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Biomedical subjects

M E Mayo

Publications and source records attributed to M E Mayo.

At least 19 recordsLinked to original sources
PubMed1992

Lower urinary tract dysfunction in multiple sclerosis.

Previous investigators have shown that in multiple sclerosis failure to empty the bladder was secondary to detrusor-distal sphincter dyssynergia or areflexia. However, our urodynamic evaluation of 46 female and 43 male patients with multiple sclerosis revealed that 63 percent of patients failed to empty their bladders because of a hypocontractile detrusor, and only 6 percent had areflexia. Detrusor-distal sphincter dyssynergia (6%) and bladder neck obstruction (6%) were present in only 12 percent of patients. Hyperreflexia was common (78%) and was associated with hypocontractility in 63 percent of patients. Urgency incontinence was significantly more common in females and voiding difficulty significantly more common in males. Sensation was also reduced in 74 percent of female and 77 percent of male patients. In conclusion, failure to empty the bladder in multiple sclerosis is most commonly associated with hypocontractility, and the combination of hyperreflexia and hypocontractility produces the symptoms of urgency and incomplete emptying.

Adult↗
PubMed1992

Lower urinary tract dysfunction in cerebral palsy.

The urodynamic findings in 33 patients with cerebral palsy referred with lower urinary tract symptoms were reviewed. Difficulty urinating was the predominant symptom in approximately half of the patients and half of these also had hyperreflexia and urgency when full. Three patients had varying degrees of retention and the remaining 14 had difficulty initiating a urinary stream. The other half had urgency incontinence as a major presenting symptom and this was associated in nearly all cases with hyperreflexia. There were 10 adults: 5 with difficulty urinating and 5 with urgency. The more serious manifestations, such as retention, were found only in the adults, suggesting that difficulty urinating may progress in adult life. Classical detrusor-sphincter dyssynergia with bladder wall changes was seen only once, and the cause of difficulty urinating in the other patients seemed to be due to a lack of voluntary control over and the hypertonus of the pelvic floor.

Adolescent↗
PubMed1991

Intraoperative cardiovascular collapse secondary to latex allergy.

An apparent allergic reaction has been noted in children undergoing open urological surgery. This condition is characterized by precipitous hypotension, tachycardia and upper body flushing, and it often causes termination of the procedure. Latex allergy has been identified as the possible inciting event. Contact of latex rubber gloves with intra-abdominal structures (handling bowel) appears to be the most dramatic trigger mechanism for this reaction. We report on 10 patients with latex allergy, 6 of whom have myelomeningocele, who have undergone reconstructive surgery. Severe anaphylactic shock developed intraoperatively in 5 patients and during a barium enema performed with a latex catheter in 1 patient. These 6 patients had previous allergic reactions to latex material, which was not detected preoperatively. In the remaining 4 patients latex allergy was diagnosed preoperatively. A total of 6 patients agreed to a skin prick test to liquid latex. Three patients reacted with a wheal size greater than or equal to a histamine control at a dilution of 1:1,000 and 3 patients at 1:100. In contrast, none of the 5 normal controls reacted to any of the concentrations including full strength latex. A history of exposure to latex products (balloons, surgical gloves, catheters, condoms and so forth) with allergic reactions should heighten surgeon awareness of a potentially severe intraoperative reaction. Furthermore, a skin prick test may be used to screen high risk patients such as those with myelomeningocele. A protocol involving preoperative corticosteroid and antihistamine therapy is recommended.

Adolescent↗
PubMed1990

Reduction in human bladder wall compliance following decentralization.

The urodynamic records of patients who presented with voiding symptoms and/or incontinence, and who had areflexia after conal-cauda equina injury (33) or a radical pelvic operation (31) were examined. In contrast to reported experimental and clinical evidence, we found a higher prevalence of decreased compliance in the patients who had undergone a radical pelvic operation than in those who had sustained conal-cauda equina injury.

Adolescent↗
PubMed1990

Urodynamic studies in children who wet.

