminal vesicle mesenchyme to differentiate into smooth muscle and express an overall morphological pattern indicative of the bladder fibromuscular wall. CONCLUSIONS: The mechanism whereby urothelium induces bladder mesenchyme to differentiate into smooth muscle is not specific to embryonic urothelium. Older urothelium and heterotypic epithelium also induce smooth muscle differentiation. With the common use of bowel, stomach and ureteral segments for bladder augmentation it is important to understand the interaction of different types of epithelium with the native bladder.

Animals↗
PubMed1998

Anatomical studies of hypospadias.

PURPOSE: Hypospadias is the most common congenital anomaly affecting the penis. Successful repair depends on an accurate understanding of anatomy. We compared the anatomy of hypospadiac and normal fetal penises. MATERIALS AND METHODS: A fetal penis at 33 weeks of gestation with distal shaft hypospadias was serially sectioned and compared to 10 normal human fetal specimens at 8 to 32 weeks of gestation. Immunohistochemical localization was performed with S-100 protein and protein gene product 9.5 to localize neurons. Blood vessels were localized by the presence of red corpuscles, and immunohistochemical staining with von Willebrand's factor and factor VIII. Three-dimensional computer reconstructions of the nerves, corporeal bodies, tunica and urethra of the hypospadiac and normal fetal penises were compared. RESULTS: Except at the region of the abnormal urethral spongiosum and glans, the hypospadiac and normal penises showed no difference in neuronal innervation, corpora cavernosa and tunica albuginea architecture and blood supply. The nerves started proximally as 2 well defined bundles under the pubic rami superior and slightly lateral to the urethra. As the 2 crural bodies converged into the corpora cavernosa, the nerves diverged, spreading around the cavernous bodies up to the junction with the urethral spongiosum without remaining at the 11 and 1 o'clock positions. Along the entire shaft of the penis there were no neuronal structures at the 12 o'clock position. The most striking difference was in vascularity. In the hypospadiac penis factor VIII immunostaining revealed huge endothelial lined vascular channels filled with red blood cells. In contrast, the normal penis had well defined small capillaries around the urethra that fanned out into the glans. Vascularity was also extensive under the urethral plate. Nerve distribution in the abnormal glans was also less extensive than in the normal penis. CONCLUSIONS: Increased knowledge of normal and hypospadiac penile anatomy with respect to the nerves, corporeal bodies, glans and vascularity is useful for the strategic design of penile reconstructive procedures.

Gestational Age↗
PubMed1998

Long-term benefits of early neurosurgery for lipomyelomeningocele.

PURPOSE: Our previous experience with early neurosurgery for lipomyelomeningocele revealed that patients undergoing repair before age 1.5 years were more likely to have normal bladder function. We evaluate the durability of the urological benefits in patients with lipomyelomeningocele with longer followup. MATERIALS AND METHODS: A retrospective chart review was performed on all patients who underwent urodynamic testing before and after primary neurosurgical repair of lipomyelomeningocele. A total of 43 patients presented between 1983 and 1995 with at least 12 months of followup (median 68, range 15 to 167). RESULTS: Of the 43 patients 36 (84%) maintained stable clinical and urodynamic function, and 7 (16%) had late deterioration, which occurred between 9 months and 8 years postoperatively. Of 19 patients with normal urodynamic studies preoperatively 14 (74%) maintained normal function. Overall, 14 of 43 patients (33%) with lipomyelomeningocele had normal bladder and sphincter function during followup. The principal predictor of long-term normal bladder function was preoperative urodynamic status, since urodynamic studies were preoperatively normal in 13 of 14 patients (93%) who maintained normal bladder and sphincter function. Late neurosurgery was equally efficacious if urodynamic studies were normal. CONCLUSIONS: Our data continue to support early diagnosis and neurosurgical intervention in patients with lipomyelomeningocele, since there is a higher likelihood of normal preoperative function that can be preserved. Furthermore, the results are durable in 84% of cases. However, close followup is necessary, since deterioration can occur up to 8 years postoperatively.

Adolescent↗
PubMed1998

Gastrocystoplasty: long-term followup.

PURPOSE: Gastrocystoplasty is no longer favored at many institutions due to complications, including the hematuria-dysuria syndrome and metabolic alkalosis. We reviewed our experience to determine the advantages and disadvantages of bladder augmentation using stomach body wall. MATERIALS AND METHODS: We retrospectively reviewed the medical records, urodynamic studies, x-rays and laboratory evaluations of 47 children who underwent gastrocystoplasty at our institution between 1986 and June 1997. Parents and patients were contacted by telephone for detailed interviews to validate the medical record and determine whether there had been any changes since the last visit. Followup ranged from 9 months to 11 years (mean 4.4 years). Bladder dysfunction was secondary to spinal dysraphism in 38 children. Other diagnoses included cloacal and bladder exstrophy, posterior urethral valves, a persistent urogenital sinus and bilateral ectopic ureters. RESULTS: Preoperative and postoperative ultrasound studies available for 79 renal units demonstrated a stable or improved upper tract in 75 (95%). Preoperative and postoperative serum sodium, potassium and creatinine levels showed no significant changes. Mean serum chloride decreased 2.7 mEq./l. and bicarbonate increased 3.3 mEq./l. In the 3 patients with renal insufficiency serum bicarbonate increased 8 mEq./l. Mean pressure specific bladder volume at less than 20 cm. water increased 177 cc and mean maximum bladder pressure decreased from 35 to 13 cm. water. Two-thirds of the patients had bacilluria and a fourth reported a symptomatic bladder infection. No patients had bothersome mucus or required routine bladder irrigation. Symptoms consistent with the hematuria-dysuria syndrome were present in 27% of the patients. No patients had symptoms more than once weekly. Symptoms occurred in 75% of the patients without a neurogenic bladder, such as exstrophy or posterior urethral valves, and in 14% of those with neurogenic bladder dysfunction. In 1 case a bladder stone developed 8 years after surgery. Five patients required reoperation for complications related to gastrocystoplasty. No patient had perforation. CONCLUSIONS: Our data show that even after a mean of 4.4 years gastrocystoplasty has significant advantages over intestinal augmentation, including decreased chloride reabsorption, mucous production and urinary infection, and an extremely low incidence of stones and perforation. The gastric patch is associated with metabolic alkalosis and the hematuria-dysuria syndrome, which may be avoided and medically treated with proper patient selection and close followup. The procedure should be avoided in sensate patients with sufficient bowel.

Child↗