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Biomedical subjects

V A Politano

Publications and source records attributed to V A Politano.

At least 19 recordsLinked to original sources
PubMed1995

Ileocolic neobladder in the woman with interstitial cystitis and a small contracted bladder.

Bladder substitution with an ileocolic segment after total cystectomy was performed in 5 women with a severely contracted bladder secondary to interstitial cystitis. The urethra was divided at the bladder neck in 2 patients and distal to it in 3. The latter 3 patients empty the bladder to completion and void naturally, while the former 2 have a large post-void residual volume and require intermittent self-catheterization. Mean patient age was 50 years and mean followup was 52 months. All patients have complete diurnal and nocturnal continence, and are free of all symptoms related to interstitial cystitis. Total bladder replacement in women with interstitial cystitis and a contracted bladder significantly improved the quality of life and is an ideal alternative to other forms of urinary diversion.

Adult↗
PubMed1994

Renal parenchyma-sparing surgery as conservative treatment of renal cell carcinoma.

OBJECTIVE: To evaluate the role of parenchyma-sparing surgery in patients with renal cell carcinoma (RCC). PATIENTS AND METHODS: Between 1965 and 1990, 34 patients with RCC underwent renal parenchyma-sparing surgery. There were 22 men and 12 women with a mean age of 62 years (range 40-89). Ten patients underwent enucleation (Group A), 15 partial nephrectomy (Group B), and nine a combination of procedures (Group C). Conservative surgery was performed in the presence of a normal contralateral unit in four patients (12%). RESULTS: Five patients developed local recurrence. Metastases appeared in six patients (18%) from 12 to 58 months post-operatively. Adequate renal function was obtained in 32 of the 34 patients. The mean follow-up for all patients was 64.6 months overall, 75.6 months for group A, 64.1 months for group B and 53.4 months for group C. The 3 and 5 year probabilities of survival for all patients were 77.8% and 69.5% respectively. The probabilities of 3 and 5 year survival were 80% for group A, 80% for group B and 71.4% and 57.1% for group C. CONCLUSION: Enucleation and partial nephrectomy are both viable options in the management of solitary or bilateral RCC, as there is no decline in effective tumour control and prognosis. Larger groups and longer follow-ups are needed to assess the role of renal parenchyma-sparing surgery more definitively.

Adult↗
PubMed1992

Complications of the Miami pouch.

The Miami pouch, a continent colonic urinary reservoir, was constructed in 75 patients after cystectomy for invasive bladder tumor (44), gynecological tumor (25), neurogenic bladder (4) and conversion of an ileal conduit (2). Continence was achieved by tapering the distal ileum over a 14F catheter and reinforcing the ileocecal valve with 3 circumferential silk sutures in a pursestring fashion. Ureterocolonic anastomosis was performed in a nontunneled fashion. There were 5 perioperative deaths. One or more early (perioperative) complications occurred in 19 patients (26%). Late complications (beyond 6 weeks) were found in 16 patients (23%). Total continence rate was 98.6% and the success rate of the ureterocolonic anastomosis was 90%. Followup was 7 to 69 months. We present a review of the technical aspects of the construction of the Miami pouch, and the early and late complications associated with this procedure.

Adult↗
PubMed1992

Transurethral polytef injection for post-prostatectomy urinary incontinence.

This report deals with 720 incontinent males injected with Polytef paste. In all cases the incontinence resulted from some form of prostatic surgery. All patients had been incontinent for at least 1 year. Approximately 88% of patients incontinent from transurethral resection (TURP) were cured or improved; 74% of patients undergoing prostatectomy were improved, and approximately 67% of patients incontinent after radical prostatectomy were cured or improved. No major complications or clinical evidence of particle migration were observed. Our 20 plus years' experience with Polytef paste has shown it to be a safe and effective method for the treatment of post-operative male incontinence, with a high success rate.

Humans↗
PubMed1991

Patient-reported sexual symptomatology in predicting functional and insufficient erectile capacity.

We evaluated the clinical utility of patient-reported erectile functioning information in discriminating Rigiscan-determined functional (greater than or equal to 70% penile tip and base rigidity and greater than or equal to 10 minutes' duration) from insufficient (less than 40% penile tip and base rigidity and less than or equal to 6 minutes' duration) erectile capacity, in a population of chronically ill men presenting with erectile dysfunction. Forty-three male veterans completed an extensive medical and psychologic evaluation, including a detailed assessment of sexual functioning, and then underwent two consecutive nights of supervised in-hospital Rigiscan sleep evaluations. Results of discriminant function analysis indicated that patient reports of morning erections and ejaculatory ability accurately predicted group membership for functional (96.7%) and insufficient (100%) categories. Careful attention to patient self-report is suggested for the urologist's initial appraisal of erectile dysfunction in populations of older, chronically ill men.

