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Biomedical subjects

W B Waters

Publications and source records attributed to W B Waters.

14 recordsLinked to original sources
PubMed1991

Penile carcinoma: a twenty-five-year experience.

The treatment of 34 patients with carcinoma of the penis was reviewed during a twenty-five-year period (1958-1983). There were 26 patients with Stage I disease, 7 patients with Stage II, and 1 patient with Stage III disease. Among the Stage I group, 12 patients underwent partial/total penectomy and immediate ilioinguinal lymphadenectomy; 14 patients were treated with partial/total penectomy and observation of clinically nonpalpable nodes. Within the observation period, 10 of the 26 patients died, with a mean survival time of one hundred thirty-three months (standard error = 20.4), and a median of one hundred twenty months. Both the Mantel-Cox and Breslow test statistics showed the survival distribution of these groups of patients not to be significantly different from each other. All 7 patients with Stage II penile cancer died, with a mean survival time of 10.6 months (standard error = 2.1) which is significantly different from the Stage I group and the reported survival of 30-60 percent in the literature. A plan of management for the primary lesion and the role of ilioinguinal lymphadenectomy are presented.

Carcinoma, Squamous Cell↗
PubMed1989

Ureteral replacement using ileum in compromised renal function.

Ureteral replacement by ileum is an accepted technique in a highly selective patient population. Two major contraindications in using an ileal ureter are compromised renal function (serum creatinine greater than 2) and a functionally abnormal bladder. We used ileum to bridge a ureteral defect in animals with half of a solitary kidney and low grade azotemia to see if the antirefluxing mechanism of the lower ureter prevented further deterioration in renal function. Twelve female mongrel dogs underwent a right nephrectomy, followed by a left partial nephrectomy six weeks later. Group I (six dogs) had a six cm. segment of ileum interposed between the upper and lower ureteral segments (nonrefluxing). Group II (five dogs) had a ten cm. segment of ileum placed from the upper third of the ureter to the bladder (refluxing). Cystograms, intravenous pyelograms, serum electrolytes, BUN and creatinine were obtained preoperatively, six weeks after the right nephrectomy, one month after left partial nephrectomy and six months after ileal replacement prior to sacrifice. The BUN and creatinine deteriorated in Group II compared to Group I, p = .02 and p = 0.4 respectively (Mann-Whitney test). The BUN and creatinine also deteriorated between one month after left partial nephrectomy and six months after ileal replacement within Group II, p = .07 and p = .14, respectively (Wilcoxon matched-pairs test) but not in Group I. These data suggest that the antirefluxing mechanism of the lower ureter might prevent further deterioration in renal function. We feel that ileum can be used with caution, as an interposition in compromised renal function.

Animals↗
PubMed1987

The Kock pouch: initial experience and complications.

The modified Kock continent internal reservoir procedure has been performed on 15 patients at our medical center since December 1984: 13 underwent simultaneous anterior exenteration for pelvic malignancy, 1 had conversion from an ileal conduit and 1 underwent cystectomy for refractory interstitial cystitis. There was no operative mortality. There were 3 early complications: a urinary leak from the pouch in 2 patients that required re-exploration to close the defect, and an enteric-Kock pouch fistula in 1 that required resection of the small bowel fistula and repair of the pouch defect. All 3 patients are doing well. The late complication in 3 cases was urinary incontinence of the efferent nipple valve with difficulty in catheterization of the stoma. Two patients have undergone revision with a new efferent nipple valve added on to the pouch and creation of a new stoma. One patient is completely dry and continent, 1 has tolerable intermittent leakage and refuses a further operation, and 1 is awaiting revision. Although the initial experience is small, we are encouraged by these results and believe that this procedure is an alternative form of urinary diversion for the properly selected patient.

Adult↗
PubMed1986

Computerized tomography scan in the preoperative staging of renal cell carcinoma.

Forty-two patients with renal cell carcinoma were evaluated with computerized tomography (CT) followed by surgical exploration, extirpative surgery, or autopsy to determine the accuracy of the CT scan in assessing the extension of the disease. There was an overall accuracy of 95 percent (40/42 patients). The two staging errors were misinterpretation of renal vein involvement and liver invasion. The CT scan is an accurate preoperative indicator of the diagnosis, state, and extension of renal cell carcinoma. Other radiologic studies (arteriography and inferior venacavography) should be used as complementary studies in selective patients.

