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Biomedical subjects

W W Leng

Publications and source records attributed to W W Leng.

8 recordsLinked to original sources
PubMed2001

Advantages of rectus fascial slings for urinary incontinence in children with neuropathic bladders.

PURPOSE: Many surgical procedures to improve outlet resistance in children with neuropathic bladders are obstructive and increase the detrusor leak point pressure. In contrast, fascial slings are designed to achieve continence by increasing the Valsalva or stress leak point pressure without altering the detrusor leak point pressure. We evaluate the effectiveness of fascial slings in achieving continence in pediatric patients with neuropathic bladder. MATERIALS AND METHODS: From October 1994 until February 1999, 10 females and 8 males with neuropathic bladder secondary to myelodysplasia or traumatic spinal cord injury underwent fascial sling procedures. Mean patient age was 14 years (range 8 to 18) and all were incontinent despite aggressive medical management. Urodynamic evaluation was performed preoperatively and postoperatively. Specific urodynamic measurements included detrusor leak point pressure, stress leak point pressure and detrusor compliance. Compliance was only compared in the 12 nonaugmented cases. RESULTS: With a mean followup of 21.2 months (range 6 to 57), preoperative and postoperative urodynamics revealed little change in mean detrusor leak point pressure (23.2 versus 23.22 cm. H2O) but a substantial increase in mean stress leak point pressure (41.6 versus 64.5 cm. H2O). Mean compliance was unchanged in the nonaugmented group (22.00 versus 26.78 ml/cm. H2O). Four patients (22.22%) remained wet after surgery, of whom 2 were successfully treated with a repeat sling procedure and 1 with collagen injection for an overall continence rate of 94.44%. CONCLUSIONS: Fascial slings can be effectively used in pediatric patients for neuropathic incontinence. Furthermore, stress urinary incontinence is corrected by increasing the Valsalva or stress leak point pressure with preservation of the detrusor leak point pressure. Preservation of detrusor leak point pressure is particularly advantageous because other forms of bladder outlet procedures achieve continence at the expense of increasing detrusor pressures, thus placing the upper tracts at risk for damage.

Adolescent↗
PubMed1999

Reconstructive surgery for urinary incontinence.

The clinical urologist often is faced with the referral of a patient with urinary incontinence refractory to conservative measures. Given the broad spectrum of causes of urinary incontinence, the clinician must base evaluation and therapeutic management on current principles of urinary tract pathophysiology. This article organizes the pertinent diagnostic considerations that must be addressed in guiding the clinician to the appropriate surgical treatment option.

Female↗
PubMed1999

Enterocystoplasty or detrusor myectomy? Comparison of indications and outcomes for bladder augmentation.

PURPOSE: We review our experience with enterocystoplasty and detrusor myectomy to delineate clinical indications and compare operative outcomes with both types of bladder augmentation. MATERIALS AND METHODS: Retrospective analysis of 61 patients who had undergone a total of 37 detrusor myectomies and 32 enterocystoplasties was performed. The patients were categorized into 6 diagnostic subsets representative of the clinical spectrum of indications for bladder augmentation. RESULTS: For most clinical indications detrusor myectomy offered comparable success or significant improvement in bladder function without incurring the significant complication rate of enterocystoplasty. CONCLUSIONS: Detrusor myectomy is a safe, successful method of bladder augmentation for most clinical indications. Myectomy does not hinder subsequent creation of an enterocystoplasty.

Adolescent↗
PubMed1999

Long-term outcome of incontinent ileovesicostomy management of severe lower urinary tract dysfunction.

PURPOSE: We evaluated the extended 5-year followup outcome of incontinent ileovesicostomy. MATERIALS AND METHODS: We reviewed the charts of 25 men and 13 women with a mean age of 44.9 years who underwent incontinent ileovesicostomy, including the original 23 patients whom we reported on in 1993. Mean followup was 52 months. We compared the incidence of complications before and after ileovesicostomy as well as long-term urinary tract status. RESULTS: Before ileovesicostomy the incidence of serious complications associated with an indwelling catheter was significant, including poor bladder compliance in 50% of cases, urosepsis in 45%, hydronephrosis in 21%, renal struvite calculi in 18%, urethrocutaneous fistula in 18%, autonomic dysreflexia in 13% and bladder calculi in 2%. After conversion to ileovesicostomy our data show that 83 to 91% of this high risk population maintained a normal upper urinary tract and normal bladder storage compliance. CONCLUSIONS: Compared with preoperative status the incidence of postoperative complications was relatively low and they were readily corrected. Ileovesicostomy is an excellent long-term management solution for severe lower urinary tract dysfunction in patients who are unable to perform intermittent self-catheterization.

Adolescent↗
PubMed1998

Management of female genitourinary fistulas: transvesical or transvaginal approach?

PURPOSE: We reviewed 25 female genitourinary fistula repairs performed at our institution from 1993 to 1997. MATERIALS AND METHODS: Our series comprised 7 primary vesicovaginal, 6 recurrent vesicovaginal, 7 complex, 1 ureterovaginal and 4 urethrovaginal fistulas. Postoperative followup ranged from 8 months to 5 years. RESULTS: Overall, 92% of the patients were cured (23 of 25). The 2 failures occurred in patients with a history of pelvic malignancy involving adjuvant therapy. CONCLUSIONS: Complex irradiated vesicovaginal fistulas require staged repairs, often with pedicle flaps. However, primary repair of uncomplicated vesicovaginal fistulas is highly successful. Limited transvesical repair of these fistulas offers reliable success with minimal morbidity and hospital stay comparable to those of the transvaginal approach.

Female↗
PubMed1998

Management of female urethral diverticula: a new classification.

PURPOSE: Symptomatic female urethral diverticula may be managed by a number of operative techniques. However, to avoid persistent or recurrent diverticula definitive therapy requires analysis of the type and nature of the diverticulum. We propose a simple classification system for the management of female urethral diverticula. MATERIALS AND METHODS: We reviewed 18 cases of urethral diverticulectomy performed at our institution in the last 5 years. Half of the patients had been treated previously elsewhere and presented with recurring or persistent symptoms. In many cases we found a pseudodiverticulum, that is a mucosal herniation through a periurethral fascial defect. We describe our clinical distinction of a true versus pseudodiverticulum. Of 7 women with symptoms of incontinence video urodynamics demonstrated stress urinary incontinence in 4 who underwent diverticulectomy and placement of a fascial sling concurrently. RESULTS: Of 18 patients 16 were cured and 2 had persistent incontinence related to loose sling placement. Revision of the slings solved these problems. No serious complications were noted. CONCLUSIONS: Preoperative radiographic imaging helps to delineate diverticulum anatomy. Our preoperative classifications correlated well with operative findings. With meticulous excision and repair of the periurethral fascia definitive cure was achieved with a single operation. Urodynamic assessment proved crucial in achieving a successful outcome in patients with preexisting incontinence. Contrary to opinion, simultaneous placement of a sling did not lead to retropubic infection or transvaginal erosion. The placement of a sling in 4 patients achieved lasting successful repair and continence.

Adult↗