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Rodney A Appell

Publications and source records attributed to Rodney A Appell.

At least 19 recordsLinked to original sources
PubMed2007

Transobturator tape, bladder perforation, and paravaginal defect: a case report.

Transobturator midurethral slings (TOT) have been shown to have less risk of vascular and visceral injury than tension-free midurethral slings. Routine cystoscopy has therefore not been felt to be necessary. A case of bladder perforation unrecognized at the time of TOT placement is presented. Findings at sling removal suggested that a clinically nonapparent paravaginal defect may have been instrumental in the injury. Consideration should be given to routine cystoscopy at the time of transobturator sling placement.

Female↗
PubMed2006

Current trends in the evaluation and management of female urinary incontinence.

Despite its common occurrence and often seemingly obvious causes, female urinary incontinence requires a thorough and thoughtful evaluation for its proper diagnosis and treatment. With rare exceptions, urinary incontinence is the result of failure of the sphincter mechanism to resist bladder pressures encountered during daily activities. This may be the result of sphincter failure, overactivity of the bladder detrusor muscle or both. In uncomplicated cases, the diagnosis is usually based on an evaluation in the office. Urodynamic and cystoscopic study may be helpful in complex, resistant and recurring cases of urinary incontinence of any cause. Most cases of incontinence may be classified as stress, urge or mixed urinary incontinence. Treatment of stress urinary incontinence focuses on supplementing the urethral continence mechanisms, particularly the urethral supports and periurethral striated muscle function. The current paradigm for the treatment of urge incontinence centres on pharmacologic therapy, primarily by correcting detrusor overactivity with antimuscarinic drugs. Other therapies aimed at altering sensorimotor function may be used in resistant cases. The treatment of mixed urinary incontinence requires consideration of the contribution of each of its components. With proper diagnosis, effective treatment is possible for most patients.

Female↗
PubMed2006

Transurethral radiofrequency energy collagen micro-remodeling for the treatment of female stress urinary incontinence.

AIMS: This prospective, randomized, controlled clinical trial was performed to demonstrate the 12 months safety and efficacy of transurethral radiofrequency energy (RF) collagen micro-remodeling in women with stress urinary incontinence (SUI). MATERIALS AND METHODS: Women with SUI, bladder outlet hypermobility, and leak point pressure (LPP) > or =60 cmH(2)O were randomized to RF micro-remodeling or "sham treatment." Adverse events (AEs) were recorded. Incidence of > or =10 point incontinence quality of life (I-QOL) score improvement, a magnitude of improvement with a demonstrated responsiveness to patient satisfaction with treatment and to > or =25% reduction in both incontinence episode frequency and stress pad weight, served as a subjective outcome measurement. Change in mean LPP served as an objective outcome measurement. RESULTS: 110 women underwent RF micro-remodeling and 63 underwent virtually identical "sham treatment" (with the exception of RF delivery). The 12 months RF micro-remodeling safety profile was statistically no different than that of sham treatment (a brief bladder catheterization). Seventy-four percent of women with moderate to severe baseline SUI experienced > or =10 point I-QOL score improvement at 12 months (P = 0.04). Women who underwent RF micro-remodeling demonstrated LPP elevation at 12 months, while sham treated women demonstrated LPP reduction (P = 0.02). CONCLUSIONS: Non-surgical, transurethral RF micro-remodeling is a safe treatment for women with SUI. In women with moderate to severe SUI, this novel therapy resulted in statistically significant improvement in quality of life of a magnitude associated with patient satisfaction with the treatment. Women who underwent RF micro-remodeling demonstrated a statistically significant elevation in mean LPP at 12 months.

Adult↗
PubMed2006

Functional obstructed voiding in the neurologically normal patient.

Voiding dysfunction is common and often is the result of urethral obstruction to urine flow. Obstruction can be due to failure of the sphincteric mechanism to sufficiently relax. Such functional obstructions may have smooth and/or striated muscle components. Identifying and characterizing functional bladder outlet obstruction enables the physician to effectively treat these symptomatic patients.

