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Biomedical subjects

P K Sand

Publications and source records attributed to P K Sand.

At least 19 recordsLinked to original sources
PubMed1991

Simple standing incremental cystometry as a screening method for detrusor instability.

One hundred consecutive neurologically normal women complaining of urinary incontinence underwent standing incremental retrograde medium-fill water cystometrograms on two different days followed by sitting and standing continuous retrograde medium-fill water urethrocystometry on a third visit between November 1987 and February 1989. Studies were done to assess the reproducibility, sensitivity, specificity, and predictive values of a simple cystometer. Standing incremental, retrograde cystometry was found to be relatively inexpensive, simple, reproducible, and sensitive. The two cystometrograms yielded similar results in 84% of the patients. The sensitivities were found to be 84.3 and 90.2% for the first and second cystometrograms, respectively. Using both cystometrograms together, we were able to detect detrusor instability with a sensitivity of 92.3% and to predict its absence with a negative predictive value of 86.7%. Detrusor instability was found in 64% of these patients. Based on these results, it was concluded that when multichannel urodynamics are not available in a high-prevalence population, standing retrograde incremental water cystometry done on two occasions may offer the physician an accurate alternative for the diagnosis of detrusor instability.

Adult↗
PubMed1990

The prognostic significance of augmentation of urethral closure pressure and functional length.

Sixty-one women with genuine stress incontinence undergoing preoperative and postoperative multichannel urodynamic investigation were tested with augmenting urethral closure pressure profiles during contraction of the pelvic floor muscles to assess voluntary control of the urethral "sphincter." Increases of 20% or more above resting functional length and closure pressure were selected as indicators of augmentation. The presence or absence of augmentation of functional urethral length and/or closure pressure during pelvic floor contraction allowed for the grouping of these patients into six subgroups which were compared for urinary symptoms, prior anti-incontinence procedures and the presence of low urethral pressure, detrusor instability and genuine stress incontinence both pre- and postoperatively. Evaluation of the patient's ability to augment functional length and closure pressure did not affect surgical success nor did its presence or absence correspond to the presence of a low pressure urethra, detrusor instability, or specific urinary symptoms. Evaluation of augmentation of functional length and closure pressure was therefore felt to be of no prognostic value during the performance of multichannel urodynamic testing in incontinent females.

Adult↗
PubMed1990

Cystometry, urethrocystometry, and videocystourethrography.

A number of techniques are available to detect detrusor overactivity. The test best suited to an individual investigator is a function of expertise, frequency of use, cost, availability, and ability to interpret the testing method. Even the simplest methods may be used effectively when the examiner understands the test and its limitations. Many investigators will find it useful to use more than one of these techniques. It is in the patient's best interest for her physician to maintain a reasonable index of suspicion and continue testing rather than submit her to inappropriate therapy based on an inadequate evaluation.

Cystoscopy↗
PubMed1990

Nonsurgical treatment of detrusor overactivity in postmenopausal women.

Detrusor overactivity with subsequent urge incontinence becomes increasingly more prevalent as women age. Because of that, most women treated for detrusor instability and hyperreflexia are postmenopausal and are not always good candidates for the same treatments given to their younger counterparts. Nonsurgical treatments of detrusor overactivity are available to postmenopausal women.

Aged↗
PubMed1989

Unsuccessful Burch retropubic urethropexy: a case-controlled urodynamic study.

A retrospective comparison was made of the urodynamic parameters of urethral sphincteric function of 21 women with failure of modified Burch retropubic urethropexy and 21 matched control subjects in whom operation was successful. The match criteria included multiple risk factors that contributed to the failure of antiincontinence surgery. The preoperative resting urethral closure pressure and urethral functional length were significantly lower in the study (failure) group than in the control (success) group. These parameters of intrinsic urethral function improved only in the control (success) group after operation. Further study showed that 17 of the 21 patients (81%) in the control (success) group had preoperative closure pressure greater than 20 cm H2O, whereas only five of the 21 patients (24%) in the study (failure) group had initial closure pressure higher than this value. Identification of a low-pressure urethra by preoperative urethral profilometry suggests a greatly increased risk for operative failure.

Adult↗
PubMed1989

Urinary frequency and urgency.

