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Biomedical subjects

Mickey Karram

Publications and source records attributed to Mickey Karram.

6 recordsLinked to original sources
PubMed2006

Various surgical approaches to treat voiding dysfunction following anti-incontinence surgery.

OBJECTIVE: The aims of this study are to report the efficacy of retropubic urethrolysis, vaginal urethrolysis, and cutting of synthetic suburethral slings in treating postoperative voiding dysfunction that occurs after anti-incontinence surgery and to report the recurrence rate of stress urinary incontinence (SUI). METHODS: All patients from January 1996 to October 2003 who presented with voiding dysfunction following an anti-incontinence procedure and who subsequently underwent either retropubic urethrolysis, vaginal urethrolysis, or synthetic suburethral sling takedown were included in the study. Pre- and postoperative irritative symptoms (urinary frequency or urgency), obstructive symptoms (hesitancy, voiding difficulty, and incomplete emptying), and stress urinary incontinence symptoms were obtained in a standardized fashion. The Incontinence Impact Questionnaire and Urogenital Distres Invetory quality of life (QOL) questionnaires were also obtained to objectify these symptoms. Other objective postoperative analysis included simple uroflowmetry, measurement of postvoid residual (PVR), and simple or subtracted cystometry. RESULTS: Forty-four patients were included in the study (suburethral sling takedown = 14, vaginal urethrolysis = 20, and retropubic urethrolysis = 10), 77% of whom had objective follow-up. Preoperatively, 31 patients (70.5%) had irritative symptoms, 41 (93.2%) had obstructive symptoms, and 6 (13.6%) had symptoms of stress urinary incontinence (SUI), while postoperatively, these symptoms were found in 30 (68.2%), 11 (25.0%), and 18 (40.9%), respectively. Postoperatively, 6 patients (17.6%) had a PVR > 100 cc, 5 patients (14.7%) had a bladder contractions, and 16 patients (47.1%) demonstrated the sign or diagnosis of (SUI). Additionally, there was a statistically significant improvement in both QOL questionnaires. CONCLUSIONS: Various surgical approaches may be used to treat voiding dysfunction following an anti-incontinence procedure. Following a vaginal or retropubic urethrolysis or takedown of a synthetic suburethral sling, obstructive symptoms are likely to improve, irritative symptoms may remain unchanged, and almost half will develop recurrence of SUI.

Adult↗
PubMed2006

Management of incontinence for family practice physicians.

Family practice physicians are likely to encounter urinary incontinence and overactive bladder (OAB) in their patients. An informed family practice physician can generally accurately diagnose the cause and type of incontinence in patients with a properly focused physical examination and, if necessary, auxiliary testing. Accurate diagnosis can lead to effective treatment when physicians are familiar with available treatment options, including pharmacologic, surgical, behavioral therapies, and catheterization.

Family Practice↗
PubMed2006

A prospective study examining the anatomic distribution of nerve density in the human vagina.

INTRODUCTION: Women possess sufficient vaginal innervation such that tactile stimulation of the vagina can lead to orgasm. However, there are few anatomic studies that have characterized the distribution of nerves throughout the human vagina. AIM: The aim of this prospective study was to better characterize the anatomic distribution of nerves in the adult human vagina. A secondary aim was to assess whether vaginal innervation correlates with the subject's demographic information and sexual function. METHODS: Full-thickness biopsies of anterior and posterior vagina (proximal and distal), cuff, and cervix were taken during surgery in a standardized manner. Specimens were prepared with hematoxylin and eosin, and S100 protein immunoperoxidase. The total number of nerves in each specimen was quantified. Enrolled patients completed a validated sexual function questionnaire (Female Sexual Function Index, FSFI) preoperatively. MAIN OUTCOME MEASURES: A description of vaginal innervation by location and an assessment of vaginal innervation in association with the subject's demographic information and sexual function. RESULTS: Twenty-one patients completed this study, yielding 110 biopsy specimens. Vaginal innervation was somewhat regular, with no site consistently demonstrating the highest nerve density. Nerves were located throughout the vagina, including apex and cervix. No significant differences were noted in vaginal innervation based on various demographic factors, including age, vaginal maturation index, stage of prolapse, number of vaginal deliveries, or previous hysterectomy. There were no correlations between vaginal nerve quantity and FSFI domain and overall scores. Fifty-seven percent of the subjects had female sexual dysfunction; when compared to those without dysfunction, there were no significant differences in total or site-specific nerves. CONCLUSIONS: In a prospective study, vaginal nerves were located regularly throughout the anterior and posterior vagina, proximally and distally, including apex and cervix. There was no vaginal location with increased nerve density. Vaginal innervation was not associated with demographic information or sexual function.

Adult↗
PubMed2005

The ability of history and a negative cough stress test to detect occult stress incontinence in patients undergoing surgical repair of advanced pelvic organ prolapse.

To determine if a negative preoperative reduction cough stress test is a viable method of detecting occult stress incontinence or urge incontinence in women undergoing surgical repair of advanced pelvic organ prolapse. A retrospective chart review was done on all patients who denied any urinary complaints and had repair of advanced pelvic organ prolapse, grade two or greater, without the addition of an anti-incontinence procedure. Additionally patients had a simple office filling study done at the time of initial examination that failed to show the sign of stress incontinence or detrusor instability. Any urinary dysfunction that developed postoperatively was noted. A total of 53 patients met the inclusion criteria. Of these patients, one patient (1.9%) developed genuine stress incontinence, and one patient complained of urgency (1.9%). Patients without urinary complaints and a negative office filling study, who were present for surgical correction of advanced pelvic organ prolapse, have a low incidence of developing occult stress incontinence. Further work-up would not be cost effective.

Comorbidity↗
PubMed2002

Predicting postoperative voiding efficiency after operation for incontinence and prolapse.

OBJECTIVE: The purpose of this study was to determine the postoperative postvoid residual volume that predicts a voiding efficiency after operation for incontinence and prolapse. STUDY DESIGN: Ninety-nine patients met the criteria for inclusion. The patients' bladders were filled retrograde through gravity, through a Foley catheter, with 300 mL of sterile water, or by subjective fullness. The catheter was then removed, and the patient was asked to void spontaneously into a measured urine collection device ("Texas hat"). A postvoid residual was then calculated (amount voided minus amount inserted). The Foley catheter was reinserted for patients with a postvoid residual of >50%. These patients were instructed to follow-up in the office in 1 week, at which time the test was repeated. This process continued until the patient had a postvoid residual of < or = 50% or was taught intermittent self-catheterization. RESULTS: Ninety patients were available for follow-up. The overall failure rate (defined as cases that required reinsertion of a catheter) was 7.8%. No patient with a postvoid residual of < or = 32% required reinsertion of a catheter. CONCLUSION: With the use of this simple bedside test, voiding efficiency was predicted in 92% of patients who voided > or = 50% of the amount inserted and in 100% of patients who voided > or = 68%.

Female↗