Erectile Dysfunction↗
PubMed1991

Ileal segment for ureteral substitution or for improvement of ureteral function.

A total of 29 patients received an ileal segment interposition between the upper and lower urinary tract for partial or total ureteral substitution, or for ileal wrapping around a massively dilated, aperistaltic ureter. Indications for an operation included the presence of an extensively diseased or short ureter and an aperistaltic megaureter that had failed previous reconstructive attempts. Nine patients (group 1) underwent an ileal sleeve procedure in an attempt to increase the ureteral peristaltic activity and facilitate drainage. Among these patients 7 (78%) had a stable upper tract radiologically and normal serum creatinine (less than 1.6 mg./100 ml.), while 2 (22%) had deterioration of the renal function. Ten patients (group 2) had undergone a myriad of reconstructions that failed and then underwent complete ureteral substitution with ileum. Among them, renal function (as evidenced by excretory urography and serum creatinine) is stable in 7 (70%) and deteriorated in 3 (30%). In 10 patients (group 3) the ureters were partially replaced by ileum in addition to a bladder augmentation procedure. Of these patients 8 (80%) have stable renal function and 2 (20%) had renal failure. Over-all, 7 patients have different degrees of renal failure; among them 2 (6.9%) are on dialysis and 2 (6.9%) have received a transplanted kidney. In groups 2 and 3 the results with an antireflux operation indicated that among 6 ureteroileal reimplantations 5 (83%) were successful, among 12 intravesical intestinal nipples 6 (50%) failed to prevent reflux and there was no case of obstruction, while among 4 ileocecal intussusceptions 2 (50%) were successful and 2 failed. Mucous secretion produced temporary ureteral obstruction in 1 ureter (3.4%), which resolved without surgical intervention. Some of the aforementioned procedures were done in the past and in some situations a different reconstructive technique would be considered presently. The surgical complexity and magnitude of the procedures justify their performance only in difficult clinical situations as an alternative to urinary diversion or renal autotransplantation.

Adolescent↗
PubMed1991

The predictive significance of patient-reported sexual functioning in RigiScan sleep evaluations.

We evaluated the relevance of patient reported sex history information in predicting erectile functioning as measured by the RigiScan monitor. A total of 46 male veterans who presented with erectile dysfunction completed an extensive medical and psychological evaluation including a sexual history, and then underwent 2 consecutive nights of inhospital RigiScan sleep evaluation performed under supervision. Multivariate analyses indicated a significant relationship among patient reported sex history information, and RigiScan measurements of tip and base duration, and rigidity. The sex history item with the greatest predictive power was the question regarding early morning erections. The results of this study highlight the importance of patient reported information, and the significance of obtaining a detailed sex history in the evaluation of older, primarily chronically ill patients who present with erectile dysfunction.

Adult↗
PubMed1989

Diluted epinephrine solution for the treatment of priapism.

We report our experience with 18 consecutive cases of priapism treated with intracorporeal irrigations of dilute epinephrine solution. Of the 18 patients 16 were treated successfully. The 2 failures had priapism 36 hours and 5 days in duration, respectively.

Adult↗
PubMed1989

Treatment of vesicouterine fistula by fulguration.

A 29-year-old woman suffered a vesicouterine fistula following cesarean section. The fistula was treated successfully after cystoscopic identification and fulguration of the tract. Although various surgical approaches to this problem have been described, and a number of cases of spontaneous resolution are reported, to date there have been no reports of treatment of this problem via cystoscopic fulguration. We advocate this simple technique as a primary approach to vesicouterine fistulas.

Adult↗
PubMed1989

[Clinical experience of tapered distal ileum for construction of a continent colonic urinary reservoir].

Construction of continent colonic urinary reservoir was performed in 44 patients after exenteration for invasive bladder carcinoma or various gynecologic tumors. The distal ileum was tapered over a 14 French red rubber catheter. The ileocecal valve was reinforced with three circumferential silk sutures in a purse-string fashion. Full continence was obtained in all patients (100%). A non-tunneled, non-refluxing ureterocolonic anastomosis was performed in all 88 ureters. No obstruction or reflux was observed in 84 ureters (95%). There were 7 early postoperative complications and 3 of them required reoperation (pelvic abscess 1, urinary leak from ureterocolonic anastomosis 1, pouch-vaginal fistula 1). Moreover, there were 7 late complications and 3 of them required reoperation (stomal stenosis 1, parastomal hernia 2). These results suggest that this method is a safe, simple and useful one for permanent urinary diversion.

