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Biomedical subjects

A A Sidi

Publications and source records attributed to A A Sidi.

At least 37 records · Page 2Linked to original sources
PubMed1988

Bethanechol supersensitivity test, rhabdosphincter electromyography and bulbocavernosus reflex latency in the diagnosis of neuropathic detrusor areflexia.

A total of 57 patients with neuropathic or nonneuropathic detrusor areflexia was studied with the bethanechol supersensitivity test, electromyography of the urethral rhabdosphincter and bulbocavernosus reflex latency. The sensitivity of these tests in detecting neuropathic areflexia was 90, 87.5 and 78.1 per cent, respectively, and the specificity was 95.6, 76 and 80 per cent, respectively. When all 3 tests were performed together the combined accuracy approached 100 per cent. These combined tests are useful in the diagnosis of patients with equivocal bladder neuropathic conditions and in those with subtle neurological lesions.

Adolescent↗
PubMed1988

Effects of botulinum A toxin on detrusor-sphincter dyssynergia in spinal cord injury patients.

We evaluated the ability of low doses of botulinum A toxin, an inhibitor of acetylcholine release at the neuromuscular junction, to denervate and relax the spastic rhabdosphincter in 11 men with spinal cord injury and detrusor-sphincter dyssynergia. Toxin concentration, injection volume, percutaneous versus cystoscopic injection of the sphincter and number of injections were evaluated in 3 treatment protocols. All 10 patients evaluated by electromyography after injection showed signs of sphincter denervation. Bulbosphincteric reflexes in the 10 patients evaluated after injection were more difficult to obtain, and they showed a decreased amplitude and normal latency. The urethral pressure profile in the 7 patients in whom it was measured before and after treatment decreased an average of 27 cm. water after toxin injections. Post-void residual urine volume decreased by an average of 146 cc after the toxin injections in 8 patients. In the 8 patients for whom it could be determined toxin effects lasted an average of 50 days. The toxin also decreased autonomic dysreflexia in 5 patients.

Adult↗
PubMed1988

Vasoactive intracavernous pharmacotherapy.

The use of vasoactive intracavernous pharmacotherapy for the treatment of impotence is rapidly expanding because of its effectiveness and the rarity of short-term complications. To minimize complications, careful selection of candidates, cautious dosage determination, and thorough instruction on injection technique are mandatory. Sustained erection should be treated with alpha-adrenergic agents after 4 to 6 hours. Frequent follow-up is mandatory after home injection begins to detect the development of penile abnormalities. Longer follow-up and additional studies are required to determine the types and incidences of long-term adverse effects of the technique.

Dose-Response Relationship, Drug↗
PubMed1987

Enterocystoplasty in the management and reconstruction of the pediatric neurogenic bladder.

Eighteen children and young adults with neurogenic bladder underwent enterocystoplasty as part of urinary undiversion or for treatment of incontinence associated with reduced bladder compliance or detrusor sphincter dyssynergia. In 12, tubular sigmoid enterocystoplasty with transureteroureterostomy was performed with the smaller diameter ureter implanted into the bowel tenia. In two patients the ileocecal segment was used to augment the bladder, and the ureters were anastomosed to the ileum. In four patients the cecum or a patch of sigmoid colon was used to augment the bladder. Young-Dees bladder neck reconstruction was performed on eight patients at the time of surgery; one later required bladder neck reconstruction, and two later required an artificial sphincter. After a mean follow-up of 20 months, 16 of the 17 available for follow-up are continent with clean intermittent catheterization every 3 to 4 hours. Nine patients require anticholinergic or smooth muscle relaxing medication to increase functional bladder capacity. Most of the patients need chronic antimicrobial treatment to control bacteriuria.

Adolescent↗
PubMed1987

Vasoactive intracavernous pharmacotherapy for the treatment of erectile impotence in men with spinal cord injury.

A total of 66 spinal cord injury patients with erectile dysfunction entered a protocol of penile intracavernous pharmacotherapy with papaverine hydrochloride (30 mg. per ml.) or a combination of papaverine (25 mg. per ml.) and phentolamine mesylate (0.83 mg. per ml.) in an attempt to restore erectile function. Of the patients 52 completed the protocol and all achieved transient functional penile erections after administration of the drug. Of the 52 responders 71 per cent currently practice self-injection as a method to restore erectile function. Sustained erections that required irrigation of the cavernous bodies with alpha-adrenergic agents developed in 4 patients and 1 suffered localized intracorporeal induration. If the long-term followup shows that complications remain relatively minor, undoubtedly vasoactive intracavernous pharmacotherapy will have a major role in the restoration of erectile function in the motivated man with spinal cord injury. However, in view of the unknown long-term effects and potential dangers of this approach it is important that patients adhere to a strict drug injection protocol under the supervision of qualified urologists who are familiar with the potential risks and complications.

