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Biomedical subjects

W H Boyce

Publications and source records attributed to W H Boyce.

At least 19 recordsLinked to original sources
PubMed1991

A comparison of anatrophic nephrolithotomy and percutaneous nephrolithotomy with and without extracorporeal shock wave lithotripsy for management of patients with staghorn calculi.

A retrospective study was conducted comparing anatrophic nephrolithotomy (10 cases), percutaneous nephrolithotomy alone (4 cases) or percutaneous nephrolithotomy combined with extracorporeal shock wave lithotripsy (23 cases) for the treatment of large staghorn calculi. A comparison based on collecting system anatomy demonstrated that anatrophic nephrolithotomy resulted in a greater stone-free rate, shorter hospitalization and lower costs while complication rates were similar. Anatrophic nephrolithotomy should still be considered a viable treatment option, especially for patients with large branched calculi in complex collecting systems.

Adult↗
PubMed1989

The role of open stone surgery since extracorporeal shock wave lithotripsy.

Of 893 stone procedures 37 (4.1 per cent) performed during the first 19 months after extracorporeal shock wave lithotripsy was instituted at our medical center were open operations. Procedures included ureterolithotomy in 23 patients (with simultaneous pyelolithotomy in 1), anatrophic nephrolithotomy in 8, pyelolithotomy in 3 (with concomitant pyeloplasty in 2), partial nephrectomy in 2 and nephrolithotomy with a bowel segment inlay in 1. The most common reasons for electing an open operation were unsuccessful endoscopic stone manipulation, presence of anatomical obstruction in the intrarenal collecting system or ureter, morbid obesity and underlying medical problems precluding lengthy repeated endourological procedures. Over-all surgical results were excellent. Our study indicates that patients who presently require an open stone operation have complex calculous disease associated with a variety of anatomical and physiological problems. Despite this finding good results may be attained.

Adult↗
PubMed1989

Selective elevation of urinary enzyme levels after extracorporeal shock wave lithotripsy.

Urinary enzyme testing has been used by many investigators to diagnose and monitor various types of renal injury. Three urinary enzymes, N-acetyl-beta-glucosaminidase, beta-galactosidase and gamma-glutamyl transferase were monitored in 17 patients before and after a single, unilateral extracorporeal shock wave lithotripsy treatment. Stones were in the renal pelvis or calices except for 1 treated in situ in the proximal ureter. Urine specimens were collected before extracorporeal shock wave lithotripsy and at 1, 3, 5, 7, 10, 14, 21 and 28 days after treatment. N-acetyl-beta-glucosaminidase and beta-galactosidase levels increased significantly after treatment (p less than 0.05). Gamma-glutamyl transferase levels increased after treatment but this was not statistically significant. All enzyme levels were highest on days 1 and 3 after lithotripsy and returned to baseline by day 28. Factors associated with post-treatment enzyme elevation included female sex, a lower pre-treatment creatinine clearance and stone size greater than 1 cm. These findings indicate that there is a transient selective increase in urinary enzyme excretion after extracorporeal shock wave lithotripsy.

Acetylglucosaminidase↗
PubMed1989

Neoadjuvant treatment of stages T2 to T4 bladder cancer with cis-platinum, cyclophosphamide and doxorubicin.