The value of urodynamic evaluation was assessed in children with diurnal and/or nocturnal enuresis without overt obstruction or neuropathy. The hypothesis that children with bladder instability and dysfunctional voiding represent 2 separate populations was also examined. A simplified urodynamic method was used to evaluate 191 children and they were divided into 3 groups: 64 had normal bladders which were stable during filling and voiding was co-ordinated and complete; 97 had unstable bladders but voiding was normal and co-ordinated; 30 had dyssynergic voiding and an increased volume of residual urine. The urodynamic evaluations were helpful in distinguishing the large number of children with normal findings in whom the problem was motivational. The children with unstable bladders had a physiological abnormality due to delayed maturation and in these cases anticholinergic and musculotrophic agents were usually helpful. The dysfunctional voiders had serious behavioural problems, were difficult to treat, and often required a multidisciplinary approach. These data indicate that there are indeed 2 distinct groups: 1 with instability alone and 1 with dysfunctional voiding with or without instability. Although infection and/or reflux are common in the former, the more devastating urinary tract changes, particularly heavy trabeculation and elongation of the bladder, occur in the latter group.

Child↗
PubMed1988

Ileocecal bladder augmentation in myelodysplasia.

We discuss 14 children and adolescents with myelodysplasia who underwent bladder augmentation with the ileocecal segment. The bowel was not detubularized nor was the ileocecal valve intussuscepted. Urodynamic evaluation was performed before and after the procedure in 13 patients with a followup of 1 to 8 years. Postoperative capacity and compliance were normal but cecal contractions occurred in 8 patients despite adequate doses of anticholinergics. Reflux was demonstrated at capacity with a cecal contraction in 4 patients but upper tract dilatation and infection were not clinical problems. Three patients required reoperation for complications owing to ureteroileal stenosis and/or urinary tract calculi. Although the clinical results were satisfactory, detubularized segments of bowel with intussuscepted afferent loop valves to prevent reflux may resolve these problems in the future.

Adolescent↗
PubMed1987

Bacteriuria with fever after spinal cord injury.

Urinary tract infection continues to be a common problem among spinal cord injured (SCI) individuals despite the strides that have been made during the last decade in the care of the neurogenic bladder. A critical analysis of the system of drainage compared with the occurrence of bacteriuria with fever (BWF) is reported in a group of 705 SCI patients. At the first year (year 1) follow-up, patients being catheterized by someone else (ICO) were much more likely to have experienced at least one episode of BWF than those on self-intermittent catheterization (SIC) (p less than 0.025) or those using an indwelling catheter (IND) (p less than 0.005). In patients who underwent external sphincterotomy, the incidence of BWF was significantly decreased in year 1 (p less than 0.025) compared to those on ICO.

Bacteriuria↗
PubMed1979

Urodynamic assessment of incontinence after prostatectomy.

There were 15 men with incontinence after prostatectomy who were assessed with a urethral pressure profile and a multichannel filling and voiding study with sphincter electromyography. Of these 15 patients 7 had sphincter weakness alone, 7 had sphincter weakness and detrusor hyperreflexia, and 1 had detrusor hyperreflexia alone. Full urodynamic assessment is essential before treatment can be recommended for incontinence after prostatectomy.

Aged↗
PubMed1979

The value of sphincter electromyography in urodynamics.

Multichannel urodynamic evaluation combined with sphincter electromyography was done on 102 patients. Normal and abnormal activity was defined. When detrusor hyperreflexia occurred in patients with obstruction, idiopathic detrusor hyperreflexia and upper motor neuron disease there was a reflex relaxation of the pelvic floor in 52 per cent of the cases. Electromyographic evidence of dyssynergia was associated with other evidence of sphincter obstruction in 50 per cent of the patients who voided by detrusor contraction and in 9 per cent of the patients who voided by Valsalva's maneuver. A diagnosis of dyssynergia should not be made from the electromyographic evidence alone, especially if the patient strains to void.

Anal Canal↗
PubMed1979

Stomal obstruction of ileal conduits in children: a urodynamic study.

