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Biomedical subjects

W W Bonney

Publications and source records attributed to W W Bonney.

At least 19 recordsLinked to original sources
PubMed1998

Neoadjuvant androgen ablation for localized prostatic cancer: pathology methods, surgical end points and meta-analysis of randomized trials.

PURPOSE: At least 7 centers or collaborative groups have performed randomized clinical trials of neoadjuvant androgen ablation and radical prostatectomy versus radical prostatectomy alone for localized prostatic cancer. Our objectives were to analyze treatment results in terms of 2 standard outcome measures, to identify patient characteristics and other factors that explain outcome differences between trials, and to use pooled data to test the hypothesis that neoadjuvant treatment alters outcomes. MATERIALS AND METHODS: Trials were identified by MEDLINE search and review of published bibliographies, and examined for pathological techniques used to assign surgical end points. An attempt was made to contact trial group members for clarification and updated information. The resulting data were transformed as needed into standardized end points of pT stage and negative surgical margin. A series of contingency tables were used to study relationships between treatment outcomes and various risk factors. RESULTS: In addition to neoadjuvant treatment, numerous risk factors related to treatment regimen and patient characteristics apparently influenced treatment outcome, and should be reanalyzed when future followup trial data become available. CONCLUSIONS: In radical prostatectomy there is a need for uniform ways to process specimens, assign surgical stage and establish standardized surgical end points. Despite differences in risk factors, the trials were similar in overall design. Within these constraints neoadjuvant androgen ablation was significantly associated with low pT stage and negative surgical margin. Longer followup is needed to validate these measures as good surrogates for tumor specific survival.

Aged↗
PubMed1997

Bladder dysfunction in schizophrenia.

In schizophrenic patients with incontinence our previous urodynamic studies showed detrusor hyperreflexia in some cases. Many schizophrenic patients have brain abnormalities similar to those associated with urge incontinence and detrusor hyperreflexia in neurological patients. We therefore propose bladder dysfunction and incontinence as previously unrecognized neurobiological correlates of schizophrenia. To clarify this concept our first step, the present study, was a patient survey for urinary problems. Incontinence was more prevalent in schizophrenic patients than in a comparison group of mood disorder patients at the same hospitals. Urge incontinence and leakage of any type were related closely to psychiatric diagnosis. These data, like our pilot urodynamic studies, suggest that incontinence represents detrusor hyperreflexia in a significant subset of schizophrenic patients. Prospective urodynamic studies will be needed to test our proposal directly.

Adult↗
PubMed1996

Voiding cystourethrography in female stress incontinence.

OBJECTIVES: The aims of this study were to determine the sensitivity of voiding cystourethrography (VCUG) in detecting incontinence in women with a history of leakage, the positive and negative predictive values of VCUG for stress incontinence, and how often a history of leakage is accompanied by urethrocele on VCUG and to correlate urethral anatomic measurements with the presence of urethrocele and stress incontinence on VCUG. SUBJECTS AND METHODS: A total of 159 women with incontinence or voiding dysfunction were evaluated by VCUG and urodynamic study (UDS). RESULTS: VCUG detected stress incontinence in 76% of women with a specific history of stress incontinence. Of 61 women with genuine stress incontinence proven on UDS, only 37 (61%) were identified on VCUG, yielding a positive predictive value of 56%. Twenty-one of 29 women without genuine stress incontinence on UDS but with apparent stress incontinence on VCUG had detrusor instability on UDS, so that urge incontinence was falsely diagnosed as stress incontinence. VCUG had a negative predictive value of 74%. In 40 women with urethroceles, 26 had stress incontinence on VCUG. The anatomic changes in posterior urethrovesical angle, urethral descent, and urethral inclination denote urethroceles but do not correlate with the presence of stress incontinence. CONCLUSION: In the evaluation of stress incontinence, VCUG is limited because of detrusor instability producing urge incontinence and therefore resulting in false-positive stress incontinence. The anatomic measurements of posterior urethrovesical angle change, urethral descent, and urethral inclination as well as the presence of urethrocele have limited ability in predicting stress incontinence.

