Biomedical subjects

S Aboseif

Publications and source records attributed to S Aboseif.

At least 19 recordsLinked to original sources

PubMed1999

Mesenchymal reprogramming of adult human epithelial differentiation.

The objective of this study was to determine whether neonatal rat seminal vesicle mesenchyme (rSVM) can reprogram epithelial differentiation in a fully differentiated adult human bladder epithelium. For this purpose neonatal rSVM was isolated from newborn (0-day) Sprague-Dawley rats, and normal adult human bladder epithelium (hBLE) was isolated from radical cystoprostatectomy specimens to prepare rSVM+hBLE tissue recombinants in vitro. After overnight culture the tissue recombinants were grafted beneath the renal capsule of male athymic rodent hosts and allowed to grow in vivo for 6 months. As controls, rSVM and hBLE were grafted separately and allowed to grow for the same period. Tissue recombinants and control tissue grafts were harvested, and secretions were collected for biochemical studies. Tissues were fixed both for histologic as well as immunohistochemical staining. Neonatal rSVM induced normal adult human bladder urothelium to form glandular structures resembling prostate. The induced prostatic acini were filled with secretions that expressed human prostate-specific secretory proteins. These findings demonstrate that adult human urothelial cells retain a responsiveness to neonatal prostatic mesenchymal inductors. Change in urothelial histodifferentiation was associated with change in functional activity. The ability of the neonatal rat mesenchymal tissues to induce morphologic as well as biochemical changes in normal adult human urothelium provides a basis for human tissue engineering and organ reconstruction.

Adult↗

PubMed1999

Long-term results of colpocystourethropexy for persistent or recurrent stress urinary incontinence.

PURPOSE: We review the long-term outcome of colpocystourethropexy for persistent or recurrent stress urinary incontinence after suspension procedure failure. MATERIALS AND METHODS: Medical records and preoperative studies were reviewed of 60 patients (mean age 60.8 years) who had undergone colpocystourethropexy after at least 1 suspension procedure (range 1 to 8, mean 2.7). Patient responses to a standardized questionnaire regarding overall health, degree of satisfaction with colpocystourethropexy, presence or absence of leakage, and pattern and degree of leakage were elicited by telephone or mail and compared with preoperative status. Results were graded according to the degree of satisfaction and number of pads used daily. Patients with persistent incontinence were reevaluated with video urodynamic studies. RESULTS: Mean interval since colpocystourethropexy was 6.9 years. Successful results (greater than 80% satisfaction and the use of 1 or no pad daily) were reported by 41 patients (69%), who were significantly younger at the time of surgery than those with unsatisfactory results. In the latter group significant urge incontinence was present in 61% before the repair and in 63% postoperatively, suggesting an additional nonanatomical cause, which was confirmed by postoperative video urodynamic studies. CONCLUSIONS: When colpocystourethropexy was used for persistent urinary incontinence after previous surgical repair two-thirds of the patients had excellent long-term results. In patients with less satisfactory results a nonanatomical cause of urinary incontinence was a major factor.

Adult↗

PubMed1997

Transurethral evaporation of the prostate for treatment of benign prostatic hyperplasia: results in 168 patients with up to 12 months of followup.

PURPOSE: We assessed the safety and efficacy of transurethral evaporation of the prostate for the treatment of symptomatic benign prostatic hyperplasia (BPH). MATERIALS AND METHODS: A total of 168 patients with symptomatic BPH underwent transurethral evaporation of the prostate. Peak flow rate, American Urological Association symptom index and post-void residual were assessed at baseline, and at 3, 6 and 12 months of followup. RESULTS: We found a statistically significant decrease in mean American Urological Association symptom index from 20.6 at baseline to 7.2 at 12 months (mean difference 13.4, 65% reduction, p < 0.0001). We also found a statistically significant improvement in mean peak flow rate from 8.2 to 18.2 cc per second, respectively (mean difference 10, 122% increase, p < 0.0001). The most frequent complications were irritative voiding symptoms in 22.6% of patients and urinary tract infections in 4.8%. There were no additional major complications. CONCLUSIONS: From these results transurethral evaporation of the prostate appears to be safe and effective for treatment of BPH at 12 months of followup.

Aged↗

PubMed1997

The effect of cryosurgical ablation of the prostate on erectile function.