Adult↗
PubMed1987

Comparison of artificial sphincter implantation and bladder neck reconstruction in patients with neurogenic urinary incontinence.

The results of artificial urinary sphincter implantation and Young-Dees-Leadbetter bladder neck reconstruction were compared in 27 patients with neurogenic urinary incontinence. Although an equal degree of continence was achieved with both procedures the reoperation rate was significantly higher in patients who underwent artificial sphincter implantation. The advantages and disadvantages of each procedure are discussed.

Adolescent↗
PubMed1987

The effect of nifedipine on cystoscopy-induced autonomic hyperreflexia in patients with high spinal cord injuries.

We evaluated the ability of the calcium channel blocker nifedipine to control autonomic hyperreflexia during cystoscopy in 7 patients with cervical spinal cord injuries. Nifedipine (10 mg.) alleviated autonomic hyperreflexia when given sublingually during cystoscopy and prevented autonomic hyperreflexia when given orally 30 minutes before cystoscopy. No adverse drug effects were observed.

Administration, Oral↗
PubMed1987

Vasoactive intracavernous pharmacotherapy--the nursing role in teaching self-injection therapy.

Our physician-nurse team management of a program in vasoactive intracavernous pharmacotherapy to treat male impotence has provided a high degree of patient and partner satisfaction. Nurses participate in the assessment of the ability of a patient or partner to master the self-injection technique, and the potential of a couple for compliance with and commitment to the program, all of which are key factors for successful home therapy. A nurse also teaches the self-injection technique. Audiovisual materials and handouts are used as teaching aids to ensure that complete and consistent information is given. The patient or partner is required to perform a self-injection under nursing supervision before a prescription for home use written. Initial followup visits are scheduled with a nurse at 1 to 2-week intervals. At these visits the nurse identifies possible patient errors in self-injection technique, dose or frequency, and answers questions about the therapy. After the couple has mastered and is comfortable with home injection, followup appointments are scheduled with the physician at 4-week intervals to monitor for possible changes in response to treatment and for an examination of the phallus.

Adult↗
PubMed1987

Penile prosthesis surgery in the treatment of impotence in the immunosuppressed man.

Thirteen male diabetic patients on immunosuppressive therapy following organ transplantation underwent implantation of 14 penile prostheses for treatment of organic impotence. Except for extended parenteral antibiotic therapy and increased steroid coverage postoperatively, the preoperative, perioperative and postoperative management in all 13 patients was similar to that of routine penile implantation procedures. No infections or erosion complications were encountered. We conclude that the penile prosthesis should be included in the armamentarium for the treatment of impotence in the immunosuppressed man.

Adult↗
PubMed1987

Adjuvant radiation therapy in patients upstaged to stage C or D1 disease after radical prostatectomy.

We administered adjuvant radiation therapy to 56 selected patients with carcinoma of the prostate whose disease was upstaged to stage C or D1 after radical prostatectomy and pelvic lymphadenectomy. The complications associated with radiation therapy were minimal. The local recurrence rate was 2% after mean follow-ups of 67 and 53 months for patients with stage C and D1 disease, respectively. The actuarial 5-year survival rate free of disease was 76% for patients with stage C and 72% with stage D1 a cancer. Further exploration of the role of adjuvant radiation therapy in the treatment of patients with pathological stage C or D1 a disease is warranted.

Adenocarcinoma↗
PubMed1986

Urinary undiversion: indications, technique and results in 50 cases.

We present our experience with reconstruction of the diverted urinary tract in 50 patients divided into 3 groups according to the presence of neurogenic bladder dysfunction, severe renal failure or normally innervated bladders and sphincters with normal renal function. The over-all success rate of anatomical and functional reconstruction was 88 per cent and we expect it ultimately to increase to 94 per cent. However, because of a 2 per cent mortality rate and a 16 per cent major complication rate, we recommend that all other therapeutic options be considered carefully before undertaking urinary undiversion when the reconstruction involves use of intestinal segments.

Adolescent↗
PubMed1986

Vesicoureteral reflux in children with myelodysplasia: natural history and results of treatment.

A total of 58 children with myelodysplasia underwent radiographic and cystometric evaluation and were followed periodically for an average of 58 months. Of this group 30 (52 per cent) demonstrated vesicoureteral reflux, including 16 with low grade and 14 with high grade reflux. In 6 children low grade vesicoureteral reflux resolved with prophylactic antibacterials only, while decompressive treatment was required in 6, antireflux surgery was required in 2 and 2 were lost to followup. Despite adequate decompressive treatment 12 of the 14 children with high grade vesicoureteral reflux required an antireflux operation and 2 were lost to followup. Among those who underwent an operation there has been no recurrent reflux but 3 children have shown evidence of upper urinary tract deterioration. We describe our current approach to the treatment of vesicoureteral reflux in children with neurogenic bladder dysfunction and suggest a management protocol based on urodynamic findings.

