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Biomedical subjects

R M Decter

Publications and source records attributed to R M Decter.

9 recordsLinked to original sources
PubMed1992

Pitfalls in determination of leak point pressure.

To evaluate the influence of the technical aspects of leak point pressure measurement we performed water cystometry and determined the leak point pressure in 23 patients 5 weeks to 21 years old with neurogenic bladders. We initially assessed the influence of catheter size on the leak point pressure and determined that the measured pressure varied in direct proportion to the catheter diameter. We further evaluated the effect of the method of infusion (gravity drip versus pump) and the infusion rate on pressures measured by a transducer in an in vitro setting. Using the gravity drip infusion technique pressure measurement was adversely affected by smaller catheter size and rapid infusion rate. With the pump infusion system neither catheter size nor infusion rate adversely affected pressure measurement. We conclude that the clinical measurement of the leak point pressure during water cystometry is influenced by the catheter size, and it is dependent upon the technique and rate of infusion. We believe that standardization of the technical aspects of leak point pressure determination would provide for reproducible results and facilitate comparisons of reports among different investigators.

Adolescent↗
PubMed1992

Transurethral electrical bladder stimulation: initial results.

Transurethral electrical bladder stimulation to rehabilitate the neurogenic bladder initially proposed by Katona has been promoted in the United States by Kaplan and Richards since the mid 1980s. Encouraged by their results, 2 1/2 years ago we instituted a program patterned on their experience. Since January 1989 we performed transurethral electrical bladder stimulation in 21 patients ranging in age from 4 months to 26 years. The cause of the neurogenic bladder was myelomeningocele in 16 patients, lipomeningocele in 4 and an incomplete spinal cord injury in 1. The stimulation was performed using equipment supplied by Kaplan and Richards, and the stimulation protocol followed their recommendations. The treatments were delivered in daily sessions of 90 minutes with about 20 sessions in a series. Of the patients 11 have undergone 1,6 have finished 2 and 4 have completed 3 series of stimulation. The ultimate objective of the program is to achieve volitional voiding. To reach that goal the stimulation must engender a bladder contraction that must then be perceived and ultimately controlled. Of our patients 20 (95%) achieved bladder contractions during stimulation, including 12 (60%) who had either a definite (7) or probable (5) sense of these contractions. To date, only 1 patient has started the biofeedback program to attempt to modify detrusor activity and he is presently wet on clean intermittent catheterization. Parents of 5 other children report minor positive changes in the child's perception of the bladder activity. Three patients noticed an improvement in the bowel program, although the effect only lasted during the month of stimulation in 1. Cystometrograms were performed before each series of treatments. Of the 10 patients with serial studies 2 had significant increases in bladder capacity and 3 demonstrated a clinically significant decrease in the end filling pressures. We have seen limited encouraging results from transurethral electrical bladder stimulation. This is a time-consuming, labor intensive program, and the parents and patients need to be informed of the actual potential for dramatic improvements.

Adolescent↗
PubMed1991

M inverted V glansplasty: a procedure for distal hypospadias.

Minimal hypospadias is a commonly encountered anomaly. Duckett's innovative meatoplasty and glanuloplasty (MAGPI) procedure has become a standard operation for the correction of these lesions. Although usually successful, the complication of meatal retraction has been recognized at times after a MAGPI. The M inverted V glansplasty was designed to address the factors leading to meatal retraction and the abnormal glans shape sometimes seen after the MAGPI. The M inverted V glansplasty derives its name from the initial M-shaped incision that reconfigures during the course of the procedure into an inverted V. Of 16 boys followed for more than 2 months after an M inverted V glansplasty 14 have achieved good results. The remaining 2 cases had a definite degree of meatal retraction but because of the meatal and glanular relationships they have a good cosmetic result. The technique, its indications and its limitations are described.

Child↗
PubMed1989

Individualized treatment of ureteroceles.

