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Shahar Madjar

Publications and source records attributed to Shahar Madjar.

12 recordsLinked to original sources
PubMed2006

Transitional cell carcinoma associated with marijuana: case report and review of the literature.

Transitional cell carcinoma of the bladder tends to occur in older patients with a history of tobacco use. We recently evaluated and treated a 45-year-old man with a history of heavy marijuana use. The patient's only risk factor for transitional cell carcinoma was the inhalation of up to five marijuana cigarettes daily for more than 30 years. We present our case and review the literature.

Carcinoma, Transitional Cell↗
PubMed2006

Periurethral mass formations following bulking agent injection for the treatment of urinary incontinence.

PURPOSE: Durasphere is gaining popularity as a bulking agent for treating women with stress urinary incontinence. We present a series of patients with periurethral mass formation following Durasphere injection. MATERIALS AND METHODS: The charts of 135 women with a mean age of 69.4 years (range 46 to 83) who underwent Durasphere periurethral injections were retrospectively reviewed. Patients who had a periurethral mass were identified and their clinical data were collected and analyzed. RESULTS: Four patients (2.9%) were diagnosed with periurethral mass formation 12 to 18 months (average 14.7) following a Durasphere injection. Clinical presentation varied, including irritative voiding symptoms, pelvic pain and urinary incontinence. All patients were found to have a tender and tense periurethral mass. A radiopaque mass was revealed during videourodynamic study in 1 patient. Incision, and transvaginal and endoscopic drainage or transvaginal excision were used to treat these masses. Intraoperative and pathological findings as well as operative outcomes are presented. CONCLUSIONS: Irritative or obstructing voiding symptoms, pelvic pain or a periurethral mass in patients with a history of Durasphere or other periurethral bulking agent injection should alert the physician to the possibility of periurethral mass formation. The true incidence of this late complication remains to be determined.

Aged↗
PubMed2005

Bladder wall abscess following midurethral sling procedure.

Midurethal sling procedures are gaining popularity as the treatment of choice for stress urinary incontinence. Complications that were described include bladder perforation, urinary retention, pelvic hematoma and suprapubic wound infection. Sling erosion and pelvic abscess are rare complications of midurethral slings. We report the first case of an abscess formed within the wall of the urinary bladder, 7 months following a midurethral sling procedure.

Abscess↗
PubMed2003

Baseline abdominal pressure and valsalva leak point pressures-correlation with clinical and urodynamic data.

AIMS: To characterize the factors contributing to changes in baseline abdominal pressure (P(abd)) and the correlation between DeltaVLPP, VLPP(tot), and other clinical and urodynamic variables. METHODS: Two hundred sixty-four female patients who had undergone an anti-incontinence procedure between February 1994 and October 1999 were retrospectively reviewed. The urodynamics performed for each patient included abdominal and vesical pressures measured in a standardized manner with the patient sitting upright and the pressure sensors maintained at the level of the symphysis pubis. VLPP was determined at bladder volumes of 200 mL during a gradually increasing Valsalva maneuver. RESULTS: Baseline P(abd) varied between 10 and 55 cm H(2)O (mean, 32.7 +/- 8.8) and were significantly correlated with patient weight (P<0.001) and with patient body mass index (P<0.001). Baseline P(abd) was not found to be correlated with patient age, Baden and Walker Classification of the grading of pelvic floor prolapse, degree of incontinence (determined by the number of pads used per day), or prior surgical procedures for stress incontinence. Higher baseline P(abd) were significantly correlated with the peak abdominal pressure reached during the Valsalva maneuver (P<0.0001) and with VLPP(tot) (P<0.0001) but not with DeltaVLPP. Higher VLPP(tot) significantly correlated with decreased age (P=0.004), less severe incontinence (P=0.004), higher peak Valsalva pressure (P<0.0001), and the ability to increase abdominal pressure for a longer period of time (time to peak P(abd) during Valsalva). VLPP(tot) and DeltaVLPP had similar statistical correlation with all the clinical variables examined and neither could predict the outcome of any anti-incontinence surgery. By using a VLPP of 60 cm H(2)O as a cutoff to differentiate severe ISD from GSUI, 211 (67.4%) of the patients would be categorized as having ISD according to their DeltaVLPP compared with only 106 (40.1%) by using the VLPP(tot). CONCLUSIONS: Baseline P(abd) varies considerably among patients, is correlated with patient weight and habitus. In addition, it varies with both the ability to be increased for longer periods of time and with VLPP(tot). Looking at VLPP(tot) and DeltaVLPP will result in a different categorization of the type of incontinence in at least 25% of patients and, thus, affect the physician's selection of an anti-incontinence procedure for an individual patient.

Abdomen↗
PubMed2003

Urethral reconstruction in spinal cord injury patients.