This article reviews the common causes for urinary urgency and frequency in women. The normal aging process and its effect on lower urinary tract function is reviewed. A stepwise evaluation and appropriate diagnostic tests are described. In addition, a wide variety of therapeutic options are discussed.

Adult↗
PubMed1989

Cryosurgery versus dilation and massage for the treatment of recurrent urethral syndrome.

One year after the initiation of a prospective, randomized, crossover trial comparing dilation and massage to urethral cryosurgery utilizing a specially designed urethral cryoprobe, our results show that cryosurgery was more effective in the treatment of recurrent urethral syndrome in women. Ninety-one percent of patients first treated with cryosurgery were successful in achieving relief from their symptoms whereas only 33% of the women initially treated with dilation and massage were successful (P = .005). In addition, cryosurgery was more successful in treating women when they crossed over after failing the other therapy (75% vs. 0%). In total, 21 of 24 patients (87.6%) were treated successfully with one of the two modalities. Nineteen of the 22 patients (86.4%) in this select group treated with cryosurgery during the trial were successful, whereas only 5 of 15 (33.3%) treated with dilation and massage were successful (P = .001).

Cryosurgery↗
PubMed1988

The effect of retropubic urethropexy on detrusor stability.

A group of 86 women with genuine stress incontinence who underwent retropubic urethropexy were evaluated with both pre- and postoperative urodynamics. Twenty of these 86 women (23.3%) also had unstable detrusors preoperatively. Eleven of these 20 women (55%) had stable detrusors after retropubic urethropexy. Five of the 66 patients (7.6%) who had stable detrusors preoperatively were found to have unstable detrusors on postoperative urethrocystometry. The overall cure rate for women with detrusor instability and genuine stress incontinence was only 30%. Analysis of symptoms, previous anti-incontinence procedures, age, parity, and cystometric parameters revealed no differences between those women who had stable detrusors after retropubic urethropexy and those who remained unstable. Similarly, patients whose bladders became unstable after retropubic urethropexy could not be distinguished from those who remained stable. Patients undergoing retropubic urethropexy should understand the possibility that the operation may cause urinary incontinence due to detrusor instability even if it cures their genuine stress incontinence, and that if they have both genuine stress incontinence and detrusor instability, their chances for an operative cure of both conditions are low.

Adult↗
PubMed1988

Incontinence history as a predictor of detrusor stability.

Between January 1983 and July 1985, 218 women underwent preliminary evaluation and urodynamic testing in our laboratory. Their symptoms and urodynamic diagnoses were compared to evaluate the ability of a patient's history to predict the stability of the detrusor. The symptom of stress incontinence was a sensitive detector of genuine stress incontinence (100% sensitivity) but was not very specific (65.2%). The symptoms of urgency and urge incontinence were found to have limited sensitivity (77.9%) and specificity (38.7%) in the detection of detrusor instability. Even patients with isolated complaints of stress incontinence had an incidence of detrusor instability of 34.9%, whereas 76.9% of those with a history of isolated urgency and urge incontinence had detrusor instability. Three percent of patients complaining of either type of incontinence had no objective evidence of incontinence on urodynamic investigation. The results of this study demonstrate that a patient's history is a poor predictor of the underlying cause of incontinence.

Adolescent↗
PubMed1988

Hysterectomy and prior incontinence surgery as risk factors for failed retropubic cystourethropexy.

The effects of prior hysterectomy and incontinence surgery were evaluated retrospectively in 86 women undergoing modified Burch cystourethropexy. These women were evaluated before and three months after surgery with multichannel urodynamic testing. Forty percent of the 50 women with prior incontinence surgery remained incontinent after the cystourethropexy even though 94% of them had undergone anatomic correction. This result was not statistically different from the 28% failure rate in patients without prior incontinence surgery. Forty-two percent of the 62 women who had previously undergone hysterectomy failed cystourethropexy despite anatomic correction in 95%. This finding was significantly different from the 17% failure rate in women without prior hysterectomy (P less than .025). This retrospective analysis suggests that prior hysterectomy may place women at increased risk of continued incontinence following cystourethropexy despite anatomic correction of urethrovesical junction descent. Contrary to the results of other investigators, women with prior incontinence surgery in this study were not found to be at significantly greater risk of incontinence after cystourethropexy.

Female↗
PubMed1987

Cryotherapy for the treatment of proximal urethral condyloma acuminatum.

