Biomedical subjects

S L Mee

Publications and source records attributed to S L Mee.

7 recordsLinked to original sources

PubMed2000

A new technique for cystocele repair and transvaginal sling: the cadaveric prolapse repair and sling (CAPS).

A new technique using cadaveric fascia lata for the simultaneous repair of a cystocele and placement of a pubovaginal sling by means of a transvaginal approach is described, and our early results are reported. We refer to this as the cadaveric prolapse repair with sling (CaPS). Fifty patients, ages 37 to 90 years, underwent a new technique for simultaneous cystocele repair and transvaginal pubovaginal sling using a single piece of cadaveric fascia. Maximum follow-up was 6 months (range 1 to 6). A 6 x 8 cm segment of cadaveric fascia lata is placed transvaginally to repair the defect through which the bladder herniates into the vagina and to provide sling support at the bladder neck/proximal urethra. The sling is anchored to the pubic bone with transvaginal bone anchors. The remainder of the fascia is then secured to the medial edge of the levator muscles/pubocervical fascia bilaterally and at the vaginal cuff or cervix with absorbable sutures to reduce the cystocele. Patients are being evaluated with preoperative and postoperative stress, emptying, anatomy, protection, instability (SEAPI) scores as well as with grading of the prolapse based on a 3-grade anatomic classification system. Presenting symptoms have included stress urinary incontinence (SUI) in 13 (26%), urge incontinence in 4 (8%), mixed incontinence in 6 (12%), and pelvic prolapse in 20 (40%). These symptoms are not mutually exclusive; some patients presented with a combination of symptoms. The mean SEAPI scores were 5.51 preoperatively and 0.63 postoperatively, representing a significant improvement (P <0.001). Of the 40 patients whose prolapse was quantified, 1 patient (2.5%) had a minimal cystocele, 16 (40.0%) had moderate cystoceles, and 23 (57.5%) had large cystoceles. After the CaPS, 36 (72%) were completely dry, 3 (6%) had persistent SUI, 1 (2%) had de novo urinary incontinence (UI), 3 (6%) had persistent UI, and 1 (2%) had mixed incontinence. No patient had permanent urinary retention. Transvaginal placement of cadaveric fascia for concomitant sling and cystocele repair provides material of excellent strength for the repair without relying on the inherently weak tissues in the patient with pelvic prolapse. Thus far, the early results with CaPS are extremely encouraging. Long-term follow-up is underway to evaluate the efficacy of this procedure.

Adult↗

PubMed1999

Erosion of woven polyester pubovaginal sling.

PURPOSE: Various materials have been used for pubovaginal slings to correct female stress urinary incontinence. Use of synthetic materials provides a theoretical advantage in that no graft harvesting is necessary. Major risks of synthetic material use are erosion and infection of the sling. We report on erosion of woven polyester slings treated with pressure injected bovine collagen (ProteGen) which required removal. MATERIALS AND METHODS: Office records of patients who had ProteGen slings removed at 5 centers during the last 24 months were retrospectively reviewed. Presenting symptoms, interval between sling placement and removal, subsequent procedures and continence status following sling removal were evaluated. RESULTS: A total of 34 women required removal of the polyester sling secondary to erosion, infection or pain. The most common presenting complaints were delayed vaginal discharge in 21 patients (62%), vaginal pain or pressure in 21 (62%), suprapubic pain in 11 (32%) and recurrent urinary tract infection in 5 (15%) at a mean of 7.95 months (range 1 to 22) after sling placement. Of the patients 17 (50%) had vaginal erosion only, 7 (20%) isolated urethral erosion and 6 (17%) urethrovaginal fistulas. In 4 patients no erosion was obvious but slings were removed secondary to vaginal pain. Before sling removal 16 patients (47%) were totally dry, 13 (38%) had some degree of urinary incontinence and 3 (8%) had retention. Following sling removal 7 patients (20%) remained dry, 25 (74%) had mild to severe stress urinary incontinence with or without urgency and urge incontinence, and 2 (6%) are pending followup. CONCLUSIONS: Woven polyester slings treated with pressure injected bovine collagen are prone to erosion. Although the ProteGen sling was recalled in January 1999, patients who have had the sling placed must be followed closely.

Female↗

PubMed1995

Temporal and spatial factors in diethylstilbestrol-induced squamous metaplasia in the developing human prostate. II. Persistent changes after removal of diethylstilbestrol.