Diagnosis, Differential↗
PubMed2006

Bladder outlet obstruction in women: iatrogenic, anatomic, and neurogenic.

This paper outlines the presentation, evaluation, and management of bladder outlet obstruction (BOO) in women as it relates to iatrogenic, anatomic, and neurogenic causes. Attention is given to the different diagnostic criteria used by various authors in their case series and studies. The lack of standardization with regard to the diagnosis of BOO in women emphasizes the fact that BOO is often a clinical diagnosis that is made by taking into account the history, physical examination, imaging of the lower urinary tract, and urodynamic pressure-flow parameters. Individual obstructive conditions including urethral stricture, postsurgical obstruction, primary bladder neck obstruction, pelvic organ prolapse, and neurogenic causes are addressed briefly.

Female↗
PubMed2006

Efficacy and tolerability of tolterodine extended-release in continent patients with overactive bladder and nocturia.

OBJECTIVE: To evaluate the clinical efficacy and tolerability of tolterodine extended-release (ER) in continent patients with overactive bladder (OAB) and nocturia. PATIENTS AND METHODS: A post hoc analysis was conducted of data from a 12-week, double-blind study of 850 patients randomized to tolterodine ER (4 mg once daily) or placebo, taken within 4 h of going to bed. Patients with a mean of > or = 8 voids/24 h were enrolled, including a mean of > or = 2.5 voids/night. Patients completed 7-day voiding diaries, and for each void an urgency rating was assessed using a 5-point scale (1, none; 5, urgency incontinence); 24-h voids were categorized by urgency rating: total (1-5), non-OAB (1-2), OAB (3-4), and severe OAB (4-5) voids. All adverse events were recorded. RESULTS: The post hoc analysis included 513 patients (243 placebo; 270 tolterodine ER; 58% men) who were continent at baseline; 47% of 24-h voids were classed as non-OAB, and 12% as severe OAB. After 12 weeks of treatment, tolterodine ER significantly reduced mean urgency rating and 24-h OAB, severe OAB, and total voids vs placebo. Tolterodine ER did not affect normal, non-OAB voids, and there were no significant adverse events related to voiding. Other than dry mouth (tolterodine ER, 9% vs placebo, 2%), all the adverse events were reported in <3% of patients; <2% of patients receiving tolterodine ER withdrew because of adverse events. CONCLUSIONS: In continent patients with OAB, tolterodine ER significantly improved urgency rating and reduced 24-h OAB, severe OAB, and total voids, suggesting that it is an effective and well-tolerated treatment option for this subpopulation. More studies are needed to better understand the clinical efficacy of tolterodine ER in this under evaluated group of OAB patients without incontinence.

Adult↗
PubMed2006

Urethral injections for female stress incontinence.

Emphasis on minimally invasive options for the surgical treatment of stress urinary incontinence (SUI) has resulted in the development of agents and techniques that improve these conditions substantially towards social continence, but currently give suboptimal cure/dry rates. The application of injectable therapy as an office procedure implies the potential for cost-efficient treatment for selected patients with UI. Continuous advances in materials technology have provided the possibility that many new urethral bulking agents will soon be available. Experience continues to accrue in clinical trials for urethral bulking with these agents, while parallel use for the indication of paediatric vesico-urethral reflux has also provided evidence of biological activity related to these compounds. The agents that are closest to complete analysis are synthetic and represent various material types and characteristics. As these materials develop, understanding of the preferred injection technique also is being gained. The delivery method and site might prove to substantially alter the biological activity of these compounds.

Biocompatible Materials↗
PubMed2006

The emergence of new drugs for overactive bladder.

Overactive bladder is a common and distressing problem. Standard therapy is directed towards modifying the detrusor motor sensitivity and response via anticholinergic medication. Currently available medications are reviewed and alternative targets for treatment are presented.

Acetylcholine↗
PubMed2006

Pharmacotherapy for overactive bladder: an evidence-based approach to selecting an antimuscarinic agent.