Between March and November 1985 we treated 89 female patients with condyloma acuminatum of the lower genital tract. All patients were evaluated with colposcopy, urethroscopy and anoscopy. Carbon dioxide laser vaporization was used to treat condylomata in the cervix, vagina, vulva, anus and distal urethra. Urethral involvement by condylomata was found in 31 patients (35 per cent). Eight patients had biopsy proved proximal urethral condylomata (9 per cent). Cryotherapy was used to treat these lesions. Six patients required only 1 treatment, while 2 required 2 treatments to cure the proximal urethral condylomata.

Adult↗
PubMed1987

Supine urethroscopic and standing cystometry as screening methods for the detection of detrusor instability.

Two hundred eighteen women undergoing multichannel urethrocystometry were also studied with supine urethroscopic cystometry and/or standing single-channel cystometry to evaluate the use of the latter two studies in screening patients at risk for detrusor instability. Thirty-one percent of the women were found to have detrusor instability on multichannel urethrocystometry. Only 24.6% of these patients were detected with supine urethroscopic cystometry, whereas 59.3% were detected with standing single-channel cystometry. The specificity of these tests was better (94.4 and 82.4%, respectively) than the above sensitivities, but analysis of their predictive values confirmed that they are both poor screening tools for populations at risk for detrusor instability.

Adolescent↗
PubMed1987

A urodynamic appraisal of success and failure after retropubic urethropexy.

Fifty patients were evaluated with microtransducer urodynamic evaluation before and three months after retropubic urethropexy. Despite a 92% subjective success rate (46 of 50 patients), 13 patients (26%) were found to be surgical failures on postoperative urodynamic evaluation. Prior incontinence surgery (28 patients) was not a statistically significant risk factor except in those with prior Marshall-Marchetti-Krantz procedures; they were found to be at increased risk of failure (67%) (P less than .001). Prior hysterectomy had no effect on surgical outcome. Functional length in the sitting position was augmented by 4.3 mm (P less than .01) after the modified Burch procedure. However, there was no significant change in closure pressure. Patients who failed incontinence surgery had significantly lower preoperative closure pressures (P less than .005) and functional lengths (P less than .025). Urethral pressure profiles may be used to identify those patients with low-pressure, short urethras; they are at increased risk of surgical failure.

Adult↗
PubMed1987

The low pressure urethra as a factor in failed retropubic urethropexy.

Eighty-six patients with preoperative and postoperative urodynamic studies who underwent modified Burch colposuspensions were divided into two groups, one with a urethral closure pressure of 20 cm H2O or lower, and one with a pressure over 20 cm H2O. The two groups were comparable except for a difference in age (53.3 versus 46.6 years; P less than .01). There were significant differences between the two groups in both preoperative and postoperative functional lengths and closure pressures (P less than .01). The low-urethral-pressure group had a 54% failure rate, compared with 18% in the group with urethral closure pressures above 20 cm H2O (P less than .0005). Low urethral pressure was found to be a significant independent risk factor for patients under the age of 50, but not independent of age in women over 50 years old. Patients under the age of 50 who have urethral closure pressures of 20 cm H2O or lower are at high risk of surgical failure when undergoing a modified Burch colposuspension (P less than .0002). These patients should not be considered appropriate candidates for this procedure.

Adult↗
PubMed1986

Conservative treatment of ectopic pregnancy with methotrexate.

Six subjects with distal ampullary ectopic pregnancies were treated with four doses of intravenous methotrexate (1.0 mg/kg) followed by four doses of leucovorin (0.1 mg/kg, intramuscularly). The diagnosis was established in all cases by laparoscopy following sonography and radioimmunoassay for serum beta subunit of human chorionic gonadotropin. Subjects were followed with daily quantitative serum beta-human chorionic gonadotropin radioimmunoassay and sonography. Five of the six subjects experienced resolution of their ectopic pregnancy without additional surgical treatment. One subject underwent salpingectomy following treatment. Morbidity also included three patients with mild stomatitis or gastritis, and two patients had transient elevations of serum transaminase levels. Two patients had protracted courses and received blood transfusions. The most abrupt response and most uncomplicated courses were experienced in the three subjects with initial human chorionic gonadotropin levels below 1000 mIU/ml. This preliminary experience suggests that methotrexate may be an effective alternative for the treatment of early ectopic pregnancy.

Adolescent↗