OBJECTIVE: To investigate the incidence and identify the possible cause of erectile dysfunction after cryoablation of the prostate. PATIENTS AND METHODS: Erectile function was examined prospectively in 15 sexually active men (aged 59-72 years) who underwent cryoablation of the prostate for clinically localized prostate cancer. Erectile function was assessed before and 6 months after treatment; after intracavernosal injection with 10 micrograms of prostaglandin E1 (PGE1), the degree and duration of erection, the size of the cavernosal arteries, the penile arterial blood flow velocity, and the time to achieve peak flow were evaluated using high-resolution ultrasonography and colour pulsed-Doppler spectral analysis. RESULTS: Post-operatively, all patients initially reported an inability to achieve an erection sufficient for vaginal intercourse. At 6 months' follow-up, erectile dysfunction persisted in nine, with minimal or no response to the intracavernosal PGE1 injections, there was a significant decrease in the peak velocity of blood flow within cavernosal arteries and a significant increase in the time to achieve peak arterial flow. CONCLUSION: Although many factors may contribute to erectile dysfunction after cryoablation of the prostate, vascular injury plays a major role.

Aged↗

PubMed1995

Transurethral Nd:YAG laser prostatectomy with a laterally firing fiber: local effects on tissue associated with erectile dysfunction.

BACKGROUND AND OBJECTIVES: Transurethral laser prostatectomy is anticipated to become a recognized alternative to conventional transurethral resection of the prostate. However, the effects of this procedure on the nerves of the pelvic plexus and erectile dysfunction remain unaddressed. The objective of this study was to evaluate the effects of laser energy on extent of prostatic damage as well as injury to periprostatic cavernosal nerves and erectile dysfunction in a canine model. STUDY DESIGN/MATERIALS AND METHODS: Six adult male mongrel dogs underwent transurethral laser prostatectomy at 30 (n = 3) and 40 (n = 3) watt power settings. Total laser energy delivered varied between 6,000 and 13,800 joules. Erectile function was evaluated by pelvic nerve stimulation at 2, 4, and 8 weeks. Animals were then sacrificed to assess histopathology of the prostate at each time point. RESULTS: Histopathologic changes were noted in the prostate in a dose-dependent manner and did not vary with different laser power settings. In dogs that received approximately 10,000 J, substantial prostate ablation confined within the capsule was achieved in every prostate gland. Adequate erectile responses were noted in five of six animals; all received < 10,000 J. In one animal that received a total dose of 13,800 J, an erectile response was not obtained, and histology revealed both prostatic capsule perforation in close proximity to the cavernous nerves and thermal neural damage. CONCLUSIONS: We conclude that cavernous nerve damage may result from excessive doses of laser energy during transurethral laser treatment of the prostate gland. In canines, the upper limit for periprostatic injury is between 10 and 14,000 joules.

Aluminum Silicates↗

PubMed1995

Neuroanatomy of the external urethral sphincter: implications for urinary continence preservation during radical prostate surgery.

Post-prostatectomy urinary incontinence probably is multifactorial and sphincteric nerve injury could be a contributing cause. Controversy still exists regarding the innervation of the external sphincter, and currently pudendal nerve injury is not believed to be an etiological factor in post-prostatectomy urinary incontinence. To understand better the sphincter and its innervation, we undertook an anatomical and histological study of 18 adult male cadavers, which revealed that the external urethral sphincter receives part of its innervation through special branches originating from the dorsal nerve of the penis after it splits from the pudendal nerve. These nerve branches were located 0.3 to 1.3 cm. from the prostatic apex, and in 50% of the cadavers they were identified only unilaterally or had only 1 branch on each side. The proximity of these nerves to the prostatic apex may make them liable to injury during radical prostatectomy. These nerves are most likely sensory in nature although the presence of motor components cannot be completely ruled out. Injury to these nerves may explain several features of post-prostatectomy urinary incontinence.

Aged↗

PubMed1995

The significance of prostatic intra-epithelial neoplasia.

OBJECTIVE: To investigate the relationship between the detection of prostatic intra-epithelial neoplasia (PIN) on initial prostate biopsy and subsequent invasive prostatic adenocarcinoma. PATIENTS AND METHODS: Thirty-six men (mean age 67 years, range 52-82) with PIN underwent digital rectal examination (DRE), serum prostate-specific antigen (PSA) measurement and transrectal ultrasonography (TRUS) before the initial biopsy and documentation of PIN. They were followed up with serial PSA, TRUS and a repeat biopsy every 6 months until either invasive carcinoma was identified or 2 years had elapsed. RESULTS: The initial biopsy revealed Grade I PIN in 33%, Grade II in 22%, and Grade III in 45% of the men. The repeat biopsy showed evidence of invasive carcinoma in 21 patients (58%; Group I), while 15 (42%) showed persistence of PIN (Group II). In Group I, 19 had had high-grade PIN (Grade II/III) on initial biopsy compared with one in Group II. The findings on DRE, and age, were no significantly different between groups. TRUS revealed a hypoechoic lesion in 15/21 patients in Group I compared with 7/15 patients in Group II. There was an increase in PSA level in 18 patients in Group I (from 8.4 to 11.6 ng/mL). CONCLUSIONS: PIN and invasive adenocarcinoma of the prostate were closely associated, and the likelihood for coexistence was higher in patients with high-grade PIN, increasing PSA level or positive findings on TRUS. We recommend that all patients who show high-grade PIN on prostate biopsy be followed very closely with serial PSA measurements and repeat biopsies from both the area of PIN and other areas of the prostate.

