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Terry W Hensle

Publications and source records attributed to Terry W Hensle.

12 recordsLinked to original sources
PubMed2007

A review of failures of endoscopic treatment of vesicoureteral reflux with dextranomer microspheres.

PURPOSE: We evaluated the appearance of the mound of failed endoscopic dextranomer microsphere injections at the time of reinjection or open ureteral reimplantation. MATERIALS AND METHODS: We performed a multi-institutional study of 80 patients (97 ureters) who were diagnosed with vesicoureteral reflux and had failed endoscopic treatment with dextranomer microspheres. Observations of injected mound characteristics were made during the time of reinjection or at open ureteral reimplantation. Correlations were made with the pre-injection grade of reflux, volume of initial injection, number of punctures used for the initial injection and presence of symptoms of dysfunctional voiding. RESULTS: Examination of the failed injection sites before subsequent injections or open surgery revealed mound abnormalities in all but 13 of the 97 ureters. Of the cases 49% demonstrated a shifted mound, 22% an absent mound and 10% a loss of volume in the mound. Of the 13 patients with normal appearing mounds 7 had improved reflux grade, 3 had worsened grade and 3 had no change. Patients with dysfunctional voiding symptoms had a second injection failure rate of 44%, compared to a 13% rate in those without symptoms of voiding dysfunction. CONCLUSIONS: Most failures of endoscopic correction are associated with mound shifting. The presence of a perfect mound does not predict success. Dysfunctional voiding predicts a lower success rate after a second injection.

Adolescent↗
PubMed2006

Endoscopic management of vesicoureteral reflux in women presenting with pyelonephritis.

PURPOSE: Vesicoureteral reflux is not usually considered a major cofactor in acute pyelonephritis in women. However, there is a subset of individuals in whom reflux must be considered in the evaluation of acute pyelonephritis. We sought to evaluate the effectiveness of endoscopic treatment for vesicoureteral reflux in this subset of patients. MATERIALS AND METHODS: We retrospectively reviewed the records of 13 female patients presenting with clinical pyelonephritis between 2001 and 2005. All of these patients had either a history of vesicoureteral reflux in childhood or a family history of reflux, or had previously undergone surgery for reflux. All patients underwent voiding cystourethrogram and dimercapto-succinic acid renal scan as part of the evaluation. RESULTS: Of the 13 individuals evaluated 9 had vesicoureteral reflux. Of these patients 5 had been operated on previously for vesicoureteral reflux, 2 had a strong family history of reflux and 2 had reflux as a child with documented resolution. Six of the 9 patients with reflux exhibited renal scarring on dimercapto-succinic acid renal scintigraphy. Endoscopic correction of reflux was done in all 9 patients and was successful in 8, as shown on voiding cystourethrogram at 3 months postoperatively. One patient required a second procedure, which was successful. Only 1 patient has had a subsequent episode of clinical pyelonephritis, and voiding cystourethrogram following treatment again revealed resolution of reflux. CONCLUSIONS: There is a subset of women presenting with acute pyelonephritis in whom vesicoureteral reflux is a risk factor. When documented, vesicoureteral reflux can be managed effectively with endoscopic treatment.

Adolescent↗
PubMed2006

Sexual function following bowel vaginoplasty.

PURPOSE: We review our 23-year experience with bowel vaginoplasty, with particular attention to postoperative quality of life and sexual function. MATERIALS AND METHODS: We reviewed the records of 57 patients who underwent bowel replacement vaginoplasty between 1980 and 2004. A total of 42 patients had the Mayer-Rokitansky syndrome, of whom 6 had varying forms of intersexuality, 6 had undergone surgery for pelvic malignancy, 1 had aphallia, 1 had cloacal exstrophy and 1 was the survivor of a conjoined twin separation. Replacement vaginoplasty was done using sigmoid colon in 39 patients, ileum in 9 and cecum in 9. Followup ranged from 18 months to 24 years, with a mean of 8.8 years. Outcome was evaluated by retrospective chart review, and the FSDQ, a validated, IRB approved instrument, was used to evaluate postoperative sexual function. RESULTS: Among the 57 patients postoperative sexual function was evaluated in 44, 9 were lost to followup and 4 were considered too young for evaluation. Of the 44 patients 36 responded to the FSDQ, 6 refused and 2 were unable to complete the questionnaire adequately. Of the 36 patients who responded 15 were married and 31 were sexually active. On a scale of 0 to 5, 28 patients (78%) reported sexual desire, 33% sexual arousal, 33% sexual confidence and 28 (78%) sexual satisfaction. In addition, 20 patients (56%) reported frequent orgasms, 8 (22%) occasional orgasms and 8 (22%) no orgasms. A total of 32 patients (89%) reported adequate lubrication for intercourse and 2 reported dyspareunia. Two of the 36 patients performed home dilation and required estrogen suppositories. A total of 34 patients used home douching and 20 required pads for mucus production. CONCLUSIONS: It appears that isolated bowel segments provided excellent tissue for vaginal replacement. For technical reasons we believe that colonic segments, particularly sigmoid, are preferable to small bowel. Sexual function following bowel vaginoplasty appears to be adequate and durable.

