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Biomedical subjects

R R Dmochowski

Publications and source records attributed to R R Dmochowski.

At least 37 records · Page 2Linked to original sources
PubMed1997

Role of the four-corner bladder neck suspension to correct stress incontinence with a mild to moderate cystocele.

OBJECTIVES: Women undergoing four-corner bladder neck suspension were evaluated for subjective and objective results of the procedure. Patients were evaluated for continence, prolapse, and symptomatic status postoperatively. METHODS: Forty-seven women underwent four-corner bladder neck suspension for moderate cystocele with (44) or without (3) stress urinary incontinence. Mean and median follow-up were 37 months (range 15 to 80). To assess results of the four-corner bladder neck suspension, two sets of outcome measures were used (subjective questionnaire, including patient satisfaction, and objective physical examination, with standing voiding cystourethrogram) to compare pre- and postoperative data. RESULTS: At the time of follow-up, 25 patients (53%) reported no incontinence, 14 (30%) reported one incontinent episode per week, and 8 (17%) reported daily loss of urine. Twenty-seven (57%) had grade I or grade II cystoceles on follow-up examination and voiding cystourethrogram; however, only 12 (26%) experienced recurrent prolapse symptomatology. Overall patient acceptance of the procedure was high (70%). CONCLUSIONS: The four-corner bladder neck suspension is an effective option in the management of moderate cystocele.

Adult↗
PubMed1997

Neuroanatomy of the male rhabdosphincter.

OBJECTIVES: The external striated urethral sphincter (rhabdosphincter) is a tubular muscle sleeve that extends from the prostato-membranous urethra and perineal membrane to the bladder neck. The male rhabdosphincter neuroanatomy remains unclear, and a better understanding of its innervation may provide insight into potential modifications of radical pelvic surgery to improve urinary continence. METHODS: Fresh cadaveric dissections of 12 male hemipelves were undertaken to investigate the neuroanatomy of the urinary rhabdosphincter. RESULTS: Neuroanatomic courses of the nerve supply to the rhabdosphincter revealed that, in the perineum, the perineal nerve (a terminal branch of the pudendal nerve) provided branches directly to the bulbospongiosus muscle and the urinary rhabdosphincter. In the pelvis, the course of the pelvic nerve was as follows: (1) arising from the inferior hypogastric plexus, it had a weblike course beneath the muscle fascia of the levator ani muscle; (2) traveling posterolateral to the rectum, it gave many branches that perforated into the lateral rectum; and (3) at the level of the prostatic apex, still beneath the levator ani muscle fascia (superior fascia), it sent multiple direct branches to the inferolateral aspect of urinary rhabdosphincter. The pudendal nerve traversed the pelvis in the pudendal canal, and, before leaving the pelvis to enter the perineum, it gave an intrapelvic branch that courses with the pelvic nerve to innervate the rhabdosphincter. CONCLUSIONS: Our understanding of the neuroanatomy of what may be the continence nerves has been improved by fresh cadaveric dissection. The rhabdosphincter receives nerve fibers from the pelvic nerve and dual innervation from an intrapelvic branch and a perineal branch of the pudendal nerve. Better understanding of these anatomic findings may have potential surgical significance with respect to improvement in postoperative urinary continence.

Cadaver↗
PubMed1997

Female Stress Urinary Incontinence Clinical Guidelines Panel summary report on surgical management of female stress urinary incontinence. The American Urological Association.

PURPOSE: The American Urological Association convened the Female Stress Urinary Incontinence Clinical Guidelines Panel to analyze the literature regarding surgical procedures for treating stress urinary incontinence in the otherwise healthy female subject and to make practice recommendations based on the treatment outcomes data. MATERIALS AND METHODS: The panel searched the MEDLINE data base for all articles through 1993 on surgical treatment of female stress urinary incontinence. Outcomes data were extracted from articles accepted after panel review. The data were then meta-analyzed to produce outcome estimates for alternative surgical procedures. RESULTS: The data indicate that after 48 months retropubic suspensions and slings appear to be more efficacious than transvaginal suspensions, and also more efficacious than anterior repairs. The literature suggests higher complication rates when synthetic materials are used for slings. CONCLUSIONS: The panel found sufficient acceptable long-term outcomes data (longer than 48 months) to conclude that surgical treatment of female stress urinary incontinence is effective, offering a long-term cure in a significant percentage of women. The evidence supports surgery as initial therapy and as a secondary form of therapy after failure of other treatments for stress urinary incontinence. Retropubic suspensions and slings are the most efficacious procedures for long-term success (based on cure/dry rates). However, in the panel's opinion retropubic suspensions and sling procedures are associated with slightly higher complication rates, including longer convalescence and postoperative voiding dysfunction.

