Biomedical subjects

Neil T Dwyer

Publications and source records attributed to Neil T Dwyer.

5 recordsLinked to original sources

PubMed2006

Pediatric kidney stones: long-term outcomes.

OBJECTIVES: To determine the specific risks for recurrent stone disease and which initial evaluations resulted in an effective reduction of risk, we undertook a long-term follow-up study of children who had experienced upper tract urinary stones. METHODS: Identified patients were contacted and interviewed using a structured questionnaire. The patient data were subcategorized and analyzed. RESULTS: The results demonstrated that our population had a recurrence rate similar to the reported adult stone recurrence rates. No evidence was found of impaired growth or development. Our population of noncircumcised boys did not demonstrate a high risk of struvite stones. Surgical techniques have evolved. Anatomic and metabolic factors were not a predictor of an adverse risk of recurrence. Cystinuria may carry extra risk, although our numbers were not sufficient to be sure. CONCLUSIONS: Extensive metabolic screening of children with upper tract urinary stones is not supported by the data from our patients. Testing for cystinuria is justified. The principles of screening and surveillance should match the recommended care of adults with stone formation.

Adolescent↗

PubMed2006

Evaluation and management of malfunctioning sacral neuromodulator.

OBJECTIVES: To describe a strategy for revising the malfunctioning InterStim device and to provide an algorithm for evaluation and management. METHODS: We retrospectively reviewed 82 patients who had undergone InterStim placement. Ten patients (eight women and two men) experienced complications and subsequently underwent revision of their device between October 2001 and October 2003. Five patients had originally received a permanent implant after a successful percutaneous test stimulation trial, and five had undergone a test stimulation using the tined lead. Indications for revision included gradual onset of recurrent voiding dysfunction (n = 2), lead migration (n = 5), generator malfunction (n = 1), generator site pain and infection (n = 1), and genital/rectal pain with stimulation (sensory discomfort; n = 1). RESULTS: Of the 10 patients who underwent revision, 7 experienced complete resolution of their problem. Eight patients had lead site changes and two had generator replacements. No intraoperative or postoperative complications occurred in the revision cases. CONCLUSIONS: In our experience, 70% of patients who undergo revision of the malfunctioning InterStim can expect success. In this study, no difference in success appeared to be related to the original cause of malfunction. In the management of malfunctioning sacral neuromodulators, we recommend an attempt at revision before permanent explantation.

Algorithms↗

PubMed2005

Conservative strategies for the treatment of stress urinary incontinence.

The conservative treatment of stress urinary incontinence for women has many facets. Each intervention may have value and patients may benefit from simple, reversible recommendations and techniques versus invasive surgery. Starting with a thorough history, lifestyle modifications may lead to decreased incontinence. Depending on the patient's goals and clinical situation, they may benefit from a pessary or anti-incontinence device. Finally, the use of pelvic floor muscle exercises has been shown to benefit a significant number of patients. Regardless of the degree of stress urinary incontinence, conservative strategies should be considered a fundamental part of the treatment plan.

Behavior Therapy↗

PubMed2005

An update on slings.

PURPOSE OF REVIEW: The aim of this article is to review the year's literature on the treatment of female incontinence with suburethral slings. RECENT FINDINGS: The use of slings to treat female stress urinary incontinence has had resurgence with new surgical techniques. The tension-free vaginal tape created in 1996 was the basis of most of the studies performed over the past year. The device was compared with more traditional surgical techniques as well as new techniques such as the trans-obturator tape. In addition the tension-free vaginal tape was examined in women with pelvic organ prolapse and older in age. The complications of the device are well known and several studies recounted these with an attempt to predict patients who will have success. Modifications to surgical technique are described to improve patient results as well as further analysis of outcomes with post-surgical urodynamic-based studies. SUMMARY: The majority of papers center on the tension-free vaginal tape and comparing other methods of incontinence surgery with the tape's success. With 7-year data, the device has secured its place in the treatment of female stress incontinence. Newer methods are being explored and are now compared with the tension-free vaginal tape's outcomes.

Female↗

PubMed2005

Renal splenosis presenting as a renal mass.

Splenosis should be considered in the differential of any patient with a history of splenic trauma or removal and a solid enhancing mass near or within the kidney. Splenosis is the autotransplantation of splenic tissue associated with splenic trauma or surgery, and can be diagnosed preoperatively, avoiding unnecessary surgery.

Accidents, Traffic↗