Adolescent↗
PubMed2005

Metabolic consequences and long-term complications of enterocystoplasty in children: a review.

PURPOSE: We summarize important metabolic consequences and long-term complications associated with enterocystoplasty with particular emphasis on the pediatric patient with genitourinary abnormalities. MATERIALS AND METHODS: A directed MEDLINE literature review for metabolic and long-term complications following enterocystoplasty was performed. Information gained through the published literature and from our database was reviewed and summarized to provide the reader with a thorough review of the subject. RESULTS: Bowel is not a perfect tissue for substitution or augmentation and its use to treat functionally and structurally compromised bladders is associated with several metabolic consequences and long-term complications. Metabolic acidosis is the most common metabolic abnormality seen. The rates and severity of these complications vary, although they may have a profound impact on patient quality of life after enterocystoplasty. CONCLUSIONS: The metabolic consequences and long-term complications associated with enterocystoplasty are important clinical features of this intervention. Careful consideration should be given to them prior to pursuing enterocystoplasty.

Child↗
PubMed2004

Endoscopic treatment with dextranomer/hyaluronic acid for complex cases of vesicoureteral reflux.

PURPOSE: The surgical correction of primary vesicoureteral reflux (VUR) is highly successful. This success decreases in more complex cases and often involves reoperation and increased morbidity. We present our experience with the use of subureteral injection of dextranomer/hyaluronic acid (Dx/HA) in complex cases of vesicoureteral reflux in which open surgery would have been indicated. MATERIALS AND METHODS: Between October 2001 and July 2003, 72 patients 9 months to 31 years old (mean age 5.6 years) underwent subureteral injection of Dx/HA for complex VUR at our institutions. Dx/HA was injected submucosally within the intramural ureter (modified STING) in most cases. A guidewire was used to manipulate the ureteral orifice and a retrograde ureterogram was used to delineate the anatomy in selected cases. The average volume of injected material was measured for each ureter. Renal sonography was performed to determine if hydronephrosis was present. At 3 months fluoroscopic voiding cystourethrograms were used to evaluate for the presence of VUR. RESULTS: A total of 93 ureters were treated in 55 girls and 17 boys. All cases were considered to be complex as 17 had persistent reflux after open surgery (7 megaureters repairs, 2 extravesical repairs, 7 intravesical reimplants and 1 blind ureter), 11 had persistent reflux and neurogenic bladder, 7 had ectopic ureters to bladder neck, 6 had bilateral Hutch diverticulum, 6 had persistent stump reflux, 5 had ureterocele after puncture or incision, 15 had duplications, 1 had the prune belly syndrome, 2 had posterior urethral valve following resection, 1 had epispadias and 1 had urogenital sinus. The average maximum reflux grade was IV. An average of 1.1 cc (range 0.4 to 2) was injected per ureter. Of the patients 69 had 3-month followup results. The overall success rate was 68% after 1 implantation (47 of 69). CONCLUSIONS: Submucosal intraureteral implantation with Dx/HA corrected complex vesicoureteral reflux in 68% of patients. In all of these patients open surgery would have potentially been difficult. The use of fluoroscopy and/or guidewires is a useful adjunct in these cases. We believe that this minimally invasive approach is warranted as an initial step in the management of complex cases of VUR before resorting to more difficult open surgical procedures.

Adolescent↗
PubMed2003

Organ-confined primitive neuroectodermal tumor arising from the kidney.

Primitive neuroectodermal tumor (PNET) of the kidney is a rare entity with high malignant potential. Of the reported cases of renal PNET, patients presented with metastatic disease and had a poor response to therapy. The authors describe a rare case of an organ-confined primary PNET arising from the kidney in a 16-year-old girl who presented with vague abdominal pain. Tumor behavior and treatment modalities are discussed.

Abdominal Pain↗
PubMed2003

The cost-effectiveness of endoscopic injection of dextranomer/hyaluronic acid copolymer for vesicoureteral reflux.