Clinical Trials as Topic↗
PubMed1997

Lower urinary tract dysfunction in patients with gastroparesis.

PURPOSE: We characterized the bladder dysfunction in patients with idiopathic gastroparesis and compared it to findings in those with gastroparesis secondary to diabetes mellitus. MATERIALS AND METHODS: The clinical and urodynamic records of 17 patients with gastroparesis (10 idiopathic and 7 secondary to diabetes mellitus) were retrospectively reviewed. RESULTS: Urinary frequency and difficulty emptying were the predominant symptoms that led to patient referral. Overall this population demonstrated diminished bladder sensation, increased capacity, decreased flow rates, elevated post-void residuals and increased rates of abdominal straining. Patients with idiopathic gastroparesis had more severe dysfunction than those with gastroparesis secondary to diabetes mellitus. CONCLUSIONS: An association between idiopathic gastroparesis and bladder dysfunction exists. These patients have bladder dysfunction that parallels but is more severe than that in patients with gastroparesis secondary to diabetes mellitus. A common autonomic neuropathic syndrome may account for both problems.

Adult↗
PubMed1997

The use of urine cytology for diagnosing bladder cancer in spinal cord injured patients.

PURPOSE: The diagnosis of bladder cancer in spinal cord injured patients is complicated by inflammatory changes caused by long-term indwelling catheters, which make cystoscopic followup difficult. We evaluated cytology as an aid in diagnosing bladder cancer in spinal cord injured patients. MATERIALS AND METHODS: The charts of 208 spinal cord injured patients were reviewed retrospectively from January 1988 to July 1995 to define the value of cytology in the diagnosis of bladder cancer in this population. In all patients at least 1 urine cytology study was done less than 3 months before bladder biopsy. We examined 272 bladder biopsies (several patients underwent more than 1 biopsy at least 1 year apart) with 1 to 6 cytology studies done before biopsy. RESULTS: Cytology results were classified as negative-no malignant cells, inflammation or benign urothelial cells, reactive-atypia or atypical reactive and suspicious-atypical suspicious, keratinizing squamous metaplasia, suspicious for cancer, cancer or dysplastic. A total of 960 cytology specimens was obtained before the 272 biopsies (average 3 before each biopsy). Of 17 patients with cancer 12 had at least 1 prior suspicious urine cytology result. The sensitivity and specificity of cytology were 71 and 97%, respectively, when evaluating only patients with suspicious findings. CONCLUSIONS: The high sensitivity and specificity of multiple cytology studies in this population suggest that cytology is a useful adjunct to improve the detection of bladder cancer in spinal cord injured patients with chronic (longer than 5 years) indwelling catheters. We recommend a minimum of yearly cytology in all high risk spinal cord injured patients with subsequent biopsies in all patients with any suspicious finding.

Humans↗
PubMed1996

Vesica percutaneous bladder neck stabilization.

The Vesica percutaneous bladder neck stabilization (PBNS) represents a minimally invasive surgical procedure for the treatment of stress incontinence caused by hypermobility of the proximal urethra and bladder neck. Since the initial description of the procedure, technique and instrumentation modifications have added to the reproducibility of this operation. Three specific modifications have been incorporated: strong attachment of the stabilization suture to the pubic bone utilizing a bone anchor; incorporation of a full-thickness broad segment of tissue including the endopelvic, pubocervical, and subvaginal fascia as well as vaginal wall in a Z suture; and loose resuspension of the proximal urethra to stabilize the continence mechanism. Cystoscopic verification of suture location precludes bladder entry or distal suture placement. This procedure has been utilized in 71 women with an overall cure rate (no stress incontinence) of 94% at follow-up of 12 months. One retropubic abscess required drainage, and a second patient required excision of a skin sinus tract caused by an infected bone anchor. Urinary retention longer than 3 weeks has not been encountered. Overall morbidity has been minimal. Long-term follow-up of continence status and other procedure-related complications is ongoing. The PBNS provides continence results and complication rates equivalent to those of other retropubic and transvaginal procedures using a minimally invasive outpatient technique.

Endoscopy↗
PubMed1996

Urologic emergencies. Trauma injuries and conditions affecting the penis, scrotum, and testicles.

Urologic emergencies involving the penis, scrotum, and testicles include priapism, paraphimosis, testicular torsion, and Fournier's gangrene. Familiarity with the signs and symptoms of these conditions can lead to prompt diagnosis. Special care is needed in differentiating testicular torsion from the more common condition of epididymitis. Evaluation of trauma injuries of the genito-urinary tract includes classification (blunt or penetrating), assessment of the extent of injury, and urologic consultation if appropriate.

Acute Disease↗
PubMed1996

Penetrating trauma to the penis: functional results.