PURPOSE: Bladder management programs for patients with spinal cord injury and neurological disease (SCIND) include intermittent catheterization and sphincterotomy with external catheter drainage. These programs depend on maintaining a patent urethra. Once urethral stricture, erosion, diverticulum or urethrocutaneous fistula occurs, the only treatments available are urethral reconstruction and urinary diversion. We evaluate the role of urethral reconstruction in this subset of patients. MATERIALS AND METHODS: The charts of 18 patients with SCIND (spinal cord injury 16, cerebral palsy 1, meningomyelocele 1) were retrospectively analyzed. Different surgical procedures had been performed according to the presenting pathology and tissue availability. RESULTS: Urethral reconstruction was performed in 17 patients with a mean age of 42.2 years (range 27 to 60). Of the patients 13 are paraplegic and 4 are quadriplegic. Urethral defects included urethral stricture in 6 cases, urethral erosion in 4, urethrocutaneous fistula in 3, urethral diverticula in 1 and combined defects in 3. Mean followup is 3.7 years (range 1 to 13) and the mean number of reoperations was 1.4 (range 0 to 4). Of the 17 patients 11 (64.7%) who underwent urethral reconstruction eventually required urinary diversion for end stage urethral pathology (incontinent ileovesicostomy 5, right colon pouches 2, other procedures 4). The mean time from first urethral reconstruction to eventual urinary diversion was 3.3 years (range 0.7 to 7). Four patients maintain a patent urethra while 1 patient was lost to followup. CONCLUSIONS: Patients with SCIND in whom urethral reconstruction is considered should be advised that urethral surgery carries a high risk of reoperation and eventual need for urinary diversion. Clearly, many patients with neurological disease and severe urethral pathology are best treated with urinary diversion.

Adult↗
PubMed2003

New periurethral bulking agent for stress urinary incontinence: modified technique and early results.

PURPOSE: Durasphere (Carbon Medical Technologies, St. Paul, Minnesota) is a newly approved injectable agent for stress urinary incontinence. Proven and potential advantages include nonimmunogenicity, tissue nonreactivity, efficacy at low injectable volume and durability. A concern regarding use is difficulty involved with application. A modified technique for easier implantation of this agent is described and early results are reported. MATERIALS AND METHODS: The surgical technique follows the standard technique for transurethral implantation of bulking agents. Steps modified to allow easier implantation of Durasphere beads include a single needle stick at the 4 o'clock position, hydrodissection with 1.5 ml 1% lidocaine into the submucosa, gradual withdrawal/advancement or rotation of the needle tip after resistance is noted and holding the needle in position for an additional 10 seconds after proper coaptation is achieved to prevent the beads from leaking out of the needle puncture site. Patient charts were retrospectively reviewed. Patient perception of treatment outcomes, a 24-hour pad test and a voiding diary were obtained and analyzed. The strict criteria of the Groutz-Blaivas score were applied as an additional measure of outcome. RESULTS: Of 70 patients 46 (65.7%) for whom full contact information was available responded. Patient age was 46 to 83 years (mean 69.4). A history of a failed prior anti-incontinence procedure was recorded in 15 patients (32.6%) and coexisting symptoms of urge incontinence or urodynamically proven detrusor instability was evident in 29 (63%) and 5 (10.8%), respectively. Bulking agent was delivered at 1 to 3 sessions (mean 1.52) 1 to 3 months apart with 2 to 6 ml (3.2 ml) injected per session. Excellent or good coaptation was achieved in 92% of injections. At a followup of up to 18 months (mean 9.4) 6 (13%), 24 (52.2%) and 16 (34.7%) patients considered themselves cured or improved, or treatment to have failed, respectively. Of the 36 patients who completed a 24-hour pad test 18 (50%), 2 (5.5%) and 16 (44.4%) had a urine loss of 8 or less, 9 to 20 and greater than 20 gm, respectively. Results of the voiding diary and the Groutz-Blaivas score are provided. CONCLUSIONS: The modified technique of Durasphere injection allows easy implantation with good coaptation in the majority of patients. Early results are encouraging. Further research may reveal whether the improved delivery techniques translate into improved outcomes with more durable results compared with other approved bulking agents.

Aged↗
PubMed2002

Impaired detrusor contractility: anything new?

Impaired detrusor contractility (IDC) is a poorly defined entity that represents a treatment challenge for the urologist. The etiology of IDC is variable and may include neurologic disorders, inflammatory conditions, and pharmacologic and psychogenic causes. The gold standard for the treatment of IDC is clean intermittent catheterization (CIC). Although well-established as efficacious and safe, CIC may be conceived as a major burden on a patient's quality of life and has been associated with urinary tract infections and urethral and/or bladder injury. Alternative treatment modalities for IDC can be divided into interventions at the nervous system supplying the bladder, the bladder itself, or the bladder outlet. We review and discuss novel and creative treatment options for patients with IDC that have been developed or tested over the past decade.

Humans↗
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

Bladder tumor antigen stat test in non-urothelial malignant urologic conditions.

BACKGROUND: The bladder tumor antigen stat is a simple and fast one-step immunochromatographic assay for the detection of bladder tumor-associated antigen in urine. OBJECTIVES: To evaluate the BTA stat in non-bladder cancer patients in order to identify the categories contributing to its low specificity. METHODS: A single voided urine sample was collected from 45 patients treated in the urology clinic for conditions not related to bladder cancer. Each urine sample was examined by the BTA stat test and cytology. RESULTS: The overall specificity of the BTA stat test was 44%, which was significantly lower than that of urine cytology, 90%. The false positive rates for the BTA stat test varied among the different clinical categories, being highest in cases of urinary tract calculi (90%), and benign prostatic hypertrophy (73%). Exclusion of these categories from data analysis improved BTA stat specificity to 66%. CONCLUSIONS: Clinical categories contributing to low BTA stat specificity can be identified, and their exclusion improves the specificity of this test.

Antigens, Neoplasm↗
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↗