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Biomedical subjects

Raymond R Rackley

Publications and source records attributed to Raymond R Rackley.

15 recordsLinked to original sources
PubMed2006

Overactive bladder: a better understanding of pathophysiology, diagnosis and management.

PURPOSE: We reviewed current information regarding the updated definitions, prevalence, etiologies, disease burden, and management of OAB from a number of perspectives, including professional impact and patient quality of life. MATERIALS AND METHODS: Published literature and current treatment concepts were reviewed regarding the understanding and management of OAB. RESULTS: OAB is a symptom syndrome including urinary urgency with or without urinary incontinence, usually with frequency and nocturia. Approximately 17% of the adult population experience OAB. There are evolving theories regarding its pathophysiology and the mechanism of action of the most commonly prescribed pharmacological therapy (antimuscarinic agents). Treatment primarily revolves around improving quality of life. CONCLUSIONS: Behavioral therapy combined with pharmacological therapy often will bring about acceptable outcomes for patients with OAB. Modalities such as botulinum toxin injections, neuromodulation, and various surgical interventions also are showing encouraging results in more refractory patients.

Adult↗
PubMed2006

Reliability and agreement of urodynamics interpretations in a female pelvic medicine center.

OBJECTIVE: To estimate the reliability and interobserver consistency of urodynamic interpretations of female bladder and urethral function. METHODS: Three urogynecologists and three female urologists at a tertiary care medical center reviewed masked, abstracted clinical and urodynamic information from 100 charts, selected for adequate completeness from a consecutive series of 135 women referred for urodynamic testing. For each of the 100 cases, the reviewers assigned International Continence Society filling and voiding phase diagnoses, and overall clinical diagnoses. Raw agreement proportions and weighted kappa chance-corrected agreement statistics (kappa) were used jointly to describe both reliability and interobserver agreement. Reliability was estimated from duplicate reviews, masked and separated by at least 4 months, of each case by each physician. Interobserver agreement was estimated from comparisons of all pairs of responses from different physicians. RESULTS: For clinical diagnosis of stress incontinence (present, absent, indeterminate), the within- and across-physician weighted kappa's were, respectively, 0.78 and 0.68. Corresponding results were 0.40 and 0.13 for detrusor overactivity without incontinence, 0.58 and 0.38 for detrusor overactivity with incontinence, and 0.51 and 0.26 for voiding dysfunction. Standard errors of each kappa were between 0.023 and 0.043. CONCLUSION: In our group, lower urinary tract diagnoses of stress urinary incontinence from both clinical and urodynamic data demonstrated substantial reliability and interobserver agreement. However, by conventional interpretation of kappa-statistics, reliability of diagnoses of detrusor overactivity or voiding dysfunction was only moderate, and interobserver agreement on these diagnoses was no better than fair. Urodynamic interpretations may not be satisfactorily reproducible for these diagnoses.

Diagnostic Techniques, Urological↗
PubMed2005

Laparoscopic and abdominal sacral colpopexies: a comparative cohort study.

OBJECTIVE: This study was undertaken to compare laparoscopic and open sacral colpopexies for efficacy and safety. STUDY DESIGN: Charts were reviewed for 56 patients who underwent laparoscopic sacral colpopexy and 61 patients who underwent open sacral colpopexy. Demographic and hospital data, complications, and follow-up visits were reviewed. RESULTS: Mean follow-up was 13.5 +/- 12.1 months and 15.7 +/- 18.1 months in the laparoscopic and open groups, respectively. Mean operating time was significantly greater in the laparoscopic versus open cohort, 269 +/- 65 minutes and 218 +/- 60 minutes, respectively (P < .0001). Estimated blood loss (172 +/- 166 mL vs 234 +/- 149 mL; P = .04) and hospital stay (1.8 +/- 1.0 days vs 4.0 +/- 1.8 days; P < .0001) were significantly less in the laparoscopic group than the open group. Complication and reoperation rates were similar. CONCLUSION: Laparoscopic and open sacral colpopexies have comparable clinical outcomes. Although laparoscopic sacral colpopexy requires longer operating time, hospital stay is significantly decreased.

Adult↗
PubMed2005

Injectable neuromodulatory agents: botulinum toxin therapy.

