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T D Richardson

Publications and source records attributed to T D Richardson.

8 recordsLinked to original sources
PubMed1997

Age-specific reference ranges for serum prostate-specific antigen.

Since PSA was discovered nearly 20 years ago, significant progress has been made in improving the clinical utility of this glycoprotein as a tumor marker. Factors contributing to the initial limitations in sensitivity and specificity of PSA as a diagnostic tool for early cancer now are understood better. As a result, PSA now is being used [table: see text] widely for the diagnosis of early, curable prostate cancer. PSA, however, because of the inability to differentiate benign processes from malignancy, fails to perform at the ideal tumor-marker level. Nevertheless, in 1997, it remains the best tumor marker in all cancer biology. The research that has been conducted by several independent investigators, showing the correlation between PSA, prostate volume, and patient age, was a vital step in the process of improving the clinical and diagnostic utility of PSA. From this, Oesterling, Dalkin, DeAntoni and others have recommended similar age-specific reference ranges for serum PSA. Subsequent investigations have supported the initial theories that the use of age-specific reference ranges would improve the sensitivity of PSA in younger men, leading to the diagnosis of additional early, organ-confined prostate cancer. The issue of improved specificity in older men has been somewhat less straightforward in that decreasing negative biopsies also result in undetected prostate cancers. The real question involves determining what percent of these undetected prostate cancers are clinically significant to the older patient. Of additional significance is the determination of differing age-specific reference ranges in whites, Asians, and African-Americans (Table 1). In 1997, it is important to know not only the age of the patient but also the race of the patient to interpret the serum PSA concentration. The clinical meaning of a given serum PSA value differs from one race to the next. The recent discovery of the different molecular forms of PSA and their potential ability to improve the diagnostic specificity of PSA is another significant step. Accordingly, the information about the relationship of age to the specific molecular forms and their ratios is a necessity. As urologists continue the quest for the ideal tumor marker for prostate cancer, utilizing age-specific reference ranges will continue to improve the clinical utility of the PSA test.

Adult↗
PubMed1997

Long-term results of transurethral collagen injection in men with intrinsic sphincter deficiency.

Male stress urinary incontinence (SUI) secondary to intrinsic sphincter deficiency (ISD) is a well-recognized potential complication of various forms of therapy for both benign and malignant conditions of the prostate. Short-term efficacy of collagen therapy for SUI in men has been demonstrated; however, little information exists on the long-term durability of this minimally invasive treatment modality. Herein, we present our long-term experience with transurethral collagen injection therapy in men with SUI. Sixty-eight men ages 45 to 75 years underwent collagen injection for treatment of urinary incontinence secondary to ISD. Incontinence resulted from radical prostatectomy (N = 47), external-beam radiation (8), cryotherapy (4), salvage radical prostatectomy (4), and transurethral resection of the prostate (TURP) (5). Response was judged according to changes in the number of pads used daily and the incontinence grade. The average amount of collagen injected was 36 cc (range 8-125 cc), and the average number of treatment sessions was 5 (range 3-15). With a mean follow-up of 38 (6-46) months, 10% of the patients were cured (no pads, Grade 0 incontinence), 10% were greatly improved (> 50% decrease in pads used or improved incontinence grade), 67% had minimal to no improvement (< 50% decrease in pads used or no change in continence grade), and 13% reported worsening of their incontinence. Patients with incontinence after TURP were most likely to achieve a favorable outcome, whereas patients with incontinence after salvage prostatectomy responded poorly. Complications were minimal and included hematuria (N = 10), transient urinary retention (8), and urinary tract infection (5). Collagen injection therapy is a safe, relatively noninvasive method of treatment for ISD in male patients. However, long-term success with collagen is disappointing in all groups with the exception of men with SUI after TURP.

Aged↗
PubMed1997

Retrograde treatment of ureteropelvic junction obstruction using the ureteral cutting balloon catheter.

PURPOSE: We assessed the efficacy and safety of a new cutting balloon catheter to treat symptomatic ureteropelvic junction obstruction in adults. MATERIALS AND METHODS: A total of 32 adults (mean age 40 years, range 18 to 79) underwent retrograde balloon incision for symptomatic ureteropelvic junction obstruction (27 primary and 5 secondary cases). Treatment outcome was based on improvement of symptoms and resolution of obstruction by excretory urography or diuretic renal scintigraphy. RESULTS: A total of 36 retrograde endopyelotomies was performed on 32 patients. Of 4 patients who underwent repeat endopyelotomy 2 had resolution of persistent obstruction. At a mean followup of 14 months (range 3 to 28) 28 of 32 patients (87.5%) were rendered symptom-free and had no obstruction on excretory urography or diuretic renography. Average hospital stay was 1.8 days (range 0 to 6) and the complication rate was 15.6% (postoperative bleeding, fever and ileus). Treatment failed in 4 patients and subsequent open pyeloplasty was successful. CONCLUSIONS: Retrograde balloon incision endopyelotomy appears to be a safe and effective treatment for ureteropelvic junction obstruction.

