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Biomedical subjects

M Heit

Publications and source records attributed to M Heit.

17 recordsLinked to original sources
PubMed2002

Release of tension-free vaginal tape for the treatment of refractory postoperative voiding dysfunction.

OBJECTIVE: To report our experience with surgical release of tension-free vaginal tape (TVT) for the treatment of persistent post-TVT voiding dysfunction. METHODS: A total of 1175 women underwent TVT placement for treatment of genuine stress urinary incontinence and/or intrinsic sphincter deficiency over a 2-year period. Additional procedures and vaginal repairs were performed as indicated. Among these patients, 23 women (1.9%) had persistent voiding dysfunction (urinary retention, incomplete bladder emptying, or severe urgency or urge incontinence) refractory to conservative management. This cohort underwent a simple vaginal TVT release procedure, performed on an outpatient basis. Preoperative characteristics, intraoperative, and postoperative details were assessed by review of operative notes, medical records, and office notes. Continence status was assessed using subjective and objective information. RESULTS: Mean age was 67 years (range 46-86 years), and the mean interval between TVT placement and release was 17.3 weeks (range 2-69 weeks; median 8.6 weeks). For the release procedure, there were no intraoperative complications, and all patients were discharged on the day of surgery. All cases of impaired emptying were completely resolved, and all cases of irritative symptoms were resolved (30%) or improved (70%) by 6 weeks. Fourteen (61%) patients remained continent 6 weeks after the release procedure, six (26%) were improved over baseline, and three patients (13%) had recurrence of stress incontinence. CONCLUSION: Refractory voiding dysfunction after TVT is a relatively uncommon situation and can be successfully managed with a simple midline release procedure. In most cases, the release procedure does not compromise overall improvement in symptoms of stress incontinence.

Aged↗
PubMed2001

Poor surgical outcomes after fascia lata allograft slings.

The objective of this retrospective case control study was to determine whether our poor surgical outcomes were associated with the material used to construct our pubovaginal slings. Autologous rectus fascia was used in 33 patients and cadaveric fascia lata was used in 12 patients who underwent pubovaginal sling placement for intrinsic urethral sphincter deficiency (ISD). Treatment was successful in 78.8% and 33.3% of patients who underwent rectus fascia and fascia lata allograft slings, respectively (P=0.006). Based on regression analysis, the sling material was found to be strongly associated with surgical outcome after controlling for all confounding variables (beta coefficient = 1,204.6, P<0.00005). We conclude that fascia lata allografts are a poor choice for pubovaginal slings.

Adult↗
PubMed2001

The clinical utility of a vaginal template designed to standardize suture placement during retropubic colposuspensions.

Suture placement and bite size utilizing a vaginal template are compared to a traditional surgical approach during modified retropubic colposuspension on four fresh-frozen human female cadavers. Overall, a larger suture bite was obtained utilizing the template (71.5 +/- 4.6 vs 46.7 +/- 25.3 mm2, P = 0.001). However, with increased surgical experience the suture bites obtained with the traditional approach and template technique were similar. Inconsistent suture placement relative to the urethrovesical junction and urethra was observed with both techniques. Differences in pelvic floor anatomy make consistent suture placement with respect to the urethrovesical junction and urethra neither possible nor entirely preferable with either technique. There seems to be little clinical value in the use of this vaginal template during modified retropubic colposuspensions.

Cadaver↗
PubMed2001

Prevention of childbirth injuries to the pelvic floor.

The majority of childbirth injuries to the pelvic floor occur after the first vaginal delivery. Cesarean sections performed after the onset of labor may not protect the pelvic floor. Elective cesarean section is the only true primary prevention strategy for childbirth injuries to the pelvic floor. Alternative primary prevention strategies include elective cesarean section for women with nonmodifiable risks for childbirth injuries to the pelvic floor, antepartum pelvic floor exercises, or intrapartum pudendal nerve monitoring. Secondary prevention strategies must focus on modifying obstetric practices that predispose women to pelvic floor injury. These factors are best delineated for anal incontinence and include restrictive use of episiotomy, mediolateral episiotomy when necessary, spontaneous over forceps-assisted vaginal delivery, vacuum extraction over forceps delivery, and antepartum perineal massage. Finally, tertiary prevention strategies should address the mode of delivery made for women with childbirth injuries to the pelvic floor who desire future fertility.