Botulinum toxin therapy is a diverse treatment option for various dysfunctions of the lower urinary tract. The limited but growing clinical experience reveals that temporary chemodenervation with reduction or loss of neuronal activity at the target organ may be achieved with minimal risk. This highly favorable risk-benefit ratio in urology is derived from the clinical ability to treat an end-organ condition effectively with controllable site-specific delivery (eg, subcutaneous, intramuscular, or instillation) combined with high affinity for toxin uptake by the peripheral cholinergic nerves. Although many questions remain regarding the optimal use of this minimally invasive option for urologic applications, the opportunity for expanding indications will provide urologists with more options for addressing difficult challenges in voiding dysfunction.

Animals↗
PubMed2005

Sling may hasten return of continence after radical prostatectomy.

OBJECTIVES: To place absorbable slings in 15 men at radical retropubic prostatectomy in an attempt to hasten recovery of continence. METHODS: Fifteen men underwent placement of a sling immediately after prostatectomy by a single surgeon. A strip of either porcine small intestine submucosa (SIS) or polyglactin mesh was placed beneath the anastomosis. The initial five slings were tension free. The last 10 were tightened just to the point they began to elevate the anastomosis. A comparison was made with the same number of men who underwent radical retropubic prostatectomy immediately before beginning this project. The average follow-up was 28.9 months. RESULTS: The first 5 sling patients (no tension) recovered complete bladder control in an average of 5.8 weeks. The 10 men with slings placed under slight tension were dry an average of 2.6 weeks after catheter removal, including 4 within 24 hours. One month later, 10 sling patients (67%) were continent, including 8 (80%) who had had the sling placed under slight tension. Six (40%) of 15 control patients were completely dry in that interval. Three months later, all but 1 sling patient (93%) was dry, but only 7 (47%) of 15 controls. All, except 1 control, were dry at 12 and 24 months. No complications were attributed to this maneuver, specifically no bladder neck contracture or retention occurred. No one in either group received incontinence treatment, although 2 control patients had either stricture or bladder neck contracture. CONCLUSIONS: The early results have been encouraging, but must be confirmed. Slight tension on the sling may be beneficial.

Absorbable Implants↗
PubMed2005

Porcine small intestinal submucosa as a percutaneous mid-urethral sling: 2-year results.

OBJECTIVE: To report the 2-year follow-up results on patients treated with a novel minimally invasive outpatient procedure for placing a mid-urethral sling, using porcine small intestinal submucosa (SIS). PATIENTS AND METHODS: Thirty-four women with urodynamic evidence of stress urinary incontinence (SUI, 19) or of SUI with a positive cough test (15) were treated. A curved ligature carrier was used to create a tract between bilateral suprapubic stab incisions and a 2-cm mid-urethral vaginal incision. A suture secured to each end of the SIS sling was placed through the eyelet of the ligature carrier. Extraction was used to position the sling at the mid-urethra, providing a backboard of support that was remodelled with ingrowth of the patient's autologous tissue. RESULTS: SUI was reportedly cured in 27 of the 34 women (79%) at the 2-year follow-up; three (9%) of those with no complete resolution were pleased with their results, because the improvement allowed them to wear an average one or fewer pads per day. One patient developed de novo urge incontinence. Three patients (9%) developed suprapubic inflammation at 10, 21 and 45 days after surgery; all resolved, but one had a recurrence of SUI. No prolonged retention, erosion or other complications were noted. CONCLUSIONS: Early results with the percutaneous mid-urethral placement of SIS are promising and potentially comparable with those after using synthetic minimally invasive slings.

Animals↗
PubMed2004

Recurrent pelvic organ prolapse in a woman with bladder exstrophy: a case report of surgical management and review of the literature.

Management of gynecologic issues in women with bladder exstrophy is challenging. Congenital pelvic organ prolapse and prolapse-associated pregnancy and delivery are common. The management of prolapse is complicated by the anatomic changes involving the bony pelvis, connective tissue support, pelvic floor, and the length and axis of the vagina. A case of recurrent pelvic organ prolapse successfully managed with a sacral colpopexy and a review of the literature are presented.

Bladder Exstrophy↗
PubMed2002

Urethral erosion of tension-free vaginal tape.

Tension-free vaginal tape (TVT) is gaining popularity as a treatment of choice for women with stress urinary incontinence. It is a minimally invasive procedure with reported short operative and postoperative hospitalization times and low complication rates. We describe urethral erosion of a TVT sling material in a 55-year-old woman who presented with immediate postoperative urinary retention. The sling material was surgically removed and the urethral defect repaired, with the patient continent at the 3-month follow-up visit. A mid-urethral synthetic sling such as the TVT can erode into the urethra.

