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Biomedical subjects

T A McNicholas

Publications and source records attributed to T A McNicholas.

11 recordsLinked to original sources
PubMed1992

Long-term results of one-stage scrotal patch urethroplasty.

Of 211 patients with urethral strictures undergoing one-stage dartos pedicled island patch urethroplasty between 1970 and 1987, 194 have been followed up from 3 to 20 years. There was 1 post-operative death (from hepatitis). During the period of follow-up, strictures recurred in 14 patients (7%), some of them as late as 15 years after an apparently successful urethroplasty. Calculi forming on hairs required treatment in 6 patients (3%) and it was necessary to revise a redundant skin pouch in 6.

Adolescent↗
PubMed1989

AIDS: the contamination risk in urological surgery.

Increasing numbers of patients infected with the Human Immunodeficiency Virus (HIV) will be encountered in surgical practice. The risk of exposure to the virus during urological surgery is unknown. In an attempt to quantify the risk and to identify procedures that require change, 427 consecutive urological operations were prospectively assessed for contamination of the surgeon's skin, face and mucous membranes by potentially infected body fluids. Contamination occurred in 136 procedures (32%), of which 37 of 123 (30%) were open operations and 99 of 304 (33%) were endoscopic. Contamination of the face and eyes accounted for 46% (46 of 99 operations) of the contamination occurring in endoscopic surgery. Attention must be paid to reducing exposure of the surgeons' skin to patients' body fluids. The surgeons' eyes should be protected by modification of urological techniques and equipment to avoid spillage.

Acquired Immunodeficiency Syndrome↗
PubMed1988

Suprapubic endoscopy: a percutaneous approach.

We have assessed whether suprapubic endoscopic surgery can be helpful in situations where transurethral access is inadequate, difficult or likely to be associated with urethral damage and have applied a modified version of the well known techniques for creating and dilating a track for percutaneous renal access to the bladder. This method has been used in a series of clinical cases and in certain experimental studies. Assessment of the techniques has allowed their modification and the development of a specially designed access cannula--the St Peter's Hospital cannula.

Endoscopy↗
PubMed1988

YAG laser treatment of early carcinoma of the prostate.

We describe our initial experience of a method which develops the role of endoscopic surgery in the treatment of early prostatic carcinoma. An "extended" transurethral resection of the prostate (TURP) under ultrasound control reduces the prostatic tissue to a thin residual capsule suitable for subsequent transmural coagulation by endoscopic YAG laser. Twenty patients with early disease were entered into the pilot study. Three were excluded after staging (2 T0a and 1 with positive nodes on pelvioscopy-T2 N1 M0); 17 received a full course of treatment. Mean follow-up was 6 months (range 1-14). Two early patients with excessive residual tissue had initially positive biopsies and underwent second treatments with subsequently negative biopsies. Two patients continue to have positive biopsies and the rest are negative. No tumour has progressed and complications have been minimal. One patient experienced reduced frequency of erections and 1 required bladder neck incision for symptomatic bladder neck stenosis at routine follow-up endoscopy. There were no other effects on either potency or continence.

Adult↗
PubMed1986

The effects of extracorporeal shock wave lithotripsy on urological prostheses and endoprostheses.

The combination of ESWL and Endourology (EU) enables a wider range of stones to be treated without open surgery than either modality alone. EU frequently involves the maintenance of a plastic prosthesis in or near the area of maximal shock wave concentration during ESWL. Prostheses subjected to a standard test treatment by ESWL and others removed from patients after ESWL were examined visually, microscopically and biochemically by electron microscopy (SEM) and X-ray emission spectroscopy (XES) to investigate the effects of ESWL on the prosthesis itself. Foley catheter balloons leaked. Previously smooth surfaces were disrupted and possibly toxic additives may be released. Care should be taken in selecting indwelling EU prostheses if ESWL treatment is likely to follow.

Bismuth↗
PubMed1986

The complications of extracorporeal shockwave lithotripsy: management and prevention.

Extracorporeal shockwave lithotripsy has been shown to be a safe and effective method of treating most upper urinary tract stones. Major complications, although few, include haemorrhage, septicaemia, "Steinstrasse" formation and cardiac arrhythmias. The experience from 600 consecutive cases is reviewed and methods of prevention are discussed.

Adolescent↗
PubMed1986

Combination of percutaneous surgery and extracorporeal shockwave lithotripsy for the treatment of large renal calculi.

Open surgery for large or complex renal calculi may be difficult, particularly in patients with recurrent stones, and may require special operative techniques to preserve renal function. With the advent of percutaneous nephrolithotripsy (PCNL) and extracorporeal shockwave lithotripsy (ESWL) new approaches are now available for the treatment of these difficult cases. A review of 67 patients who presented between November 1984 and May 1986 has shown that it was possible to clear large stones in 71% of patients using a combination of PCNL and ESWL. There was no mortality; the morbidity for both procedures was low and was less than when either procedure was used alone for the treatment of complex stones.

Combined Modality Therapy↗
PubMed1985

Extracorporeal shockwave lithotripsy, endourology and open surgery: the management and follow-up of 200 patients with urinary calculi.

The management and follow up of 200 consecutive patients with renal and ureteric calculi are presented. The primary treatment of 185 (92.5%) was by extracorporeal shockwave lithotripsy (ESWL), of whom three (1.6)%) with large calculi underwent percutaneous nephrolithotripsy (PCNL) prior to ESWL as a planned combined procedure. Twelve (6%) were treated by PCNL or ureterorenoscopy (URS) as their definitive treatment and three (1.5%) by conventional open renal and ureteric surgery. The average in-patient stay was 3.8 days and most returned to normal activity within one day of discharge. Of the 185 patients 102 (55%) required no analgesia after treatment by ESWL, 29 (15.6%) required parenteral analgesia and the rest were comfortable with oral non-narcotic medication. Thirty (16%) required auxillary treatment by percutaneous nephrostomy (PCN), PCNL and URS following ESWL for obstructive complications from stone particles. Two required further ESWL and one PCNL at three months for large fragments. Overall, open surgery was required for only 1% of renal calculi and 13% of ureteric stones. These results are consistant with the extensive West German experience confirming that most urinary calculi are now best managed by ESWL and endoscopic techniques. Where these facilities are available open surgery should only be necessary for less than 5% of upper urinary tract stones.

Adolescent↗