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Biomedical subjects

M Karram

Publications and source records attributed to M Karram.

13 recordsLinked to original sources
PubMed2001

A randomized, double-blind placebo-controlled trial of the effects of the 5-hydroxytriptamine(4) agonist cisapride on the female urinary bladder.

OBJECTIVE: Anecdotal reports have proposed the use of the 5-hydroxytriptamine(4) agonist cisapride as a treatment for female voiding dysfunction on the basis of the known prokinetic actions of the medication. The purpose of our study is to assess the effects of this agent on the normal bladder in vivo. STUDY DESIGN: In this randomized, double-blind placebo-controlled trial, patients were randomized to receive either 20 mg cisapride or an identical placebo. They then underwent urodynamic evaluation that included uroflowmetry, multichannel filling cystometry, pressure-flow studies, and a urethral pressure profile. After a washout period of at least 7 days, subjects were then crossed over to the other arm and the tests were repeated. RESULTS: Twenty women without significant urinary incontinence agreed to participate. There was a decrease in the maximum cystometric capacity from 556 mL for placebo to 496 mL for cisapride (P <.001). There was no difference in the detrusor pressure at maximum flow, the maximum detrusor pressure, the flow rate, or the percentage of maximum cystometric capacity voided. CONCLUSIONS: In healthy women, cisapride caused a significant decrease in the maximum cystometric capacity, which could account for the higher reported rates of urinary frequency and urgency with this medicine. There was no evidence that this prokinetic agent improved voiding function.

Adult↗
PubMed2001

High uterosacral vaginal vault suspension with fascial reconstruction for vaginal repair of enterocele and vaginal vault prolapse.

OBJECTIVE: The purpose of this study was to review retrospectively the functional and anatomic outcomes of women who underwent vaginal repair of enterocele and vault prolapse with the use of an intraperitoneal suspension of the vaginal vault to the uterosacral ligaments in conjunction with fascial reconstruction of the anterior and posterior vaginal wall. STUDY DESIGN: Two hundred two women with advanced symptomatic uterovaginal prolapse or posthysterectomy vault prolapse underwent a standard transvaginal procedure to correct their prolapse between January 1997 and June 2000. Anatomic results were assessed by standardized examination from 6 months to 3 years after the operation. Functional results were assessed subjectively and with standard quality of life questionnaires. The average age of the women was 60.3 years. Follow-up data were available for 168 of the 202 women. Fifty-three percent of the women had their uterus in place and underwent a vaginal hysterectomy. The prolapse repair was a primary procedure in 45.2% of the women and was performed for a recurrence or persistence in 54.8% of the women. Sixty percent and 78.6% of women underwent anterior and posterior repair, respectively. Thirty-five percent of the women underwent an anti-incontinence procedure. RESULTS: Eighty-nine percent of the women expressed satisfaction with the results of the procedure. Ten women (5.5%) underwent a repeat operation (by the authors) for recurrence of prolapse in one or more segments of the pelvic floor. Quality of life assessment revealed a significant reduction in all aspects of daily living, when the short forms of the incontinence impact questionnaire and urogenital distress inventory were evaluated before and after the operation. Major intraoperative complications included 5 cases (2.4%) of ureteral injury, 1 case of a small bowel injury, and 1 case of a pelvic abscess that required abdominal exploratory operation and diversion of the colon. CONCLUSION: High uterosacral ligament vaginal vault suspension with fascial reconstruction would seem to provide a durable anatomic repair with good functional improvement in patients with significant complex uterine or vaginal vault prolapse.

Adult↗
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↗
PubMed1999

Pharmacologic causes of female incontinence.

The etiology of female urinary incontinence is complex and multifactorial. Many medications have adverse effects on the lower urinary tract, including the promotion of incontinence in certain women. Medications may cause incontinence through three main mechanisms: decreased intraurethral pressure, increased intravesical pressure, and indirect effects on the lower urinary tract. Careful adjustments of a patient's medications based on a knowledge of pharmacologic mechanisms of action may restore continence in some women.

Age Factors↗
PubMed1999

A bladder-neck support prosthesis for women with stress and mixed incontinence.

