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Biomedical subjects

Roger R Dmochowski

Publications and source records attributed to Roger R Dmochowski.

62 records · Page 4Linked to original sources
PubMed2002

Overactive bladder in men: special considerations for evaluation and management.

Lower urinary tract symptoms (LUTS) in men may arise from a variety of underlying causes, including benign prostatic hyperplasia. LUTS may have a significant component of storage symptoms (urgency, frequency, urge incontinence) at presentation; however, the absence of overactive bladder (OAB) symptoms does not necessarily imply pure outlet obstruction nor does their presence indicate the lack thereof. Symptomatic correlates to urodynamic findings are high when considering isolated OAB symptoms. However, mixed presentations or more overtly obstructive scenarios have less correlation with baseline symptom appraisal instruments. The ideal approach for diagnosis and management is predicated on a graded approach, with more invasive evaluation withheld for those men in whom presumptive therapy fails or who present with associated complex symptoms and in whom a higher level of intervention is being considered. The increasing incidence of LUTS with age implies a partial detrusor contribution, which must be considered in the overall management schema.

Adult↗
PubMed2002

Future studies of overactive bladder: the need for standardization.

Clinicians and researchers agree that pharmacologic studies of the overactive bladder (OAB) require precise planning, strict adherence to study design, and meticulous attention to study conduct and statistical methods. In addition, there should be straightforward and highly directed formulation of the conclusions derived expressly from data that have been collected. The exact methods to achieve these ends, however, are often debated among statisticians and experts in study design and by physicians who interpret the clinical implications of the findings. For these reasons, the conclusions of clinical research in OAB are commonly criticized on the basis of study objectives, study design, statistical methods, or conclusions. However, a subtler, but possibly more critical problem exists: the method of defining the population and the methods for collecting the data for the efficacy outcome parameters, including frequency, urgency, and urge incontinence.

Adult↗
PubMed2002

Beyond collagen: injectable therapies for the treatment of female stress urinary incontinence in the new millennium.

Previous experience with GAX-collagen has shown that the endoscopic correction of female SUI is both possible and effective. It is clear, however, that durability remains a primary concern when implementing this approach to treatment. The availability of recently developed and newly emerging materials, carefully designed using the tenets and techniques of biotechnology and materials science, may provide solutions to some of the difficulties beleaguering this treatment option. Results with currently available injectables are summarized in Table 1. Careful review and critical analysis of new bulking agents will soon reveal which materials approach the therapeutic ideal. It is likely that the ultimate choice of a particular substance, synthetic or biologic, may best be determined by the clinical circumstances involving the individual patient.

Biocompatible Materials↗
PubMed2002

UroLume stents: lessons learned.

PURPOSE: The UroLume (American Medical Systems, Minnetonka, Minnesota) endoprosthesis has been commercially available since 1990 and has been advocated for use in men with urethral stricture disease and detrusor-sphincter dyssynergia due to spinal cord injury. Despite reports of its success and ease of removal, we have noted management problems in several complex cases. MATERIALS AND METHODS: We retrospectively analyzed the outcome of 10 men who required several additional procedures or experienced complications following UroLume placement. RESULTS: Of the patients 4 had detrusor-sphincter dyssynergia and 6 had urethral stricture disease. All patients with detrusor-sphincter dyssynergia required hospitalization for management of urosepsis within 4 to 10 months of stent placement, and all 4 experienced stent migration requiring placement of a tandem stent (3), bladder neck resection (3) or sphincterotomy (1). Two men were in retention following placement of a second stent and required stent explantation. Of the other 6 men 2 had bulbar and 3 had membranous urethral disease, and 1 had a severe bladder neck contracture following radical retropubic prostatectomy. Strictures recurred within the stent lumen in all 6 men and/or adjacent to it in 3. At least 1 repeat procedure was required in all 6 men (within 6 months in 5), and 1 experienced significant bleeding during open explantation which required perineal urethrostomy. CONCLUSIONS: In our referral experience stent migration and recurrent stenosis were noted following UroLume insertion. Placement of a tandem stent was associated with urethral obstruction. In many cases these adverse outcomes may be secondary to improper patient selection. Therefore, judicious use of the UroLume stent and proper case selection are essential since stent removal is not always straightforward.

Adult↗
PubMed2002

Efficacy and safety of transdermal oxybutynin in patients with urge and mixed urinary incontinence.

PURPOSE: We evaluated the efficacy and safety of an oxybutynin transdermal delivery system (TDS) in a general population of patients with overactive bladder and urge or mixed urinary incontinence. MATERIALS AND METHODS: Following symptom stabilization or treatment withdrawal 520 adult patients were randomized to 12 weeks of double-blind daily treatment with 1.3, 2.6 or 3.9 mg. oxybutynin TDS or placebo administered twice weekly, followed by a 12-week open-label, dose titration period to assess efficacy and safety further. Evaluations included patient urinary diaries, incontinence specific quality of life and safety. RESULTS: A dose of 3.9 mg. daily oxybutynin TDS significantly reduced the number of weekly incontinence episodes (median change -19.0 versus -14.5, p = 0.0165), reduced average daily urinary frequency (mean change -2.3 versus -1.7, p = 0.0457), increased average voided volume (median change 24 versus 6 ml., p = 0.0063) and significantly improved quality of life (Incontinence Impact Questionnaire total score, p = 0.0327) compared with placebo. Average voided volume increased in the daily 2.6 mg. group (19 ml., p = 0.0157) but there were no other significant differences between 1.3 and 2.6 mg. oxybutynin TDS and placebo. The most common adverse event was application site pruritus (oxybutynin TDS 10.8% to 16.8%, placebo 6.1%). Dry mouth incidence was similar in both groups (7.0% versus 8.3%, p not significant). In the open-label period a sustained reduction of nearly 3 incontinence episodes per day was reported for all groups. CONCLUSIONS: Doses of 2.6 and 3.9 mg. oxybutynin TDS daily improve overactive bladder symptoms and quality of life, and are well tolerated. Transdermal oxybutynin is an innovative new treatment for overactive bladder.

Administration, Cutaneous↗
PubMed2002

(S)-oxybutynin (Sepracor).

Sepracor is developing (S)-oxybutynin, a single-isomer version of Alza's Ditropan (racemic oxybutynin), a muscarinic acetylcholine receptor antagonist, as a potential treatment for urinary incontinence.

Animals↗
PubMedDate not supplied

Transdermal drug delivery treatment for overactive bladder.

Overactive bladder is commonly treated with oral anticholinergic drugs such as oxybutynin chloride. Although oral anticholinergic agents have been effective in controlling urinary urgency and incontinence, adverse events, particularly dry mouth, often cause patients to discontinue oral therapy and to endure incontinence. Oxybutynin can be delivered transcutaneously, maintaining the efficacy of oral oxybutynin while significantly minimizing side effects (e.g., dry mouth) that may complicate therapy. By avoiding hepatic and gastrointestinal metabolism of oxybutynin, less N-desethyloxybutynin (N-DEO) is produced and this compound is deemed to be responsible for anticholinergic side effects such as dry mouth. This novel oxybutynin formulation offers patients with OAB and urge urinary incontinence a well-tolerated option for managing the symptoms of overactive bladder.

Administration, Cutaneous↗