Abscess↗
PubMed1988

Periurethral polytetrafluoroethylene injection following urethral reconstruction in female patients with urinary incontinence.

We present our results with periurethral polytetrafluoroethylene (Polytef) injection after urethral reconstruction in 20 female patients with urinary incontinence. These patients have failed previous urethral reconstructive procedures to cure incontinence, including Young-Dees-Leadbetter bladder neck reconstruction, transvaginal urethroplasty, transvaginal urethral plication and vesical flap urethroplasty. Of the patients 4 also underwent a bladder augmentation procedure. After polytetrafluorethylene injection 10 patients (50 per cent) were cured of the incontinence, 2 (10 per cent) had marked improvement from the preoperative condition, 5 (25 per cent) had definite improvement but still wear pads for protection and 3 (15 per cent) had no change from the preoperative condition. Bladder pressure recordings did not demonstrate a difference in results among patients with detrusor stability or instability. Periurethral polytetrafluoroethylene injection remains a valuable procedure in the management of persistent incontinence after bladder neck and urethral reconstruction.

Adult↗
PubMed1988

Stapled and nonstapled tapered distal ileum for construction of a continent colonic urinary reservoir.

A continent colonic urinary reservoir was created in 10 patients who had undergone anterior exenteration for invasive bladder carcinoma. A tapered distal ileal segment with a catheterizable abdominal stoma provided full continence in all 10 patients. Tapering of the terminal ileum was achieved with a gastrointestinal anastomosis stapler in 5 patients or with a bowel clamp in 5 others. Three purse-string sutures of 2-zero silk were placed on the tapered ileal segment to increase the intraluminal pressure. A nontunneled ureterocolonic anastomosis was performed in all 20 ureters. No obstruction or reflux was noted in 19 ureters (95 per cent). Hydronephrosis at the anastomotic site was noted in 1 ureter and was successfully dilated percutaneously.

Adult↗
PubMed1986

Centrifugal cytology: a new technique for urine cytology.

A new technique, centrifugal cytology, appears to have a high recovery rate of malignant cells from voided urine specimens resulting in a high probability of early disease detection and should be considered a good supplement to cytoscopic evaluation of high-risk populations.

Centrifugation↗
PubMed1986

Female urinary incontinence: preoperative selection, surgical complications and results.

A total of 98 women with stress urinary incontinence underwent surgical repair via 3 different techniques: 38 patients underwent a Burch colposuspension (group 1), 25 underwent a Stamey procedure (group 2) and 35 had a modified Pereyra operation (group 3). The main indication for an operation was clinically unacceptable incontinence, and urodynamic studies were done on all patients with associated stress and urge incontinence or who underwent reoperation. Subtracted bladder pressure recording was an important preoperative screening tool, since patients with high pressure instability did worse surgically than those with a stable bladder or low pressure instability. In patients with detrusor stability similar results were achieved for initial surgery and reoperations. Among the patients with a stable bladder with and without a previous anti-incontinence operation the over-all results were better in groups 1 and 3 than in group 2. Complications were of lesser magnitude in groups 2 and 3 than in group 1.

Adult↗
PubMed1986

Sphincterotomy failure in neurogenic bladder disease.

Among 60 spinal cord injury patients who underwent external urethral sphincterotomy 45 experienced success and 15 failed. Failure was established when symptomatic urinary tract infections and high vesical residuals persisted. Urodynamic findings demonstrated detrusor areflexia in 10 patients (66 per cent), detrusor-sphincter dyssynergia in 2 (13.2 per cent), detrusor hyperreflexia with unsustained bladder contractions in 1 (6.6 per cent), and detrusor hyperreflexia and bladder neck obstruction in 2 (13.2 per cent). Among these failures poor detrusor contractility predominated. Detrusor-sphincter dyssynergia may indicate an inadequate surgical relief of obstruction. Bladder neck obstruction may indicate that a bladder neck incision should be considered when an external sphincterotomy is performed.

Adult↗
PubMed1986

Augmentation cystoplasty in the management of neurogenic bladder disease and urinary incontinence.

Vesical augmentation procedures were performed on 15 patients for neurogenic bladder disease and urinary incontinence. Enterocystoplasty with ileum, cecum and sigmoid was used associated with different operations to prevent upper tract deterioration or urinary incontinence. The small bowel stored larger amounts of urine at a lower maximal detrusor pressure at capacity than the large bowel. All ureterointestinal and ureterovesical reimplantations were successful, including 5 ureteroileal with the Camey procedure. The 2 failures, characterized by persistent urinary incontinence, included a male patient who refused intermittent catheterization and a girl with persistent hypersecretion of mucus and recurrent urinary tract infections.

Adolescent↗