Adolescent↗
PubMed1996

Recalcitrant gross hematuria secondary to left renal vein hypertension.

Left renal vein hypertension is a most uncommon and rarely a well-documented cause of gross hematuria. We report a case of lateralizing, gross hematuria resulting from left renal vein hypertension in an individual with a history of a prior Whipple procedure. The diagnosis was suspected at the time of renal angiography and proven by renal venography. Complete rapid resolution of the hematuria and hypertension was achieved following placement of a left renal vein stent.

Hematuria↗
PubMed1996

Half-life determination of serum free prostate-specific antigen following radical retropubic prostatectomy.

OBJECTIVES: Prostate-specific antigen (PSA) continues to be the the most clinically useful tumor marker for prostate cancer. Recently, several molecular forms of PSA have been detected and characterized. These specific forms, including free PSA and PSA complexed to alpha 1-antichymotrypsin, can be measured and their proportions determined. In doing so, the sensitivity of PSA as a tumor marker can be maintained while the specificity is improved. In order to maximize the clinical utility of free PSA, the half-life and elimination kinetics of free PSA from the serum were determined. METHODS: Twenty-five patients, ages 43-74 years (mean 60 years) with biopsy proven, organ-confined adenocarcinoma of the prostate who underwent anatomic radical retropubic prostatectomy, were identified. For each patient, venous blood samples were obtained preoperatively, and at 60-minute intervals beginning 1 hour after the prostate was removed. The specimens were handled and stored in a consistent fashion. Using the AxSYM immunoassay analyzer (Abbott Diagnostics, Abbott Park, IL), the serum free PSA values were determined and plotted as a function of time for each patient. From the 25 individual elimination curves that were generated, the half-life of serum free PSA was determined. RESULTS: The mean half-life of serum free PSA was 110 minutes +/- 18.6 minutes (SD). Analysis of the individual and cumulative elimination curves indicates that the elimination of free PSA from the serum following radical prostatectomy follows a biphasic pattern. CONCLUSIONS: Unlike PSA, which has a half life of 2-3 days, the half-life of serum free PSA is 110 minutes (1.83 hours). This short half-life may have significant implications for the use of percentage of free PSA as a clinically useful tool in distinguishing patients with early, curable prostate cancer from men with benign prostatic hyperplasia (BPH) only.

Adenocarcinoma↗
PubMed1995

Endoscopic injection of glutaraldehyde cross-linked collagen for the treatment of intrinsic sphincter deficiency in women.

OBJECTIVES: To determine the clinical efficacy, safety, and durability of endoscopically injected glutaraldehyde cross-linked (GAX) collagen for the treatment of intrinsic sphincter deficiency (ISD) in women. METHODS: Forty-two women with a mean age of 64 years (range, 28 to 88) underwent injection of GAX collagen for ISD. Collagen was injected via a transurethral or periurethral approach. Treatment outcome was based on the change in stress leak point pressures (SLPP) and individual incontinence grades before and after collagen injection. RESULTS: With a mean follow-up of 46 months (range, 10 to 66), 83% were cured (n = 17), greatly improved (n = 5), or improved (n = 13), and 17% were unchanged (n = 3) or worse (n = 4). The median number of treatments was 2 (range, 1 to 8). The 22 women greatly improved or cured required a mean of 2.4 collagen injection treatments, whereas the 20 women who were improved, unchanged, or worse had a mean of 4.1 treatments (P = 0.009). The mean amount of collagen injected per patient was 28.3 cc (range, 2.5 to 85). The group of women who were greatly improved or cured had a mean of 17.5 cc of collagen injected, whereas those who were improved, unchanged, or worse had a mean of 39.5 cc injected (P = 0.002). Mean pretreatment SLPPs of women improved, greatly improved, or cured versus the women unchanged or worse were not significantly different (P = 0.015). The 35 women who were improved or cured had a significant increase in mean SLPP of 65.4 cm H2O (P = 0.001) compared to a mean change in SLPP of 14.7 cm H2O in those women who were unchanged or worse (P = 0.038). CONCLUSIONS: GAX collagen injection for the treatment of stress urinary incontinence secondary to ISD appears to be safe, effective, and durable; hence, it should be considered the treatment of choice in appropriately selected female patients.

Adult↗
PubMed1969

New B.N.F.

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Aged↗