Female↗
PubMed2002

Contemporary evaluation and management of the female urethral diverticulum.

We are in agreement with Davis and Telinde, who state, "The most important single diagnostic instrument for the discovery of suburethral diverticula is the high index of suspicion" [25]. The key to successful treatment of a female diverticulum is not only in the surgical management but also in the identification and evaluation of patients who present with a myriad of symptoms. It is our responsibility to include urethral diverticula in the differential diagnoses before the labels of interstitial cystitis, urethral syndrome, or urgency frequency syndrome are misplaced. The diagnosis may be elusive and the pathology difficult to identify on physical examination. However, if the index of suspicion is high and the proper radiologic imaging studies are gathered, then the correct diagnosis will often be made. The evaluation of the female urethral diverticulum has evolved greatly over the past several years. However, once appropriate diagnosis is made, the management scheme is fairly straightforward. Strict adherence to principles of surgical reconstruction allows one to eradicate the diverticulum while simultaneously preventing complications and recurrences.

Adult↗
PubMed2002

Laparoscopic ileovesicostomy.

PURPOSE: We present our initial experience with laparoscopic ileovesicostomy for managing neurogenic bladder. MATERIALS AND METHODS: A 5 port transperitoneal approach was used for laparoscopic ileovesicostomy. After bladder preparation a 17 cm. ileal segment was harvested and used as the urinary conduit. Ileovesical anastomosis was formed using intracorporeal suturing and knot tying techniques. RESULTS: Operative time was 4 hours. Blood loss was less than 100 ml. Physical activity and oral intake resumed on postoperative day 1 and the patient was discharged home on postoperative day 3. The postoperative narcotic requirement was 4 mg. morphine sulfate equivalent. There were no intraoperative or postoperative complications. CONCLUSIONS: Laparoscopic ileovesicostomy in this initial experience was associated with acceptable operative time and minimal postoperative morbidity. It may serve as an excellent minimally invasive alternative to conventional open ileovesicostomy.

Female↗
PubMed2002

Sodium pentosan polysulfate reduces urothelial responses to inflammatory stimuli via an indirect mechanism.

PURPOSE: Sodium pentosan polysulfate has been promoted as a urothelial cytoprotective agent for treating interstitial cystitis. The nuclear transcription factor nuclear factor kappaB is thought to have a role in mediating the urothelial inflammatory response of interstitial cystitis. We further defined a possible cytoprotective effect of sodium pentosan polysulfate by characterizing the effect of the drug on the expression of nuclear factor kappaB. MATERIALS AND METHODS: For cell culture human urothelial cells were incubated in various concentrations of sodium pentosan polysulfate for 16 hours in keratinocyte serum-free medium. They were subsequently treated with the known nuclear factor kappaB stimulants tumor necrosis factor-alpha, lipopolysaccaride (LPS) and double-stranded RNA (dsRNA). Each stimulant was then incubated with sodium pentosan polysulfate separately and the mixture was used to treat cultured urothelial cells. For electrophoretic mobility shift assay total cell extracts were prepared and run in electrophoretic mobility shift assays using a radiolabeled nuclear factor kappaB consensus sequence as a probe. Western blot analysis was done to assess nuclear factor kappaB activation by measuring degradation of the inhibitory subunit of the nuclear factor kappaB complex. RESULTS: Nuclear factor kappaB activation by tumor necrosis factor-alpha, LPS and dsRNA was unaltered when cultured cells were incubated in sodium pentosan polysulfate before treatment. In contrast, nuclear factor kappaB activation by LPS and dsRNA was suppressed when the stimulants were incubated with sodium pentosan polysulfate before cell treatment. This suppressive effect was confirmed by Western blot analysis. CONCLUSION: Sodium pentosan polysulfate may have a nonspecific effect against the viral (dsRNA) and bacterial (LPS) activation of nuclear factor kappaB. The observed clinical effect of sodium pentosan polysulfate may be mediated by nonspecific binding of sodium pentosan polysulfate molecules and the inflammatory stimulants of urothelial activation. These findings suggest a mechanism of action for sodium pentosan polysulfate that occurs in the urine rather than at the mucosal membrane by direct interaction of the drug with potential interstitial cystitis inducing inflammatory agents.

Anti-Inflammatory Agents, Non-Steroidal↗