We reviewed 52 children with ureteroceles in an effort to evaluate the various facets of this disorder that influenced our surgical management. There were 12 single system ureteroceles and 40 duplex system ureteroceles. Total reconstruction was performed in 16 duplex system and 8 single system ureteroceles, of which 88 per cent required no further surgery. Upper pole heminephrectomy or ureteropyelostomy with partial ureterectomy was performed in 22 patients with duplex system ureteroceles with the goal of obviating lower tract surgery, of whom 12 (55 per cent) required subsequent surgery. In 6 patients, 4 with single system and 2 with duplex system ureteroceles transurethral incision of the ureterocele was the initial procedure with the expectation that improvement in function and hydronephrosis would facilitate subsequent lower tract surgery. Two of these patients required subsequent reconstruction. Recommendations regarding management are based on initial pathological condition, patient age and the presence of a single or duplex system ureterocele.

Child, Preschool↗
PubMed1988

Vesicoureteral reflux in boys.

The natural history of vesicoureteral reflux in children is well documented. In most series girls comprise the majority of the children followed. We reviewed the presentation and course of 86 boys with primary vesicoureteral reflux to define the nature of reflux in that selected population. Of the boys 25 per cent presented when they were less than 3 months old and the youngest tended to have the most severe reflux. Presentation was usually with urinary tract infection but 14 per cent had dysfunctional voiding symptoms without urinary tract infection. Based upon their presentation and initial evaluation the patients were allocated to 1 of 3 treatment protocols: observation, chemoprophylaxis or surgery. No renal parenchymal loss was detected in the boys on observation. Surgical therapy was free of serious complications. Over-all, this modified approach to the management of reflux in boys is acceptable although further followup will be required to confirm these initial conclusions.

Cystoscopy↗
PubMed1988

Use of the AS800 device in exstrophy and epispadias.

Urinary continence is one of the more difficult goals to achieve in patients with exstrophy or epispadias. The artificial genitourinary sphincter provides an alternative to reconstruction of the bladder neck for management of this problem. Although excellent continence can be obtained with bladder neck reconstruction, results of a second procedure of this type seldom are reported. We used the AS800 device in 16 patients with exstrophy and epispadias, 13 of whom had undergone a prior bladder neck operation. We defined our results as total success and continence success, and have achieved over-all rates of 69 per cent (excludes those awaiting revision) and 90 per cent (those with an active device), respectively. Although the frequency of revision and erosion was significant, the ultimate outcome in this difficult patient group was satisfactory.

Adolescent↗
PubMed1988

Hypospadias repair by bladder mucosal graft: an initial report.

Surgical correction of major hypospadias defects is a challenging problem. Bladder mucosa has been reported as an excellent tissue for construction of a neourethra. We used bladder mucosa in 13 boys to create 15 neourethras when there was inadequate preputial skin to perform a vascularized pedicle flap or a free preputial graft. In 3 cases a bladder mucosa graft was used for initial repair of the hypospadias. All other boys had undergone prior hypospadias surgery. In 4 boys the initial result was satisfactory. Seven minor complications occurred in 5 boys, while 4 had more major complications. In 2 boys severe problems with stricture necessitated graft replacement and a satisfactory outcome has not been achieved. Our problems with stricture and stenosis seem to be related to the use of a subcutaneous tunnel for the graft bed and coring of the glans to create the meatus. Over-all, in 11 of the 13 boys the bladder mucosal graft provided an excellent resolution of the complex problem with easily managed postoperative complications.

Child↗
PubMed1988

Bladder augmentation in the pediatric age group.

In summary, enterocystoplasty has become an effective, safe and very useful addition to management of vesical dysfunction in children. The use of bladder augmentation has become more universally accepted with the recognition of the safety of clean intermittent catheterization and the development of efficient antireflux mechanisms when ureteral reimplantation into the bowel is required. However, the surgeon who wishes to participate in this endeavor must have a solid foundation and understanding of vesical urodynamics and must be committed to offering these children an ongoing program to manage their life-long problems associated with their primary disease as well as the special need associated with augmentation procedures.

Bladder Exstrophy↗