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Biomedical subjects

W L Furlow

Publications and source records attributed to W L Furlow.

At least 37 records · Page 2Linked to original sources
PubMed1985

Long-term results with transpubic urethroplasty.

From 1973 to 1982, 44 patients underwent transpubic urethroplasty for traumatic prostatomembranous strictures and were followed for 1 to 10 years. The most frequent late sequelae were permanent erectile dysfunction (22 patients) and progressive erectile dysfunction (4 patients). Of the 44 patients 6 (14 per cent) had significant primary urinary incontinence that necessitated placement of a genitourinary sphincter and 2 (4.5 per cent) had incontinence after secondary transurethral procedures because of involvement of the remaining voluntary sphincter mechanism. Prosthetic devices may be useful in correcting erectile dysfunction and urinary incontinence in this difficult patient population. Of 13 patients with post-urethroplasty strictures 10 required dilation.

Adult↗
PubMed1985

Recurrent or persistent urinary incontinence in patients with the artificial urinary sphincter: diagnostic considerations and management.

Clinical experience in the selection of patients for implantation of the artificial urinary sphincter and the surgical techniques for sphincter implantation indicate a need to provide suitable guidelines for patient followup and the management of post-implantation urinary incontinence. Two types of post-implantation incontinence are recognized: 1) immediate post-activation incontinence and 2) delayed or recurrent incontinence. The potential causes, and the diagnostic and management techniques are dependent on not only an understanding of device function but also on the use of already available clinical tools. Physical examination, inflate-deflate roentgenograms of the device, cystoscopy and retrograde urethrography each has an important role in determining the cause and, therefore, the appropriate remedy for the restoration of urinary control. Causes that result in loss of urinary control after implantation include improper operation of the device by the patient, detrusor hyperreflexia, occlusive cuff erosion, improper cuff sizing and device malfunction. Proper recognition of the precise cause of post-implantation incontinence and workable guidelines for management will provide for effective assurance that urinary control can be restored successfully.

Equipment Failure↗
PubMed1985

The artificial urinary sphincter: experience with the AS 800 pump-control assembly for single-stage primary deactivation and activation--a preliminary report.

The introduction of a new pump-control assembly mechanism for the artificial urinary sphincter has eliminated the need for two-stage surgical procedures in patients with urinary incontinence and has provided the option of deactivation or activation both at the time of implantation and at a later time, in accordance with the clinical judgment of the surgeon. Individualization of treatment on the basis of the patient's clinical condition is a considerable advance in the management of urinary incontinence because it allows broader applications in the use of the artificial sphincter.

Adult↗
PubMed1985

Use of the artificial urinary sphincter in the management of severe incontinence in females.

AS 792 and AS 800 sphincters were implanted in 31 female patients with incontinence due to various causes including neurologic dysfunction, recurrent stress incontinence, spinal cord trauma and pelvic trauma. Continued continence has been achieved in 21 of these patients. Erosions required removal of the device in the ten other patients. The AS 800 model has significant modifications that allow activation and deactivation without additional operative procedures. Satisfactory continence can be achieved in properly selected patients. The integrity of the vesicovaginal surgical plane is the key to success. Patients with multiple operations are the most difficult to manage and delayed activation is mandatory. Intermittent catheterization can be safely done and mechanical reliability is good.

Adolescent↗
PubMed1984

Inflatable penile prosthesis. New device design and patient-partner satisfaction.

The three most significant factors in achieving patient-partner satisfaction with a penile prosthetic device are selection of the patients, realistic expectations of both the patient and the partner, and reliability of the device. Exchange of information between the clinical observers and the design engineers can significantly enhance the reliability of the device.

Erectile Dysfunction↗
PubMed1984

Incontinence, intermittent self-catheterization and the artificial genitourinary sphincter.