In an attempt to diagnose stomal obstruction before radiological evidence is present, urodynamic perfusion studies were done on 40 children with ileal conduit diversion. Residual urine, capacity, resting pressure and mean emptying pressure were recorded after perfusion of the conduit with normal saline at 10 ml. per minute. Emptying pressure appeared to be the most sensitive parameter of obstruction. Residual urine may be normal in early obstruction and may be increased in the presence of normal emptying pressures in atonic conduits.

Adolescent↗
PubMed1979

Bladder function in children with meningomyelocele: comparison of cine-fluoroscopy and urodynamics.

We have assessed 60 children on an outpatient basis with cine-fluoroscopy combined with urodynamics. Bladder and rectal pressure together with sphincter electromyography were measured during bladder filling under fluoroscopy, which was followed by measurement of rectal pressure and sphincter electromyography during voiding under fluoroscopy. Comparison of the x-ray studies and urodynamics showed that the cystogram alone was not a reliable indicator of ray studies and urodynamics showed that the cystogram along was not a reliable indicator of detrusor function. The sphincter electromyogram during voiding must be interpreted in the face of intra-abdominal pressure changes owing to straining or Credé's maneuver. Residual urine estimations and the appearance of the bladder outflow on fluoroscopy were better parameters of outflow obstruction than sphincter electromyography.

Adolescent↗
PubMed1978

Detrusor hyperreflexia: the effect of posture and pelvic floor activity.

Detrusor hyperreflexia is described in patients with neurological disorders, bladder outflow obstruction, persistent enuresis and in female incontinent patients with obvious neurological or urological disease. Postural changes were present in 60% of the patients and in 45% of the patients examined reflex relaxation of the pelvic floor occurred with the uninhibited detrusor contractions.

Adult↗
PubMed1977

Echinococcal cyst of the kidney.

A renal echinococcal cyst presenting with ureteral obstruction is described. Characteristic diagnostic features, including renal angiography, are discussed. Whereas partial nephrectomy is appropriate for a small closed renal cyst, total nephrectomy is indicated for most large or open cysts.

Echinococcosis↗
PubMed1977

Massive bladder stone.

3 cases of massive bladder calculus are described and are of interest not only because they are rare, but also because of the remarkably few symptoms they produced.

Aged↗
PubMed1976

Intermittent non-sterile self-catheterization.

Fourteen patients suffering from voiding disorders of various aetiologies were taught the art of intermittent self-catheterization. The rationale of this form of treatment is discussed and it is suggested that this regime may play a useful role in the management of patients who are not amenable to surgery or other forms of treatment.

Adult↗
PubMed1976

Single dose intravesical thiotepa as an adjuvant to cystodiathermy in the treatment of transitional cell bladder carcinoma.

Tumour cell implantation may be a factor in the aetiology of recurrent well-differentiated superficial bladder tumours. A prospective trial is reported in which single dose intravesical thiotepa was administered to a group of randomly selected patients immediately after cystodiathermy. A control group of patients was treated by cystodiathermy alone and tumour recurrence in the 2 groups was compared. Significantly fewer patients in the thiotepa-treated group developed recurrent tumour and there was also a significantly reduced incidence of pure vault recurrence in this group. The beneficial effects of adjuvant thiotepa were apparent after 1 treatment. In this series of patients no benefit resulted from the continued use of adjuvant thiotepa once a patient developed a recurrent tumor.

Carcinoma, Transitional Cell↗
PubMed1976

Structure and function of the rabbit bladder altered by chronic obstruction or cystitis.

Decreased muscle contractility has been observed in association with intercellular collagen deposition after acute urinary obstruction. Chronically induced (2 months) bladder neck obstruction in rabbits produced similar marked changes in the ultrastructure of the bladder wall, with widening of the intercellular spaces and formation of collagen. Resting intravesical pressure was greater in animals with bladder neck obstruction than in the controls, yet response to stimulation was not impaired. Bacterial cystitis, in contrast, produced no consistent change in ultrastructure but the response of intravesical pressure to pelvic nerve stimulation was reduced. It is concluded that intercellular collagen deposition is not responsible per se for impaired conduction of nerve stimuli; perhaps discrete conduction pathways exist in the detrusor and the intercellular electrotonic spread of action potentials is not essential for contraction.

Animals↗