Adolescent↗
PubMed1995

Preliminary report: detrusor hyperreflexia in schizophrenia.

The object of this study was to demonstrate detrusor hyperreflexia (DH) in schizophrenic patients. Twelve consecutive schizophrenic patients were evaluated by DSM-IIIR diagnostic criteria and other standard psychiatric measures, urological history and examination, and urodynamic study. All were referred for clinical indication, voiding dysfunction, or incontinence. Two patients were excluded for confounding variables, mental retardation and benign prostatic hypertrophy. Of the ten evaluable patients, four had DH. Detrusor hyperreflexia does occur in a subset of schizophrenic patients, even in the absence of other recognized disease to explain the occurrence. This relationship, previously unreported, warrants further investigation.

Adult↗
PubMed1994

Basis of severity grade in detrusor hyperreflexia.

For both treatment and research it is useful to classify detrusor hyperreflexia/instability according to degree of severity, because it relates to symptomatic impact. However, there has been no systematic evaluation of criteria for severity assignment. This report compares patient classification by urodynamic data according to 3 methods: arbitrary criteria, a severity index, and an empirical cluster analysis. Within the primary urodynamic data there were no natural groupings as a basis for division into discrete patient groups. By all three methods, however, severity level did relate to symptoms.

Adolescent↗
PubMed1994

Crypt cell thymidine incorporation in ileal urinary pouch. Preliminary report.

This is a brief communication about mucosal change in ileal urinary reservoirs, the earliest reported observations to date. Previous authors described early villous atrophy and crypt elongation, late panmucosal atrophy and metaplasia. Crypt cell proliferation should be a forerunner of these events and therefore warrants quantitative measurement. We studied continent pouches in dogs on postoperative days 42 and 43 using in vivo tritiated thymidine incorporation into crypt cell DNA, a novel application of autoradiography for urinary reservoirs. Adjacent normal ileum provided the internal control. Increased crypt cell thymidine incorporation was confirmed at this early time.

Animals↗
PubMed1993

Topical effect of intravesical oxybutynin.

Intravesical oxybutynin was instilled into rat bladders in graded doses by repeated catheterization to study the local bladder effects of drug concentration and incidental urinary infection. On the thirteenth day, after 5 doses, bladders were recovered for measurement and histological study. In the highest dose group, systemic absorption from the bladder caused weight loss and cachexia. However, in no group was there any clear evidence of drug-related mucosal or bladder wall change. Instead, the two high dose groups seemed somehow protected from the combined adverse effects of catheterization and infection.

Administration, Intravesical↗
PubMed1990

Absorbable staples in continent ileal urinary pouch.

Continent ileal urinary reservoirs were created in dogs to study absorbable surgical staples. Within each pouch, certain controlled observations were possible. The staples and chemically similar polyglactin absorbable sutures caused almost identical tissue reactions. The staples outlasted the sutures, probably because of greater size. Inverted and everted staple closures worked equally well. It appears feasible to consider clinical urinary diversion with absorbable staples, a time-saving method.

Animals↗
PubMed1987

Yield of cancer tissue from prostatic needle biopsy.

This study concerns the quality of human prostatic cancer needle biopsy specimens for routine diagnosis and for bioassay. We examined routine hematoxylin and eosin-stained microscopic sections from 20 prostatic cancer patients, 159 needle cores in all, 71 positive for tumor. Linear core measurements were made with a calibrated ocular micrometer, each segment counted positive if it contained any tumor. Among all subjects there were 35.5 cm of tumor-bearing core length, 26 per cent of the total core length but 60 per cent of the length if completely negative cores were excluded. From these data we calculate a 91 per cent probability of detecting any cancer present if at least 4 cores are taken.

Adenocarcinoma↗
PubMed1986

Stability of sublines in the R3327-H rat prostatic tumor.

Over several years of in vivo maintenance passage the R3327-H rat prostatic tumor has given rise to nine unique sublines in our laboratory. Some have emerged under selective treatment pressure while others apparently represent spontaneous or random modulation. Each new subline embodied an altered histology, growth rate, metastatic pattern or treatment sensitivity in comparison to its parent subline. However, each has been subsequently passaged enough times to provide evidence of considerable phenotypic stability, a notable point in view of the R3327 tumor's well known potential for modulation.