Adenocarcinoma↗

PubMed1995

A randomized study comparing visual laser ablation and transurethral evaporation of prostate in the management of benign prostatic hyperplasia.

PURPOSE: We evaluated the safety, efficacy, failure and complications of 2 techniques of laser prostatectomy for benign prostatic hyperplasia (BPH): transurethral evaporation of the prostate (evaporation) versus visual laser ablation of the prostate (coagulation) in a randomized trial. MATERIALS AND METHODS: A total of 64 consecutive patients with symptomatic BPH was randomized to undergo evaporation (32) or coagulation (32). American Urological Association symptom score, peak urinary flow rate and post-void residual urine volume were measured at baseline, and at 1, 3, 6 and 12 months. Other parameters evaluated included prostate volume by transrectal ultrasound, total laser energy per patient and per cc volume of the prostate, number of laser fibers per prostate, duration of catheterization and hospitalization, need for re-catheterization, and failure and complication rates. RESULTS: Our main findings were that patients undergoing laser prostatectomy using the coagulation technique (visual laser ablation of the prostate) had higher reoperation rates (16% versus 0%, p = 0.0199) and were 4 times more likely to have prolonged postoperative urinary retention (25% versus 6.3%, p = 0.0389), evaporation and coagulation were effective at relieving symptoms of prostatism with significant improvement in American Urological Association symptom scores and post-void residual urine volumes compared to baseline, improvement in peak flow rates was significantly greater in patients undergoing evaporation at 1, 3, 6 and 12 months (p < 0.001) compared to coagulation, and a significantly greater amount of laser energy was required to evaporate a unit volume of prostate tissue compared to coagulation (2,251 J./cc versus 1,036 J./cc, p < 0.03). CONCLUSIONS: Between the 2 major techniques of laser prostatectomy, transurethral evaporation is associated with better results at up to 12 months of followup.

Aged↗

PubMed1995

Transurethral collagen therapy in women.

PURPOSE: We evaluated our recent experience with transurethral collagen therapy in women. MATERIALS AND METHODS: A series of 44 women with video urodynamic evidence of intrinsic sphincter deficiency were treated with transurethral collagen therapy using local anesthesia. Median patient age was 72 years (range 41 to 94). Mean duration of incontinence was 72 months. Incontinence was grade 3 in 42 patients. Mean abdominal leak point pressure before treatment was 56 cm. water. Patient response to treatment was evaluated by the change in the number of pads required to effect significant improvement. RESULTS: Median number of pads used was 5 pretreatment (range 3 to 12) and 3 posttreatment. A total of 20 patients was cured and 8 others required only 1 pad daily after treatment (63% cured or needing no pads daily). Of the cured patients 4 had used greater than 10 pads daily before collagen injection. One treatment was given to 22 patients and 7 have not improved of whom 2 underwent only 1 treatment. Mean volume of collagen used to effect a cure was 9.1 cc. CONCLUSIONS: Collagen injection is a useful treatment for the severely incontinent female patient with intrinsic sphincter deficiency.

Adult↗

PubMed1994

Role of penile vascular injury in erectile dysfunction after radical prostatectomy.

OBJECTIVE: To investigate the cause of erectile dysfunction after nerve-sparing radical prostatectomy for clinically localized adenocarcinoma of the prostate (stage A or B). PATIENTS AND METHODS: Erectile function was evaluated in 20 patients, mean age 65 years (range 44-74), both pre-operatively and 1 year after surgery by intracavernosal injection of a vasoactive agent (papaverine hydrochloride or prostaglandin E1) and pulsed Doppler ultrasonography. The degree of erection, the size of the cavernosal artery and penile arterial blood flow velocity were assessed. RESULTS: Results revealed that the decreased response to intracavernosal injection of a vasoactive agent was associated with a significant reduction in both the diameter and velocity of blood flow within cavernosal arteries in 40% of patients after surgery. The pathological stage of the tumour did not correlate with the degree of vascular injury. CONCLUSION: We conclude that post-prostatectomy impotence is multifactorial but vascular injury plays a substantial role.