PURPOSE: Vesicoureteral reflux is a risk factor for progressive renal damage associated with urinary tract infection. Mild to moderate reflux is routinely treated with long-term antibiotic prophylaxis to prevent recurrent infections and open surgical reimplantation for breakthrough infections despite antibiotic therapy. Endoscopic subureteral injection of implant material is a therapeutic alternative to long-term prophylaxis and open surgery but its widespread use in the United States has been prevented by the lack of a stable implant material. Dextranomer/hyaluronic acid copolymer has been shown to be a safe, effective and durable implant material and was recently approved in the United States. We estimate the effect on costs and cure rates of introducing endoscopic injection with dextranomer/hyaluronic acid copolymer as a treatment alternative in the United States. MATERIALS AND METHODS: We constructed a model that mimics current clinical practice of vesicoureteral reflux treatment for 6 years, and incorporates spontaneous resolution and surgical intervention rates obtained from 2 long-term followup studies. The treatment algorithm was established using medical data from the literature, and clinical management practices from a Delphi survey of 27 pediatric urologists and nephrologists across the United States. Endoscopic injection was introduced into the model as replacement to surgery or alternative to long-term antibiotic prophylaxis. The effectiveness of dextranomer/hyaluronic acid copolymer was calculated from 140 patients (208 ureters) with grade III reflux treated in a clinical study of 221 children in Sweden. RESULTS: With current practice, the average cost per patient in 6 years was 6,640 US dollars and 23.5% of patients continued to have reflux. Replacing open surgery with endoscopic injection led to similar cure rates (22.2% failures) but costs were reduced to 5,522 US dollars. When injection was performed after 1 year of antibiotic therapy failure rates were reduced to 8.5% but costs increased to 7,644 US dollars. CONCLUSIONS: Our results show that a persistent approach to endoscopic surgery can be expected to result in overall success that equals or exceeds open surgery at a lower cost. This finding is particularly true if open reimplant is reserved for patients with high grade or persistent vesicoureteral reflux.

Antibiotic Prophylaxis↗
PubMed2003

The influence of paternal age on down syndrome.

PURPOSE: Children born to older parents are at greater risk for genetic abnormalities, such as Down syndrome. The influence of maternal age on Down syndrome is well established but little is known about the genetic consequences of advanced paternal age. MATERIALS AND METHODS: Data on the incidence of Down syndrome from 1983 to 1997 (3,419 cases) were obtained from the New York State Department of Health congenital malformations registry. Parental age was modeled as individual age groups and by a single linear covariate (drift model). The log linear chi-square test and a test of significance of different explanatory variables were used to evaluate these models to determine significance. We compared actual Down syndrome rates by maternal age with the estimated rate corrected for paternal age. RESULTS: From 1983 to 1997 a dramatic increase in the number of infants born to parents 35 years or older was observed. During the 15-year study period there was an increase of 111% and 60% in the number of mothers and fathers 35 years old or older, respectively. There was no parental age influence on Down syndrome until age 35 years and older. A paternal age effect was seen in association with a maternal age of 35 years and older, and it was most pronounced when maternal age was 40 years and older (p = 0.0004). In this later maternal age group the paternal contribution to Down syndrome was 50%. CONCLUSIONS: Advanced paternal age combined with maternal age significantly influences the incidence of Down syndrome. This effect may represent a paradigm for other genetic abnormalities in children of older fathers.

Adult↗
PubMed2002

Vesicoureteral reflux: a new treatment algorithm.

Vesicoureteral reflux (VUR) affects about 1% of all children and carries an increased risk of pyelonephritis and long-term renal impairment. There are several approaches to the treatment of VUR: antibiotic prophylaxis (conservative treatment), open surgery, and endoscopic treatment. For many patients, endoscopic treatment cures VUR with a single procedure, eliminating the need for long-term antibiotic treatment and avoiding the trauma of a major surgical procedure. The choice of material for endoscopic treatment is of key importance, and, until recently, all available materials were associated with concerns regarding safety and efficacy. Emerging data demonstrate that dextranomer/hyaluronic acid (Dx/HA) copolymer has good long-term safety and efficacy in treating VUR. A new treatment algorithm is, therefore, proposed, recommending that most children with persistent VUR (longer than 1 year) be offered endoscopic treatment with Dx/HA copolymer as an alternative to prolonged antibiotic prophylaxis or open surgery.

Algorithms↗
PubMed2002

Buccal mucosa grafts for hypospadias surgery: long-term results.

PURPOSE: We review the long-term results of buccal mucosa grafts used as part of secondary hypospadias repair. MATERIALS AND METHODS: We evaluated 47 patients for 10 years and analyzed long-term results of buccal mucosa grafts for hypospadias repair. Of the 47 patients 40 have been followed for more than 3 years. RESULTS: The overall complication rate was 32% (13 of 47 cases). All complications occurred in the first 6 months following surgery, and the complication rate was significantly lower in the last 7 years of the series (19%) compared to the first 3 years (60%) (p = 0.01). All 3 patients in this series with a preoperative diagnosis of balanitis xerotica obliterans had a significant postoperative complication. CONCLUSIONS: Buccal mucosa appears to be a durable source of nongenital tissue for urethral replacement. Attention to detail in terms of graft harvest, graft preparation and graft fixation helps to avoid major postoperative complications. Onlay grafts appear to be preferable to tube grafts, and patients with the diagnosis of balanitis xerotica obliterans would appear not to be candidates for 1-stage urethral reconstruction using buccal mucosa.

Adolescent↗