Anti-Bacterial Agents↗
PubMed1986

Influence of intestinal segment and configuration on the outcome of augmentation enterocystoplasty.

The clinical and urodynamic results of enterocystoplasty were compared in 3 groups of patients in which the intact ileocecal segment (10 patients), tubular sigmoid segment (16) or sigmoid cup-patch segment (8) was used. In all 3 groups the upper urinary tract and renal function improved or remained stable, and the functional bladder capacity increased. All patients experienced involuntary, volume-dependent vesical contractions of comparable intensity 3 months postoperatively. After a mean followup of 19.4 +/- 8.9 months only 12 per cent of the patients with a cup-patch configuration demonstrated volume-dependent contractions, compared to all patients with ileocecal cystoplasty and 94 per cent with sigmoid tubular cystoplasty. The intensity of these contractions was significantly less in the cup-patch configuration group compared to the other groups. Patients with cup-patch cystoplasty achieved a significantly higher rate of urinary continence than those in the other 2 groups. It appears that the sigmoid cup-patch configuration may provide a lower pressure system and better continence compared to the intact ileocecal or tubular sigmoid segment, although the latter techniques have specific applications when confronted with a wide gap between the ureters and bladder or when dilated ureters require anastomosis to the bowel.

Adolescent↗
PubMed1986

The value of urodynamic testing in the management of neonates with myelodysplasia: a prospective study.

We report the results of a prospective study conducted to identify neonates with myelomeningocele at risk for changes in the upper urinary tract. Thirty newborns underwent full urological evaluation and were followed for a mean period of 18.2 months. The initial studies included voiding cystourethrography, excretory urography and urodynamic tests. Followup consisted of periodic radiographic studies and repeat urodynamic testing if any changes were observed. According to urodynamic findings the patients were divided into 2 groups: group 1 consisted of 9 neonates (30 per cent) with detrusor-sphincter dyssynergia and high pressure, decreased-compliance bladders, and group 2 consisted of 21 children (70 per cent) with atonic bladders and low pressure, reduced-compliance bladders without dyssynergia. In group 1, 55 per cent of the patients had initially abnormal radiographic findings in contrast with 28.5 per cent in group 2. Anticholinergic drugs and clean intermittent catheterization or vesicostomy reversed the changes in 40 per cent of the children in group 1, 40 per cent remained stable and 20 per cent showed signs of deterioration. Four children in group 1 with normal neonatal radiographs were treated expectantly and at followup they all showed signs of deterioration. The neonates in group 2 with normal radiographic findings remained normal at followup. Of those who initially had changes 67 per cent reversed to normal without treatment, 17 per cent remained stable and 17 per cent had deterioration. Newborns with detrusor-sphincter dyssynergia or high pressure, reduced-compliance bladders are at high risk of having upper urinary tract changes and require preventive decompressive treatment. Children with atonic or low pressure, reduced-compliance bladders and those with a coordinated bladder and sphincter are at low risk and need only close followup.

Electromyography↗
PubMed1986

Intracavernous drug-induced erections in the management of male erectile dysfunction: experience with 100 patients.

A total of 100 men with organic impotence underwent a trial of intracavernous drug-induced erections with a mixture of papaverine (25 mg./ml.) and phentolamine (0.8 mg./ml.). The response rates, that is functional erections, were 100 per cent in patients with neurogenic impotence, 65.7 per cent in those with vasculogenic impotence, 90 per cent in the undetermined group and 64.7 per cent in the neurogenic/vascular impotence group. Of the responders 79.5 per cent elected to practice self-injection as a method to restore erectile function. The dose required to obtain functional erections in the purely neurogenic impotence group was significantly lower than that required in other groups. Complications were few and included 4 patients with sustained erections that required intervention. Intracavernous injection of vasoactive drugs appears to have promising value in the treatment and differential diagnosis of erectile dysfunction.

Adult↗
PubMed1986

Recent advances in the diagnosis and management of impotence.

Recent experience with the implantation of the OmniPhase, FlexiFlate, and Hydroflex penile prostheses at our institution has shown all three to provide good axial rigidity and relatively good concealment, although the phallus tends to be much more expanded than normal with all three devices when they are in the nonfunctional position. Urologists who are familiar with penile implantation surgery will encounter no technical difficulties with the implantation of these new devices. Rather, long-term mechanical reliability will be the crucial factor that will cause implanting surgeons and their patients to shift from one prosthesis to another.

Diagnosis, Differential↗