Adenocarcinoma↗

PubMed1993

Calcitonin gene-related peptide: possibly neurotransmitter contributes to penile erection in monkeys.

The distribution of calcitonin gene-related peptide (CGRP) immunoreactivity in the cavernous tissue and the erectile response to intracavernous injection of CGRP was investigated in 7 monkeys. Intracavernous CGRP increased cavernous arterial flow and induced cavernous smooth muscle relaxation and venous outflow occlusion. Intracavernous injection of CGRP antibody did not significantly change the erectile response to cavernous nerve stimulation. Histologic staining for CGRP immunoreactivity showed nerve fiber-like staining within the cavernous arterial wall and the cavernous smooth muscles. These data suggest that CGRP may contribute to penile erection in monkeys.

Animals↗

PubMed1993

Genital self-mutilation.

We report a series of 14 patients with 19 self-inflicted genital injuries during a period of 10 years. Of the patients 65% were psychotic and 35% were not psychotic. Repeated attempts at genital self-mutilation occurred in 31% of the cases, mainly in the psychotic group. A history of alcohol and/or drug abuse was present in 55% of the cases. Injuries varied from simple laceration of penile or scrotal skin to actual amputation of the penis or testis. The degree of injury did not differ between the psychotic and nonpsychotic patients. Surgical management and outcome varied according to the severity of the injury, the delay in presentation for treatment, and the degree of alteration in the mental status and behavior. Followup of 9 patients showed good cosmetic results with no immediate or delayed complications related to the injury. The functional results in patients with penile replantation were satisfactory. In 1 patient a urethral stricture developed that was successfully managed endoscopically. Erectile function was difficult to assess because of the marked diversity of sexual behavior in this group.

Adult↗

PubMed1993

Wolfram's (DIDMOAD) syndrome and its urological manifestation.

We report 2 patients with DIDMOAD syndrome (diabetes insipidus, diabetes mellitus, optic atrophy and neural deafness), with emphasis on the urological aspects and their management. Both patients underwent thorough radiological endoscopic and urodynamic evaluation, in addition to detailed evaluation of other systems involved. Each had the characteristic hyper-reflexive neurogenic bladder with sphincteric dyssynergia, which resulted in severe urinary tract dilation. One patient was diagnosed at this institution and managed conservatively with clean intermittent catheterisation and anticholinergic medication; the second patient was referred to us after several attempts at surgical correction. The presentation, details of the urological evaluation with special emphasis on the urodynamic findings, and the outcome of different means of management are discussed.

Adult↗

PubMed1993

Quantification of prostaglandin E1 receptors in cavernous tissue of men, monkeys and dogs.

Prostaglandin E1 (PGE1) has been shown to relax the muscles of the corpora cavernosa and inhibit spontaneous activity, and clinical trials have proved its safety and effectiveness when given intracavernously to induce erection. Through use of a specific PGE1 receptor binding assay, we undertook this study to quantify its receptor density and measure binding affinity. The cavernous tissue of normal and impotent men as well as that of monkeys and dogs was studied in an attempt to understand their different responses to the intracavernous injection of PGE1. Our results showed a lower receptor density in impotent men than in normal men and monkeys and a complete absence of receptors in dogs. These findings correlated well with the clinical response to intracavernous injection of PGE1.

Alprostadil↗

PubMed1989

Spinal anesthesia and electroerection in dogs and monkeys.

We studied the penile erectile response to cavernous nerve electrostimulation in five monkeys and eight dogs before and during spinal anesthesia. Anesthesia was obtained by intradural injection (at L4-L5 level) of either xylocaine (two mg./kg. body weight) or tetracaine (0.2 mg./kg.). In monkeys, systolic blood pressure reduction (average 17.2%), slight elongation and tumescence of the penis, and increase of intracavernous pressure were noted after spinal anesthesia. Electrostimulation of the cavernous nerves resulted in longer erection and detumescence phases than obtained before anesthesia. In dogs, a similar blood pressure decrease (16.6% average) was noted after anesthesia. The response during anesthesia to electrostimulation of the erectile nerves was, however, variable. Changing the animal's position abolished the erectile response in three of four dogs while no change of erectile response due to anesthesia could be demonstrated in the remaining four dogs. We conclude that spinal anesthesia seems to enhance simian, but not canine, erectile response to electrostimulation of the erectile nerves, possibly via interference of the autonomic regulatory mechanism.