Multiple drugs are now available for the treatment of overactive bladder. Currently, the pharmacological approach is to deal with the problem at the neuromuscular junction by attempting to stop the activity of the neurotransmitter with antimuscarinic medications. This article reviews the positive and negative aspects of the agents that are currently available for use in the US. In randomised clinical trials, extended-release formulations of these agents appear as effective as the immediate-release formulations, but are associated with fewer adverse effects. Attempts to use entities that are muscarinic M(3) selective antimuscarinic agents have not significantly improved the efficacy, but have reduced the major adverse effect of excessively dry mouth. Dose escalation or titration is addressed to enhance efficacy further. None of these drugs appear to cause significant cardiac or CNS adverse events. This supports the continued use of these agents for overactive bladder symptomatology, as they appear to be effective in reducing symptoms and remain generally well tolerated.

Evidence-Based Medicine↗
PubMed2005

Pelvic organ prolapse and the lower urinary tract: the relationship of vaginal prolapse to stress urinary incontinence.

Vaginal prolapse and urinary incontinence frequently coexist. Rather than having a cause-and-effect relationship, these two common problems share etiologic factors. Specific tissue and functional deficiencies resulting in prolapse also are significant contributors to lower urinary tract symptoms, particularly stress urinary incontinence. This article reviews this relationship, the etiologic factors, and aspects of the clinical evaluation of the patient with prolapse and stress urinary incontinence.

Female↗
PubMed2005

Female neurogenic vesicourethral dysfunction: evaluation and management.

This paper outlines the evaluation and management of neurogenic vesicourethral dysfunction (NVUD). The anatomy and neurophysiology involved with lower urinary tract functions are reviewed. Multiple sclerosis, diabetes, lumbar disc prolapse, and Parkinson's disease are specifically addressed. Proper evaluation of patients suspected of having NVUD, which is fundamental to making an accurate diagnosis, is discussed. This is followed by options for initiating individualized management plans that focus on protecting and preserving renal function, in addition to relieving the symptoms of NVUD.

Behavior Therapy↗
PubMed2005

Bladder-health diaries: an assessment of 3-day vs 7-day entries.

OBJECTIVES: To assess the reliability of symptom reports in 3-day vs 7-day bladder diaries used in clinical trials of patients with overactive bladder (OAB) and to compare those results and related issues with previous reports. MATERIALS AND METHODS: We analysed two large-scale, randomized, phase 3 clinical trials of the use of transdermal oxybutynin for treating patients with OAB. The first trial (Trial A, 520 patients) compared three doses of transdermal oxybutynin (1.3, 2.6 and 3.9 mg/day) with placebo. Patients documented their OAB symptoms in a 7-day diary. The second clinical study (Trial B, 361 patients) compared the efficacy of 3.9 mg/day transdermal oxybutynin with 4 mg/day extended-release tolterodine and with placebo; this trial required symptom recording for only 3 days. The internal consistency of the data from the 7-day trial was determined and then compared with the 3-day trial results. RESULTS: Patients on transdermal oxybutynin or long-acting tolterodine for their OAB symptoms showed a clinically and statistically significant improvement, results that were documented in both 3-day and 7-day bladder diaries. However, compared with 7-day symptom records, 3-day diaries were associated with significantly better compliance with record-keeping (P < 0.001). CONCLUSIONS: Seven-day diaries used in clinical trials supply accurate and reproducible data on clinical manifestations of OAB, but 3-day diaries are equally effective and have the potential for better accuracy through increased patient convenience. Three-day diaries may also reduce the tendency for patients to complete gaps in record-keeping from memory.

Benzhydryl Compounds↗
PubMed2004

A case for botulinum toxin-A in idiopathic bladder overactivity.

Botulinum toxin (BTX) has been shown to be an effective agent in suppressing detrusor overactivity due to neurogenic causes. Similar to results obtained with traditional agents to treat bladder overactivity (ie, antimuscarinic medications), the use of BTX has been extended to patients with idiopathic detrusor overactivity. This article briefly reviews the use of BTX to treat disorders of detrusor overactivity and, based on early clinical and laboratory results, establishes the case for its use as a therapeutic modality to treat idiopathic detrusor overactivity.

Botulinum Toxins, Type A↗