Although the artificial genitourinary sphincter is ideally suited for incontinent patients who can empty the bladder completely, we have observed 22 patients with artificial sphincters who also perform intermittent self-catheterization to augment bladder emptying. No cuff erosions have occurred to date, with 11 patients on intermittent catheterization for more than 30 months. In patients who will require intermittent self-catheterization after sphincter implantation the cuff should be placed around the bladder neck. We believe that patients with sphincteric incontinence and decreased bladder contractility resulting in excessive residual urine volume are reasonable candidates for use of the artificial sphincter with intermittent self-catheterization.

Adolescent↗
PubMed1983

Hormonal treatment at time of radical retropubic prostatectomy for stage D1 prostate cancer.

We classified 70 prostatic cancers as stage D1 at the time of pelvic lymphadenectomy and radical prostatectomy. For retrospective analysis after 1 to 14 years of followup, the patients were divided into 32 in whom endocrine therapy had been given immediately postoperatively and 38 in whom it had not. These 2 groups did not differ substantially in patient age, Gleason grade, pathologic stage, tumor volume or seminal vesicle involvement. The mean number of involved nodes per patient was higher in the hormone-treated group (2.9 versus 1.8). According to Kaplan-Meier projections 88 per cent of such patients without hormonal treatment will have progression within 5 years, compared to only 14 per cent of those given hormonal treatment immediately. However, projected survival differed little between the groups, most likely since 17 of the 18 patients with progression in the nontreated group were given hormonal treatment as soon as progression was substantiated. Definitive assessment of the impact of the timing of endocrine therapy on patient survival and time to disease progression awaits a randomized trial with long-term followup.

Adenocarcinoma↗
PubMed1983

Radical prostatectomy incontinence and the AS791 artificial urinary sphincter.

The AS791 prosthetic sphincter was implanted in 66 patients with urinary incontinence after radical prostatectomy. Of these patients 49 (74 per cent) were continent 3 months to 4 1/2 years after implantation. Excluding the 22 patients who had had previous pelvic radiation therapy 41 (93 per cent) were continent. Mechanical problems have been few, establishing the reliability of this unique sphincter mechanism.

Humans↗
PubMed1982

Bilateral pelvic lymphadenectomy and radical retropubic prostatectomy for adenocarcinoma of prostate with regional lymph node involvement.

Ninety-nine patients with adenocarcinoma of the prostate and regional lymph node involvement underwent pelvic lymphadenectomy. Therapeutic results were analyzed in 70 patients who subsequently underwent radical retropubic prostatectomy with or without concomitant therapy (usually hormonal) and in 29 patients who received radiation or hormonal treatment only but without prostatectomy. Follow-up ranged from one to fourteen and one-half years. The over-all projected survival rates (Kaplan-Meier) at five and ten years (88 per cent and 71 per cent, respectively) in the prostatectomy series were comparable to those of an age-matched control group. Concomitant bilateral orchiectomy provided a high projected (76 per cent at ten years) nonprogression rate. Over-all survival rates in the nonprostatectomy series were poor. Only the number of nodes involved was associated with survival and time to disease progression. Patient age, tumor bulk, seminal vesicle involvement, and tumor grade (Mayo and Gleason scores) had no definite relationship to survival. Pelvic lymphadenectomy and radical retropubic prostatectomy for prostatic adenocarcinoma may be therapeutic in some patients with limited (less than or equal to two positive nodes) nodal disease.

Adenocarcinoma↗
PubMed1982

Relationship between grade and stage of adenocarcinoma of the prostate and regional pelvic lymph node metastases.

The relationship of grade and local tumor extent to pelvic nodal involvement was assessed surgically in 469 patients who underwent pelvic lymphadenectomy and radical retropubic prostatectomy for adenocarcinoma of the prostate. Grade and local stage alone and combined score were associated in a linear fashion with nodal involvement. Gleason sum and Mayo grade alone were not predictive of nodal metastases. Some patients with a Gleason score of 4 had positive nodes and some with a score of 8 to 10 had negative nodes. Mayo sum (grade plus stage) consistently was related to negative nodal involvement.

Adenocarcinoma↗
PubMed1981

Radical retropubic prostatectomy and pelvic lymphadenectomy for high-stage cancer of the prostate.