OBJECTIVE: To evaluate the safety and efficacy of a bladder-neck support prosthesis, a vaginal device designed to support the bladder neck, in women with genuine stress and mixed incontinence. METHODS: For enrollment, incontinent women underwent a history, physical examination including cotton-swab test, urinalysis, postvoid residual urine, and multichannel urodynamic testing. Those with genuine stress incontinence or mixed incontinence and urethral hypermobility completed 7-day bladder diaries, the Incontinence Impact Questionnaire, and underwent standardized pad tests. They were fitted with a prosthesis and seen weekly to optimize fit and efficacy. At week 5, they underwent repeat evaluations with the best-fitting prosthesis in place. RESULTS: Seventy women were enrolled and 53 completed the 1-month study (29 genuine stress incontinence, 24 mixed incontinence). The mean ages were 50.4 years for genuine stress incontinence (range 24-76) and 55.7 years for mixed incontinence (range 30-88). A statistically significant reduction in incontinence was noted on pad testing (genuine stress incontinence, mean 46.6-16.6 g; mixed incontinence, mean 31.9-6.8 g) and in the bladder diary (genuine stress incontinence, mean 28.6-7.8 losses per week; mixed incontinence, mean 30.2-15 losses per week). Quality-of-life scores improved in both groups. With the device in place, urodynamic testing indicated normalization of urethral function without evidence of outflow obstruction. Subjects found the device comfortable, easy to use, and convenient. Side effects included five urinary tract infections and 23 cases of vaginal mucosal soreness or mild irritation. CONCLUSION: The bladder-neck support prosthesis significantly reduced involuntary urine loss in women with stress and mixed incontinence.

Adult↗
PubMed1998

Teaching the pelvic organ prolapse quantitation system.

OBJECTIVE: The objective of this study was to determine the ease with which the new Pelvic Organ Prolapse Quantitation system could be learned by residents and medical students. STUDY DESIGN: Standardized multiple-choice tests were administered to 51 obstetric and gynecology residents and medical students from 4 community-based and university-based programs. Parallel pretests and posttests were administered in conjunction with a 17-minute video demonstration of the Pelvic Organ Prolapse Quantitation system and with the addition of a visual memory aid. The posttest was repeated 3 months after the video presentation. RESULTS: The use of a 17-minute video significantly enhanced participants' ability to interpret examination findings when expressed in the terminology of the system (mean improvement in scores 33%, P <.0001). Posttest scores were similar regardless of the type of program or exposure to urogynecology faculty. These scores were maintained at the 3-month retesting. CONCLUSION: The Pelvic Organ Prolapse Quantitation system can be effectively taught by means of a public-domain video presentation.

Audiovisual Aids↗
PubMed1996

Pyometra following Le Fort colpocleisis.

The Le Fort colpocleisis is an obliterative procedure used in the treatment of pelvic prolapse in elderly women where prolonged reconstructive surgery or general anesthesia may be medically contraindicated. Advantages include the ability to perform this procedure quickly under regional anesthesia with a low postoperative complication rate. The authors describe a previously unreported complication of partial colpocleisis requiring subsequent hysterectomy. A 92-year-old woman presented with a 10-day history of lower extremity edema and pelvic pain. She had recently undergone a second partial colpocleisis for recurrent pelvic prolapse in which the drainage channels were partially obliterated. Radiologic evaluation revealed an enlarged complex pelvic mass. At the time of laparotomy, an enlarged uterus filled with purulent material was noted which necessitated subsequent hysterectomy. It was concluded that, although uncommon, postoperative infection is a recognized complication of Le Fort colpocleisis. To minimize the chance of abscess, adequate lateral channels should be created and maintained during colpocleisis to allow drainage of postoperative secretions, bleeding and inflammatory exudate.

Aged↗
PubMed1994

Randomized double-blind trial of terodiline in the treatment of urge incontinence in women.

OBJECTIVE: To evaluate the effects of terodiline in women with urge incontinence. METHODS: After a 2-week run-in period, 93 women with urinary frequency and urge incontinence were randomized to either placebo or terodiline, 25 mg twice daily, in a double-blind study for 4 weeks. Symptoms were evaluated using daily frequency-volume charts to record voiding frequency, number of incontinent episodes, absorbent pad use, and quality of life. RESULTS: The terodiline group showed a 70% decrease in the mean (+/- standard deviation) number of incontinent episodes per week (15.8 +/- 24, decreasing to 4.9 +/- 11.9; P < .01), which persisted throughout the study period. The placebo group achieved a 9% reduction in the mean number of incontinent episodes (13.0 +/- 11.3, decreasing to 11.9 +/- 16; P < .05) only in the final week of treatment. Side effects, especially anticholinergic side effects, were more common in the terodiline group, but resulted in only one dropout. Both the treated and placebo groups improved in daytime frequency and quality-of-life indices. CONCLUSION: Terodiline is well tolerated and effective in reducing urge incontinent episodes in women.