Cesarean Section↗
PubMed2000

Urinary incontinence in women: evaluation and management.

Because the prevalence of urinary incontinence increases with age, a working knowledge of the diagnosis and treatment of the various types of urinary incontinence is fundamental to the care of women. As the population of the United States ages, primary care physicians can expect to see an increasing number of patients with urinary incontinence. By obtaining a careful medical history and performing a comprehensive physical examination, the primary care physician can initiate successful treatment for the majority of patients without the need for invasive testing. This article offers a comprehensive approach to the evaluation and management of urinary incontinence in women.

Algorithms↗
PubMed2000

Intraurethral ultrasonography: correlation of urethral anatomy with functional urodynamic parameters in stress incontinent women.

To determine whether differences in functional urodynamic parameters can be explained by changes in urethral anatomy, 39 patients underwent intraurethral ultrasonography to obtain a 360 degree view of the urethra. The point of maximal rhabdosphincter thickness was identified in all patients. The thickness, circumference and area of the urethral smooth and skeletal muscle layers were calculated. Data from patient histories and urodynamic evaluations were compared with this anatomical survey. The urodynamic diagnoses were as follows: 10 patients were normal, 24 had genuine stress incontinence and 5 had intrinsic sphincter deficiency. These patients had decreasing rhabdosphincter thicknesses of 3.91, 3.35 and 2.70 mm (P = 0.048). A weak linear relationship was found between maximal urethral closure pressure and rhabdosphincter (r = 0.40, P = 0.013) and longitudinal smooth muscle (r = 0.35, P=0.027) thickness. It was concluded that a loss of urethral resistance as measured by maximal urethral closure pressure is associated with changes in urethral anatomy identified by intraurethral ultrasonography.

Adult↗
PubMed1998

The urinary bladder of a woman is a novel site of luteinizing hormone-human chorionic gonadotropin receptor gene expression.

OBJECTIVE: The female reproductive tract contains functional luteinizing hormone-human gonadotropin receptors; therefore our objective was to test the hypothesis that bladder trigone, which is derived from intermediate mesoderm along the urogenital ridge during embryonic development of the female reproductive tract, may also contain these receptors. STUDY DESIGN: Bladder trigones or domes were biopsied from 15 premenopausal and 19 postmenopausal women undergoing surgical correction of genital prolapse, incontinence, or both. The biopsy specimens were submitted for luteinizing hormone-human chorionic gonadotropin receptor analysis by in situ hybridization and immunocytochemical examination. The receptor immunostaining was visually scored by 3 investigators without knowing the identity of the menopausal status. RESULTS: In situ hybridization demonstrated the presence of receptor transcripts, and immunocytochemical examination revealed the presence of receptor protein in bladder trigone. The bladder trigones from postmenopausal women contained lower levels compared with those from premenopausal women, implying that luteinizing hormone might down-regulate its own receptors. Transitional epithelium contained the highest receptor levels followed by smooth muscle and blood vessels. The bladder dome contained receptor levels similar to those in trigone, which suggests that a common embryologic origin is not the only reason for bladder trigone containing the luteinizing hormone-human chorionic gonadotropin receptors. Rather, they are present because luteinizing hormone-human chorionic gonadotropin may regulate bladder functions in women. CONCLUSIONS: A woman's urinary bladder, which has never been thought of as a gonadotropin target, has now been demonstrated to contain luteinizing hormone-human chorionic gonadotropin receptors. These findings suggest for the first time that gonadotropins directly regulate bladder functions in women.

Adult↗
PubMed1997

Infectious peritonitis complicating suprapubic catheter removal.

Peritonitis following suprapubic catheter placement may result from inadvertent placement of the drain through the large and small bowel and bladder base. The author describes a case of infectious peritonitis which developed after suprapubic catheter removal. The patient, underwent suprapubic catheter placement after Burch Colposuspension for genuine stress incontinence. The catheter was removed with a full bladder after an uneventful postoperative course, but the patient subsequently developed acute infectious peritonitis due to extravasated urine from the cystostomy site. It was concluded that suprapubic catheters should be removed after the bladder is emptied, to prevent this complication. This may be most important in patients who void without residual prior to epithelialization of the cystostomy site.

Adult↗
PubMed1997

An alternative statistical approach for predicting prolonged catheterization after Burch colposuspension during reconstructive pelvic surgery.

