Biomedical subjects
Publications and source records attributed to W M O'Brien.
A new technique for percutaneous placement of a suprapubic tube has been developed, which allows controlled entry into the bladder over a guide wire to avoid the potential hazards of blind trocar cystotomy. A Foley style catheter can be placed, which is less likely to become dislodged than other types of percutaneous suprapubic catheters currently available.
By age 75, between 10 and 25 percent of men require intervention for problems caused by benign prostatic hypertrophy. Symptoms of bladder outlet obstruction include hesitancy, terminal dribbling, postvoid fullness and double voiding. Symptoms of bladder irritability include frequency, urgency, dysuria and nocturia. Urinary retention, hydronephrosis, azotemia and worsening obstructive symptoms are indications for treatment. In addition to catheter drainage or surgical resection, new treatment options include the use of alpha-adrenergic blockers and antiandrogens, as well as balloon dilatation of the prostate. Transurethral resection of the prostate remains the mainstay of treatment, providing effective relief in 85 percent of patients. Since only the enlarged portion of the prostate is removed, prostatic cancer or recurrence of benign prostatic hypertrophy is possible.
We reviewed our experience with percutaneous nephrostomy placement in children less than one year of age during a five-year period. Placement was successful in 8 of 9 cases. There were no complications. The procedure favorably altered the outcome for each patient and was useful for reversing azotemia prior to surgical intervention for repair of an obstructed system (2 renal units), for providing drainage of pyonephrotic kidneys (3 renal units), for demonstrating inadequate recovery of renal function after relief of obstruction (2 renal units), and for replacing a surgically placed nephrostomy that was dislodged (1 renal unit). Our experience has encouraged us to accept the technique, and we believe that it is a valuable nonsurgical alternative that should be available to urologists managing infants with urinary tract pathology.
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We report a case of radiation-induced neurogenic fibrosarcoma that developed in a patient who received radiation therapy for seminoma. The sarcoma developed within the irradiated field after a latency period of nineteen years. Although the occurrence of a secondary neoplasm is unusual, this possibility should be included in the differential diagnosis of patients who present with tumor growth after a long interval following radiation therapy.
Infection with human papillomavirus has been identified as a significant risk factor for the development of cervical neoplasia. Knowledge of the characteristics of infecting human papillomavirus in male patients is lacking. We studied 37 men who presented with genital condyloma to identify the clinical appearance of the lesion, histological features and human papillomavirus type as determined by deoxyribonucleic acid molecular hybridization analysis. Of the patients 32 had penile shaft condyloma: 23 noticed the lesion themselves and 9 presented because the partner had condyloma. An adequate amount of deoxyribonucleic acid was available for analysis in 26 men. Lesions were caused by human papillomavirus types 6, 11 and 31, and uncharacterized types. Five patients had penile shaft and urethral condyloma. In 4 patients infection was caused by more than 1 type or subtype. Neither clinical nor histological features could reliably predict the infecting human papillomavirus type.
Attempts to dilate the urethra with metal sounds and to insert a resectoscope sheath with the metal obturator can be traumatizing in patients with urethral stricture or false passage. We describe a simple technique that uses endourological instruments to facilitate insertion of the resectoscope sheath and placement of the post-resection Foley catheter.
The treatment options for the management of the patient with priapism have changed markedly within the past several years. When possible, the underlying cause of the priapism should be identified. Therapy should be guided by the results of aspiration of the blood-filled corpora cavernosa of the erect penis. Early intervention through pharmacologic manipulation or surgical shunting should not be delayed while trying conservative measures.
Hypospadias is a common congenital problem in boys. Neonatal recognition is essential, and circumcision must be avoided. Although there is no increase in risk of other genitourinary anomalies, hypospadias, when associated with cryptorchidism, warrants further evaluation to exclude an intersex disorder. Surgical reconstruction ideally should be performed when the child is between six and nine months of age.
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A case of colovesical fistula secondary to diverticulitis that had the unusual presentation of epididymitis is presented. The current literature on diverticulitis involving the urinary tract is reviewed.
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We reviewed the records of 31 patients treated during the last 5 years for ureteral stricture disease. The causes of stricture formation included ureteroenteral anastomoses (23 per cent), open ureterolithotomy (19 per cent), ureteroscopy (19 per cent), other urological procedures (16 per cent), general surgical and gynecological procedures (13 per cent) and miscellaneous causes (7 per cent). Of the patients 24 were managed initially with antegrade or retrograde balloon dilation or stenting and favorable outcomes were achieved in 12 (50 per cent), with a mean followup of 13 months. Of the 12 patients who failed endourological management 6 subsequently underwent open repair with a 100 per cent success rate. The remaining 7 patients underwent an open operation as the initial management and successful results were achieved in 6. The over-all rate of successful management of ureteral stricture disease using endoscopic and open surgical techniques was 77 per cent. A total of 7 patients (23 per cent) failed attempts at intervention: 5 showed evidence of decreasing renal function and 2 required nephrectomy.
Serial measurements of urinary hydroxyproline excretion were performed in 16 patients with stage D2 prostatic cancer to evaluate its role as a marker for following disease course. Patients were defined as having stable or progressive disease by the criteria of the National Prostatic Cancer Project. For patients with stable disease and those with disease progression excretion of hydroxyproline did not correlate with the clinical course. We did not find that hydroxyproline was a useful marker in the clinical setting to follow patients with prostatic cancer.
Testicular torsion is characterized by the sudden onset of testicular pain associated with abdominal pain, nausea and vomiting. Fever is unusual and urinalysis is often normal. Fever, pyuria, dysuria and urethral discharge are characteristic of epididymitis. Radionuclide scanning and Doppler ultrasound are helpful in establishing the diagnosis. If the diagnosis is uncertain, the patient should be considered to have testicular torsion until it is proved otherwise. Undiagnosed torsion leads to testicular necrosis.
Factors determining the likelihood of urinary tract infection in children include host susceptibility, such as the presence of obstructive uropathy, neuropathic bladder or dysfunctional voiding. Bacterial virulence, as in infection by fimbriated Escherichia coli, is also a factor. With a few exceptions, diagnostic evaluation should be performed following the first infection. Early aggressive therapy has the goal of preserving renal function.
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