Animals↗
PubMed1984

Cryotherapy.

Since 1969 cryosurgical perineal destruction of the prostate has been developed at the University of Iowa for treatment of patients with prostatic cancer. The technique of this procedure has been the subject of previous reviews. This is a summary of our experience of patient survival and the effect on local prostatic cancer growth in those patients with various stages of the disease subjected to perineal cryosurgical destruction of their cancer. We also report briefly on our experience in the laboratory where the Dunning tumor model is used to study the effect of cryosurgery as well as combinations of immunological modifications.

Adult↗
PubMed1983

Cryosurgery in prostatic cancer: elimination of local lesion.

From 1969 through 1976, we performed cryosurgery in 229 cases of prostatic cancer. Most of these patients had bulky, locally extensive primary tumors, and one-half had disseminated disease. Through the open perineal approach, which gives exposure for an adequate freeze, cryosurgery has been well tolerated. The primary surgical goal has been to reduce or eliminate the local lesion to minimize subsequent cancer-related lower urinary tract problems and to cure those patients with truly localized disease. In every case cryosurgery produced dramatic shrinkage of the local lesion. After four to eight weeks a local recurrence was suspected in 13 per cent, and 41 per cent eventually had some evidence of a recurrent cancer nodule or persistent cancer in the bladder neck. In a series of statistical analyses we have related these recurrences to other clinical factors. Cryosurgery has been a safe, effective way to reduce or eliminate the primary prostatic cancer, even in patients with large local lesions.

Aged↗
PubMed1982

Cryosurgery in prostatic cancer: survival.

From 1969 through 1976 we performed cryosurgery in 229 cases of prostatic cancer. This article presents survival in cryosurgery and other treatment groups. In every stage, despite a preponderance of large primary tumors and poor-risk patients, cryosurgery matched total prostatectomy and compared favorably to other modalities, including radiation therapy, at our center and elsewhere. According to previous authors, and in view of the present data, eradication of the local lesion is associated with better survival even in advanced cases. Cryosurgery provides a safe, effective method.

Aged↗
PubMed1980

Penile prostheses for the treatment of impotence.

Eighty-nine patients were treated for impotence with penile prostheses. The Small-Carrion prosthesis was used in 56 patients, the inflatable prosthesis in 27 and Pearman's prosthesis in 6 patients. The overall functional results with the Small-Carrion and inflatable prostheses were comparable.

Adult↗
PubMed1978

Urinary cytology and bladder biopsy in patients with bladder cancer.

Two hundred fifty patients with bladder tumor were evaluated over a three-year period. Cystoscopy, cytology, and random bladder and tumor biopsy were part of the workup. The follow-up of these patients resulted in a total of 509 cystoscopies, 772 specimens of bladder washings and urinary cytologies, and 503 tumor or selected mucosal biopsies. The value of cytologic study of bladder washings and cystoscopic urine samples as well as the importance of selected site mucosal biopsies in detecting "field changes" in the bladder epithelium associated with bladder tumors are discussed.

Biopsy↗
PubMed1978

Biopsy and clinical course after cryosurgery for prostatic cancer.

Open perineal cryosurgical prostatectomy has been reported previously in 154 consecutive prostatic cancer patients at our center. In 37 of these patients post-cryosurgery biopsies of the prostate were obtained. In the present report we compare this tissue to the preoperative biopsies. The data suggest that well differentiated cancers are associated with advantageous survival in cryosurgery patients. Lymphoid and eosinophilic cell infiltrates may represent post-cryosurgical local immune responses, with improved survival. Estrogen therapy seems to suppress this local immune response. One month or more after cryosurgery cancer in the biopsy correlates with palpable local recurrence but prior to 1 month it does not correlate. Cryosurgery by the open perineal approach has been an effective method to eliminate the primary lesion in localized and extensive prostatic cancer.

Biopsy↗