In an ongoing phase II study 17 patients with potentially operable transitional cell carcinoma of the bladder (stages T2 to T4, Nx, Mo) have been treated with intravenous cis-platinum (50 mg.per m.2), cyclophosphamide (400 mg.per m.2) and doxorubicin (40 mg.per m.2). They were to receive 3 treatments at 3-week intervals before cystectomy and 2 treatments at 3-week intervals commencing 5 weeks after cystectomy. Of 17 patients 14 (82 per cent) completed all 3 preoperative treatments but only 7 (41 per cent) continued on to complete the entire 5 treatments. In most cases incomplete therapy was due to patient refusal. Toxicity was low as measured by World Health Organization standards. Of the 17 patients 9 (53 per cent) exhibited objective tumor response (pathological downstaging or greater than 50 per cent reduction of tumor volume determined by either computerized tomography scan and/or endoscopic examination. When the determination was made by endoscopy the changes were dramatic and not borderline.) No patient demonstrated a pathological complete response. All 9 of the responders (100 per cent) remain clinically free of disease at a median follow-up of 19 months (range 4 to 30 months). The 8 nonresponders have done poorly with 5 dead of disease, 1 alive with pelvic recurrence and 2 free of disease at 4 and 12 months. These tumor response rates compare favorably with other cis-platinum-based combination regimens. The response to the chemotherapy appears to be an important prognostic indicator. Phase III trials must be conducted to determine whether this neoadjuvant chemotherapy regimen has a significant effect on long-term patient survival.

Aged↗
PubMed1988

Urethrovasocutaneous fistula.

We report a case of urethrovasocutaneous fistula in an elderly man. There were several possible etiologic factors in this case including: prior vasectomy and transurethral prostatectomy, urinary tract infection, and neurogenic bladder.

Aged↗
PubMed1988

Isolated vesicorectal internal urinary diversion: a 37-year review of the Boyce-Vest procedure.

The challenges that management of exstrophy of the bladder pose the pediatric urological surgeon have resulted in a multitude of ingenious operations and a voluminous literature on exstrophy. Despite this intense interest in an uncommon anomaly, no consistently satisfactory approach to achieve urinary continence in children with exstrophy has evolved. We summarize a 37-year clinical experience with a form of urinary diversion that provides sphincteric urinary continence, and unexcelled long-term preservation of renal function and upper urinary anatomy. From our review it appears that the infant with exstrophy is served best by neonatal closure of the exstrophic bladder with attempts to establish urinary continence later in childhood. When other methods to establish urinary continence are unsuccessful and satisfactory anal continence has been demonstrated, a diverting colostomy combined with anastomosis of the isolated bladder to the isolated rectal stump offers an acceptable long-term alternate form of urinary diversion to produce sphincteric urinary continence with relative freedom from upper urinary deterioration.

Adolescent↗
PubMed1988

Financing residency training in urology.

Five educators concerned with changes occurring in the financing of medical education and care reviewed the present status of residency programs and their financing. Future support depends on political decisions as well as demonstrable needs. The effects of anticipated reductions in funding for residents and their programs may be countered by the development of alternative sources and the restructuring of present programs for more efficient operation. The need for leadership is clear.

Costs and Cost Analysis↗
PubMed1988

Radiologic contribution to the management of patients undergoing extracorporeal shock wave lithotripsy.

Since its first clinical application in 1980, the use of extracorporeal shock wave lithotripsy (ESWL) has dramatically changed the treatment of urinary tract stone disease. More than 80% of patients with urolithiasis will undergo ESWL as a first line therapy. Detection of stones, appropriateness of ESWL treatment, successful stone therapy, termination of the ESWL procedure, and evaluation of treatment complications are all dependent on radiologic input. The application of adjuvant interventional radiologic percutaneous techniques will extend the use of ESWL to an additional 15% of patients and reduce the need for surgical intervention. Additionally, percutaneous techniques can be used to improve success rates in problematic cases and to treat complications related to the ESWL procedure. This article discusses the pre- and postprocedural radiologic evaluation of patients undergoing ESWL. Adjuvant interventional radiologic techniques useful in the management of these patients are also discussed.

Humans↗
PubMed1986

Postoperative anatrophic nephrolithotomy bleeding.