A series of 340 patients with adenocarcinoma of the prostate treated by bilateral pelvic lymphadenectomy and radical retropubic prostatectomy was reviewed to determine the factors that influence survival and time to progression of disease. Follow-up ranged from 1-12 1/2 years. Factors evaluated were grade, stage, and bulk of tumor; influence of seminal vesical involvement and number of pelvic nodes involved; age of patient; and year of surgery. Tumor grade was the only factor related significantly to patient survival. However, grade, stage, and bulk of tumor were all significantly associated with interval between surgery and disease progression. Furthermore, in Stage C disease, seminal vesical involvement (C+) was an adverse factor for disease progression, particularly among patients with low-grade tumor. This is in contrast to the finding that, among patients with Stage D1 disease, those with seminal vesical involvement experienced more favorable survival times and times to progression of disease when compared with patients without seminal vesical involvement. Overall, patient survival compared favorably with an age-matched control group for all stages, A through D1. Patients with few pelvic nodes involved had a survival experience nearly comparable with that of an age-matched control group. This suggests that pelvic lymphadenectomy might have a therapeutic value and that patients with pelvic nodal disease only, without evidence for metastatic disease, should not be denied radical surgery. The influence of concomitant hormonal manipulation or radiotherapy (or both) on patient survival and disease progression is not conclusively answered in this report.

Adult↗
PubMed1981

Implantation of a new semiautomatic artificial genitourinary sphincter: experience with primary activation and deactivation in 47 patients.

AS 742 is a new semiautomatic artificial genitourinary sphincter that has been used at the clinic for the last 21/2 years in the management of urinary incontinence. Compared to the previous model the simplified design provides for much easier implantation, more reliable function related to cuff pressures and to cuff configuration, and more flexibility in the selection of the site for cuff placement. In addition, this new device has enabled the development and use of a new concept of primary and secondary activation. A total of 47 patients (41 male and 6 female subjects) has undergone implantation of the AS 742. Of the 42 patients who had primary activation 34 experienced continence without further surgical revision. The remaining 5 patients who primarily had deactivated devices subsequently had the devices activated and the patients are dry. Of the 8 patients with initial failures 2 had infection and 6 had primary cuff erosion of the urethra. In 4 of the 8 patients the cuff was replaced, and the device was deactivated and then activated after 3 to 4 months. All 4 of these patients are continent. Followup for these patients has ranged from 6 to 30 months. Over-all, 43 of the 47 patients are continent.

Adolescent↗
PubMed1981

Transpubic urethroplasty in children.

In 12 children with membranous urethral strictures transpubic urethroplasty has been performed successfully with minimal morbidity and no mortality. Of the 12 patients 8 are completely continent after transpubic urethroplasty, 2 have partial continence and 2 are incontinent. Wedge resection of the pubic symphysis afforded satisfactory exposure to the prostatic urethra, and none of the 12 patients experienced orthopedic instability, abnormal gaits or pelvic girdle pain. In 3 patients there was loss of erectile function after pelvic injury, which reflects the significant risk of impotence after crush injury to the pelvis with rupture of the posterior urethra.

Adolescent↗
PubMed1981

Management of high grade transitional cell cancer of the upper urinary tract.

A total of 175 patients was operated on for grade 2, 3 or 4 transitional cell epithelioma of the upper urinary tract. Followup was between 5 and 26 years. The operations involved total nephroureterectomy, simple nephrectomy and local resection. Patient survival correlated well with tumor stage and, particularly, with tumor grade, and, consistently, was inferior to that of an age and sex-matched control group. The correlation of survival and ipsilateral tumor recurrence with the type of operation suggests that patients with grade 2 tumors may benefit from total nephroureterectomy. The incidence of ipsilateral tumor recurrence (28 per cent) was high in this group. The radical procedure seems to be of no benefit to patients with grade 3 or 4 tumors. The incidence of subsequent bladder tumor was 30 per cent in patients with grades 2 and 3 tumors. The latent period ranged from 2 months to 10 years (average 23 months); 82 per cent of the tumors occurred within 3 years of treatment of the upper tract tumor.

Adult↗