PURPOSE: The erectile function, cosmetic appearance, indications for surgical exploration and need for specific diagnostic tests were evaluated in patients with penetrating penile trauma. MATERIALS AND METHODS: We reviewed 26 cases of penetrating penile trauma seen during a 4-year period. RESULTS: All patients with corporeal injuries who were followed (73%) were potent. Two patients with minimal corporeal injury who did not undergo exploration did well. Retrograde urethrography did not identify any previously unsuspected urethral injuries. CONCLUSIONS: Excellent functional results may be obtained after penetrating trauma to the penis. Select patients may not require retrograde urethrography and some with minimal wounds, even if involving the corpora, can be treated nonoperatively.

Adolescent↗
PubMed1996

Risk factors for bladder tumors in spinal cord injury patients.

PURPOSE: We evaluated risk factors for the development of bladder tumors in spinal cord injury patients. MATERIALS AND METHODS: A retrospective review was done of all bladder tumors at 1 institution with matched controls for 7 years. RESULTS: We identified 17 malignant and 2 benign tumors. Indwelling bladder catheters and a history of bladder stones were statistically significant risk factors. Four patients with negative biopsies underwent repeat biopsy due to suspicious cytology and cancer was found. CONCLUSIONS: An indwelling urinary catheter and a history of bladder stones are statistically significant risk factors. Cytology and biopsy are complimentary in the evaluation of urothelial malignancy in this population. A high index of suspicion and thorough evaluation are needed in spinal cord injury patients.

Aged↗
PubMed1996

Percutaneous bladder neck suspension: technique and results.

Percutaneous bladder neck stabilization (PBNS) represents a minimally invasive surgical procedure for the treatment of stress incontinence caused by hypermobility of the proximal urethra and bladder neck. Since the initial description of the procedure, technique and instrumentation modifications have added to the reproducibility of this operation. Three specific modifications have been incorporated into this procedure: strong anchoring of the suspension suture to the symphysis pubis using a bone anchor, incorporation of a broad segment of vaginal wall with a Z suture, and loose resuspension of the proximal urethra. Cystoscopic verification of suture location precludes bladder entry or distal suture placement. This procedure has been currently used in 71 women with an overall cure rate of 94% (no stress incontinence) at follow-up of 12 months. One retropubic abscess required drainage. A second patient required excision of a skin sinus tract cause by an infected bone anchor. Urinary retention of > 3 weeks has not been encountered. Overall morbidity has been minimal. Long-term follow-up of continence status and other procedure-related complications is ongoing. PBNS provides equivalent continence results and complication rates as compared with other retropubic and transvaginal procedures with a minimally invasive outpatient technique.

Female↗
PubMed1995

Non-operative management of the urinary tract in spinal cord injury.

Various options exist for the management of the lower urinary tract in chronic spinal cord injury. These options include chronic indwelling catheterization, urethral sphincterotomy, and intermittent catheterization supplemented with anticholinergic agents. Sixty-four spinal cord injured patients, treated with intermittent catheterization and anticholinergic therapy, were evaluated for long-term efficacy in maintaining upper tract status and preservation or improvement in continence. Complications of therapy were also evaluated. Therapy was based upon initial urodynamic evaluation followed by limited subsequent evaluation of the urinary tract. Mean follow-up was 54 months. Only 1 patient developed hydronephrosis. Fifty-nine patients either became continent or experienced improved continence on therapy. Eight patients required surgical procedures either to increase outlet resistance (2) or to decrease intravesical pressures (6). The most common complication of therapy was urinary tract infection. Thirty-nine infections occurred in 23 patients, 16 of which were febrile. Fifteen patients were non-compliant with treatment recommendations. The only factor related to therapeutic complications which reached statistical significance was non-compliance with therapy. The combined use of intermittent catheterization and anticholinergic agents provides an effective means to prevent hydronephrosis and establish continence in chronic spinal injury.

Adolescent↗
PubMed1994

The risk of rhabdomyolysis and acute renal failure with the patient in the exaggerated lithotomy position.

Rhabdomyolysis with subsequent renal failure has been well documented as a complication of major trauma. However, this complication from elective urological procedures is less well recognized. In 10 patients who underwent elective urethroplasty serum levels of creatine kinase and urinary myoglobin were examined preoperatively and postoperatively. These patients were placed in the lithotomy position for several hours and had minimal muscle dissection. Serum creatine kinase was noted to increase significantly postoperatively to greater than 1,000 units and in 1 patient myoglobin was detected in the urine. This finding indicates that there is, indeed, a risk of muscle injury and potential rhabdomyolysis in these patients from the use of the exaggerated lithotomy position.

Acute Kidney Injury↗