We reviewed 530 patients treated with anatrophic nephrolithotomy during a 14.5-year period. Significant postoperative renal bleeding occurred in 34 cases (6.4 per cent). The average postoperative blood transfusion requirement in this group was 5,279 cc. Bleeding patients were significantly older and they had worse renal function compared to the nonbleeding group. If bleeding did not begin immediately it usually started 5 to 8 days postoperatively. Bleeding dyscrasias were identified in 6 patients and correction allowed nonoperative management in 4. Epsilon aminocaproic acid was helpful only in the treatment of patients with slow, lower volume bleeding. Eight patients required 9 open renal explorations to control bleeding. Two arteriovenous fistulas and 1 false aneurysm were identified. An attempt at angiographic embolization of an arteriovenous fistula was unsuccessful. Only 1 patient required a nephrectomy (1 of 34 or 2.9 per cent) and there was no mortality. A treatment plan for this complication is described.

Adult↗
PubMed1986

The Boyce-Vest operation for exstrophy of the bladder. 35 years later.

Twenty-four patients with exstrophy of the urinary bladder (23 patients) or epispadias (1 patient) who were treated by the Boyce-Vest operation have been followed for a total of 482 patient-years (range 3 to 34 years, mean 22 years). In all patients upper urinary morphology and renal function have remained normal, and those with preoperative compromise have stabilized or improved. Postoperatively, no patient has developed an electrolyte imbalance or metabolic acidosis requiring treatment, urinary calculi, or malignant change in the vesicorectal reservoir. Although the procedure and the exstrophy-epispadias complex present many unresolved of management. The infant with exstrophy of the urinary bladder appears best served by early neonatal closure of the exstrophic bladder as described by Jeffs, 6,8 with attempts at establishing urinary continence later in childhood. 6,8,11 When other methods to establish urinary continence are unsuccessful and satisfactory anal continence has been demonstrated, the Boyce-Vest procedure offers an acceptable long-term alternative to establish sphincteric urinary continence. Properly managed, the newborn with uncomplicated exstrophy should have a life expectancy equal to that of any other neonate. More importantly, it is within our ability to provide such patients with adult social acceptability and relative freedom from urinary disease.

Adolescent↗
PubMed1985

A double-blind comparison of dezocine and morphine in patients with acute renal and ureteral colic.

The safety and analgesic efficacy of dezocine and morphine in the treatment of acute renal or ureteral colic due to calculi were evaluated in 2 multicenter, double-blind studies, comparing 10 mg. dezocine and 10 mg. morphine in 88 patients, and 15 mg. dezocine and 10 mg. morphine in 61 patients. All patients received an intramuscular injection of the test drug, and pain intensity and pain relief were evaluated through 4 hours after drug administration. Vital signs, degree of sedation and adverse effects also were recorded. Mean efficacy scores were virtually identical for 10 mg. dezocine and 10 mg. morphine but 15 mg. dezocine produced consistently better analgesia than 10 mg. morphine. This superiority of 15 mg. dezocine was statistically significant on the pain analogue scale at 1 to 4 hours. More morphine-treated than dezocine-treated patients withdrew from each study because of inadequate pain relief. The frequency of adverse effects was not significantly different between groups in either study and none of the patients had clinically significant changes in vital signs. These results indicate that dezocine is a safe and effective analgesic for the treatment of renal and ureteral colic due to calculi, and 15 mg. dezocine were more effective than 10 mg. morphine in this pain model.

Acute Disease↗
PubMed1985

Pediatric anatrophic nephrolithotomy.

A 15-year experience with pediatric anatrophic nephrolithotomy was reviewed. There were 11 procedures performed in 10 patients. Average patient age was 9.43 plus or minus 1.54 years (standard error of the mean). Preoperative urine cultures were positive in 6 of 11 cases. Metabolic or structural defects were identified in all patients. Postoperative morbidity was minimal. Adequate followup was available in 9 patients, for an average length of 4.6 plus or minus 0.96 years. Stones recurred in 7 of 9 patients (78 per cent) but in 2 the new calculi were small and asymptomatic. Anatrophic nephrolithotomy can be performed safely in children but a high incidence of structural and metabolic abnormalities predisposes these patients to recurrent stones.