Carcinoma, Renal Cell↗
PubMed1985

Normal excretory urography in patients with primary kidney neoplasms.

The records of 65 consecutive patients discharged from the hospital with a diagnosis of primary parenchymal neoplasm of the kidney were reviewed. Four of the 65 patients had neoplasms which were not detected by excretory urography. The 4 undetected lesions included 3 renal cell carcinomas and 1 oncocytoma. All of these lesions projected from the anterior or posterior surface of the kidney, and all 4 were clearly demonstrated by computed tomography. Normal findings on an excretory urogram do not completely exclude a neoplasm of the kidney. When there is strong clinical suspicion of a renal neoplasm, computed tomography should be the initial examination or should be done even if the urogram has shown normal findings.

Adenoma↗
PubMed1985

Urinary undiversion using the existing ileal loop and distal right ureter.

Urinary undiversion is an accepted technique in a highly selective patient population. We reconstructed the urinary tract in six female mongrel dogs. A 15 cm. segment of ileum was isolated, both ends were closed and bowel continuity re-established. The proximal two-thirds of each ureter were anastomosed to the proximal end of the ileal segment. The distal one-third right ureteral segment, in continuity with the bladder, was anastomosed end-to-side to the distal ileal segment. Information from the intravenous pyelograms, renal function tests, electrolytes and pathological studies showed normal upper tracts without dilatation or obstruction, preservation of renal function and normal electrolytes except for mild hyperchloremia in all 6 animals. There was chronic pyelonephritis in one animal and mild focal renal inflammation in two animals. The uretero-ileal anastomoses were patent and the ureters were not dilated. The interposed ileum functions well as a conduit and does not become a reservoir over time. We believe incorporating ileum into the urinary tract in this technique of undiversion is a safe and effective clinical alternative in selected patients.

Animals↗
PubMed1979

Management of infected polycystic kidneys.

We report 5 cases of severe uncontrolled infection of polycystic kidneys. Retrograde pyelography antedated infection in 2 of the patients. Difficulty in establishing the diagnosis was demonstrated in all cases. Each patient was treated initially with antibiotics but definitive therapy required an operation in 4 cases.

Adult↗
PubMed1979

Operative versus non-operative management of patients with staghorn calculi and neurogenic bladder.

During the last 5 years 22 patients have been treated at our hospital for staghorn calculi and neurogenic bladder. In 17 patients an operation was done soon after discovery of the calculi, while 5 patients were followed non-operatively. The latter 5 patients had a rapid downhill course marked by sepsis and renal function deterioration and an operation was necessary in 4 of the 5 cases. Injudicious non-operative therapy only prolongs the relentless effects of staghorn calculi in patients with spinal cord pathology.

Adult↗
PubMed1979

Sexual impotence: the overlooked complication of a second renal transplant.

The incidence of sexual impotence in 20 men who have received at least 2 kidney transplants was 65% compared to 10% after the first transplant. The importance was transient (2 to 4 months) in both affected men after the first transplant but permanent (2 to 10 years) in 6 men after the second operation. We attribute this increased percentage of impotence to the second end-to-end arterial anastomosis that requires division of the internal iliac arteries. We suggest that the second transplant be placed end-to-side into the common iliac artery.

Adult↗
PubMed1978

Sexual impotence: the overlooked complication of a second renal transplant.

THE INCIDENCE OF SEXUAL IMPOTENCE IN 20 MEN WHO HAVE RECEIVED AT LEAST 2 KIDNEY TRANSPLANTS WAS 65 PER CENT COMPARED TO 10 PER CENT AFTER THE FIRST TRANSPLANT. The impotence was transient (2 to 4 months) in both affected men after the first transplant but permanent (2 to 10 years) in 6 men after the second operation. We attribute this increased percentage of impotance to the second end-to-end arterial anastomosis that requires division of the internal iliac arteries. We suggest that the second transplant be placed end-to-side into the common iliac artery.

Adult↗