Our objective was to use an alternative statistical approach to identify clinical and urodynamic predictors of prolonged catheterization following Burch colposuspension. Seventy women with genuine stress incontinence underwent Burch colposuspension with suprapubic catheter placement at Rush Presbyterian-St. Luke's Medical Center from 1 July 1992 to 1 October 1993. Patient charts were retrospectively reviewed to extract pertinent variables from their history, examination and preoperative urodynamic evaluation. The day of suprapubic catheter removal was considered the end-point 'event' for the purposes of survival analysis. This statistical model allowed us to identify preoperative clinical parameters important in determining the percentage of patients requiring catheters as a function of time. The need for defining prolonged postoperative catheterization was eliminated. Aging (P=0.01), increasing maximal urethral pressures (P=0.02) and menopausal status (P=0.02) were important in determining the percentage of patients requiring catheters as a function of time. Data from our preoperative voiding studies were not predictive of prolonged catheterization following Burch colposuspension.

Adult↗
PubMed1997

Prolonged urinary retention after collagen periurethral injections: a sequela of humoral immunity.

BACKGROUND: Approximately 3% of candidates for collagen periurethral injections are ineligible because of an immediate hypersensitivity reaction to skin testing. After a negative skin test, physicians believe patients should be free of any adverse clinical events from hypersensitivity reactions. We present a patient who developed prolonged urinary retention from a delayed hypersensitivity reaction after negative skin testing. CASE: After a negative skin test, a 51-year-old woman underwent collagen periurethral injections for recurrent genuine stress incontinence associated with a fixed bladder neck. After reporting complete resolution of symptoms, she developed complete urinary retention associated with a delayed hypersensitivity reaction at both the skin test and injection sites. Her retention resolved after a year of intermittent catheterization and antibiotics for persistent urinary tract infection. CONCLUSION: Delayed hypersensitivity reactions may be associated with an adverse clinical event in up to 2.5% of patients despite a negative skin test. After skin testing, physicians should counsel their patients accordingly.

Collagen↗
PubMed1996

Clinical correlates in patients not completing a voiding diary.

Our objective was to determine whether voiding diary non-compliance was an important clinical predictor for the absence of urinary symptoms. History questionnaires and voiding diaries are mailed to all patients before initial visits. The study included 349 patients capable of filling out the history questionnaire and voiding diary prior to their initial visit. The control group (n = 261) consisted of patients who filled out both forms. The study group (n = 88) consisted of patients who filled out their history questionnaire yet left their voiding diary blank. Study variables were extracted by chart review to determine the clinical significance of non-compliance with voiding diary completion. Non-Caucasian patients were less likely to complete their diary (P = 0.008). Patients presenting for treatment of pelvic organ prolapse (no urinary symptoms) were also less likely to complete their diary (P = 0.01, OR 0.41, 0.20-0.85). These patients should be counseled about the importance of the voiding diary in validating urinary symptoms. Urodynamic diagnosis were similar in patients considering surgical correction of pelvic organ prolapse, independent of diary non-compliance.

Case-Control Studies↗
PubMed1990

Radioactive fallout reconstruction from contemporary measurements of reservoir sediments.

The temporal history of atmospheric deposition to a watershed area can be preserved in the sediment of a lake or reservoir that is supplied by the watershed. The 137Cs and isotopic Pu concentrations with depth were determined in the sediments of two reservoirs, Enterprise and Deer Creek, which are located in widely separated regions of the state of Utah. Our data not only reconstruct the history of the total radioactive fallout in the area, but also permit estimating the contributions from global sources and from the Nevada Test Site detonations in the 1950s.

Cesium Radioisotopes↗
PubMed1982

The effects of dissecting tools on the trace element concentrations of fish and mussel tissues.

A comparison of the effects of dissecting tools composed of various materials on the trace element content of the muscle of the marine bluefish, Pomatomus saltatrix, and the soft tissues of freshwater mussels, Eliptio complanatus and Lampsilus radiata, is presented. The fish were dissected with blades made of stainless steel, Lexan plastic, titanium, and Teflon-coated stainless steel. The mussels were dissected with stainless and Teflon tools only. Elements measured included As, Cd, Cr, Cu, Hg, Ni, Pb, Se, Sn, Te, V, and Zn. Significant concentration differences (P = 0.01) were not found for any element in fish or mussel samples dissected by the different tools.

Animals↗