Butylamines↗
PubMed1989

Changes in urethral resistance after surgery for stress urinary incontinence.

Seventy women with stress urinary incontinence underwent simultaneous voiding-urethrocystometry using microtip transducers and an 8-channel recorder, before and three to twelve months after either the modified Burch (48/70) or the modified Pereyra (22/70) retropubic urethropexy. Increase in urethral resistance (p less than 0.005) was more marked following the Pereyra procedure (0.042 +/- 0.039 to 0.07 +/- 0.061) and 30 percent experienced postoperative voiding difficulties, compared with the Burch procedure (0.035 +/- 0.029 to 0.055 +/- 0.03) where 20 percent experienced postoperative voiding difficulties. Of those patients who voided without a detrusor contraction prior to surgery (35/70), in 50 percent a detrusor contraction component developed to their voiding mechanism postoperatively (p less than 0.05) and overcame the increased urethral resistance with no postoperative voiding difficulties. In the remaining 50 percent a detrusor contraction failed to develop during postoperative voiding and 90 percent of them demonstrated reduced flow rates and increased use of Valsalva maneuver, and needed prolonged postoperative bladder drainage prior to resumption of spontaneous voiding (p less than 0.005). Inability to develop a detrusor contraction during voiding in face of increased urethral resistance promoted by the incontinence surgery provided a suitable explanation for post surgery voiding difficulties in 20 to 30 percent of patients.

Adult↗
PubMed1989

Urethral syndrome. A comparison of different treatment modalities.

Sixty women with the diagnosis of urethral syndrome were consecutively assigned to one of three treatment modalities. The first group (20 patients) was treated with tetracycline, 2 g/d for ten days. The second group (20 patients) was treated with three serial urethral dilations at two- to three-week intervals, and the third group (20 patients) received placebo for ten days and served as a control group. A detailed clinical evaluation and uroflowmetry were performed before treatment and eight weeks afterwards. A subjective cure, which was defined as an absence of symptoms at the follow-up visits, was achieved in 20% of the placebo group, 50% of the tetracycline group and 75% of the urethral dilation group (P less than .01). An objective improvement in uroflowmetry occurred only in the group treated with serial urethral dilation.

Adult↗
PubMed1988

Detection of human papillomavirus deoxyribonucleic acid from vulvar dystrophies and vulvar intraepithelial neoplastic lesions.

Vulvar biopsy specimens from 16 patients with gross lesions of the vulva consistent with vulvar dystrophy were examined histologically and for the presence of human papillomavirus deoxyribonucleic acid by southern blot hybridization. None of the nonatypical dystrophies probed positive for human papillomavirus; however, three of five atypical hyperplastic dystrophies (vulvar intraepithelial neoplasia) contained human papillomavirus deoxyribonucleic acid type 16. We conclude that human papillomavirus does not seem to be a causal factor in nonatypical chronic epithelial changes of the vulva.

DNA, Viral↗
PubMed1988

Local steroid application for hyperplastic dystrophy of the vulva. Clinical and pathologic evaluation.

Fifteen women complaining of vulvar pruritus of at least three months' duration were evaluated clinically and noted to have white lesions of the vulva consistent with hyperplastic dystrophy. Histologic evaluation confirmed the diagnosis, and all the patients were treated with local application of halocidine cream and crotamiton cream. After six weeks of therapy a repeat clinical and histologic evaluation revealed 13 of the 15 patients to be completely relieved of the vulvar pruritus, and 12 of the 13 were histologically demonstrated to have complete reversal of the hyperplastic process to normal skin. The other two denied any improvement in their pruritus and were histologically noted to have persistence of the hyperplastic process. A good clinical and histologic correlation was noted following local steroid application in patients with histologically proven hyperplastic dystrophy.

Adult↗