Adolescent↗
PubMed1979

Heterozygous cystinuria and calcium oxalate urolithiasis.

Many variables are known to be associated with the formation of calcium oxalate urolithiasis but none is essential for the initiation or growth of stones. It is likely that the predisposition to stone formation is related to multiple factors. We herein describe still another metabolic state that seems to predispose to calcium oxalate stone disease, namely heterozygosity for cystinuria. Cystine screening tests were done on 24-hour urine specimens obtained from 126 patients in whom recurrent calcium oxalate stones form and 84 controls and quantitative amino acid determinations were done on all positive specimens. Of those studied 17 of 126 stone patients and 1 of 84 controls were heterozygous cystinurics. A test of the differences between the relative frequencies of cystinuria heterozygotes in the 2 groups with Fisher's exact test revealed them to be highly significant (p less than 0.001). Our study indicates that carrier status for 1 of the cystinuria genes predisposes to calcium oxalate stone formation but, like other factors related to urolithiasis, it is not a necessary cause of stone disease.

Adolescent↗
PubMed1979

Childhood urolithiasis.

Between 1965 and 1976, 54 children with urolithiasis were evaluated and treated. Age, sex, race distribution, patient symptomatology, stone localization and type are outlined. The relationship of stone formation to urinary infection and/or genitourinary anomalies is reviewed, and treatment and recurrence patterns are studied.

Adolescent↗
PubMed1979

Biochemical profiles of stone-forming patients: a guide to treatment.

A formal protocol, controlled metabolic evaluation is essential to the most effective treatment of any patient with renal calculi, regardless of the crystalline composition of the stone. The design of the protocol and of the data sheets should be compatible with ease of diagnosis and selection of corrective therapeutic measures. These data also serve as a reference to monitor response to treatment. Treatment is highly individualized with the objective to reduce all potentially crystallizable ions to basal levels. If this is difficult to accomplish certain ratios of ions are brought to as near normal values as possible.

Adult↗
PubMed1979

Results of urinary diversion in patients with myelomeningocele.

Among 481 children with myelomeningocele seen at the North Carolina Baptist Hospital since 1949, 46 have undergone a urinary diversion procedure, as follows: ileal loop in 43; sigmoid loop in two; and transverse colon conduit in one. The indications for diversion were incontinence in 28, urinary infection or pyelonephritis in 27, and hydronephrosis, pyelocaliectasis, and reflux in 12 patients. No deaths resulted from the diversionary procedures. One patient required early surgical revision and seven patients required late surgical revision. Two patients have since died, 44 have been followed for an average of 7.9 years, 15 for more than 10 years. Overall, of 26 patients with normal prediversionary intravenous pyelograms (IVP's), 88% now have normal or nearly normal IVP's; of 14 patients with abnormal prediversionary IVP's, 79% now have normal, improved, or unaltered IVP's. Renal function has remained normal in all 44 patients, and renal calculi have developed in 10 patients. Ileal loop diversion appears to convert a high-pressure system into a low-pressure system, thereby helping to prevent further renal damage. This procedure tends to stabilize, rather than improve, urinary-tract function. For these children already so incapacitated by their basic disease, this goal is acceptable, particularly since it also provides continence and independence from parental nursing.

Adolescent↗
PubMed1979

Low molecular weight urinary proteins and renal lithiasis.

Twenty-four hour urine specimens were obtained from 20 active calcium oxalate stone formers, 20 inactive calcium oxalate stone formers, 8 struvite stone formers, and 9 non-stone forming controls. Proteins with molecular weights less than 50,000 daltons were concentrated by ultrafiltration and separated by sodium dodecyl sulfate polyacrylamide gel electrophoresis. Fourteen of the 17 active calcium oxalate stone formers had low molecular weight urinary proteins (less than 35,000 daltons) present in their urine whereas none of the inactive stone formers or struvite stone formers had similar patterns. Only one of the nine control patients had similar proteins present.

Calcium↗