Anesthesia, Spinal↗

PubMed1989

Acetylcholine as a possible neurotransmitter in penile erection.

We investigated the erectile response to intracavernous injection of increasing doses of acetylcholine (0.5 to 500 micrograms.) in 10 monkeys. To differentiate between nicotinic (ganglionic) and muscarinic (parasympathetic postganglionic) effects, acetylcholine was likewise administered after 1.6 mg. trimethaphan camsylate and 0.1 mg. atropine, alone or sequentially. Erections were induced by cavernous nerve stimulation before and after atropine. Acetylcholine induced a dose-dependent, triphasic erectile response: a first tumescence phase followed by contraction and a subsequent second phase of tumescence. Atropine reduced but did not abolish the erectile response to acetylcholine: attainment of maximal intracavernous pressure after neurostimulation was both delayed and reduced (mean 25 cm. H2O). Only after combined nicotinic and muscarinic blockade was the erectile response to acetylcholine completely abolished. Histologic staining for acetylcholinesterase in five additional monkeys that had not received acetylcholine showed dense staining within the cavernous erectile tissue and around the cavernous arteries. Our data suggest that acetylcholine is a possible neurotransmitter for penile erection in monkeys.

Acetylcholine↗

PubMed1989

Rapid, contrast-enhanced, diuretic magnetic resonance imaging of unilateral partial ureteral obstruction. An experimental study in micropigs.

The value of rapid, contrast-enhanced, diuretic magnetic resonance (MR) imaging (using ferrioxamine B and furosemide) in demonstrating partial unilateral ureteral obstruction and the potential of such MR imaging in differentiating obstructive from nonobstructive hydronephrosis was assessed in six micropigs. MR imaging (0.35 Tesla, partial-flip technique with repetition time [TR] of 125 milliseconds, echo-delay time [TE] of 20 milliseconds, and flip angle of 70 degrees) was performed before, and at 5, 12, and 19 days after partial ureteral obstruction. Additionally, MR images were acquired 5, 12, and 19 days after release of obstruction. The diuretic was injected 10 minutes after the contrast medium. MR findings were correlated with results from nuclear scintigraphy (99mTc-DMSA uptake). MR images provided good morphologic detail from which renal size, parenchymal thickness, and degree of hydronephrosis could be determined. Contrast medium allowed assessment of cortical uptake and urinary excretion. The course of cortical signal enhancement best characterized the difference between obstructive and nonobstructive hydronephrosis. Normal kidneys and kidneys with nonobstructive hydronephrosis showed progressive decrease in cortical signal enhancement (-11.7% within 40 minutes) after furosemide injection. The kidneys with obstructive hydronephrosis demonstrated a plateau of signal enhancement without decrease (-0.7% within 40 minutes). These results demonstrate the utility of rapid contrast-enhancing, diuretic MR imaging in differentiating obstructive from nonobstructive hydronephrosis.

Animals↗

PubMed1989

Noncontrast and contrast enhanced MR imaging in the evaluation of partial ureteral obstruction: an experimental study in the micropig.

Twelve Yucatan micropigs (3 controls; 3 sham-operated; 6 with unilateral obstruction) were studied to assess the value of noncontrast and contrast-enhanced (Gadolinium-DTPA) magnetic resonance (MR) imaging in the evaluation of partial ureteral obstruction. MR findings were correlated with findings of quantitative (Tc-99m-DMSA) scintigraphy, and histology. On noncontrast T1-weighted images, the normal porcine kidney demonstrated good corticomedullary contrast (CMC = 16.8% +/- 5.0). Five minutes after administration of Gd-DTPA, there was enhancement of the renal cortex (+24.4% and medulla (+46.2%), and CMC was no longer discernible. Enhancement of the urine within the collecting system (+119.1%) was also observed. The obstructed kidneys demonstrated marked thinning of the renal parenchyma and decreased signal intensity on noncontrast T1- and T2-weighted images (P less than 0.01). Urine in the dilated collecting system did not differ significantly from urine in controls except in the three animals with urinary tract infection (P less than 0.05). Five minutes following injection of Gd-DTPA, there was enhancement of the renal parenchyma in all kidneys. Excretion was seen in three pigs and no excretion in two. Thus, useful information can be obtained in partial ureteral obstruction from both pre-contrast and Gd-DTPA-enhanced MR images of the kidney.

Animals↗