To determine if the metaplastic effects of diethylstilbestrol (DES) on prostatic development are reversible, human fetal prostates (obtained from abortus specimens 6-22 weeks old) were bisected mid-sagittally; one half was grafted under the renal capsule of untreated, athymic, male nude mice and the contralateral half was similarly grafted into DES-treated hosts. Severe squamous metaplasia seen in the prostatic ducts after 1 month of continuous DES exposure either disappeared entirely or became reduced in extent and degree after retransplantation of the DES-treated specimens to untreated, intact male hosts and 2 additional months of growth. However, 14 of 21 DES-treated prostates harvested after a 2-month recovery period without DES revealed ductal dilatation (ectasia) and persistent distortion of ductal architecture. Ectasia was most severe in the proximal ducts near the urethra and in prostates 17 weeks or older at the end of 1 month of DES treatment. The clinical consequences of early alteration of prostatic ductal architecture and development are potentially deleterious, as men who were prenatally exposed to DES may be at increased risk for the development of prostatic disease.

Animals↗

PubMed1989

Radiographic assessment of renal trauma: a 10-year prospective study of patient selection.

To develop criteria to determine which patients require radiographic assessment after blunt renal trauma, we studied prospectively 1,146 consecutive patients with either blunt (1,007) or penetrating (139) renal trauma between 1977 and 1987. Based on our preliminary results from 1977 to 1983, in which none of the 221 patients with blunt trauma and microscopic hematuria without shock had significant renal injuries, we designed a prospective study to determine if such patients could be managed safely without radiographic staging. During the last 10 years significant renal injuries were found in 44 patients (4.4 per cent) with blunt trauma and gross hematuria or microscopic hematuria associated with shock, and in 88 patients (63 per cent) with penetrating trauma. No significant injuries occurred in the 812 patients with blunt trauma and microscopic hematuria without shock, 404 of whom had complete radiographic assessment and 408 of whom did not. There were no delayed operations or significant sequelae related to the renal injury in these patients. We conclude that complete radiographic staging is mandatory in patients with penetrating trauma to the flank or abdomen and in patients with blunt trauma associated with either gross hematuria or microscopic hematuria and shock. However, patients with blunt trauma, microscopic hematuria and no shock who do not have associated major intra-abdominal injuries can be managed safely without excretory urography.

Abdominal Injuries↗

PubMed1989

Indications for radiographic assessment in suspected renal trauma.

We recommend that the criteria for radiographic assessment of suspected renal trauma be: (1) penetrating trauma to the flank or abdomen, regardless of the degree of hematuria; (2) blunt trauma and gross hematuria; or (3) blunt trauma associated with microhematuria and blood pressure below 90 mm Hg before or after emergency room admission. In hemodynamically stable patients in whom renal injury alone is suspected, we recommend intravenous urography, which will adequately stage 60 to 85 per cent of renal injuries. Computed tomography should be performed if the urography results are equivocal or as the primary study when multiple injuries are suspected. Arteriography can be reserved for patients with suspected renovascular injuries in whom CT scans are inconclusive.

Classification↗

PubMed1988

Small caliceal stones: is extracorporeal shock wave lithotripsy justified?

Of 446 patients treated by extracorporeal shock wave lithotripsy 22 had small nonobstructive caliceal stones associated with lumbar or flank pain. Size (less than 1 cm.) and location of the stone did not explain the severity of the symptoms, nor would they have been an indication for open or percutaneous stone removal. Followup consisted of a sonogram and a film of the kidneys, ureters and bladder on postoperative day 1, a film of the kidneys, ureters and bladder 2 weeks after treatment, and a film of the kidneys, ureters and bladder and/or excretory urography after 3 months for patients with residual stone fragments. All patients were interviewed 3 to 15 months after treatment to ascertain the resolution or persistence of the symptoms. After extracorporeal shock wave lithotripsy, 3 of 22 patients had persistent stone fragments for more than 3 months: 2 reported no change and 1 had marked improvement of the symptoms. Of the remaining 19 patients 15 (79 per cent) had complete resolution of the pain and 4 (21 per cent) had significant symptomatic improvement. Thus, 20 of 22 patients (91 per cent) achieved complete or significant relief of pain. The only complication was a perirenal hematoma that resolved spontaneously. These results indicate that small, nonobstructive caliceal stones can be responsible for persistent, severe flank pain. Extracorporeal shock wave lithotripsy is an effective, noninvasive treatment for caliceal stones and it can be justified as therapeutic treatment when the correlation between a small caliceal stone and persistent flank pain is indeterminable.

Adult↗

PubMed1987

Computerized tomography in bladder rupture: diagnostic limitations.

Because computerized tomography is often the first test performed in patients with blunt abdominal and pelvic trauma we designed a prospective study to determine if it might be as accurate as retrograde cystography in the diagnosis of bladder rupture. Patients who had suffered blunt trauma with gross hematuria or who had pelvic fractures and microhematuria underwent computerized tomography followed by retrograde cystography. A urethral catheter was inserted and clamped during computerized tomography to ensure bladder filling. Of our first 2 patients computerized tomography showed no evidence of opacified urinary extravasation in 1 and only subtle evidence in the other. Cystography revealed gross intraperitoneal extravasation of opacified urine in both patients. Presently, retrograde cystography, including a film of the distended bladder and a drainage film, remains the most reliable test in suspected bladder rupture.

Adult↗